The Roses and Thorns of ABA in a Clinic Setting

Applied behavior analysis can be delivered in a variety of settings.  Professionals in this ABA field work in homes, schools, and clinics, and each of these environments has their pros and cons.  I have worked in all three of these settings, and currently work in a “center” that is very much structured like a school.  Let me begin by saying that in-home ABA is not for me, and I am happy to have found the right kind of environment for me, ABA in a clinic setting.  There may be some people who prefer in-home sessions, but I personally find them very aversive.  Working in-home for over a year and a half, I have had experiences with helpful and unhelpful families, with healthy and unhealthy home environments, etc.  The aspect that wore on me the most was the feeling of isolation.  I could go weeks without seeing a coworker.  I would drive (often very far) to a session, see all kinds of behaviors (all while being watched by parents with the “how are you going to handle this” look on their face), get back in my car and drive to another session in the completely opposite direction, and do it all over again.  I was lucky to make friendships with coworkers through my student program, but we all had to really force our way into each other’s lives #BEMYFRIEND, but true interaction was few and far between. It is important to know yourself when figuring out the best environment for you to be in every day.  I know that I need daily interaction with coworkers, the daily support of “you’re doing a great job!” or “Oh man, your client’s having a tough day, huh?” and some good ol’ “water cooler” chit chat.  Those, even small, interactions make my day so much better.

With all of this being said, though, clinic-based ABA does not come without its flaws.  While clinics and schools have the coworker interaction, the support and praise to get you through the day, and the hallway chit chat, the collaboration it takes for everyone working with one client is difficult to achieve.  Often in clinics and school settings, one client has multiple staff, plus everyone else in the room or classroom.  Teachers and RBTs and BCBAs may all be in the same room, and giving the student different prompts, simply because they did not realize that there was a preceding prompt from someone else.  A client may be in the middle of a behavior, and be seeking attention, and while this is being ignored by one staff, another staff could completely reinforce the behavior, if the situation was unbeknownst to them.  This type of problem does not occur when you are alone with a client in their home.  It is simply harder for all individuals involved to be on the same page.

For the clients – In-home sessions allow for more individualized intensive intervention in the client’s most natural environment.  School and clinic ABA sessions offer real-world problem solving, and more unplanned reasons to teach flexibility, as well as social skills training.   The different settings offer different kinds of experiences for the staff, though, and you really have to know yourself to know where you will thrive best in order to best support your clients.

About the author: Alice Okamoto lives in the Raleigh area of NC with her boyfriend and two dogs.  She is in her last semester of her M.A. program, and hopes to sit for the exam next spring. Alice likes anything that has to do with food, wine, and the beach!

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