What Does Center-Based Therapy Look Like? Learn from a Hopebridge BCBA

Creating an Effective Learning Space for Children with Autism and Developmental Delays

We know it can be tough for any family to trust someone else to look after your children. For families affected by autism spectrum disorder (ASD) and other developmental delays, the thought of someone else caring for your child can be even more nerve-wracking, although you know it is likely what is best for them.

There are so many unknowns through the process and we want to break down some of them to help put your mind at ease when making therapy choices. As part of the blog’s education series, Board Certified Behavior Analyst (BCBA) Jamie Hill walked us through what it’s like to spend a day at a Hopebridge center.

BCBA Jamie Hill answers: ‘Where does my child spend his day at Hopebridge and what does a session look like?’

Before diving into the Hopebridge play-by-play, let’s start at the beginning. Why choose center-based therapy over in-home treatment or school offerings?

Each has its pros. Every child will require different needs – and it can seem scary to take some kids out of their comfort zone – but there are clear benefits of in-center options that make it all worthwhile:

• Ability to offer intensive therapy
  Through applied behavior analysis (ABA) here in the center, we are given an opportunity to intensively work on adaptive living, communication and social skills. Programming is tailored for each individual patient using their strengths and interests to address where there are deficits in any of those domains. With the ability to work one on one, the skills assessments we use are typically much more in depth than those of other providers. We are also fortunate enough to be able to provide multiple learning opportunities to practice the same skill to encourage skill acquisition.
• More control over variables
  At our centers, the therapy team has more control over the environment. We can eliminate possible barriers to learning and can have a child come to a new environment where they’re not conditioned to respond in the way they might at home. If we need it to be very sanitized and controlled, that is possible, but we can also plan for more unstructured sessions that provide incidental opportunities to work on new skills.
• Alignment with insurance
  Insurance is a crucial factor for many families. Insurance companies require we submit treatment plans with objective goals specific to the learner, and if not enough progress is made on them, they could potentially decrease coverage of therapy hours or deny it altogether. Thankfully, the in-center experience allows us more room to craft special situations to teach and probe the specific skills and behaviors we outlined in the treatment plans.
• Transition preparation
  For families who want their children to eventually attend school, it’s good practice to take them to a place that can get them accustomed to leaving home and mimic similar experiences. Attending in-center ABA therapy helps establish a new routine, explore a new environment and allows the child opportunities to interact with new faces as they learn to play near peers and participate in activities like circle time.
• 360-degree services all in one place
  One thing that sets Hopebridge apart, even from other therapy centers, is the focus on multiple therapies under one roof. With diagnostic testing, ABA therapy, occupational therapy and speech therapy in some of our centers, many of our families do not have to drive to multiple facilities to receive services.
• Multiple highly trained care providers
  Autism therapy centers are uniquely equipped for situations that may seem out-of-control for others. Every adult in the immediate Hopebridge environment is highly trained in handling a wide range of circumstances. Because of this, we are able to help and support our patients’ learning through a variety of ways by working as a team. We also have BCBAs on site every day who can help out throughout the day, as well as supervision from clinical directors, regional BCBAs, regional managers and more to ensure clinical quality and safety.
• Access to peers
  Depending on the functioning level of the learners, the center atmosphere provides opportunities for peer interaction. This is especially beneficial for those who don’t have siblings and have not been around other children. We teach our kids to tolerate being around others and so they can eventually move towards cooperative and social play.

Building Effective Spaces Within an Autism Therapy Center

Now that you know the benefits of center-based therapy, you’re probably wondering what it looks like and if your child will be comfortable here.

To create effective spaces, we make sure the center is broken up into designated areas. Physical boundaries provide structure for our learners; informing them where to go and stay within certain parameters, which is especially important for those who are known to ‘elope’ at times.

We work hard to make sure each space is organized and visually represented in a way that makes sense to our kiddos. Labeled bins in the play area, for instance, enable the children to gather items and clean up after themselves. Photos of each space are also included in visual schedules for many learners.

Like the therapy itself, which is tailored to each kid, therapy rooms can vary depending on functioning levels and goals. At a Hopebridge center, you’ll likely find:

• Semi-private therapy rooms shared by kids on the same ‘team’
  Typically, each will have his or her own area with a desk or table, two chairs (one for the learner and one for a therapist), shelving for personal belongings and a space for program materials. A whiteboard lists all the child’s information – whether they nap, time of lunch, name of BCBA, pickup time, etc. A bookshelf holds potential reinforcements, which may include activities or items they strive to work towards or play with their therapists.
• Group therapy room set up like a mock classroom
  These rooms are for some of our kids who are working on more advanced skills or those who will soon transition to a classroom or similar setting. The space provides opportunities to practice skills used to prepare them to go to the “least restrictive environment” (LRE), which is school for many of them. While some of our kids are with their one-on-one therapist all day, this room features a horseshoe-shaped table we sometimes use to have multiple kids practice responding to one adult.
• Gross motor area
  Shared with the occupational therapy team, this space is sometimes referred to as the “gym.” It is home to items like balls, scooters, a mini trampoline, basketball hoop and other items kids can interact with to help build gross motor movement.
• Play area
  While kids can play in multiple areas of the center, this space was created for functional play skills. Depending on the center, it might feature items like trains, car ramps, a play kitchen and other toys that can be used by children on their own or with a peer.
• Circle time area
  This space is used to help children practice sitting as a group and respond to a novel therapist. Each circle time is differentiated to meet the needs of the children on that team, but each utilizes visual schedules, sing-along songs, calendar time and the reading of a book, all with a varying level of difficulty for each team.
• Craft area
  This space is just as it sounds! Here, kids can work on following multi-step instructions, learning the function of common art materials and making and matching their crafts to peers’ or a therapist’s sample. It also provides opportunities for learning how to use fine motor skills, such as cutting, gluing and using coloring utensils.
• Bathroom
  Personal hygiene is a big focus for many of our kiddos. We have a fully equipped bathroom to teach the most commonly taught personal hygiene skills, such as hand-washing, toilet training, brushing teeth, and dressing and undressing.
• Designated space for occupational therapy
  Some of our therapy options have their own spaces and tools, in addition to the shared spaces.

Sessions Tailored For Your Child

Like everything in our centers, sessions fall at different ends of the spectrum and are personalized to the needs of each kid. What doesn’t vary is the focus on building positive relationships throughout our sessions.

No matter what level the learner is at, the first thing we work on is “pairing.” Through this process, we focus on associating highly preferred activities and items with the therapist in order to help build the relationship and instructional control. From there, we branch off, depending on the skill level and current team schedule.

For many, we start with hygiene and adaptive living situations. Typically, this will include brushing teeth, completing a dressing routine or getting ready for a toilet training session.

From there, we might move to the tables, or natural environment training for some. Therapy doesn’t always take place at a desk! For younger learners, I often set up for teaching and learning to take place throughout the centers so they don’t even realize they’re ‘working.’ There is a lot of play-based teaching.

For older or higher functioning learners, we might focus on learning to take care of themselves, creating and following a schedule, longer duration of independent work, cooperating with a peer to accomplish a goal, chores or meal prep. Typically, the focus for these learners would be how to best prepare them for the transition to school or another placement.

While the goals, strengths and deficits for each individual might vary, our focus is to increase our kids’ social, communication and adaptive living skills repertoire does not change.

The supplies we utilize range from books, crayons, pencils, scissors, paint, Playdoh and gross motor equipment, to communication-centered tools like the Picture Communication Exchange System (PECS) language builder cards and tablets. There are board games, which kids can use to learn to cooperate with peers and tolerate losing, as well as associative learning games that are not as competitive. Visual schedules, timers and electronic data collection systems also play an important role in the progress of sessions.

Center days are pretty mapped out. Every 15 minutes, each team has a specific focus, which include working one-on-one at their table, strengthening their mode of communication, cooperating with a peer or learning how to take care of themselves. Sometimes we have surprises, but all in all, we and the kids have clear schedules and targets.

A Caregiver’s Role in Therapy

As always, this is a team effort. A lot of the changes that happen in the center can be generalized into the home, but it takes a collaborative effort with families to actually see those changes come to life.

Your role as a parent is significant. I encourage you to ask questions – as many as you want! You have the liberty to come in and check out the space to understand where your child will be and what they do here. You know your child best, so if you think of something that would help him or her, tell us. That may mean providing a visual schedule before they even start services with us. Our teams want to work with you to best prepare your kids.

We love these kids as our own, but it is never our intention to keep your child here with us long-term. Our goal is to best prepare them to be as independent and self-functioning as possible, as well as provide training and education to the people who are most involved with them.

Learn More About Center-Based Therapy

If you’re interested in learning more about center-based therapy options, connect with us online to talk about what it could be like for your child at one of our many Hopebridge centers across the country.

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