ABA parent training is an important part of any ABA program. It involves teaching parents critical skills to ensure generalization, improve functioning in the natural environment, reduce the parent’s stress level, and generally make life more enjoyable for everyone.
Or does it?
Parent training is a term thrown casually around by ABA professionals as just another part of any ABA program. Most insurance companies require that you include parent training goals in your treatment plan and report on progress with each new authorization.
But few BCBAs® ever receive formal training in providing effective parent training. Professors teaching the courses for the verified course sequence teach using behavioral skills training (BST) as the best method for teaching parents and confederates to use ABA strategies. Research demonstrates the effectiveness of BST but does it actually result in lasting change for families as a method of parent training?
Just as knowing how to demonstrate a skill isn’t the same as incorporating it into your everyday life, BST alone is not enough. You must take steps to ensure the parent uses the strategies you teach when you’re not around.
First, let’s get clear on exactly what parent training is. A study by Bearss et al. (2015) compared the effectiveness of parent training versus parent education on clinical outcomes. The authors identified them as distinctly different.
They defined parent education as the delivery of helpful information about a variety of topics including treatment options, diagnosis, evaluation and advocacy. Parent training included teaching techniques to address challenging behavior such as analyzing antecedents and consequences or implementing strategies to reduce challenging behavior. The authors measured the impact of these 2 strategies on challenging behavior occurring in the home.
In this study, parent training yielded a better outcome than parent education. What’s particularly interesting about this study is that parent education, even though it did not directly address issues related to challenging behavior also saw an improvement, a 31.8% decrease in the ABC-I which is a parent-rated scale to measure challenging behavior. Parent training saw a 47.7% decrease. Yes, this is better, but the question is why did parent education, which offered no direct strategies for reducing challenging behavior see this level of improvement?
The authors didn’t dig too deeply into this question, but parent education must have addressed some need for the parent. Maybe it helped them view their child’s challenging behavior through a different lens or maybe it helped them establish more realistic expectations for their child.
While it’s clear that parent education alone isn’t the right answer, it’s probably also true that something happening during parent education that created some improvement for the family.
Parent training is often also referred to as caregiver training, parent coaching, or family treatment guidance. However you refer to it, parent training involves teaching specific ABA strategies related to their child’s treatment. Based on the study by Bearss et al. (2015), it’s probably also important to incorporate elements of parent education to see the greatest impact.
In a typical ABA program, parent training is provided by the BCBA®. This is often due to requirements by the insurance company and because BCBAs® should have the best understanding of how to teach the skills parents need to learn.
Most insurance companies also allow BCaBAs to provide the same services as a BCBA® as long as they receive supervision, usually the standard 5% supervision. Some insurance companies have stricter guidelines and do not allow a BCaBA to bill for some services.
BCBAs® providing supervision to trainees could delegate some of the parent training responsibilities to the trainees, but it’s likely that this will remove the training as a billable event. This means that for the time to be billable, the BCBA® must be present and providing the training. Make sure to check with each insurance company to make sure you understand the requirements.
If the RBT demonstrates strong clinical skills, consider inviting the parent(s) to participate in sessions with the RBT. Assuming that the RBT has strong treatment fidelity, this offers parents more opportunities to observe the interventions used in treatment. This amplifies and supports the parent training that you do but should not replace direct parent training by the BCBA®.
Often, this is the structure I use:
This process might take place over the span of a week or even a month. Allow the parents to determine how quickly you move through each step. Some families are so eager to learn how to help their children that they push to take on the next skill. Others are so overwhelmed with life that they can only take small steps at a time.
Parents should always be encouraged to observe and participate in sessions but not all RBTs are ready to participate in parent training. During supervision sessions, prepare the RBT for parent training before you reach step 9 with the parents. If the RBT isn’t ready to guide parents, make sure that the parents understand they can observe sessions but the RBT will not discuss what they are doing. Parents should direct any questions they have to you as the BCBA®.
Some states and insurance companies allow for non-certified staff to bill for parent training. If this is the case where you are, it’s critical that you ensure the staff receives training and supervision to make sure parent training is effective. Both of our CEU courses, Reducing Parent Stress Through Effective Parent Training and Enhancing Interactions: How to Use the ACT Matrix to Build Partnerships with Parents and Staff, provide a good introduction to effective parent training and are appropriate for non-certified staff providing parent training. Reducing Parent Stress Through Effective Parent Training is only available in the Master ABA Dojo so join us today!
Although there’s limited available research to help us understand the barriers to providing effective parent training, articles by Helton and Alber-Morgan (2018) and Allen and Warzak (2000) bring some important barriers to light.
For parent training to be truly effective, it’s important to address as many of these potential barriers as possible. You likely can’t overcome all barriers. Time constraints, requirements of payors or your employer, or your personal experiences all impact your parent training.
Whether you’re a business owner, independent contractor, or employee, there’s no doubt you need more hours in your day. You have endless tasks to accomplish each day, week, and month. You’re under pressure to maximize your billable time but must also complete documentation and plan for sessions. Developing a parent training plan or curriculum for each family likely falls outside of what’s possible to squeeze into your daily routines, leaving you with the following options:
The above list flows loosely from least effective to most effective. “Winging it” during parent training often leads to parents discussing the crisis of the week (COW) and you making off-the-cuff recommendations. These recommendations are disjointed and difficult for parents to actually utilize. Many times you address the same questions again a few months later because the issue remains unresolved.
If you have strong supervisees or RBTs® on the case, you might consider delegating the planning of parent training sessions. Staff might create a written plan for you to review with parents during sessions. They might also include a homework calendar or other visuals to support the parents’ use of the recommended strategies. Although this is time-effective, it would be difficult for the staff to know when and how to adjust the language used or strategies included to make the training truly dynamic.
Many BCBAs® rely on a “plan when you can” strategy for parent training. They create a loose plan for training then supplement sessions with off-the-cuff responses to parent concerns. For highly experienced BCBAs®, this might be the most effective method of parent training. It provides a balance between structure and flexibility. For newer BCBAs®, this strategy shares many of the disadvantages of the “wing it” strategy. It’s incredibly easy to get caught up in the COW when there’s not plan for each session.
There are many great parent training curriculums available on the market today. Each one offers different resources and focuses on different aspects of client need. Most seek to teach parents to identify the function of challenging behavior and use that information to determine how best to respond to the behavior. Although parents often need this information, a study by Taylor et al. (2019) found that parents reported BCBAs® focused too much on their child’s problem behavior. Parent training should include a balance of information that focuses on the child’s strengths and meets the individual needs of the parents.
Few curriculua include information about skill acquisition, reinforcement, or motivation. The ACHIEVE Parent Training Curriculum includes 26 lessons, homework assignments and quizzes that cover both important skill acquisition strategies and important information to understand challenging behavior.
ACHIEVE is available on Amazon, but if you buy through Master ABA, you receive a substantial discount. Click here to learn more.
You can’t control all parent stress, but you can influence many aspects of it. Ask yourself if your parent training is decreasing parent stress…or increasing it.
A study by Baker et al. (2005) looked at the stress experienced by parents of toddlers with and without ASD. They highlighted many sources of stress for parents of autistic children, including their child’s intellectual deficits, especially if they had difficulties with verbal expressive language or cognitive inconsistencies. Their child’s personal characteristics including adaptability, demandingness and level of distractibility also impacted parent stress.
Other factors that impact parent stress included:
Parent stress interferes with relationships and often leads to failure to follow through with BCBA recommendations.
Imagine being a parent under the constant watchful eye of different providers, all looking to tell you how to parent your child. You don’t spend time with family or friends and can’t take your child to Disney like you had once envisioned because of your child’s behavior. You’re essentially trapped at home, unsure what to do. How would you respond to someone coming in to teach you how to parent when you’re under such extreme stress?
According to Allen and Warzak (2000), one of the reasons parents fail to follow through with recommendations are faulty establishing operations. Parents may not be motivated to use the interventions we recommend. This might be because we fail to identify intermediate outcomes and parents have trouble keeping up momentum toward a long-term goal. Parents also encounter competing social approval when family and friends express disapproval of the therapist’s recommendations.
Take time to carefully consider the establishing operations impacting the parents’ motivation to follow through with your recommendations. What variables can you alter to reconfigure the establishing operations to increase the likelihood the parents will follow through with recommendations?
Learn more about making a difference in the lives of parents and earn 1 General CEU while you do it. Take our CEU course: Reducing Parent Stress Through Effective Parent Training. It’s only available in the Master ABA Dojo so join today!