ADA In-Home and Community Services: The "Mentor Model"
The ADA Therapeutic Approaches
The therapeutic approaches that we use with the children and families that we work with are a blend of very conventional approaches – such as the use of Applied Behavior Analysis (ABA) therapy – as well as unconventional approaches. This includes the fact that our work with your family will be in your home and community. Though we will occasional see some of our clients in our office in Fairfield, our focus is to involve our staff with your family "where the action is happening." In addition to ABA therapy, we also draw on methods from Cognitive Behavior Therapy (CBT), Family Systems Therapy and Positive Psychology. We emphasize promoting healthy relationships among family members and others, engaging in activities that are action oriented and meaningful to your child, and activities that help your child see a purpose to what we are asking them to do. We also provide direct instruction that will allow you and your child to better understand the "reasons why" we behave the way we behave.
The daily activities with both our clinician and Mentor personnel emphasize feedback to both you and your child in "real time" as we model appropriate interactions and behavior over the 15-to-30-hours per week that you and your child are with our staff. This type of "Incidental Learning" – where we can catch you and your child in the act of real-time struggles and successes – is the basis of our approach. A typical day involves a high level of structured activities following consistent schedules and routines. Mentors and therapists both engage in therapy the entire time they are with your family, even when it just looks like they are following familiar routines. Our approaches will also routinely expect direct involvement from all family members so that our staff can give feedback to everyone involved. This allows for you and your child to generalize what is being learned with staff present, to when they are not in your home. For years Dr. Weiss would be asked the rhetorical question "could you just move in with us?" to address the issues within the family. Now, with the support of you and your insurance company, we are "moving in!"
Promoting your child’s tolerance for "demands" being placed on them: A "Pivotal Response"
Central to our approach is routinely imposing demands on your child with the expectation that they will cooperate with these demands. The large majority of children that we work with have a history of resisting adult directions. Indeed, for most of our clients, demands being placed on him or her are triggers for very difficult behavior. Many children diagnosed with Autism can be quite rigid in their thinking and behavior. Developing your child’s willingness and ability to cooperatively respond to an adult direction is a "Pivotal Response (see Pivotal Response Treatment, by Robert & Lynn Koegel, 2019). That means that if your child becomes skilled and willing to follow adult directions without conflict, this positive response opens the door for many many other skills and abilities to come forward. As this relates to children on the Autism Spectrum, becoming more flexible in response to others around them is pivotal to reducing their rigidity. Imagine how different your child’s life (and your family’s life) would change if your child was more cooperative. Cooperation is ‘pivotal’ to promoting less rigidity and more mature behavior. To that end, we don’t avoid demands. Rather, we seek them out. However, the demands are not arbitrary or capricious. The typical daily demands are those that you would expect from any child – regardless of the Autism diagnosis. This will include daily living skills, communicating appropriately, participating in social activities, joining into therapeutic activities, daily chores, homework and more.
We will have two types of service providers working with your child once approved for a 26-week period (renewals must occur every 6-months) by your insurance carrier:
"Clinical Staff" – Psychologists, Licensed Professional Counselors, Licensed Clinical Social Workers and/or Board Certified Behavior Analysts (BCBAs).
- Direct work with your child at home and in the community – 3 to 6 hours weekly;
- Developing, implementing and modifying treatment plans related to your child and family;
- Training and supervision of the Mentor staff, parents or other relevant parties identified by the family (e.g., childcare providers, extended family, etc.);
- Data gathering, analysis and reporting;
- Communication with the family, school personnel, Medical team or others that you deem the clinicians should be communicating with;
"Mentors" – Para-professional staff responsible for day-to-day follow-through on the programs developed for your child.
- 20-to-25-hours per week with days and times to be determined.
- 3 or 4 different Mentors with any one child, to promote diversity;
- Follow through on Behavioral-Developmental Treatment Plan;
- Include both "work" and "play," such as:
- Morning, after-school, and/or bedtime routines per the requests of the family;
- Hygiene and personal care;
- Homework and other school requirements;
- Chores around the house;
- Social activities with family and/or friends (e.g., supervising play dates or get-togethers);
- Community activities ranging from haircuts and shopping trips, to fun outings to community activities (e.g., arcades, parks and playgrounds, Rock N Jump or Bounce facilities, movies, festivals, etc.);
- Outdoor physical activities such as hiking, biking, seasonal activities (e.g., skating, sledding, beach trips, apple picking hikes, etc.), swimming and sports or other forms of physical exercise (e.g, Tennis or golf activities, etc.);
- In-home fun activities such as reading together, board games, cooking activities with the kids (but not doing the cooking for the family, per se).
Highlights of the services
- At home and in the community;
- Morning, afternoon and evening involvement as a function of the "target" behaviors;
- Systematically confronting challenging behavior in real-time demand situations;
- Promoting developmental milestones;
- Creating and facilitating friends and a social life;
- Parent training and family support (not respite or childcare).
- Defining "Target" and "Alternative" Behaviors;
- The use of positive reinforcement and negative consequences;
- What is "intrinsic reinforcement?"
- The use of "planned ignoring", and "waiting your child out;"
- When to ignore a behavior vs. when to respond (learning how to "pick your battles");
- Structuring you and your child’s day;
- How to plan for a structured day;
- How to avoid confrontation by scheduling rewards after challenges;
- Learning how to reduce task demands by "segmenting" the day;
- The use of visually represented materials:
- Visual schedules – dovetailing small demands with small rewards on the schedule;
- Menus of reinforcers;
- Using instructional reminders (e.g., "If-Then" cards);
- Explaining "why" to your child;
- Writing "Social Stories" which explains "why" the rules are the rules;
- Use of Systematic Desensitization;
- How to set up gradually increasing "behavioral challenges" with your child;
- How, when and where to set up "unexpected" violations of routines;
- How to generalize your child’s behavior across settings, with different people, for different activities;
- Interacting with the Social World
- Planning for social partners and social opportunities;
- Methods of promoting "Social Thinking;"
- How to think about me vs. you – perspective-taking, the use of video and more Social Stories
- Promoting turn-taking & reciprocity social interactions and communication.