Almost everything I later learned the hard way was findable on the first phone call. I just did not know what I was listening for.
This is what I would listen for now.
What the intake call is about
When I called the ABA clinic, they scheduled us quickly and I was grateful. It felt like they were doing us a favour.
What I did not notice was what the call consisted of. The questions were about what insurance we had and how many hours had been approved. Nobody asked anything about my son. And when we arrived and met the person who would actually be working with him, she knew his name and nothing else. Whatever I had said on the phone had not travelled.
Compare that to the intake at the place we ended up. It was long. It covered his history and, separately, what I was worried about. Then the therapist had actually read it, and knew what he liked and what he did not like before she met him.
So the test is simple and you can run it for free:
Listen to what the intake call is about. If every question is about coverage and authorised hours, and none is about your child, you have learned what the operation is organised around.
One caution, because I do not want to hand anyone a bad rule. Fast scheduling is not itself a warning sign. If you have been on a waitlist for eight months, fast is a genuine good and you should take it. The signal is fast scheduling combined with no questions about your child and no handover afterwards. That combination is capacity being filled rather than a child being assessed.
How many people are in the room
I assumed the difference between the two places would turn out to be the rooms themselves. It was not. The rooms were quite similar.
The difference was how many people were in them. At the ABA clinic there were many children and parents at once, providers and kids stacked on top of each other. The waiting room looked like a Starbucks at rush hour, people constantly arriving and leaving.
The other place ran controlled environments. Not multiple children and providers layered into one space. My son had one licensed therapist with him.
That is not an aesthetic preference. For a child who is already spending most of his capacity on managing input, the number of other humans in the room is a load-bearing variable. And it is a question you can ask before you enrol: how many children are in the space at once, and what is the ratio?
Who will actually be with your child
At the ABA clinic they were hiring continuously and the turnover was enormous. Every week somebody was gone and new people had joined. My son’s person changed roughly weekly.
At the other place, the providers held master’s or doctoral degrees and had years of experience.
I want to be accurate rather than rhetorical about the comparison, so here are the actual requirements. The RBT Handbook, published by the certifying body itself, requires a Registered Behavior Technician to be at least 18, hold “at least a high school-level education or the equivalent”, complete a 40-hour training, pass a competency assessment and a background check. Once certified, they must receive ongoing supervision for “a minimum of 5% of the hours you spend providing behavior-analytic services each calendar month.”
Forty hours is one working week of training. Five percent of 20 hours is one hour of supervision. Those are floors rather than descriptions of every provider, and plenty exceed them, but they tell you what a service can look like while remaining fully compliant. I have written more about that in who is actually in the room with your child.
Sit in the waiting room
Nobody inside the clinic ever told me anything was wrong. I did not notice any pushback from staff, no quiet word from a technician, no supervisor disagreeing with the hours. If you are waiting for someone on the inside to raise a flag, you may wait a long time.
What I learned, I learned in the waiting room, and it came from two things that cost nothing and require no permission.
Talk to the other parents. They will tell you things no intake call will. Ask how long they have been coming, whether their child’s therapist has changed, and whether anything has actually shifted at home. Most people answer honestly, because they have been waiting for someone to ask.
Watch whether the faces change. This was the thing that settled it for me. New people every week. Once you notice the churn you cannot un-notice it, and it tells you what the working conditions are like without anyone having to say so.
You can do both of these before you commit to anything. Ask to wait for twenty minutes on an ordinary weekday afternoon, and pay attention to the room rather than the brochure.
What good looked like, concretely
It is easy to say “find a provider who communicates well”. Here is what it actually consisted of, so you know what you are asking for.
- A long intake covering his history and my concerns as separate things.
- A therapist who had read it before meeting him.
- A full evaluation first, rather than starting from a standard target list.
- Goals built around the child and the family, not around what insurance or the school district would fund.
- An update after every session. She took the time, every time.
- An open door to sessions. I could join if I wanted to.
- Email updates and phone consults between sessions, as a normal part of the service.
The result of all of that was the thing I had been failing to get for years: the therapy transferred to home. Which makes sense. What travels out of a room is what was built around your actual child and shared with the people who live with him. What was performed for one room stays in that room.
The questions, in order
If you only ask a few, ask these.
On the first call
- What will you ask me about my child before we start?
- What does your intake involve, and who reads it?
- How many children are in the space at one time, and what is the ratio?
Before you enrol
- Who specifically will work with my child, what are their qualifications, and how long have they been with you?
- What is your staff turnover?
- How much supervision do those hours get? Ask for a number.
- Will you evaluate before setting goals?
- Will the goals be built around my child and our family, or around what is authorised?
- Can I join sessions?
- How will I hear what happened, and how often?
The one that matters most
- What would discharge look like, and have you discharged children before?
Our speech provider eventually discharged my son because he no longer needed the service, and offered phone check-ins for a few months because I was not ready to stop. At the ABA clinic I could never get anyone to tell me what finishing would even look like, and the answer to my son being distressed was a request that I ask insurance for more hours.
A provider who can describe the end is telling you something. So is one who cannot.
