Why Home Therapy?

by Anne Sebastian
This article was first published in Because We Care newsletter in August 2002.

Anne Sebastian is a former lawyer who has implemented an effective home therapy programme for her son. Recently, she gave a talk about her experience and shared useful tips for parents who would like to set up a home therapy programme for their children. Here, we bring you the excerpts:

In February 2000, my son, M, was diagnosed with autism. We started him on behaviour and speech therapy in Singapore, but soon found ourselves in North Carolina, the USA, where my husband had been posted for work purposes.

In North Carolina, M was enrolled in a statewide programme called TEACHH where he shared the classroom with a number of other autistic children of a specific age-range. In the classroom, every child was given a workstation to begin a task, in accordance with a row of pictures (the visual schedule). Work was to be done alone and independently, and once the task was completed, the child had to refer to the next picture and then move on to the next workstation.

Although there was Circle Time and a group meal to encourage social interaction, my husband and I were of the opinion that the TEACHH system was not as suitable for M as we had hoped. For one, the group of children that he was with did not prove to be effective role models for each other. Moreover, working alone at separate workstations did not promote social interaction or language skills. Instead, it seemed as if the isolation of each child was emphasized. Because M was already verbal by that time, we opted for an integrated mainstream class for 5 hours a day, and then also placed him on about 25 hours of behaviour therapy a week in the home setting as well.

By September 2001, at the age of 4 years and 6 months, M had received home-based behaviour therapy for a little over a year. He was re-assessed, and we were told that on one scale, his developmental age was 5 years 4 months. More importantly, his score on CARS (an autism diagnostic test) had fallen below the autistic cut-off level.

We returned to Singapore after that, and sought to implement the same home-based therapy framework for M as the one that he had received in North Carolina. The first two individuals that we hired for home teachers were a brother and a sister, but both of them did not turn out to be suitable eventually. Fortunately, two family friends (who are very fond of M) agreed to work with him, and both committed to the programme for a year. Some time later, I also found another lady to commit as a home teacher, and as a team, these individuals have been making a significant impact on M’s continued progress and learning.

Research has indicated that the home and neighbourhood environment is a better treatment setting for the autistic child. Therapy on the principles of Applied Behaviour Analysis (ABA) is also more individualized and tailored to the specific child. Home-based therapy makes better use of the family’s time (for one, it cuts down on travelling time from therapy centre to therapy centre) and because teaching assistants are used, the cost for intensive therapy is minimized. Hiring the ABA specialist to work directly with the child can be very expensive, and not all specialists have the time to spare.

Many parents get frustrated with the lack of effective and reliable help for their children with autism. Here are a few things that I look out for when hiring a home teacher:

• highly motivated and responsible
• speaks grammatically correct English
• can teach for at least 3-4 hours at a stretch

M had university students working with him when we were in North Carolina. I always emphasized that they were not there as babysitters. They taught and took data, and they participated actively in the bi-weekly team meetings that were held with the programme supervisor.

These are some of the things that you should look out for when engaging the programme supervisor. He or she should:

• have a Master’s degree in Psychology or Special Education
• have significant practical experience in using the ABA method with autistic children
• be familiar around data sheets and be able to analyse data
• be someone whom you feel comfortable with
• be someone who is willing to discuss with you the specifics of the programme

This is what the supervisor does:

• provides the initial training and ongoing supervision for the home teachers
• analyses data
• draws up new learning objectives and tasks/activities
• helps procure materials to execute these goals

Do not forget how IMPORTANT your role is as a PARENT. Without you, your child’s home programme is likely to falter or stagnate at some point. This is what I do:

act as a fulcrum to co-ordinate across the many individuals who work together to help M. Often, this involves a great deal of communication and patience. I need to foster a sense of teamwork and maintain the team’s morale, just as much as they keep my spirits up with notes or observations of progress

• work with the supervisor in the formulation of new learning goals
• educate myself and the home teachers on autism in general, and ABA strategies in particular
• obtain materials for learning activities, including reinforcers
• review the data taken for the day, and provide feedback to the home teachers regarding their performance (whether positive or negative) through the communication log
• keep the programme folders supplied with data sheets
• help M to generalize the skills that the home teachers have taught him in the one-to-one setting

Here are some notes on how to set up the work-place at home. It should:

• be quiet and free from distraction
• be about half the size of a typical HDB master bedroom
• be inaccessible to the child outside of learning hours
• have a door with latches both inside and outside

Of course, it would be impossible for me to list all of the many other factors that I have experienced contribute towards an effective home therapy programme. Nonetheless, I truly believe that it is a system that works for children with autism, and hope that you will be able to set one up for your own child as well. Best Wishes and Good Luck!

If you have found the information in this article useful, please pass it on to your friends.

If you would like to set up a Home Therapy Programme for your child, please call Wee Care's School Administrator at +65-6836-1450 to book an appointment with our Early Intervention & Rehabilitation Team.

For more information about the other Therapy Programmes available, please visit our website at www.weecare.com.sg.