Returning to Posting & Discharging from Service - Jan 11, 2019
Recently, I have had several people in the Autism community encourage me to resume my blog posts. It started with a trickle, like when I was interviewing a potential therapist and they said "I read your blog and understand your philosophy so I think I'd like to work with you" and then it became "I really wish you would post more - it helped me understand concepts I was learning" so here I am.
My goal through 2019 will be to post a few times a month, and/or have my therapists guest-host a blog post about something they see, think about, or have learned.
What's on my mind though, has inspired me to share some thoughts for this blog. The subject is discharges.
I remember going into the ABA world thinking, children with Autism HAVE TO be in service, how else can they learn? Their brains work differently - they'll never be the same. Someone with skills must be with them... ... and on and on. My perspective has shifted drastically with almost 15 years under my belt.
ABA therapy is not a fix-all. It is not a final destination. It is not a life-long committment. It is not the most appropraite service forever. However, length of service per child is individual. Intensity of services is individual. There are always exceptions.
Forever is: the real world.
My discharge criteria is largely this: the child brings things from life into sessions, the child is capable in the environments they're in outside service, the child is able to learn from people other than therapists, the child doesn't need xx number of repetitions to learn something. Obviously, this list is not at all exhaustive and there are a tonne of data-based criteria that also influence discharge however, the list I've provided is generally the things that make my ears perk up, and make me think: hmm, something is happening outside service that is very very good.
For me, I'd rather not over-do service. In my history I've had several takeovers from other providers, and have seen the effects of rote-learning, rote-teaching, rote-responding. It's hearbreaking. It's soul-crushing. It's not going to get the child very far in life - in fact, it's likely to increase the chances that they will be teased, and will easily be labeled. This is not the goal of service. One of my most successful discharges (to this day) is a little girl who after 2 years of service goes to school (diagnosis in hand - not hidden from the school), and is in a TYPICAL classroom, with one singular area in her IEP: communication. Not alternative. Not exempt. Not accomodated. Modified. Modified Communication. Her IEP specifies that she may need written instructions read to her, and may need extra time to complete work, which could include her telling an assistant her thoughts, and having them write them down for her. Is her success typical? No. Is she the exception? Maybe. She is herself. She worked hard through programming, I pushed her hard to learn a variety of skills, and she flourishes. Does she still struggle? Yes. Do her parents still find her difficult? Yes. But is she able to learn in a classroom? Yes. Is she able to take lessons in a group in the community? Yes. Is she able to go shopping, go out to movies, and other public venues and act in appropriate ways and communicate her needs without problem behaviour? Yes. Would you pick her out of a crowd? Not likely.
Discharge is a good thing. It is the end of a chapter. It is not the closing of a book. Every single skill deficit a child has cannot be addressed in therapy. Therapy would never end. Therapy lays a foundation to learn skills in a typical environment. Yes, after therapy has ended, it may take a child time to adjust, but it also takes time for the family to adjust. It's hard to go from 2, 3, 4 or 5 day a week blocks of time a child is DEDICATED to learning skills they're missing, to simply nothing. (It feels weird for us to leave too!) However, the skills (if the foundation is there) will be enouraged, reinforced, and maintained IN THE REAL WORLD at the rate necessary for THE REAL WORLD. Which is exactly what our kids need.
Services such as OT and SLP can run during therapy, and can even continue after and be amazingly beneficial. Other services that can help further include: social skills groups, skill training group, and small ratio classes to learn whatever skill.
Discharge is a good thing. It is also scary. Children who are discharged are likely discharged based on your clinician's decision that they can learn in whatever environment they're put in. This is the goal. It is a huge success to see kids leave service, it's a huge success to hear the updates, its a huge success to open up the world of possibilities that the child can access without someone explicitly teaching them.
One quick note: Please, please do not think I subscribe to a "one-size-fits-all" philosophy. Qualified clinicians making qualified decisions about your individual child is NECESSARY. Please don't take my ramble to a clinician with an attitude that "Anita said..." Your child's team know what is best for your child. Ask for discharge information from YOUR clinician. Enusre your clinician is a BCBA or BCaBA. Discuss success in service with them. Each child is different. Many children benefit from hours of ABA after being discharged from IBI. If that's how your child still needs to learn: that's okay. Each child is different. Know your child. Know your circumstance. Ask questions. Get educated. Don't overgeneralize. (okay maybe that wasn't a quick note).
