Thursday, December 2, 2010

How to Hire a Therapist

This was how I was feeling the other day when our longest serving therapist for Alanna announced she was resigning.  In truth, I am very happy for her - she is moving on to a solid full-time job at the school board.  She will be in classrooms and has years of experience working with kids on the autism spectrum.  Some lucky parents are going to be fortunate to have her around for their kids.

On the other hand, she has been with Alanna since she was 22 months old, and she knows Alanna inside and out... she calls them Alanna's "tells".  This is important because she can adapt her instruction based on how Alanna is reacting.  This takes a long time to develop well.  So I am admittedly very bummed about this situation.

Luckily we have already hired a replacement for this therapist.  Here is my advice for hiring therapists.  As always you are free to take it or leave it, or better yet, improve on it.

First - unless you are lucky enough to be in an area with private agencies (which in Canada is pretty much only the larger urban centres of at least 500,000 people), most therapists are independent.  In the South West catchment region for Ontario's Autism Intervention Program, there are no local agencies, though I am aware of a pre-school type program operating in Windsor.

Here is what I've found:
1.  The majority of therapists are women.  This is not very surprising in a profession working with younger children.  Also, men are likely to face huge obstacles (read: bias) against them because of the vulnerability of the population.  I am normally very positive about men working with children.  However, the thought of a male therapist alone with my little girl for hours a week, often working on things like toileting just doesn't sit with me.  It's completely unfair but that's just the daddy protector coming out in me.
2.  The majority of independent therapists are young.  Young being - early to mid twenties.  Most therapists who do well at the profession either get promoted to senior therapist positions (writing programming and supervising other therapists), or they leave in favour of something full-time with benefits in preparation for their up-coming maternity leave.
3.  Even with good pay and other perks, turn-over will be too high.  It takes a long time to train a therapist well, but there are two problems with ABA therapy jobs.  First, to make a living the therapist has to cobble together hours with multiple families.  The pay is therefore highly dependent on how busy they become.  They also have to deal with problems directly with the families and have no one to go to bat for them if there's a working issue.  Second, although most therapists enjoy working with children, it is a little isolating. If the child is presenting behaviours (i.e. you are being kicked, punched, bitten) and/or the child is not verbal (i.e., social behaviour is limited), it is a lot of work, and oftentimes there is no gratification because changes can be slow.
4.  Like anyone else, people leave for good reasons.  They get a better paying job, they want to change to careers, they get pregnant, their spouse got transferred, etc.  It all happens to everyone.
5.  Experience is great but "fit" is more important.  It's great if you can find an experienced therapist, but it will do you no good if the therapist is not experienced with your child's age group, or the way they learn.  I'd much rather hire a therapist who loves young children and is enthusiastic than someone who has worked exclusively with teenagers but has years of experience doing it.  Remember, this person is going to be spending hours together (probably 1:1) with your child every week.  They need to like each other!

I have resigned myself to #3 but wish I could do better.  It would be nice if everyone stayed at least a year but I'm not holding my breath.  Good times.


  1. oh man have we struggled with number 5.
    Keep the faith brother. Its tough craps. We have been doing this for just over a year now, and one great one left, one just became strange and I fired her and the other two oldies remain ( i am always fearful that someones boyfriend is going to ask them to marry and move to some far away land and I will lose them, even though I am Muslim and against pre-marital relations! haha).

    The new girl is really inexperienced and more like respite. ANd this is Toronto, where the numbers of people in the field are high....

    I am repelled by most people I interview, they offend me. Its hard.

  2. The interview process is painful, we are in Toronto, and for every 20 interviewed there is 1 possible. References are critical. We also found it good to:
    1) Get police clearance for vulnerable people (make sure a predator is not being invited to the home), 2) Introduce any potential to our son - he is always right in picking the great ones, if no natural attraction no go, 3) Learn ABA cold to ensure pointed questions can be asked in the interview, 4) Any one that makes promises of quickly recovering a child should be shown the door immediately, 5) Anyone that talks “around” your child like he/she is not in the room should be shown the door immediately, 6) Ask for a Psychologist reference, if they are any good they have these references. Many of the poorest ones we have seen are near spam on the boards out there and Abucus (Ontario) is no better but at least a start point, 7) Ask other parents for therapist referrals if you have any in your circle, if not find and join a local support group (the Regional offices have the list of these and there are many in the province), 8) go through a typical therapy day/session and ask for questions/feedback – if they got none it may be they do not know much.
    We have found experience, references, and our own knowledge of ASD, ABA, RDI, and other therapeutic methods are the critical items. We have to know just as much or more than our Psychologist (about autism and therapy) since our son is ours – we set the objective, we know him, and through experience we know when to go that little bit more. Parents have to rely upon their knowledge. One can not blindly put faith in the person coming in the door, there are so many terrible ones out there! I honestly think there is a small section of “providers” that have glommed onto the desperation of parents and are exploiting this for sole gain (not a surprise I am sure).