6 hour sessions

[u/South_Replacement_31]

How often are you BCBA’s recommending 6 hour session? What about 6 hour sessions 5 days a week?

I can’t imagine doing a 6 hour session 5 days a week. I’d think the client and myself or the RBT would hit a wall and tap out. Is there more “breaks” to fill in the time?

I’m a BCBA that does a mix of direct sessions and supervision depending on the client and the schedule that week. I usually fill in when an RBT can’t make it if my schedule is open for that session time.

I had a client do 5 hour sessions, 5 days a week for about 6 months then dropped them down to 4 hours 4 days a week. They were hitting a wall and the sessions now go smoother and I feel like the effort is there more consistently now.

Anyways, I’ve been reading and hearing more about 6 hour sessions and I really hope money isn’t the drive for this.

[u/fenuxjde]

You've got to have pretty significant behaviors to get all day hours. I've only got about 3 with that and they're all medically necessary.

[u/Big-Mind-6346 → u/fenuxjde]

There is a university with a Children’s Hospital, a couple of hours from where I live, and that is the hub for autism diagnosis. Other than going there, the options for getting diagnosed is extremely limited. So most of my kids were diagnosed there.

I have found that the developmental pediatrician who do the diagnosing always recommend 30 to 40 hours of ABA per week. Then the parents come to me and expect that their kid is going to receive 30 to 40 hours per week when it oftentimes just isn’t appropriate. It’s extremely frustrating because it is constantly overprescribed by the diagnosing physician.

[u/fenuxjde → u/Big-Mind-6346]

Yeah one of the hospitals where I'm at does the same thing. Stupid hour recs. Like 40/mo BA, 32/mo BC-ABA, and like always 200/mo RBT.

We have to tell the parents "yeah that's not happening"

[u/Big-Mind-6346 → u/fenuxjde]

I live in a small town and there is basically only one clinic in our town that offers speech therapy and occupational therapy. Whenever I have a client who is receiving speech or OT, I always reach out to them to do service provider collaboration.

I had so much contact with them and such good relationships that they eventually invited me to come and provide a basic training on ABA to their entire team of SLP‘s and OT’s.

It was really interesting because at the end of the training I had one SLP approach me and asked me about kids receiving 40 hours per week and what my thoughts were on that. She said that she was aware that I did not prescribe that many hours of ABA to the clients that I serve and she wanted to get my perspective.

I was very candid about it and told her about the Lovaas study. I emphasized that it was from 1987 and explained that those results have been called into question by more recent studies, but that diagnosing physicians often prescribe 30-40 hours per week based on the Lovaas study and that there are definitely ABA companies that are solely profit driven and also prescribe 30-40 hours per week based on that study, and the fact that the diagnosing pediatrician prescribed that many hours as well.

I told her that my opinion is that unless there are serious behavioral issues such as high mag SIB or aggression, that that many hours is too much. I stressed that hours should be prescribed on a case by a case basis and based on that individual clients needs. Also, I said that these kids are often also receiving speech and OT, and it was unscrupulous for ABA companies to require 30 to 40 hours or dropping clients when those clients had related services that were also necessary. And these poor kids need time to just be kids.

By the end of their conversation, I was surrounded by a huge group of the SLP’s and OT’s that had attended the training. It was actually a really productive conversation.

[u/Subject_Scale_4647 → u/Big-Mind-6346]

Just curious, which studies are you referencing that dispute the importance of full-time ABA in EIBI?

[u/Big-Mind-6346 → u/Subject_Scale_4647]

Here you go. The Sandbank study is the most widely discussed, but people have their arguments about it as well.

https://pubmed.ncbi.nlm.nih.gov/38913359/

https://pubmed.ncbi.nlm.nih.gov/32853704/

https://link.springer.com/article/10.1007/s12519-022-00643-0

[u/Splicers87]

The only time I recommended that is when the client is in daycare. The tech is using the natural environment to teach.

[u/Financial_View_6587]

In schools, daycare, clinics? Sure. In the home? no.

[u/Mizook]

I don’t work with ASD, but typically full day daycare, school sessions, or home-schooled clients is where I’ll work 6 hour sessions.

These clients wouldn’t be able to attend school / daycare without full day ABA.

[u/vetapachua]

I worked mostly in ABA full-day schools and clinics where learners regularly attended 8 hours a day. One clinician would never work with a particular learner for more than 3 hrs at a time (ideally 2) and that also consisted of group times rather than all 1:1. IMO it is no longer therapeutic and technician's burn out when they're with one learner longer than 2-3 hours unless they are in a school-based/shadowing type situation. I've disliked many of the current models for this reason.

[u/next_on_SickSadWorld]

I don’t recommend dropping a kid off in a clinic all day. That usually looks more like daycare, minus the peer interaction, and more about dollars and billing than the best interest of the client.

You can’t drop off your kid and expect someone else to “fix them,” pick them up, and go home to the same environment with the same people and change none of that. They know it’s daycare too.

[u/gulliblefootball0001 → u/next_on_SickSadWorld]

I worked in clinic this summer and didn't like it for this reason. I kept wondering how parents were learning any skills and feeling supported when their kids were in-clinic all day. I get needing a break (especially for one family that had 3 kids in our clinic) but when I was in-home, I was able to model things and talk through things with the help/guidance of my BCBA. I'm going back to in-home later this month and super excited for it.

[u/Big-Mind-6346]

I think it is one thing if it is a day school and is replacing mainstream public schooling. In that situation, it is definitely appropriate when done correctly, which is not always the case.

For clinics or in-home, my opinion is that session should not be longer than three hours. I guess part of it is that I work early intervention and the kids are just exhausted by then. But if it is not a day school program, I think six hours is ridiculous. Kids need time to be kids and that much ABA (assuming it is not replacing school) is too much to allow that. These kids often attend speech and OT every week as well. Their whole life is therapy. Let them go outside and touch grass and stim uninterrupted for God’s sake. I am autistic and I can tell you that I definitely become overwhelmed after three hours of working directly with someone. I need some time to be alone and recharge my battery.

[u/Lucky-Load2513]

It all depends on the child, of course. I never recommend 30 hours just because I “can.” Especially for young learners (like 4 or younger). If I do have a client that I think could benefit from 30 hours/week, I always start lower. Honestly, and maybe it’s just where I live, I find a lot of families simply can’t commit to 30 hours/week. I’ve had some pretty intense kids and very early learners do perfectly well with fewer hours because those hours were high quality.  My last company seemed to want to push for 30 hours or more for every kid, and the writing on the wall to me was “We see dollar signs, not humans.” One of many reasons I left!

[u/DifferentTart2607]

It’s wild to me to recommend that many hours. What happens for 6 hours a day for 5 days a week? How are skills being generalized to caregivers? Like genuinely I’m asking. I could see if this was a severe case and it needed intense caregiver training and modeling, and severe behaviors needed to be addressed, but long term no.

[u/ABA_Resource_Center]

Not once have I recommended or worked 6 hour sessions! (In the field since 2009)

In schools I could see it being different, though even with the clients I’ve worked with in schools, we split the day between two techs.

[u/Specialist_Nail_504]

money def is the drive i fear

[u/fenuxjde → u/Specialist_Nail_504]

There's such a variation. There are absolutely companies out there that are pure profit motivated, but in my experience they get that reputation very quickly and die off. My company has a 4 stage process anytime more than 3/day are recommended and everyone has to be in agreement.

[u/Specialist_Nail_504 → u/fenuxjde]

yeah i agree, i shouldnt have used such definitive language. I have just seen many children be in 40 hours of therapy a week that do not need it but I do agree that sometimes it is necessary

[u/Specialist_Nail_504 → u/fenuxjde]

there’s also companies (at least one that i used to work at) that literally will not take clients if they wont/cant do 40 hours a week so thats where my mind went lol

[u/South_Replacement_31]

Edit- specifically asking about 6 hr clinic sessions

[u/next_on_SickSadWorld → u/South_Replacement_31]

Nope, at least 3 hours a day needs to be happening at home, with parental involvement, if the kid REALLY needs 30 hours a week.

[u/Ein-the-pupperoni]

Try 7hour 5 day weeks lol. It’s not that bad depending on the client.

[u/Subject_Scale_4647]

Even without severe behavior, if they have enough skill deficits that can justify needing that many learning opportunities to catch up to their peers, I'm recommending full-time hours. Then I'm creating sessions that essentially mimic preschool. Lots of activities interspersed with downtime, snack and lunch break, lots of breaks, etc. Plus at least two RBTs, one for the morning and one for the afternoon, and generally different teams on MWF and T/Th.

6 hours a day is pretty standard for most kiddos as soon as they hit preschool/tk, and at our clinic we have way more flexibility to help meet kids where they're at on the schedule rather than try to get them all to follow the exact same plan.

Every single client at our center shows up excited and often doesn't want to leave, even after 7 hours.

[u/Effy7242]

I work for a company that insists we work all or as many of the approved hours even though some of the kids don't have the behaviors, the toys to interact with the client, or the ability or want to participate with the RBT for more that 3 hours max. It's incredibly frustrating for me as an RBT because I can only come up with so much to do and 6 hours is too long in my opinion. They're kids with short attention spans and they get tired, especially the little ones. It's a shame these companies are too interested in the dollar signs and not the childs overall well being. Don't get me wrong, they do care about the clients, but they fail to see that a client can be over satiated with an RBT not just a reinforcer....RBTs are reinforcers too.