Why In-Home Behavioral Counseling is a Best Practice
Today I met with a 7 year-old boy in my cramped 48 square foot office. He was eager to play with the different toys that he could see, but there were other priorities that needed to be addressed. I hadn’t seen him for 5 weeks and his mother looked a bit frazzled. I had 45 minutes to check in with her about the treatment plan we had developed in our last meeting, answer her many questions, and spend time with her son. At this point I’m conflicted. I know I won’t see this family for another 4-5 weeks and if this boy is going to get any better, I have to ensure the mother knows how to deal with his physical aggression. What do I do? This is what I and many other therapists working in health organizations are dealing with today: too many clients, not enough time. Many therapists do a great job and offer quality therapy in this setting, but most say they just don’t have the time to see the results they hope for.
When a family shows up in my office, it is rare that I get a clear picture of what is happening at home. Some exaggerate the problem, and don’t share the whole story of why the child just slapped them in the face. Some kids have a hard time communicating or even understanding their behaviors, the home environment, and family dynamics. If a therapist is in private practice, they may see the family and child more regularly, but they still don’t see the entire picture. As a professional, I can get information from assessments and in interviews of parents and the child, but I still miss critical information that only comes with multiple observations of the child at home; not a clinic or office setting. This is why school districts have a policy to use direct observations of children before they complete functional analysis of behaviors and behavioral support plans.
The most effective behavioral work I do is done in real world environments. Here I can watch the triggers, see how a child behaves, how the parent or siblings react to the behavior and determine how a child eventually calms down. When I’m in the home I can see what resources are available or are missing. I can see the child’s safe zones, what they play with, where they create space, and how I can change the environment to be more effective in eliminating the child’s maladaptive behaviors. I can model for parents how to respond in different situations, help them establish effective visual strategies, and encourage them when they positively react to help their child avoid negative behaviors. Parents need just as much training and reinforcement as the child.
This model of therapy rarely occurs. If a child has Medi-Cal and their behaviors qualify, then they may receive TBS services [which is in home therapy]. If a child has been diagnosed with Autism Spectrum Disorder, they may qualify for in-home therapy. There are even a few school districts that are investing in in-home therapy instead of sending children to group homes. In home therapy is rare and very few private licensed therapists provide this best practice to their clients.
I explained to that 7-year-old boy and tell each of my clients that my goal is for them to “fire me” as soon as possible (positive way). They often look at me confused, then smile at their parents. Instead of time in my office, they would rather experience transformation and growth in their relationships. I want that for them too and the most effective way I can meet their goals is if I can deliver the treatment more quickly, more consistently, and more economically. This can be achieved with in-home behavioral counseling.