Early intervention decisions are typically made by families in crisis who have been deluged with referrals to potential programs, lists of waiting children, descriptions of insurance coverage, philosophical approaches to treatment and more. All of this information generally arrives at a time of high anxiety when a family is trying to make sense of a diagnosis and figure out what to do for their child.
The following is a guide for deciding among services for your child, written by professionals for families and by providers for evaluation by families.
Start with the child’s profile, not the service menu
It is very helpful to your family’s case to write down all of the changes that your family needs to make. Stating general goals, such as helping your child to improve their communication, will result in a service plan that is generally focused. By stating very specific goals, such as teaching a child to request use of preferred items without escalation, helping a child to stay calm during activities’ transitions, or increasing length of time that your child participates in group activities (i.e. 10 minutes), every provider can see that you and your family are working towards the same exact things.
Identifying the families’ true concerns is essential as well. A family who is struggling to take care of their child’s needs to eat may not benefit from a wonderful social skills program, even an excellent one.
Separate the clinical need from the logistical constraint
When looking at services offered by different providers, the considerations of transportation, care of siblings, parents’ work schedules, and a child’s ability to travel to sessions are not afterthoughts. A program of four sessions a week for 6 weeks would likely not be as good as a lighter program of home-based sessions for a year or so. It is best to get a family’s realistic ‘ceiling’ early in the process and then look at all of the available programs with that in mind.
Compare delivery formats on their actual trade-offs
The physical format of a program to teach children with Autism can have a very different cost than what is printed on brochures and websites. Most intake conversations rarely delve past the approach or philosophy of a particular provider or agency.
| Format | Strongest for | Main trade-off | Family time demand |
| Home-based | Daily routines, caregiver coaching, generalization to real settings | Limited peer exposure, household disruption | High, caregiver usually present |
| Center-based | Structured teaching, peer practice, consistent staffing | Skills may not transfer home without planning | Moderate, travel and scheduling |
| School or preschool embedded | Classroom participation, naturally occurring opportunities | Less individual intensity, shared decision-making | Low direct, high coordination |
| Parent-mediated | Low-intensity needs, long-term sustainability | Depends heavily on caregiver capacity and support | Very high initially |
| Telehealth coaching | Rural access, supervision, follow-up between visits | Harder with young children who need hands-on support | Moderate |
Whether or not a combination of settings is offered by a provider is also noteworthy. More important, however, is whether or not that provider can describe how skills that are learned in one setting will generalize to other settings.
Questions that reveal how a provider actually operates
While most intake conversations revolve around the philosophy of a given program, practice is where the real difference between providers can be observed.
- Who will be in the room each week, what are their credentials, and how often does a supervisor observe sessions directly?
- What is your annual staff turnover, and what happens to a child’s program when a therapist leaves?
- How are goals written, how often are they reviewed, and what data will we see at each review?
- What does caregiver training look like in month one versus month six?
- How do you respond when a child shows distress during a session, and what would cause you to change or pause a program?
- How do you coordinate with speech, occupational therapy, and the child’s preschool?
- What would discharge or reduced intensity look like, and what criteria trigger that conversation?
Listen for discharge planning
Ask the provider to describe “step down” of service and/or how services will “fade.” Families who are committed to supporting their child’s independence want to know how the services they are committing to pay for will decrease over time and how soon others (e.g. Grandmother) will be expected to support use of new skills or behaviors. Typically, programs that are oriented to supporting a child’s independence will describe how support will fade from the provider and others over time, including who will support use of skills/behaviors learned.
Evaluate the family-centered claim against evidence
While almost every quality provider of young children with autism and other developmental disabilities describes his or her work as “family-centered,” there are several things that families can look for to determine whether or not this description actually rings true.
One factor to look for is cultural and linguistic diversity, or at least an ability to describe adaptations to a family’s cultural or linguistic background when their ways of functioning, or routines, are different from those of typical clients.
Confirm individualization in writing
Families interested in ABA therapy for children in Rhode Island should ask for examples of current treatment plans. Look for generic lists of goals as well as an expectation of the same number of hours per week for every child. Even programs of high quality can differ significantly in the quality of their plans. It is best to look at the ways in which a program can meet the needs of a family before they agree to serve them.
Weigh cost, coverage, and the real schedule
Be very aware of how insurance authorization for programs (even those well-reasoned clinically) will frequently determine the intensity of service for families. Ask to confirm the number of authorized hours, prior authorizations needed, and the family’s share of cost for sessions in addition to the number of sessions that exceed the family’s realistic attendance for a period of time.
- Verify in-network status for the specific service code, not the organization generally.
- Ask what portion of authorized hours typically goes unused and why.
- Establish how cancellations and staff absences are handled financially.
- Request the expected wait from intake to first session, and from assessment to active treatment.
Making a decision based on these criteria will allow families to make decisions that will work for them in the long run. Of course, a program can always be changed in the future, but it is best to start with a program that will work for your household.
