Teaching Children with Autism

Teaching Children with Autism, continued

For the past six years, I have been supervising IBI programs for children with autism. Since I charge more than many parents of children with autism care to pay, I produced a cover letter explaining why I charge what I do. I offer it here as perspective:

To the Parents of Children Whose IBI Programs I Supervise

When I meet with parents to discuss whether they would like me to serve as Clinical Supervisor of their child’s IBI program, I encourage them to get in touch with me whenever they wish, assuring them that I am as near as their telephone or e-mail. Unfortunately, relatively few parents do so, although I have heard indirectly that some of them have questions about my fees and my role in their child’s program. I will try to speak to those concerns here.

Ontario’s IBI program is based on the principles of Applied Behaviour Analysis (ABA), one of the very few treatment approaches supported by scientific research into its effectiveness. There are dozens of other approaches to the treatment of autism, but most of them have no more than anecdotal support, and they are not being funded through the IBI program.

When Ontario’s early intensive behavioral intervention program for young children with autism was set up, parents were provided with two options: (1) they could have service provided by the agency which administers the IBI funding in their region of the province – the Direct Service Option or DSO, or (2) they could opt to be given money with which to hire their own service providers – the Direct Funding Option or DFO. It was understood and stated that the amount of money that parents would receive would not necessarily cover all of the treatment expense, and that funding would not necessarily be continued until the parents are satisfied that it is no longer needed.

It was and is intended by the Government that the IBI treatment team be composed of one or more Instructor Therapists, a Senior Therapist, and a Clinical Supervisor. As one of the people responsible for getting the Direct Funding Option up and running, I took time to put on paper my thoughts about the responsibilities of each of these team members. Discussion of the Clinical Supervisor’s role follows:

Clinical Supervisors of IBI programs are expected to have the knowledge and experience necessary to design, implement and supervise IBI programs. Since Clinical Supervisors tend to differ in their areas of expertise – some might be quite suitable as supervisors of programs for high functioning children, for example, but have little or no knowledge of programming for low functioning children, and vice versa – suitability for the role should be assessed on a case-by-case basis.

As a general rule, it will be the responsibility of the Clinical Supervisor of a child’s IBI program to ensure that the people he or she is supervising have and/or are receiving sufficient training and supervision to do a good job with that particular child, although the training and supervision duties will be shared between the Clinical Supervisor and the Senior Therapist, and the Senior Therapist may actually be the person who provides most of the hand-on training and supervision of the front-line staff. That is, the Clinical Supervisor needs to decide whether or not each individual working on the child’s IBI team, under his or her supervision, is suitable for their role in the child’s IBI program, even though the Regional program carries the final responsibility for determining the acceptability of staff being paid out of IBI funding.

The Clinical Supervisor may or may not have as much direct ABA experience as the Senior Therapist, but he/she (1) should have a thorough knowledge of autism and ABA, including the most effective teaching strategies currently in use in ABA programs, and (2) should be able to bring a broader perspective to the program than someone whose main background and training is primarily in the application of Applied Behaviour Analysis to individuals with ASD.

Ongoing supervision by the Clinical Supervisor responsible for the child’s program might ideally be expected to require about 10% of the service hours. That is, for a program that is being provided for 20 hours per week, Clinical Supervisor time should ideally be about 8 hours per month. However, since that would be more expensive than most programs can afford, a more reasonable requirement might be a minimum of two hours of Clinical Supervisor time per month for a program that is up and running smoothly. However, more time would be required if the program is just being set up, if it needs a lot of fine tuning (as would be the case if there is either relatively little or a lot of progress being made), if the Senior Therapist is minimally experienced for his/her role, or if the Instructor Therapists need a lot of supervision and/or training; and it is the ethical responsibility of the Clinical Supervisor to determine just how much supervision time is required for any particular IBI team and program with which he/she is involved, and to see that it is provided.

This is not a responsibility that can be delegated (e.g., to the child’s parents), since it is imperative that the instruction being provided is designed specifically for the child and continually re-designed to fit the child’s current response to the instruction which he or she has been receiving, and few parents or Instructor-Therapists have the education and experience to do this on their own. If this becomes an issue, the funding agency – Autism Intervention Services (AIS) – should be consulted.

The Clinical Supervisor’s time should be divided amongst consulting with, observing and supervising the Senior Therapist and the Instructor Therapists, reviewing the child’s binder and monitoring the child’s progress, and suggesting changes to the child’s program to ensure optimum progress across the various areas that should be included in the child’s curriculum.

To put the fees that I charge into perspective, you should know that it typically takes six years of postgraduate study, plus another year of supervision and further exams, to become a psychologist. In comparison to other professions, psychologists’ fees are relatively low – the last time any of my family used a lawyer, for example, she was charging $525 per hour. For my role in a child’s IBI program, I currently charge $420 per month for a minimum of 2 hours per month of program supervision, which is less than is called for by the Ontario Psychological Association’s fee schedule – since I am particularly interested in children with autism – and when I charge for my travel expenses, it is only enough to recover my actual travel costs (in contrast to those of my colleagues who charge for their travel time as well).

Since I am semi-retired, I only devote about 20-25 hours per week to this supervision-of-IBI practice. In 2013, that brought in about $39,000 at a cost of about $12,000 – for a net pre-income-tax income of $27,000, or about $26 per hour. Nevertheless, if what I charge is causing you undue hardship, please do speak to me about it.

Recently, it has come to my attention that I need to provide explicit clarification for one point that hasn’t received sufficient attention above. Consequently, I have drafted an additional paragraph to be added this letter. It isn’t yet as elegant as I would like it to be, and I will try to find some better wording when I have time:

You will have been provided with information about the progress that your child will have to make to continue to be funded through this IBI program – the so-called management criteria – since the government needs to ensure that the province is getting a good return for the money it is spending. Typically, that progress will be reviewed every six months, and criteria have been established to determine whether or not your child’s treatment will continue to be funded through this particular program. You should know that, as Clinical Supervisor, I need to work within the constraints established for this program, and I will not be able to recommend that you continue to receive funding through it unless your child’s progress meets the criteria that have been established for continued funding. That is not because I don’t care about your child’s treatment, but because IBI service providers such as myself are required to work within the guidelines that have been established for participation in the IBI program.

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