More Hurt Than Help: Problems with NJ In-home Therapist Program

ABA—Applied Behavior Analysis—-has been the teaching technique that my son Charlie seems to learn best with. More than a few families we have known have not had such a positive experience with ABA or with behavior therapy, for reasons that seems to vary from what sort of learning program suits a child’s needs best to the training of the therapists. The ABA that Charlie does is a far cry from “rigid” behavior modification. Indeed, under one behaviorist who was hired by the school district of the town that we used to live in, some of Charlie’s difficult behaviors worsened.

The August 29th Star-Ledger (northern New Jersey) reports on the lack of training and supervision over hundreds of behavioral aides and assistants in a state-sponsored program, the Intensive In-Home Community Treatment and Behavioral Assistance Program. The program was launched in 2002 with the intent of providing families with in-home therapists who would “help thousands of emotionally disturbed and mentally ill children without sending them to institutions, hospitals or jails.” $100 million later, over 140 complaints have been filed by families “alleging everything from workers not showing up to threatening violence.” The state has paid for “hundreds” of behavioral assistants who needed only a high school diploma and a car to qualify to be sent “fragile home situations without clearly defining their job.” Families interviewed in Long Branch noted that they had all, at one time or other, signed time cards that inflated the number of hours therapists had actually worked. Noted the parents, one of whom has a child with “mild autism”:

Few assistants came with a written plan outlining what they were to do, the parents said, and many seemed unsure of their first step. Typical activities were shopping, playing video games or basketball, or running errands, the parents said.

Every parent present admitted, at one time or another, to having signed time cards that inflated how much time the aide actually worked.

One parent of a 14-year-old boy recalled vouching for a 90-minute session that actually lasted half an hour.

“You’re feeling so intimidated, and you’re so glad to have someone there helping you,” she said.

After the Intensive In-Home Community Treatment and Behavioral Assistance Program was instituted in 2005, some 300 companies—”both longtime nonprofit social service agencies and newcomers”—sought permission to provide in-home care, paid for by the state of New Jersey. State officials stopped accepting applications in 2005, the Star-Ledger notes: One wonders at the types of agencies that can provide therapists, and what screening of potential therapists and training involve.

We certainly could apply for an aide from the state. One reason we decided not to (and we are fortunate that we able to provide Charlie with therapists who are highly and carefully trained to teach him), is that we did not know about what kind of therapist might be provided, with what training, and what knowledge of autism. The stories of therapists who took their own children along on activities, or of one who “took away [a mother's] 10-year-old son’s toys and threatened to punch him in the face,” confirm my worries about the lack of training and qualifications of some state-paid-for behavior therapists—and they also cast a negative light on behavior therapy, which can be useful and highly effective, if done right.

I’m not happy about my tax dollars going to therapies that seem potentially able to hurt, when so much good could be done instead.