Sometimes, individuals with autism are placed in a residential facility, whether it be for safety, a placement that better meets the child’s needs, or other reasons. Depending on the type of residential facility, treatment may take place anywhere from a few days to one year, at which point the client is discharged to home (or another less restrictive placement in some cases). Also sometimes residential facilities just don’t work out—maybe they’re too far from home for regular visits or it just isn’t a good fit for the child.
Making the transition from a residential facility to home can cause great anxiety for an individual with autism of any age. Even with a regular routine, life at home will be quite different from the structure of a residential facility. Parents can make this hard transition a little easier by planning well for the child’s return back to home. Read on to learn more about how to make a good transition from a residential facility to home so that everyone is comfortable.
Life in a Residential Facility
It’s important to understand the structure of a residential facility so you can continue some of the same routines when your child returns home. A residential facility provides much more than housing—it is designed to keep a person with autism safe, while they also learn routine and work on behaviors and academics.
Most facilities utilize applied behavior analysis (ABA) as a keystone part of their programming, especially for a child with self-injurious or aggressive behavior. When the child enters the facility, they’ll be given a functional behavioral assessment (FBA). An FBA takes a deep look at problematic or maladaptive/dangerous behaviors and helps the board-certified behavioral analyst (BCBA) working with your child formulate a plan to target and minimize that behavior.
This individualized plan changes and adapts during your child’s time at the facility. As they begin to meet treatment goals, new ones are set to keep your child moving forward.
During the day, your child will work on schoolwork, either one-on-one with their therapist or other trained staff, and other times they will be working on living skills, such as washing and folding clothes, doing dishes, and cleaning their rooms.
Clients are also encouraged to participate in social skills and interaction, be out in the community, and find healthy hobbies. However, each day, even on the weekends, there is strict adherence to routine and structure, which studies have shown helps individuals with autism thrive. When your child returns home, it’s important to formulate your own routines and structure and keep them very clear.
As part of placement in a residential facility, parents are usually given some level of parent training to help them better understand autism and resources and ideas to help their child. You will likely learn the techniques and routines taught by the behavioral staff from the facility, and keeping them in place when your child transitions back to home is paramount.
Preparing for the Transition Home
Why is routine so important? Children, adolescents, and adults with autism can become anxious and distressed at sudden changes or transitions. Keeping a child with autism engaged and occupied in healthy activities is essential to help provide them with coping mechanisms and relieve anxiety and stressful situations.
The hope and goal for each person with autism are to be in the least restrictive environment possible. Because autism is a spectrum disorder, some individuals need a higher level of care to help manage stress and learn coping skills. If your child’s residential treatment center has decided it’s time to discharge, the treatment team feels your child has learned and possibly mastered these skills, and the least restrictive environment would be home-based. Others may need to be discharged to a group home first before making the final transition home. Group homes are less restrictive than inpatient residential facilities, and your child will still be provided with services and behavioral support.
There will be a comprehensive discharge plan so that stability can be maintained upon return home. Since you have been involved in your child’s care, you will participate in the discharge plan to ensure your child is set up with the proper services once they return home.
One of the most vital things to continue is applied behavior analysis (ABA), which your child received in residential treatment. You may have been familiarized with ABA during parent training, and it’s necessary to have a provider set up once your child is discharged. Also, talk with your child’s treatment team before discharge to discuss some of the behavior programming that worked with your child best. While this likely will all be written along with the discharge plan, it’s important to have a conversation with the team so you can help model ABA practices at home.
ABA is a science-based therapy that works to understand behavior and learning. Generally, it uses several different techniques to promote learning and desired behaviors and to minimize and eradicate undesired behaviors. After an assessment, your child’s home ABA team will develop an individualized plan that’s unique to your child’s needs, just as was practiced in the residential facility. Some of the tenets of ABA include:
- Positive reinforcement. This is one of the main hallmarks of ABA. A goal is set for a desired behavior, and every time the desired behavior is repeated, the child receives a reward (you may have seen this used with a token board). Negative behaviors are not rewarded or noticed (unless there’s a safety issue that must be addressed).
- ABCs (antecedent, behavior, consequence). If there is an undesired behavior, understanding the “whys” of why that behavior is occurring can help diminish it. The antecedent is what happens directly before the behavior (e.g., a child becomes upset when screen time is over and has a meltdown). The antecedent here would be denied access to a preferred activity. Next, ABA therapists look at the behavior itself, which was a meltdown. Next comes the consequence. The word “consequence” can easily be associated with negativity, but not in the case of ABA. If the child produces a desired behavior (e.g., not having a meltdown over the end of screen time and transitioning without incident to the next activity), then this action is reinforced positively as a positive consequence. If an undesired behavior occurs, no reaction or reinforcement is given (unless there is a safety issue).
Those that provide ABA therapy are board-certified board analysts (BCBAs) and registered behavior technicians (RBTs). In some states such as Pennsylvania, Licensed Behavior Specialists can supervise cases. In order to work, a BCBA must possess a master’s or Ph.D. in psychology or behavioral analysis, must pass a national certification exam, and must be licensed by the state (in most states). An RBT should have relevant experience, receive direct training under the BCBA’s supervision, and receive thorough training including a competency exam. Typically, the RBT is your child’s one-on-one, and the BCBA supervises the programming weekly or bi-weekly.
ABA can be performed in a clinic, in school, or in the home setting. Often, the home setting is preferred because the child is in their natural environment and where they spend the most time. This is also where undesired behaviors can often occur. To prepare for the transition home, try to have ABA services ready and set up for your child. In-home services can often be 30 hours a week or more, providing your child with the programming, routine, and structure they received while in residential care.
Depending on your child’s age and the level of care needed, you may also want to consider day rehabilitation programs or day treatment programs. Your child will still be living with you but will spend their weekdays in a program that may be similar to their former residential program. Rehabilitation programs focus on structured activities and support in the community that are not related to employment. For example, your child has graduated high school or finished a program but is not yet ready to enter the workforce.
Day treatment programs are not community-centered and occur in a clinic setting. They focus on fostering daily living skills along with therapy. Both of these programs are suited for older adolescents and adults with autism.
Maintaining Routine and Schedule at Home
Having a robust amount of ABA hours per week can certainly help with maintaining a routine and schedule. However, it’s essential to compose and maintain routines within your home so the transition from residential treatment isn’t too bumpy.
For something very concise, write out a daily schedule for your child to follow. This can be done using a visual schedule (pictures, which can be on a board or a mobile app) or it can be done by writing the schedule out.
Make sure the schedule is simple enough for your child to follow, but try to include steps within each task, For example, “7 am – Wake Up” could have a list of steps that looks like:
- Wake up on time
- Choose clothing
- Take pajamas off and put clothing on
- Put pajamas in a laundry hamper
- Eat breakfast
- Take vitamins
- Brush teeth
- Go to school (if applicable)
This may seem like a lot of work, but if a child with autism knows what to expect at every turn, it will lower their stress and anxiety, which overall leads to less undesired behaviors, fewer meltdowns, etc., over time.
Timers or alarms can also help keep your child on track. If they’ve earned iPad time, set an alarm for the desired amount of screen time. When the timer goes off, screen time is over, and you move to the next activity. These types of transitions can be difficult at first—expect pushback or meltdowns—but over time, the routine will become second nature. Always use positive reinforcement and praise when your child succeeds during a typically-tough transition. This will help reinforce the desired behavior over the undesired one.
Consistency is also imperative. It can be difficult with day-to-day busy parent schedules, but do your best to keep routines consistent and at the same time every day. Inconsistency can be confusing to your child and might not produce the desired outcome. If there must be a change in the usual schedule or routine, try to inform and prepare your child as early as possible so they know there will be a difference. Also—life is unpredictable! Your BCBA and RBT can help show you skills to help manage unexpected or unwanted transitions, so always reach out to them with questions and be involved in each session.
The clinical nature of the transition home is important, but the most important thing is to simply love your child and welcome them home. Each child with autism is different—one child may be overly affectionate upon returning home and another may be very distant. You know your child best. Watch their cues, respond appropriately, and always reach out to your ABA team if you need support or have questions.