ABA therapy is widely considered the gold standard treatment for children on the autism spectrum – and it’s particularly valuable when it’s intensive, starts early, and is combined with other critical interventions, such as speech therapy and occupational therapy. That said, finding the right Cleveland ABA therapy provider for your child can seem daunting – particularly if you’ve already had a negative experience.

When implemented appropriately, ABA has proven unequivocally to help children learn invaluable skills in areas like communication, self-regulation, social interactions, and self-care. It is our firm belief and practice that the best form of ABA therapy is naturalistic, play-based, and enjoyable for the child. That’s not to say we don’t challenge our patients. We do, as it’s necessary for them to gain the skills we’re trying to teach them. However, sessions that are too intense, rely too heavily on negative reinforcement, or use goals that are beyond what is realistic for a child will not only yield less progress, they may actually set your child back.

The unfortunate reality is that not all ABA therapists are cut from the same cloth, and not all clinics hold themselves to the high standards that we do at Therapy & Wellness Connection. Unlike more established fields like speech-language pathology, occupational therapy, or physical therapy, ABA therapy is less regulated.

Certified behavior analysts, or BCBAs, do have an intensive credentialing process. Among the requirements for BCBAs:

• Earn at least a master’s degree or doctoral degree in Behavior Analysis or related field such as psychology or education, with a focus on behavior analysis – with courses covering ethical conduct, principals of behavior analysis, research and data analysis, problem identification & assessment, intervention consideration, implementation management, etc.
• Complete a minimum 1,500 hours of relevant, supervised experience in an ABA setting.
• Pass a national certification exam.
• Apply for certification with the Ohio Board of Psychology.
• Attend a Pre-certification workshop and exam on Ohio ABA regulations (as detailed in Chapter 4783 of Ohio Revised Code and the Ohio Administrative Code).
• Renew COBA certification every two years (which requires proof of at least 23 hours of continuing education, with a minimum 4 hours of training in ethics, professional conduct, or cultural competency).

While these standards align with what one might expect in a field of professionals working one-on-one with children who have complex behavior needs and challenges, the same is not true of registered behavior technicians, or RBTs. And it’s RBTs who primarily administer Cleveland ABA therapy – under the supervision of a qualified BCBA.

RBTs are paraprofessionals. They are required to meet the basic eligibility requirements (at least 18-years-old, have a high school diploma, pass a background check, complete 40 hours of training, complete an initial competency assessment), then apply, take & pass the RBT exam, and then maintain their certification with ongoing supervision, adherence to ethics, and annual renewal. So where as it takes hundreds and lots of education to become a BCBA, RBTs are providing the frontline care with 40 hours of training.

Of course, there are many RBTs who are excellent and provide stellar ABA services to their clients. There is ample scientific data supporting the value of ABA in general. But as the number of autism diagnoses has risen steadily over the last two decades (the CDC estimates 1 in 44 children has an autism diagnosis), so too have the industries that serve them. Not every provider or clinic is as rigid about who they accept or how much oversight they receive. That can compromise the quality of care, as the value of ABA therapy rests heavily on who is administering it.

All of this can feel overwhelming for parents looking to find the best possible treatment for their child.

Our TWC Cleveland ABA therapy team has some questions parents can ask to determine whether a clinic/ABA therapy provider is right for your child:

• What is the ratio of BCBAs to RBTs at your clinic? The lower the ratio, the better, but there may be some variation depending on their patients’ severity level.
• What training and expertise does your staff have? As mentioned before, BCBAs must have extensive education and training, and they are the ones who will be developing treatment plans for your child. But it’s the RBTs who will be implementing them. Ask whether the providers encourages staff to undergo ongoing training. Inquire whether they have direct experience with your child’s specific challenges and needs.
• What types of intervention are used in your ABA clinic? ABA therapy is not a one-size-fits-all approach. There are actually many different ways to administer this research-based treatment. Ask the provider about their therapy philosophy and approach. Some tend to use more discrete trial training (which is more systematic and usually involves a child sitting at a table) while others prefer a more natural, organic approach to learning. Some therapy clinics will use both, depending on the child. You will also want to know whether they use positive reinforcement. “Punishment” or negative reinforcement may be effective in altering behaviors, but it’s not necessarily the best approach – especially because when there is potential for it to be over-used or abused. Positive reinforcement should be the primary approach.
• Does your clinic provide any other specialized services? Children on the autism spectrum may be prescribed a number of treatments, including speech therapy and occupational therapy. They may also benefit from tutoring, homeschooling, social skills groups, specialized therapies (music, equine, etc.), etc. It can be very helpful for these kids to have a “one-stop-shop” for these services. Therapy & Wellness Connection is one such place where kids can receive multi-disciplinary services and interventions.
• What is the treatment plan? Treatment plans must be created specifically for your child, depending on a functional behavior assessment. The plan should include both proactive and reactive strategies to manage and reduce problematic behaviors and encourage socially appropriate behaviors/responses. Ideally, the plan of care is going to have clear functional goals and objectives that identify age-appropriate challenges that are both engaging and fun for the child – and most likely to be generalized into other environments. It should also include parent involvement and training, to some extent. The more carryover we can get across environments, the better.
• What sort of safety measures are in place at your clinic? You as a parent want to know what measures are taken to prevent abuse, what the procedure is for reporting concerns with parents, how often parent observations are allowed, how inappropriate/excessive/dangerous behaviors may be dealt with, etc. You also want some insight into how secure the facility/session will be, particularly if your child is at high-risk for self-harm or elopement.

If your child has been diagnosed with autism and referred to Cleveland ABA therapy providers for services, our team at TWC can help answer any questions you have about our staff, our facility, our philosophy, and our practice.

Therapy & Wellness Connection – your connection to a life without limitations – provides ABA therapy to children in Akron, Cleveland, Brecksville-Broadview Heights and surrounding communities. We also offer summer camp, day programs, education services, vocational counseling and more. Call us at (330) 748-4807 or send us an email.

Additional Resources:

Low standards corrode quality of popular autism therapy, By Emily Sohn, Oct. 28, 2020, Spectrum News

More Blog Entries:

Cleveland ABA Therapists on Differences Between Bribery vs. Reinforcement, Sept. 10, 2022, Cleveland Behavior Therapy Blog