Behavioral Health Consultants

We serve the entire Los Angeles County area, with the bulk of our clients based in Glendale, La Crescenta, La Cañada, Burbank, Pasadena, Mid-Wilshire, West Los Angeles, and surrounding areas.

All you need to do is make an appointment with the Intake Department in the Regional Center in your area. If you need help finding out where your local Regional Center, feel free to contact us and we will be happy to put you in touch.

We do our best to accommodate your scheduling needs. As such, we have a wide range of availability between the hours of 8:00AM and 7:00PM, from Monday through Saturday.

Typically, services rendered during the morning to early afternoon hours are not subject to a waiting list. Services rendered during after school or evening hours, however, usually are, but we will always do what we can to accommodate your family's needs. Please do not hesitate to contact us no matter your scheduling concerns.

After the Functional Behavioral Assessment is reviewed by the Clinical Services Department at Regional Center, it must then be approved. Depending upon funding and other variables beyond our control, services could begin in as little as a few weeks after approval.  However, on occasion we have seen approvals for services delayed for as much as a year. Each case is different. As a general rule of thumb, we budget a few months for the start of services.

Typically, the Assessment can be completed in a month or less.  Regional Center gives the provider much longer to do the Assessment, but BHC likes to operate as quickly and efficiently as possible so that families can start working toward their goals right away.

This is a complex and important question that deserves a detailed response as it relates to our services.

BHC utilizes the Applied Behavior Analysis (ABA) Model for each child’s treatment plan.  Research suggests that treatment should typically start while the child is under three years old. ABA is based on the concept of breaking skills down into smaller more manageable tasks and goals until the child learns the skill.  This integrated approach teaches skills that build upon and complement each other. 

Early Learners
Research suggests that 1:1 behavioral therapy should be administered initially in the home setting, and then generalized to other settings such as school (Lovaas, 1993). At Behavioral Health Consultants, treatment begins in the home setting. Transition to school and other placements occurs once the child reaches school age. 

The ABA treatment focus is on the reduction of "maladaptive behaviors" such as tantrums, aggression and self-injurious behaviors. For children under three years of age, the child’s natural environment is the ‘learning classroom”. Therapists will apply Incidental Teaching and Natural Environmental Training models to build rapport and teach age-appropriate skills. Goals for young children include: reducing maladaptive behaviors, increasing language skills, developing play skills and increasing imitation and gross motor skills. 

Older Children
More structured teaching is incorporated during sessions around this time.  Older children are usually required to sit for periods up to 30 minutes in length, typical to a school environment. Skills are taught through a variety of teaching strategies such as Discrete Trial Teaching, Natural Environment Teaching, Incidental Teaching, and Peer Integration. Goals for older children include: following instructions, increasing socialization, advancing observational learning, building complex language, and generalizing learned skills. These are prerequisite skills that a child must learn in order to progress to more complex behaviors.

Features of our model:

• Individualized treatment customized to the child’s individual needs.
• Comprehensive treatment: all skills are addressed, including language, adaptive, social, and so on.
  
• Principles of Applied Behavior Analysis are used to teach functional skills and to reduce maladaptive behaviors.
• Supervision is conducted on a weekly basis.
• Parents receive training throughout the course of their child’s treatment.
• Latest research findings are incorporated into our treatment planning.
• Learning objectives are age-appropriate.
• Treatment is intensive.

Assessments
All Functional Behavior Assessments are conducted and written by the ABA Supervisor.

Parent Training
Therapists, Clinical Supervisors and the ABA Supervisor provide parent training.

Supervision Standards
Supervision for ABA services is conducted on a weekly basis. Supervision during ABA sessions focuses on reviewing progress toward program or behavior goals and modifying program or behavior goals if necessary. 

Frequency of Supervision
BHC provides one hour of Clinical Supervision for every 10 hours of ABA services that take place at the child’s residence. Additional Clinical Supervision also takes place during Clinic Meetings, when new therapists begin working, during individual consults, group training sessions and at any other time that supervision is requested or deemed appropriate.  The ABA Supervisor is responsible for overseeing all supervision sessions.

Supervision of Individual Treatment Plans
The ABA Supervisor conducts the initial Functional Behavior Assessment on every case referred to BHC.  Recommendations for hours needed for clinical services and the specific programs to be implemented are based on each consumer’s individual needs. The ABA Supervisor is solely responsible for conducting and reporting on the Assessment.

The ABA Supervisor meets with parents or caregivers to review their role in their child’s ABA treatment plan.  Clinical Supervisors then meet with parents to introduce therapists and to conduct the initial parent training.  

Clinic meetings are held twice a month.  During clinic meetings, therapists, parents, the Clinical Supervisor and ABA Supervisor review progress toward goals and new interventions that will be introduced.  Parents also meet with Clinical Supervisors once a week to discuss any concerns regarding treatment services.

Prior to report writing, the ABA Supervisor visits the home to observe each child’s behaviors, and speaks with parents regarding issues and progress.  Changes to treatment plans are also discussed at this time.

Case Staffing  
Cases are staffed based on who would be the best fit for each child based on relevant work experience, expertise.  BHC does not staff cases based on personality traits, ethnicity or culture. The ABA Supervisor has the final say on decisions regarding staffing.

Development of Adaptive and Socially Significant Behaviors
Learning basic living skills is the foundation for learning more complex adaptive skills. When the child demonstrates age appropriate skills and behaviors, he or she moves on to more complex coping, problem solving and socialization skills. Going to school, for example, requires the incorporation of a wide spectrum of abilities if the child is to be successful in the school environment. Schools challenge children to solve problems, cope with adversity, learn how to play with others, how to communicate one’s needs, how to focus, comply and express oneself appropriately. The ABA treatment plan is designed to target these and other issues with each child.

Reduction of Maladaptive Behavior
Children are taught more socially appropriate behaviors that eventually serve as "replacement" behaviors for maladaptive behaviors such as self-injury and tantrum behavior.

Generalization
Each target skill builds upon another.  Generalization is targeted immediately to ensure skills are transferred from one situation to another, such as from communicating with caregivers at home to interacting with classmates at school.  Emphasis is placed on generalizing skills across people (such as the child's parents, nanny, extended family and teachers) and across learning environments (home, community, school, etc.).

Parental Involvement
Parents are incorporated in the child’s ABA program immediately.  Emphasis is placed on training parents to follow the ABA Treatment Plan, learning to "reward" their child for appropriate behavior, assessing their child’s behavior (e.g. Why is a specific behavior occurring?), data collection, and learning to maintain their child’s acquired skills.   

Transition and School Inclusion
Community Outings are incorporated so that skills can be taught and generalized in the setting in which they are meant to be used. Treatment gains are often generalized to school through the use of a one-on-one aide and/or the treatment itself may even be carried out at the school itself. Steps are carefully taken to ensure consistency across the child’s comprehensive treatment plan.  Consultations with school staff and other providers are provided when requested by parents, Regional Center service coordinators and/or teacher specialists.

Transition to Independence
BHC addresses transition to independence or less restrictive treatment settings through the following methods.

"Fading" to Success
Careful consideration of prompt compliance is reviewed and discussed on a weekly basis.  Care is taken to ensure that assistance provided to the child  is systematically faded based on success. Therapists and parents are trained to utilize the least intrusive prompt necessary when providing assistance to the child.

Naturally Occurring Reinforcement Schedule
At some point in the ABA treatment program, transitioning the child to a naturally occurring reinforcement schedule is prioritized. What this translates into is that the child being given fewer and fewer rewards for the same behavior, a process known as “thinning.” Theoretically, when the child internalizes a reward, the internalization of that reward will, over time, define the communication. That is, the behavior begins to occur in a natural state.

An example of this is found in the simple act of greeting another person. When a smile is added to a greeting such as "Hello", the smile becomes part and parcel of the greeting and serves to reinforce and validate the greeting. The clearer that the message can be delivered, with the concomitant metacommunication validating it, the clearer will be the interpretation of the message.

From Home to More Independent Living
As mentioned, our goal at BHC is for children to generalize and implement their learned skills and behaviors to living more independently. To expedite this process, the ABA Program is individualized so that children will progress ‘at their own speed,’ and, in incremental steps. Success is measured by the children’s ability to generalize skills and behaviors by applying them appropriately in a wide spectrum of community-based settings.

Process
Skills acquired at home are generalized across environments, people, stimuli and instructions.  Once a child adapts to the structure of his or her "Discrete Trials," for example, the next goal is to make the instructional setting as natural as possible. Natural Environment Teaching (NET) and Pivotal Response Training (PRT) are usually implemented to transition the child away from a structured setting to a more natural setting.

Natural Environment Teaching (NET) involves generalizing learned skills to natural occurring situations. For example, through play activities, an ABA therapist may teach the child to request by using a process called “Manding”.  Manding occurs when a therapist uses a certain physical act, such as reaching for a toy, as an opportunity to teach the child a certain behavior, such as how to make a request. In this case, the therapist might say, “Oh, I see you would like the truck. Please say "truck.”  When the child responds with the appropriate word, the child immediately receives access to the truck and, more importantly, natural reinforcement.

Pivotal Response Training (PRT), on the other hand, is based on the concept that there are two ‘pivotal’ behaviors that affect a wide range of behaviors. With children experiencing autism spectrum disorders, motivation and responsiveness to multiple cues are key variables in PRT.  It is suggested by some researchers that positive changes in one area will create or trigger a positive change in the other area. Theoretically, PRT is able to increase the generalization of new skills while increasing the motivation of children to demonstrate the behaviors being taught to them. Components such as child choice, turn taking and making reinforcement contingent upon behaviors are also central to PRT.

Skill Building
Every skill taught within our ABA Program builds upon each other.  In order for advanced skills to be introduced, there has to be certain pre-requisite skills that must first be met.  In this sense, each skill that is taught will be later used to teach the child another skill, possibly a more advanced skill.  Therefore, a skill that has been previously acquired will never stop being practiced.  Since each skill is used to build the next skill, this ensures that maintenance of previously acquired skills continues throughout the child’s program.

Data Collection
In order to determine if a skill has been successfully learned, consistent and accurate data collection must be kept. To start, we must first establish a method of measuring the specific target or behavior.  Each target and behavior must have a clear operational definition. This definition will ensure consistency across therapists and care providers. Once a method of measurement is clearly defined, data collection and measurement of generalization can then proceed.  

Measurement
The operational definition will clearly define the response that is expected and in what teaching environment generalization will take place. A skill is not considered mastered until the child is able to demonstrate the skill across various individuals, settings, instructions and stimuli with more than 80% accuracy. Behavioral data is collected using Rates of Behavior versus Progress.

Rates of Behavior. Data collection consists of the "ABC’s" (Antecedent, Behavior and Consequence) of frequency and duration.  Each behavior is expressed as a frequency per hour.

Progress: Frequencies are calculated every two weeks for both therapy and non-therapy hours.  Progress is measured in terms of frequency reduction, such as from .70 per hour to .50 per hour.

Maintenance
Once it is determined that a specific skill has been acquired, generalization continues. However, the frequency in which the skill is practiced gradually decreases.  Maintenance is conducted so that the child does not lose the acquired skill.  Rather, the child is ‘tested’ occasionally to determine if the skill is being maintained.

Parents are required to participate on a daily basis during their child’s ABA program. Parents receive weekly training on ABA techniques utilized within our agency.  During the initial Functional Behavior Assessment, parents are instructed that participation in their child’s treatment program is mandatory. Parents agree to and sign BHC’s Parent Agreement before their child receives any ABA services.  The Parent Agreement outlines in detail the role parents must take during their child’s ABA sessions.  

This role will include:

Treatment Planning
Meetings between parents and Clinical Supervisors are conducted weekly.  During parent meetings, Clinical Supervisors review the child’s progress with programming and behaviors.  Parents also use this time to notify Clinical Supervisors of any concerns or issues with programming and/or behaviors during non-therapy hours.  Clinical Supervisors collaborate with parents on how to successfully problem solve behaviors and/or program concerns.

Treatment Implementation
Parents are aware and agree to follow all behavior interventions set forth in their child’s treatment plan.  Parents essentially take over when therapists leave.

Analysis of Treatment
Data collected during therapy and non-therapy hours are reviewed weekly during parent meetings.  During this time, programs and interventions are reviewed with parents. In addition, parents inform Clinical Supervisors when interventions used during non-therapy hours are unsuccessful.  Parents and Clinical Supervisors will collaborate and problem solve each of the program or behavior concerns. 

Parent Programs
All daily life skills (e.g. dressing, washing hands, toileting, bathing, brushing teeth, etc.) must be implemented by the parent or caregiver. The parent or caregiver provides all instructions delivered during these programs. Therapists also use this time to coach parents or caregivers and to give constructive feedback. 

Parents are required to participate for a specific amount of time (as outlined in the treatment plan) during each ABA session. If it is observed that parent participation is not being conducted, a meeting with the parent will be scheduled to address the issue. The Clinical Supervisor and/or the ABA Supervisor will reinforce the importance of parental participation in the ABA treatment program.

Without a doubt, the parent is a key component of a child's success. In order to help maximize this role, BHC emphasizes the following additional training objectives:

Learning Objectives
Parents are provided with materials outlining each of the below mentioned ABA techniques. In addition, handouts are given to parents at the end of training sessions.

Reinforcement: Training begins with teaching parents on how to successfully reward their children for appropriate behavior. Parents are expected to demonstrate appropriate reinforcement within one month of treatment.

Behavioral Deficits: Parents are provided with training on the four behavioral deficits observed in children with autism, which include Social Integration, Language, Play Skills and Self-Help Skills.  

Behavioral Excesses: Parents are also expected to learn the four behavioral excesses observed in children with autism, which include Tantrums, Aggression, Non-Compliance and Self-Stimulatory Behavior.

Function: Parents are taught that each behavior a child engages in has a certain function.  Parents are then taught that interventions for behaviors depend on the function of the child’s behavior (in other words, you cannot implement an intervention unless you know the function of the behavior). Training on the function of behaviors occurs immediately.

ABC’s of Behavior: Antecedent, Behavior and Consequence. Once parents understand the function of behaviors, they are then taught how to determine the function.  Parents are trained on how to conduct a Functional Behavior Assessment on their child’s behavior, which will allow them to implement their own interventions without assistance from a therapist.

Behavior Reduction Procedures: Training continues on how to successfully implement behavioral interventions.  Parents are expected to learn the following several techniques, including Redirection, Extinction, Over-Correction, Response Cost and Differential Reinforcement.

ABA Basics: Training is provided on many of the ABA techniques utilized at BHC, including Discrete Trial (DTT), Natural Environment Teaching (NET), Pivotal Response Training (PRT), Picture Exchange Communication System (PECS), Incidental Teaching and Peer Integration Programs.

Generalization and Maintenance: Parents are trained on how to correctly generalize and maintain their child’s learned skills.

Method Objectives
Parent training includes lecture and direct one-on-one demonstration with their child.  Techniques are first modeled for the parent. After demonstrations, parents are expected to apply the learned technique in the presence of the instructor. Additional demonstrations are provided when necessary.

Since parents receive hands-on training during their child’s ABA session, parents are given immediate verbal feedback.  ABA therapists coach parents during all parent participation sessions.  Therapists do not wait for the parent to finish implementing the procedure incorrectly before feedback is provided.  Rather, therapists interrupt parents immediately to provide them with feedback.  In addition, parents are provided with first-hand demonstrations on all ABA techniques.

Parents are also asked to keep track of their child’s behaviors during non-therapy hours.  Data consists of what behaviors are occurring, why the behavior occurred, what consequence was provided, whether or not the consequence was effective in reducing the behavior and how long the behavior lasted.  Data is collected weekly during parent meetings.  Although parents are instructed to keep data weekly on their child’s behavior, some parents do not follow through with data collection.  When this occurs, parents are instructed of the importance of data collection and how it is vital that they provide this information.  If parents fail to follow through with data collection during non-therapy hours for three consecutive weeks, service coordinators are contacted and this information is reported in the upcoming progress report.

Yes. Since the goal of the program is to lay a foundation upon which the child and the parents can build, the maximum duration for services is two years. At this point, families should have the tools necessary move forward autonomously. However, if there still exists a need, this should be discussed with your ABA Supervisor so that other avenues can be explored.

• If a parent has a concern with respect to their child’s treatment plan, parents are asked to address this issue with their child’s Clinical Supervisor.  The Clinical Supervisor will meet with parents to address these and all other concerns.  
• If parents are not satisfied with the outcome of the meeting, they have the option to speak with the ABA Supervisor. The ABA Supervisor will address their concerns and create a plan of action to resolve issues.
• If parents remain unsatisfied after having met with the ABA Supervisor, they have the option to speak with the agency director and/or schedule an additional meetings with other BHC managerial staff.