Parent Guidelines for Home Therapy
The following are guidelines that should be adhered to by all participant families receiving home-based services
through the Building Futures Autism Clinic. Please initial each guideline as it is reviewed, and sign/date below
to reflect your acknowledgment of therapy guidelines.
_____A predetermined therapy schedule will be developed by the ABA Lead Therapist in collaboration with
the ABA therapist and family. The therapy may be conducted at the home and/or community setting. Students
should be at home or in the community at the predetermined time and ready to begin therapy. The ABA Lead
Therapist must approve any changes to this schedule.
_____If you are running late for a scheduled therapy session, please call your child’s assigned ABA therapist to
inform them of your arrival time. If your child is sick or cannot have his/her regularly scheduled therapy for
any reason, please contact the assigned ABA therapist as soon as possible.
_____If you need a therapist to transport your child for any reason, a release of liability MUST be on file at the
office of SOS Health Care, Inc.
_____Observation of ABA home-based therapy by non-family members (i.e., speech therapists, school staff)
must be approved by the ABA Lead Therapist.
_____Data will be collected on all identified targets for data-based decisions as this is a core aspect of Applied
Behavior Analysis (ABA).
______ In the home, there should be a room devoted for ABA therapy that is clean, organized, and distractions
minimized (e.g., no ringing telephone, restricted pet/sibling access, etc.) with a table and chairs. Parent
involvement should be directed by the ABA therapist. Depending on your child’s needs, some therapy will be
conducted in this room, but other therapy might be conducted outside on the playground, in the community, etc.
______ All materials required for ABA therapy are your responsibility. The clinic will provide an ABLLS-R
book for each child. Some good resources include Different Roads to Learning (www.difflearn.com) or
www.vbteachingtools.com, other parents that have had ABA home-based programs, or local yard sales.
_____During therapy time, whether at home or in the community, the ABA therapist should take the lead in
problem behavior intervention. Parents should follow the direction of the ABA therapist during this time.
Therapists have specific training in the function of problem behavior and the safe implementation of problem
behavior intervention.
_____The clinic management reserves the right to assign or re-assign a therapist to a child as the needs of the
clinic dictate.
_____On days that ABA therapists are scheduled to provide therapy in the home or in the community, an adult
(age 18 or over) must also be present during the entire therapy interval. Preferably, this adult should be a parent.
ABA therapy is NOT babysitting and should not be treated as such.
_____Tuition payment is due to SOS Health Care Inc., P.O. Box 7136, Myrtle Beach, SC 29572 by the 15th of
the month for the next month's therapy services. For example, January 15th is the deadline for February services,
etc.
_____ At least one family member per student is expected to attend monthly parent meetings in which
information and specific education is shared. These sessions will focus on providing basic therapy skills to
parents so that learning is likely to be furthered. This will also provide a time in which parents can ask specific
questions regarding therapy. Announcements of upcoming parent meetings will be posted on our website
(www.absspotlight.com).
_____Clinic staff will be using videotape to monitor progress and for training purposes. The video will not be
used for other purposes, unless written permission is granted. All records will be maintained according to
confidential standards and will only be released with the explicit permission of the parent/guardian.
_____Any violation of the above stated parent guidelines may result in the immediate discontinuation of ABA
therapy services by Building Futures Autism Clinic.
I give permission for my child to be photographed for Building Futures Autism Clinic and SOS Health Care
website and publications about autism/behavioral therapy.
Yes
No
I have read and understand the above listed policies.
___________________________
Parent/Guardian
___________________________
Date
ABA Clinic Information Form
Name________________________Sex_____Age_____Birthdate___________
Address___________________________________Home Phone____________
City/State/Zip_____________________________________________________
Grade______School________________________________________________
Father’s Name________________Day Phone__________Cell Phone_________
Mother’s Name_______________Day Phone__________Cell Phone_________
Please provide two additional emergency contacts, if parent is not available.
Name___________________________Phone____________________________
Name___________________________Phone____________________________
Does your child take any medication that may affect behavior? If yes,_______________
Does your child have allergies?________________________________________________(use back if needed)
Family Physician___________________Phone____________Insurance Co._______________
I certify that my child is physically able to take part in all activities offered. I will not hold Applied Behavioral Services, Inc. or SOS
Health Care, Inc. responsible in case of accident or injury as a result of participation. I further authorize any medical treatment, which
may be deemed necessary, while my child is participating in the clinic. I also authorize that Applied Behavioral Services, Inc. or SOS
Health Care, Inc. to obtain immediate medical care if any emergency occurs while my child is participating in the clinic. I also
understand that Applied Behavioral Services, Inc. or SOS Health Care, Inc. will notify me should my child become ill, and I agree to
pick up my child as soon thereafter as possible.
Parent/Guardian Signature____________________________Date________________