ABC outcomes & research
The ABC team knows that quality depends on doing the right things at the right time (e.g., core clinical processes) and focusing on changes that matter to families (e.g., outcomes). Clients, families, and stakeholders have a right to know how both processes and outcomes are monitored as a reflection of the quality of services provided by an organization. Our outcomes initiative is led by a team of dedicated, caring professionals who focus on accountability to families and stakeholders and contributing to the scientific literature to advance our understanding of treatment outcomes for behavioral early intervention services. Read some of our recent work here.
Clinical process data for 2023
Since our inception, we have carefully created and managed our intake, assessment, treatment, family guidance, and discharge preparation processes to ensure that families receive the best early intervention services possible. Our Clinical Directors evaluate the quality of programming for each and every child using a structured Case Review auditing process. In addition, we measure the quality of our processes by focusing on hiring and training a highly qualified workforce (goal of RBT certification within 40 days from hire), creating manageable caseloads for our BCBAs (goal is average caseload of 8 or few clients per BCBA), fulfilling authorized services as promised (goal is 90% fulfillment) and actively engaging families in the process of assessment and treatment (goal is 2 hours per month of family guidance and collaboration). See our most recent data on each of these metrics here.
89%
Of technicians become RBTs within 40 days.
83%
Average case load size with CDs when compared to those without CD
1.7
Average number of sessions of family guidance per patient per month
58%
Average number of patients receiving at least 2 sessions of family guidance per month
Patient outcomes
In addition, our ABC team also measures the patient outcomes achieved through our treatment efforts. Our families seek early intervention services with goals of (a) achieving language, social and adaptive skills that will ensure readiness for success in school, (b) managing challenging behavior that is most impactful to health and safety, (c) minimizing the negative impact of the characteristics of autism on everyday life and functioning, and (d) ensuring long-term quality of life with less stress for everyone in the family. We measure outcomes related to each of these goals at intake, throughout treatment, at discharge, and at follow up. We take a balanced approach to measurement, incorporating standardized measures that our completed by our clinical team (i.e., clinician reported outcome measures; CROMs) as well as measures that capture the experience and perspective of our patients and families (i.e., patient reported outcome measures; PROMs), consistent with the recommendations of the International Consortium of Health Outcome Measures (ICHOM) and the Behavioral Health Center of Excellence (BHCOE).
Challenging Behavior
- 2021 White Paper on Reduction of Challenging Behavior
Impact on Autism Characteristics
- Our research on the Autism Impact Measure
Skill Development & School Readiness
- School Placement
- Bracken School Readiness
- Changes on Curriculum Measures
Parent and Family
- CFQL - Quality of life
- Parenting Stress Index - Short form
2021 White Paper on Reduction of Challenging Behavior Summary
Many of the families we serve are concerned about challenging behaviors, particularly ones that impact health and safety (e.g., *self-injurious behavior, aggression, *elopement). We collaborate with families to develop a behavior intervention plan with the goals of (a) decreasing challenging behavior by at least 80% and (b) achieving that goal within the first year of therapy. We examined the effects of treatment on challenging behaviors for 20 of our clients.
All clients were 2-6 years of age with a mean age of 2.9 years at the start of the study and 5.7 years at the conclusion. All had received ABA therapy for at least a year and for an average of 27 months (range 14-37 months). We measured the frequency of episodes of aggression, elopement, property destruction and self-injurious behavior at the start of intervention and at the termination of treatment or during the most recent 3 months of care. Clients experienced an 86% decrease in challenging behaviors and these treatment effects were maintained as the dosage (i.e., number of treatment hours per week) decreased by almost 20% with the greatest reductions observed during the first year of treatment. The greatest reductions were observed for aggression and property destruction, which were the most frequent behaviors at the beginning of treatment and the least frequent behaviors at the last measurement.
*Self-injury refers to any behavior could inflict harm oneself such as biting or slapping oneself or banging any body part against a hard surface.
*Elopement refers to running or wandering away from a caregiver or secure location
Behavior Reduction Percentage
Timing of Administration
Parenting Stress Index 4- Short Form (PSI-4 SF)
The PSI-4 SF is a parent reported measure of the stress associated with the role of parenting. Studies have found that parents of children with autism often experience higher levels of stress than parents of neurotypically developing children or children with other identified conditions including intellectual and developmental disabilities (Hayes & Watson, 2013). Parents of children served at Action Behavior Centers are asked to complete the PSI at intake and every 6 months throughout treatment. Our most recent analysis (October, 2023) included data from 298 families who have completed the PSI at intake, six months into treatment, and one year into treatment. For these families, the average initial PSI scores fell at the 57th percentile decreasing to the 53rd percentile at one year of treatment (see the graph below for all families). For the families that were the most stressed at intake (n=34), the average initial PSI scores were at the 93rd percentile indicating very clinically significant levels of stress and the average scores decreased to the 80th percentile at one year of treatment indicating a reduction in parenting stress.
School Placement
Action Behavior Centers provides early intervention services and strives to prepare patients to succeed after intervention in school and everyday life in the least restrictive and most inclusive environments. Thus, we track school placement for families who exit services at school age. We track outcomes for families who exit services as part of our graduation process (i.e., all metrics and goal achievement suggest the child is ready to move on to school services without additional ABA) or who choose school (i.e., metrics and goal achievement suggested that that additional services were warranted but the family choose school without additional ABA services). Our team conducts a follow up survey with families about their child’s school placement approximately 3 months after discharge.
Seventy-seven families (30 graduated, 47 choose school) exited services in these categories in 2021 (Cohort 1) and were sent the survey. Of the 47 families who chose school rather than continued services, 22 responded (47%) and 10 of those 22 families (45%) indicated that their child was in a general education placement for at least half of the day. Of the 30 families with a graduate, 19 responded (63%) and 17 of those 19 families (89%) indicated that their child was in a general education placement for at least half of the day. The 19 families also received a follow-up survey later in the year and all 13 who responded indicated that the placement remained the same.
The preliminary data for patients exiting between Sept 2022 and Sept 2023 (Cohort 2) are very similar with 47% of those who chose school and 84% of those who graduated being served in general education for at least half of the day. This graph and data description will be updated as more data are gathered.
Cohort
Bracken School Readiness Assessment - Third Edition BSRA-3
The Bracken School Readiness Assessment Third Edition is a norm-referenced standardized assessment that provides a quick screening of concept knowledge to help determine if a child is ready for school. The BSRA-3 is conducted with clients of Action Behavior Centers who are nearing discharge to inform our discharge planning, to guide final phases of treatment, and to evaluate the outcomes of our EIBI treatment model. Data collection is currently underway, and the first analysis will be posted in 2024!
Curriculum Measures
At intake and every 6 months throughout treatment, our BCBAs assess patient skills using measures that guide our goal selection and curriculum implementation. That is, these assessment help us know what to teach next in order to build strong learning, communication, and social foundations for future success. Progress on these measures indicates that patients are learning new skills. The measures, along with others, help to inform our decisions about treatment continuation and discharge. Our first large scale analysis of these measures will occur in 2024.
Our Ongoing Research Efforts
The Autism Impact Measure (AIM) is a promising outcome measure that allows parents to report on the core characteristics of autism and the impact of those core characteristics on everyday life over the past few weeks. The early evidence suggests that this tool is reliable, valid, and sensitive to changes associated with treatment over a relatively brief period of time. However, most of the published research on this tool has not included diverse samples with representation of different races, ethnicities, and primary languages. Action Behavior Centers is partnering with Western Psychological Services (the publisher of the AIM) and colleagues Dr. Ivy Chong (Little Leaves, Inc.) and Dr. Ryan Martin (Mosaic Pediatric Therapy) to ensure diverse representation in research on the AIM.
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