The moment your family decides to look for support for your child with autism is a critical point in time for any family. There are many questions that any family with a child with autism has in regards to looking for help to provide the best support for their child with autism. I hope that the following information will provide you with some guidance and insight as you search for a program for your child.
Next up to look at are the differences between Center based programs and ‘programs’ that just look really good on paper.
WE ARE SEEKING WARM & MOTIVATED STAFF!!!
Here is a snapshot of what a truly supportive environment looks like vs. what looks impressive papers and brochures look like – it starts with the people.
I hope that families can trust their instincts when it comes to their child and be wary of a center that has therapists that do not seem to be engaged with the children and families in the center. A center that has a cold, clinical feel to it as opposed to a warm and welcoming feel is also a red flag. The environment of the center is so important and families should get a sense of the environment during their first visit. If a family gets a sense that the center is not the right fit for them and their child, then that is data as well.
Questions worth asking on your first visit:
- How do staff handle moments of frustration or overwhelm?
- What’s the typical therapist-to-child ratio during sessions?
- How long have most of the therapists been with this center?
- Can you observe a session before committing?
Ask about the approach of the therapists and how they work with the children and families. Also ask about the support that the center offers to families as well as how the therapists meet with families to provide coaching and suggestions for how to support generalization of new skills learned in the center by your child. So, on the surface, a center may look to be meeting your needs and providing what your child needs; however, after further investigation, you may find that there are some shortcomings. So, do your due diligence and don’t be afraid to really investigate and ask a lot of questions in order to find the best center for your child.
Turnover is a plague in autism centers and it can cause a great deal of stress for children who have to get to know and trust a number of different people. Indeed, it can be very draining for any child but particularly for a child on the autism spectrum who often requires a great deal of consistency in order to cope.
Evidence-based doesn’t mean one-size-fits-all
In terms of the approaches or techniques that a center may use with your child, it is best to look for approaches that have substantial amounts of evidence that they can improve the outcomes for children with autism. One such approach is that of Applied Behavior Analysis (ABA). There are many different techniques that are used within the framework of ABA and many different methods for delivering ABA. The quality of the implementation of any techniques is much greater than the technique itself. For example, there are many different approaches that can be classified under the heading of ABA. Some of the older approaches to ABA were based on very structured and stereotypical implementations of the techniques (e.g., table time). However, many of late, there have been many more naturalistic approaches to ABA that can be very effective for children with autism as long as they are properly implemented. It is very important to understand the approach that a center may use and how it has evolved over time. If the center cannot describe the different techniques that they use and how they are implemented, then this is a big red flag. If the center becomes defensive when you ask for more information about the different techniques that they use, then this is also a big red flag.
No good center treats all kids the same. And that’s because kids with autism are not a monolith, but rather a vast and varied group of kids with different autism profiles, strengths, and needs. And so, as a center, we gather lots of information from a kid and their family prior to developing a plan and then update that plan as the kid grows and needs change. That’s how we make sure that each kid is getting the most out of their time at the center, and that we are supporting them in the ways that they need most.
What good looks like, side by side
| What to look for | Green flag | Red flag |
| Staff consistency | Low turnover, familiar faces | New therapists every few months |
| Treatment approach | Individualized, updated regularly | Same program for every child |
| Family involvement | Regular coaching and communication | Parents kept at arm’s length |
| Environment | Warm, sensory-considered, flexible | Sterile, rigid, or chaotic |
| Transparency | Open to questions and observations | Vague or defensive about methods |
Family involvement isn’t optional
For treatment to be effective, it must generalize to all parts of your child’s life and to all people with whom your child has interactions. Many programs today fail to realize that the child with autism is not the only one affected by his/her treatment. In fact, parents and family members of children with autism are greatly affected by their child’s treatment as well. Thus, it is crucial that all family members be included in a child’s treatment as well. This can be done by having all family members join in on certain parts of a child’s session, or by teaching family members how to implement certain skills that a child is learning in session. By doing so, the child’s treatment can be as effective as possible, and can apply to all situations in which the child interacts with others.
Most important is that the skills that your child learns in his/her sessions at the center will only generalize to the natural environments and situations where they will be needed if the child and family practice the skills in those contexts with tools and support provided by the center. The family should be seen as an extension of the child’s therapy team and the center should make every effort to involve the family in all aspects of the child’s program, including training them in how to support the child’s learning and providing them with tools to use outside of the center.
For families in the Triangle area of North Carolina who are seeking to refer their child with autism to a center, I highly recommend autism center in Cary, NC, a center for children with autism operated by Bierman Autism Centers. They have a staff of highly trained therapists and offer a number of individualized and evidence-based approaches to meeting the needs of children with a wide range of needs, and take the involvement of the family members and the caregiver of the child with autism very seriously.
Practical Matters
Location: Although a program may be on the other side of town, it is worth traveling to for a program in which your child will spend hours each day. Look for a program in which your child can participate on a frequent basis and that has a schedule that can accommodate your child’s growth and changing needs. Session frequency: How many days and hours per week will your child participate? What is the typical schedule and how may it change as your child develops? Insurance: How does the center handle with regard to insurance? Who is the best contact for questions and approval for services? Waitlists: What is the typical waitlist time? How does the center support the families of children waiting for services to begin?
It really doesn’t matter how many false promises are offered about a perfect, ideal and utopian environment for a child with autism at a center. There will never be a center that meets all of your child’s needs. If a center promises you a perfect environment for your child then it is likely a center where your child will fail.
(And yes, I know this section feels more administrative than the others. But I’ve watched families choose a center based purely on clinical reputation only to spend six months drowning in paperwork with no support. The logistics are part of the care.)
A final thought
You don’t have to find the perfect center. No center is perfect for every child. But you can find a great center where your child is truly seen, and is being cared for by people who care about your child, and are being paid to do a job as therapists, not just as people collecting a paycheck. And you can find a center where your child and your family are valued, and you are a partner with the staff at the center. Finding that perfect combination is not easy, but it is out there. Keep asking the tough questions until you find it.
