Thinking “Big Picture”: Promoting Quality in ABA Services

This piece was authored by Kathleen Bailey Stengel, Sr. Vice President ABA at Aveanna Healthcare.Think-Big

The “gold standard” for effective treatment for individuals with autism has always been Applied Behavior Analysis (ABA). However, as ABA services are increasingly sought after and provided to large groups of individuals, new clinicians are being trained and certified at a rapid pace. Because of this, a true “standard” for these ABA programs is difficult to define in the marketplace.

Where the Difficulty Lies
A quick scroll through social media sites can highlight complaints from both consumers and clinicians regarding poor programming, lack of evidence based treatment plans, and ineffective data collection. Part of this difficulty lies in the individualization of programs as ABA programs are typically designed for each individual, which results in certified and credentialed providers not developing standards of care across the board rather than the individual client. While many individual practitioners are experiencing success at their practice, providers and funders often run into issues when scaling practices toward large populations and across many practitioners to obtain (effective) outcomes expected by stakeholders and clinicians. Ongoing supervision and training of staff, standard documentation practices, and consistency of clinical interventions and outcomes are enormous challenges faced by clinical organizations as they grow and move into community-based integrated service models. Though challenging, there are methods to smooth this transition.

Setting up for Success
As a behavioral health provider across many states, we maintain large waiting lists for clients and are constantly hiring new clinicians at a rapid pace in order to keep up. One of the most difficult tasks we’ve experienced is maintaining appropriate clinical and operational checks and balances while providing services to families who are in dire need of them. This need for effective monitoring and supervision of clinical programs is essential in assuring the ABA programs we provide remain the “gold standard”. Therefore, it is a priority to hold all our clinical programs to the high standards that ABA has demonstrated and knows so well.

At Aveanna, creating and maintaining organizational quality indicators has been a priority over the last 3 years. As part of this initiative (and given the larger size of our programs), it has been imperative to have a partner electronic platform that allows us to continue providing excellent ABA case management services, while reducing time costs related to supervision and training, information storage and data collection, and management at the individual and aggregate levels. Rethink Behavioral Health, a division of Rethink First, has been this partner for Aveanna. The Rethink platform has provided us with tools to standardize our clinical documentation and data management, while allowing an efficient way to access and review all of the clients’ records.

With these features in place, we have been able to identify and monitor clinical quality indicators that will give us the opportunity to standardize and shape the clinical skills of our staff to reach the services and outcomes that we expect for all of the individuals we serve. As an example and a baseline point, we identified the following essential quality indicators that will be at the core of each and all programs offered. These quality indicators are the backbone of our standard performance expectations and will continue to pave the road for further development of all our clinical staff and the achievement of consistently valuable treatment outcomes.

Key Quality Indicators:

  1. Individual goals clearly match the assessments
  2. Goals are measurable
  3. Data collection systems selected match the stated goals
  4. Lesson plans for each goal are completed
  5. Positive Behavior Support plan is written and in place
  6. Graphs for each and all goals are up to date and complete
  7. Graphs reflect changes in interventions as needed
  8. Intervention protocols are evidence-based
  9. Follows up with supervision round recommendations

Thanks to Rethink Behavioral Health, we are able to audit the program integrity remotely to assure compliance with basic clinical standards. Our goal with standardizing and reverse engineering clinical outcomes at the clinician level is twofold: to create a basic standard of care while allowing the clinician to individualize treatment as well as to work toward creating a baseline for measuring large population aggregate results in the future.

When we can finalize and control the variables for treatment implementation across our national program, we will then move toward aggregating the data from Rethink on the children’s plans and measure full programmatic integrity. This data will then drive decisions from the child level all the way up through executive decisions. With Rethink as a partner in data collection and treatment integrity, the collected data will allow us in the future to make changes to our clinical and organizational structure that have direct and meaningful impacts on client outcomes across locations.

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform offers both Clinical and Practice Management tools along with RBT Training, VB-MAPP licenses, and more than 1500 resources/materials as curriculum pieces. Schedule a demo today at your convenience!