Consent for Applied Behavior Analysis (ABA) Services

I understand that Behavior Analysts are ethically required to recommend evidence-based services and that other treatments and therapies that my child participates in could affect ABA treatment. I agree to communicate all current and future treatment, therapy, and medication changes to the Behavior Analyst at Firefly Therapy Clinic as soon as I am aware of the change. I also understand that ABA therapy is most effective when attendance meets prescribed amounts, and that not meeting my child’s ABA therapy attendance requirements could reduce the effectiveness of treatment.

I understand that Firefly Therapy Clinic will take all reasonable steps to protect my privacy per HIPAA requirements.  I understand that the service provider will not discuss my child’s treatment with anyone outside of Firefly Therapy Clinic without first gaining my consent to disclose the information. When other families are present in the clinic during my child’s sessions, I understand that staff will not discuss my child or my child’s programs with anyone outside of my child’s service team.

I understand that there are some limitations to confidentiality in certain circumstances.  This includes times when the service provider believes that my child is in severe, immediate danger to themself or others. Also, because staff are mandated reporters,  I understand that the behavior analyst or behavior therapists may break confidentiality when making a report to child protective services if there is a concern of suspected abuse. Confidentiality may be breached when lawfully required or when a third party is needed to gain payment for services.  I understand that my child’s assessment and treatment at Firefly Therapy Clinic will occur alongside other children receiving services and could be seen by other therapists, children, and families participating in ABA services who are not part of my child’s service team. Additionally, I understand that Firefly Therapy Clinic trains ABA staff on a variety of strategies across individuals and that staff members in-training may be observing my child’s assessment or therapy for training purposes.

I understand that Firefly Therapy Clinic uses video, photograph, and audio recording for the purpose of supervising and training staff and that these recordings will not be distributed, used on social media, or used for any other purpose than training and supervising staff.

I understand that the duration of treatment is based on the individual needs of my child. Ongoing data-collection, analysis, and assessment will allow the service provider to determine the level of support needed.  I understand that the amount of ABA treatment needed may change over time as my child builds skills and approaches behavioral levels that are similar to peers of the same age. When it is determined that ABA services are no longer medically necessary, I understand that services will be discontinued.  Additionally, if my child does not make progress with the recommended services, and does not show improvement after all programmatic changes and improvements have been made, I understand that I will receive a referral to another practitioner and services will be discontinued through a step-down reduction as appropriate.  

During an initial assessment, I understand that Firefly Therapy Clinic will require me to complete several online questionnaires, surveys, and rating scales to gain information about my child. I will also be asked to give specific details about my child’s behaviors and situations or people involved in behavioral events. I understand that these items are time-sensitive and that not completing them in a timely fashion could result in delays in treatment for my child.  I understand that I will meet with the service provider to describe my concerns, as well as my child’s skills, preferences, dislikes, and challenges. I understand that the service provider will also attempt to work directly with my child in order to assess skills, deficits, and behavioral challenges, which may require 1-3 hours and could span across one or two meetings. Once the assessment has been completed and I have finished and submitted all online assessments, I understand that the service provider will schedule a meeting with me to review the assessment report and treatment plan with recommended goals and strategies, including instructional procedures and behavior intervention plan. 

Prior to beginning treatment with my child, I understand that the service provider will meet with me to discuss all prescribed goals, strategies, interventions, and treatment parameters of instructional procedures and behavior intervention plans. ABA treatment includes therapeutic interventions provided directly to my child by Firefly Therapy Clinic staff.  I understand that this includes preventative strategies to encourage skill-building and understanding in my child; reactive strategies to foster continued skill development and discourage problematic behaviors; and guided responding that can include the use of modeling, gesturing, vocalizing, and physical guidance to help my child complete responses. I understand that these strategies will be evidence-based, individualized for my child, and that I can ask questions and request changes at any time in order to have full participation in my child’s therapy. I also understand that I will be expected to take a role in my child’s therapy by practicing ABA strategies, participating in training, and taking notes and data on behaviors. I understand that my full participation will be critical to my child’s progress including my attendance at parent training sessions and progress meetings, as well as completing data-taking and note-taking activities on a regular basis.

When changes need to be made to my child’s ABA therapy services, such as to instructional procedures or behavior intervention plan, I understand that I will be asked to approve of and consent to recommended changes.  I understand that this can be after a change is suggested by me or the service provider, such as when adding new goals, changing or adding behaviors targeted for reduction, changes to intervention strategies. While this is most likely to be needed with quarterly, semi-annual, or annual progress updates, I understand that changes may be requested by me or the provider any time they are deemed necessary. Suggested changes will be evidence-based, individualized and can include preventative strategies to encourage skill-building and understanding in my child; reactive strategies to foster continued skill development and discourage problematic behaviors; and guided responding that can include the use of modeling, gesturing, vocalizing, and physical guidance to help my child complete responses. I understand that these strategies will be evidence-based, individualized for my child, and that I can ask questions and request changes at any time in order to have full participation in my child’s therapy. I also understand that I will be expected to take a role in my child’s therapy by practicing ABA strategies, participating in training, and taking notes and data on behaviors. I understand that my full participation will be critical to my child’s progress including my attendance at parent training sessions and progress meetings, as well as completing data-taking and note-taking activities on a regular basis.

When re-assessment is needed due to changes in skills or behaviors, or when requested by the third party, I understand that I will be asked to complete rating scales, surveys, and questionnaires needed for assessment purposes. I understand that these items are time-sensitive and that not completing them in a timely fashion could result in delays in treatment for my child. Additionally, my child will receive a direct assessment of skills and behaviors. I understand that this can include a review of my child’s progress as well as assessing new and current areas of development. Once the assessment has been completed and I have finished and submitted all online assessments, I understand that the service provider will schedule a meeting with me to review the assessment report and treatment plan with recommended goals and strategies, including instructional procedures and behavior intervention plan. 

I understand the policies and procedures regarding my child’s ABA assessment and treatment.  I have been given an opportunity to ask questions, request changes, and collaborate with my child’s treatment. I understand that my consent is voluntary and that I can withdraw my consent at any time without penalty or recourse.