In-Home vs In-Clinic

In-Home or In-Clinic ABA? How to decide which is best.

So, you have done the hard work. Your child is diagnosed, you’ve battled the long waitlist for insurance, and now you can pick your child’s therapy provider. There are so many options out there that you are feeling incredibly overwhelmed. I am here to help.

We know that ABA therapy can occur in-home (aka home-based ABA) or in-clinic (aka center-based ABA), but which is best for my family and child? What about both?

The idea of participating in, in-home and in-clinic ABA will likely sound appealing to many, best of both worlds! However, there are few companies that offer this option. Assent Therapy ABA will be a provider who offers both options once a clinic is opened in Summer 2024. For now, we will discuss the issue of picking the delivery of your child’s therapy in your home or in a center.

Let me walk you through how to decide.

Think about your family and your child. Where are you now? Where do you want to be over the next 3 years? What kind of future do you see for your child? What are your biggest goals? ABA is a huge commitment, especially if you plan to participate in services for years. Many children are in intensive ABA services (30+ hours per week) for 2+ years. Thinking about these questions can help determine your path towards a wonderful future, filled with challenges and blissful progress.

Now that you’ve envisioned your life. Let’s make a pros and cons list and get the answers to which option you should pick. Below are the many of the different values that families have to weigh in on when making this decision.

1. Consider your barriers first or your non-negotiables.
   1. Examples of non-negotiables/barriers: transportation costs, travel time, needing to work during day, your child potentially being harmed, or language/cultural barriers.
2. If getting your child to a clinic at 8 am and picking them up at 4, (or half day around 12, if they are part-time), would not be realistic due to working, consider in-home.
3. Kids who start in-clinic therapy often get sick A LOT. Can you accommodate early pick-ups and missed work? Do you have friends or family to help?
4. If the idea of having other people come into your home multiple days a week makes you feel uneasy, consider in-clinic.
5. Your child will likely struggle with the new changes, seeing other children engaging in intense behaviors, how does that make you feel? Maybe consider in-home.
6. Do you have strict cultural or religious practices you’d like your child to be able to adhere to? In-home may be better due to your ability to be present during these times for practice.

Sometimes these non-negotiables and barriers can determine which option is the best right away. If you are still in the middle, keep reading.

• Next, I would encourage you to think of your biggest worries about your child starting ABA, your values/hopes, what is important to you, as parents, and what you hope your child achieves from ABA.

Let me get you start with this:

• If it is important to you want your child to be around peers who are diagnosed with ASD, then going to a clinic is probably best.
• If you want to see everything your child is doing, or fear for their safety, or just be heavily involved, in-home is best.
• If your number one goal is for your child to master as many academic skills and be as prepared for school as possible, in-clinic is likely the best solution for your values (Dixon, Burns, et al., 2016).
• If your child learning life skills (aka self-help skills) like dressing, tooth brushing, etc. is more important to you, absolutely consider in-home therapy. Clinical settings can work on those skills, but in my experience, the transfers of what your child learns from while at their center and what they bring home are often limited.

Many parents worry about their child’s separation anxiety, I would encourage you to consider your child’s path in the next few years. If they will be going to school (and you don’t plan to homeschool), then in-clinic would be a great way to start working on school preparation. If your child is 2 – 3.5 years old, then you can justify keeping your child in-home. Many in-home providers offer community support, so a slow introduction of the separation could be done this way.

• As you start to sway one way or the other, your next task is to find a company that can adhere to values, addressing any of your concerns with solutions. There are many companies that are out there, with quite a few different solutions, so do your research. Ask questions, and know it is okay to come with a list of them.

At the end of the day, think about your child and what you want to see of them in the next few years. Work on finding an ABA company that matches up with your values and puts your child’s needs first, and allows you to feel comfortable with your decision. See how Assent Therapy ABA can be a perfect fit. 

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Dixon, D. R., Burns, C. O., Granpeesheh, D., Amarasinghe, R., Powell, A., & Linstead, E. (2016). A Program Evaluation of Home and Center-Based Treatment for Autism Spectrum Disorder. Behavior analysis in practice, 10(3), 307–312. https://doi.org/10.1007/s40617-016-0155-7