The last 18 months have changed so much for our learners due to unexpected modifications in routine and new expectations. Social distancing to keep children safe has resulted in limited opportunities to engage in group instructions in-clinic, which was a hallmark of our School Readiness Program (SRP) at BCOTB. Although group instruction opportunities have been placed on hold, in-clinic therapy provides a wide variety of programs to help learners transition from 1:1 therapy to a school setting successfully.
How 1:1 In-Clinic Therapy Can Help with School Readiness
The structure of in-clinic therapy requires many transitions from one location to another which mimics transitions within the school environment. Learners are expected to separate from their parent(s) in the lobby and transition into the clinic. Once inside the clinic, learners are expected to transition to various locations including a table in a therapy room for Discrete Trial Training (DTT), the playroom for Natural Environment Teaching (NET), the bathroom, etc. multiple times per session.
While engaged in DTT programs at the table, our learners are taught to sit for extended time periods (typically 15 to 45 minutes), listen to and follow directions, look at program materials, and respond verbally (vocally, with a communication tool, or sign language). These are all skills that are also required in a school setting. An example of a DTT program that could benefit your learner in a school environment is learning how to respond to simple personal questions: they may be asked by peers or school staff including their name, age, where they live, and their parents’ names. Other examples include imitation skills, completing tasks within a specific time frame, first/then contingencies (e.g., “First we finish the math lesson and then we go to lunch”), and learning how to complete work independently. There is a wide variety of DTT programs available and each one is carefully selected by the learner’s Case Manager (BCBA-Board Certified Behavior Analyst) with parental input for the learner’s individual needs.
Natural Environment Teaching (NET) provides further learning opportunities such as, sharing with others, taking turns, playing with toys functionally, responding to their name being called, walking with adults appropriately (including stopping and waiting when asked), waiting in a location when instructed or after asking for something, tolerating delays and denials, and making eye contact. Safety skills are also taught with our newly added playground that includes a slide, swing, and monkey bars. A 1:1 therapist carefully watches the learner at all times and teaches them how to use the equipment safely.
BCOTB also offers desensitization programs that may be helpful once your learner enters a school environment. Desensitization is a step-by-step process of exposing the learner to small amounts of the aversive situation or item until they are calm during that step and then moving on to the next step. Desensitization programs that can help transition to school settings include getting used to wearing a mask, reacting appropriately to loud noises (peers and fire alarms), and sitting on the toilet which is a prerequisite skill for toilet training.
In-Clinic therapy can also help increase your child’s communication as requesting (manding) skills are targeted throughout the session. Independent communication is key in the school environment and our learners are taught to ask questions, request things that they want or need (including the bathroom to prevent accidents) and ask for help in a variety of circumstances.
Our individualized approach also provides specific behavior plans for any maladaptive behavior your child engages in. These behavior plans are carefully constructed by the Case Manager with prevention methods (antecedent manipulations) and appropriate interventions after the behavior has occurred (consequence manipulations) to decrease/eliminate and replace the problem behaviors. A reduction of problem behaviors helps your child increase their instruction time and learn more skills in-clinic and in the school environment. It will also help your child access less restrictive settings within the school system.
When Group Instruction Returns to the Clinic
Once social distancing protocols are no longer necessary, BCOTB is prepared to return to providing group instruction (e.g., circle time) and increasing peer interaction programs during NET time.
Group instruction involves your learner sitting with a group of their peers for 30 minutes with the expectation that they will follow group and individual instructions. The learner will be expected to discriminate between a group instruction and an individual instruction. This will teach your child to respond to an instruction when the therapist says, “Everyone clap your hands” or respond to an individual direction if the therapist says, “Johnny, stand up.” Group instruction will also require your learner to transition to table work from circle time to complete a fun arts and crafts activity with their peers that also includes group instructions. Your child’s 1:1 therapist will help as needed to complete the activity.
In addition to group instruction, Centers will also return. In-clinic centers imitates the Centers that your learner will experience in their school setting when they are expected to complete an activity within a specific time frame with peers and then transition to a variety of activities (typically a minimum of 5 activities) when instructed for a total of 30 minutes.
Although we have all faced major challenges in the past 18 months, BCOTB remains dedicated to assist learners and their families with easing the transition into the school system with a variety of early interventions. The School Readiness Program targets learners ages 3 ½ to 5 years old, but we also offer the Toddler Achievement Program (ages 1 ½ to 3 ½ years old) and the School Success Program (ages 5-10 years old). No matter where your learner is in their ABA journey, BCOTB is prepared to assist them with individualized care.
If you think your child would benefit from any of the above programs, please contact BCOTB at (813) 814-2000 to learn more and schedule a meet and greet!
**BCOTB has been Tampa’s leading provider of pediatric ABA therapy since 2003. With four clinic locations throughout the Tampa Bay area, we know that our clinic is the right spot for your early learner! BCOTB focuses on in-clinic early intervention for children from birth to ten years old. BCOTB accepts most major insurances, including, but not limited to: Aetna, Anthem, Baycare, Beacon, BCBS, Cigna, CMS, Florida Blue, Humana, MHNet, Meritain Health, Magella Health, UnitedHealthcare, and TRICARE.**