How do you Keep my Child Safe During Autism Therapy? Learn from a Hopebridge BCBA

Hopebridge Professionals Share How ABA Therapy is Proactive When it Comes to Safety

As parents, we know the well-being of your children is probably what keeps you up at night. Making sure they are safe when in arm’s reach is important, but you want to know they are protected when they are out of your sight as well. It can be extra stressful for families touched by autism spectrum disorder (ASD).

This thought is not lost on us at Hopebridge. The safety of your children is a priority here in our centers, which is why our teams are proactive on these measures through programming and training. To keep your minds at ease, as well as share a few tips for parents, Hopebridge Greenwood BCBA Kaitlin Rodrigues and Safety Care Trainer Jenna Timpson share how applied behavior analysis (ABA therapy) is designed to keep your children safe within our centers and beyond their walls.

BCBAs and Safety Care Trainers Answer: ‘What Safety Procedures are in Place Within the Center?’

The first step to keeping everyone safe in our centers is understanding that all behaviors – both positive and maladaptive – occur for a reason. Maladaptive behaviors are those we do not like to see; those traditionally considered “negative,” such as tantrums, self-injury (head-banging, biting, picking own skin, hair-pulling), eating non-consumable items (known as PICA), and aggressive behavior. When managing one of these more challenging behaviors, it is important we try to identify why it is taking place. In doing so, we can manage it with the least restrictive mode possible by proactively developing the skill set around any holes they may have.

Learning the reasons behind these behaviors helps us determine programming around those deficits so children on the spectrum can live more independently. For example, functional communication training could benefit a child by enabling them with the skills to more appropriately tell us what they need or want. Or another may need to build tolerating skills to transition away from preferred activities to another less preferred activity. By working on increasing independence, we do not have to be in their bubble as much, and therefore decrease the engagements that may frustrate them, which can lead to maladaptive behaviors.

Preventative and Proactive Measures

One of the benefits of focusing on safety care is the strong focus on preventative measures to ultimately decrease maladaptive behaviors before they have the chance to arise. Everyone is safer when we can stop them before they start or deescalate them enough to remain hands off.

Here are some of the proactive efforts from Hopebridge in order to maintain safety in our centers:

• One-to-one staff for all kids
  A comprehensive ABA program like Hopebridge’s is designed to have one therapist designated to keep an eye on one specific child. This team member will always know where the kid is and ensure he or she is within an arm’s length. This way, if something that would typically upset that child happens, they can try to intervene before it becomes an issue.
• Pairing process
  Pairing individuals with their therapists is a key strategy we use within ABA. It is important the children want to be here and enjoy working with our team, so we put an extra emphasis on making sure our kiddos have fun and build trust with their therapists.
• Getting kids comfortable
  By using progressive ABA strategies and compassionate care practices, we work to get our kids into a place where they are happy, relaxed and engaged. When they are comfortable, they are more likely to help keep themselves and others safe.
• Developmentally age-appropriate activities
  Children with autism may be working on different skills at different times and levels, so a benefit of center-based therapy is we can utilize various areas of the building with this in mind. While children of different ages still impact and see each other, we aim to set them up in therapy rooms with the appropriate peers, in addition to other programming. This also includes lunch time, group times and circle times to simulate a school setting. There are individualized activities for each child, yet we try to have those working on similar goals within the same type of environment, which helps maintain safety.
• Reinforcement of positive behaviors
  While inherent to ABA therapy in general, reinforcement of positive behaviors does not just help children reach their skills goals, it also plays a role in reducing maladaptive behaviors. We want kids to feel like it is much better to engage in positive behaviors rather than throw a tantrum that could put themselves or others in a dangerous situation.
• Extra equipment and resources
  We always have additional resources on hand in case there is a potentially maladaptive occurrence. From two-way radios to extra staff, the tools for communication and intervention are always available. Plus we have mats, pillows and other tools nearby in case we need to resort to them to maintain safety.

On top of this, basic safety skills are naturally built into ABA programming. For example, teaching a child to hold someone’s hand while walking and respond when someone tells them to stop are skills we can teach. At a glance, these may not seem important, but without these skills, a community parking lot situation when you are with your child can suddenly become very unsafe.

Therapists are experienced in teaching children to follow directions and help them tolerate certain things that they may not be reinforcing or fun in order to help them and their families get through the day more fluidly. Taking advantage of the time we have in ABA, we can teach them on a basic level by tailoring the learning environment to each individual and breaking skills down into smaller steps. We know it might not go well at first, but comprehensive therapy allows us the time to commit to them, whereas parents may not have that luxury within the normal day-to-day routine.

Safety Care Training

We place our focus on teaching independence and practicing differential reinforcement so safety care procedures are only used when necessary. The way ABA is designed, BCBAs and RBTs are taught to use the least restrictive mode possible; only to use physical management if there is imminent harm for the individual.

While we take all the preventative actions we can, should there be an issue, every team member – BCBAs, RBTs, occupational therapists, speech therapists, clinic managers, etc. – is properly trained to handle a range of situations. This way everyone is on the same page should anything occur.

• In-house BCBAs at each center
  At any given time, there is someone nearby to help. BCBAs are able to jump in if the severity of the situation is higher than the comfort of the Registered Behavior Technicians (RBT). We always encourage them to reach out to a trainer, BCBA or RBT fellow so we can go in and assist, if needed. These are added supports that are somewhat unique to autism therapy centers, which may not always be available in other home-based or school settings.
• Careful review of the environment
  If a situation occurs that could potentially turn unsafe, one of the first things we do is consider the surroundings. Other therapists will take their kids away from the immediate environment. We also aim to clear the area to minimize anything that could become dangerous.
• A barrier between the child and behavior
  Therapists can intervene, if needed, if there is an instance of physical aggression or property destruction, such as hitting or throwing objects. Intervention may include engaging in individualized calm-down strategies with that child or prompting communication as a means to deescalate. If it escalates, the therapist will use a least-to-most restrictive method of managing the behavior, which would start with removing access to any potentially dangerous items and/or blocking and redirecting.
• Differential reinforcement
  When transitioning children away from another individual’s maladaptive behavior, we try not to give that behavior attention. Instead, we make sure to give the child we are with a lot of attention and praise for acting appropriately. We want the other children to think it’s “cooler” to engage in the situation with their therapists than to watch their friend participate in the less desired behavior.

Hopebridge employs trainers to provide training within each center around the country. While the procedures are not often needed, housing this role internally, rather than hiring an external company, is a benefit because it provides the opportunity to ask questions, debrief and refresh skills more immediately and frequently as an extra layer of assurance. We also have a dedicated compliance department that is committed to ensuring safe and quality care for all of our children, families and team members.

Replacement Behaviors and New Habits

When first entering ABA therapy, the majority of parents’ concerns lie around communication. This is very important, but even more important is maintaining their well-being. As we focus on functional communication, we first focus on safety through appropriate replacement behaviors. For instance, instead of throwing oneself to the floor when asked to finish with the TV or a device, we teach them to communicate, “can I have more time?” or “can I finish this show?”

Another question when we hear from parents enrolling their children in autism therapy is: “If my kid is in a center where all children are working on challenges, is my child going to pick up ‘bad’ behavior?”

Families may be worried their child will begin to exhibit a new maladaptive behavior after watching others, and while this is valid, it is our job to minimize the risk. That is one of the goals of differential reinforcement. Therapists keep their focus on these children to redirect them somewhere else and work to gain their attention in another way. We do not want the child participating in the maladaptive behavior to get all the attention, because the others may take it as a good thing and want it for themselves, especially those in the younger developing ages.

A Caregiver’s Role in Safety at the Centers and in the Community

One of the biggest takeaways we have for parents in the safety arena is to reinforce positive behaviors. It is easy to forget that what we might consider as “negative attention” is still attention some will desire. By reprimanding a kid (which is not something we do at Hopebridge) for throwing a tantrum, you might actually be encouraging the behavior.

Another proactive measure is to be aware of potential triggers for your kid and plan for the unexpected. When out in the community or even at home, survey the area for potential hazards and be prepared to handle the challenges that might arise.

While it is important to look out for these triggers, you also do not want to avoid them. For instance, some parents know their child hates eating in the kitchen, so they let them sit on the couch, but escaping it often leads to a more difficult transition when we try to go back to it. Instead, work on it in steps. The first day, the parent could have them walk to the table, then back to the couch to eat. The next day, encourage the child to sit down at the table for a few seconds before heading back to the couch. Avoidance only strengthens the challenge, so work together to face it.

Taking advantage of parent training at Hopebridge can also lead to a more secure setting here in the center and at home. All of our programs are personalized for each family, so if there are more specific incidents you have questions about or want more explicit strategies, parent training is a great opportunity for you to have one-on-one time with your child’s BCBA.

Using preventative strategies is our first line of defense here in the centers, and it can be for you too. Be aware of triggers and proactively determine your plan so you are equipped to handle it when you are faced with those situations.

Keep Your Child Safe with Help from Hopebridge

If you’re interested in learning more about how Hopebridge works to keep kids safe in and out of the centers through our ABA therapy program and other comprehensive services, please get in touch with us online to find a center near you.

*Informed consent was obtained from the participants in this article. This information should not be captured and reused without express permission from Hopebridge, LLC.