ABA parent training is an important part of any ABA program. It involves teaching parents critical skills to ensure generalization, improve functioning in the natural environment, reduce the parent’s stress level, and generally make life more enjoyable for everyone.
Or does it?
Parent training is a term thrown casually around by ABA professionals as just another part of any ABA program. Most insurance companies require that you include parent training goals in your treatment plan and report on progress with each new authorization.
But few BCBAs ever receive formal training in providing effective parent training. Professors teaching the courses for the verified course sequence teach using behavioral skills training (BST) as the best method for teaching parents and confederates to use ABA strategies. Research demonstrates the effectiveness of BST but does it actually result in lasting change for families as a method of parent training?
Just as knowing how to demonstrate a skill isn’t the same as incorporating it into your everyday life, BST alone is not enough. You must take steps to ensure the parent uses the strategies you teach when you’re not around.
Is Parent Training the Same As Parent Education?
First, let’s get clear on exactly what parent training is. A study by Bearss et al. (2015) compared the effectiveness of parent training versus parent education on clinical outcomes. The authors identified them as distinctly different.
They defined parent education as the delivery of helpful information about a variety of topics including treatment options, diagnosis, evaluation and advocacy. Parent training included teaching techniques to address challenging behavior such as analyzing antecedents and consequences or implementing strategies to reduce challenging behavior. The authors measured the impact of these 2 strategies on challenging behavior occurring in the home.
In this study, parent training yielded a better outcome than parent education. What’s particularly interesting about this study is that parent education, even though it did not directly address issues related to challenging behavior also saw an improvement, a 31.8% decrease in the ABC-I which is a parent-rated scale to measure challenging behavior. Parent training saw a 47.7% decrease. Yes, this is better, but the question is why did parent education, which offered no direct strategies for reducing challenging behavior see this level of improvement?
The authors didn’t dig too deeply into this question, but parent education must have addressed some need for the parent. Maybe it helped them view their child’s challenging behavior through a different lens or maybe it helped them establish more realistic expectations for their child.
While it’s clear that parent education alone isn’t the right answer, it’s probably also true that something happening during parent education that created some improvement for the family.
Parent training is often also referred to as caregiver training, parent coaching, or family treatment guidance. However you refer to it, parent training involves teaching specific ABA strategies related to their child’s treatment. Based on the study by Bearss et al. (2015), it’s probably also important to incorporate elements of parent education to see the greatest impact.
Who Can Provide ABA Parent Training?
In a typical ABA program, parent training is provided by the BCBA. This is often due to requirements by the insurance company and because BCBAs should have the best understanding of how to teach the skills parents need to learn.
Most insurance companies also allow BCaBAs to provide the same services as a BCBA as long as they receive supervision, usually the standard 5% supervision. Some insurance companies have stricter guidelines and do not allow a BCaBA to bill for some services.
BCBAs providing supervision to trainees could delegate some of the parent training responsibilities to the trainees, but it’s likely that this will remove the training as a billable event. This means that for the time to be billable, the BCBA must be present and providing the training. Make sure to check with each insurance company to make sure you understand the requirements.
If the RBT demonstrates strong clinical skills, consider inviting the parent(s) to participate in sessions with the RBT. Assuming that the RBT has strong treatment fidelity, this offers parents more opportunities to observe the interventions used in treatment. This amplifies and supports the parent training that you do but should not replace direct parent training by the BCBA.
Often, this is the structure I use:
- Develop a partnership with parents
- Identify appropriate parent training goals
- Teach a skill to the parents didactically (without the learner there) using the ACHIEVE curriculum
- Model the skill with the learner
- Allow the parents to practice the skill either through role play or with the learner
- Provide feedback and answer questions without the learner present
- Ask the parent to be present during a supervision session where the RBT will be utilizing the skill
- Encourage the parent to be present during an appropriate amount of a session with the RBT
- Encourage RBT to describe what the are doing or the decisions they make, if appropriate
- Observe the parent utilizing the skill during a subsequent parent training session
This process might take place over the span of a week or even a month. Allow the parents to determine how quickly you move through each step. Some families are so eager to learn how to help their children that they push to take on the next skill. Others are so overwhelmed with life that they can only take small steps at a time.
Parents should always be encouraged to observe and participate in sessions but not all RBTs are ready to participate in parent training. During supervision sessions, prepare the RBT for parent training before you reach step 9 with the parents. If the RBT isn’t ready to guide parents, make sure that the parents understand they can observe sessions but the RBT will not discuss what they are doing. Parents should direct any questions they have to you as the BCBA.
Some states and insurance companies allow for non-certified staff to bill for parent training. If this is the case where you are, it’s critical that you ensure the staff receives training and supervision to make sure parent training is effective. Both of our CEU courses, Reducing Parent Stress Through Effective Parent Training and The Partnership Language 5-Day Challenge, provide a good introduction to effective parent training and are appropriate for non-certified staff providing parent training.
Barriers To Effective Parent Training
Although there’s limited available research to help us understand the barriers to providing effective parent training, articles by Helton and Alber-Morgan (2018) and Allen and Warzak (2000) bring some important barriers to light.
- Clinicians, especially ones who are new to the field may struggle with translating ABA jargon into language parents can understand.
- Parent motivation may be low due to unrealistic expectations for progress or a lack of intermediate goals that show progress.
- Clinicians might not have the time to prepare materials or create lessons for parents causing them to just “wing it” when it comes time for parent training.
- Parent training may lack structure which can lead to parents trying to address the crisis of the week.
- Clinicians might have difficulty getting parents to “buy-into” using recommended strategies.
- Parent stress limits the parents’ ability to participate in parent training, learn new skills and utilize skills taught independently.
For parent training to be truly effective, it’s important to address as many of these potential barriers as possible. You likely can’t overcome all barriers. Time constraints, requirements of payors or your employer, or your personal experiences all impact your parent training.
Addressing Time Constraints
Whether you’re a business owner, independent contractor, or employee, there’s no doubt you need more hours in your day. You have endless tasks to accomplish each day, week, and month. You’re under pressure to maximize your billable time but must also complete documentation and plan for sessions. Developing a parent training plan or curriculum for each family likely falls outside of what’s possible to squeeze into your daily routines, leaving you with the following options:
- “Wing it”
- Delegate planning
- Plan what you can
- Use a commercial curriculum and customize to address the individual needs of each family
The above list flows loosely from least effective to most effective. “Winging it” during parent training often leads to parents discussing the crisis of the week (COW) and you making off-the-cuff recommendations. These recommendations are disjointed and difficult for parents to actually utilize. Many times you address the same questions again a few months later because the issue remains unresolved.
If you have strong BCBA candidates or RBTs on the case, you might consider delegating the planning of parent training sessions. Staff might create a written plan for you to review with parents during sessions. They might also include a homework calendar or other visuals to support the parents’ use of the recommended strategies. Although this is time-effective, it would be difficult for the staff to know when and how to adjust the language used or strategies included to make the training truly dynamic.
Many BCBAs rely on a “plan when you can” strategy for parent training. They create a loose plan for training then supplement sessions with off-the-cuff responses to parent concerns. For highly experienced BCBAs, this might be the most effective method of parent training. It provides a balance between structure and flexibility. For newer BCBAs, this strategy shares many of the disadvantages of the “wing it” strategy. It’s incredibly easy to get caught up in the COW when there’s not plan for each session.
There are many great parent training curriculums available on the market today. Each one offers different resources and focuses on different aspects of client need. Most seek to teach parents to identify the function of challenging behavior and use that information to determine how best to respond to the behavior. Although parents often need this information, a study by Taylor et al. (2019) found that parents reported BCBAs focused too much on their child’s problem behavior. Parent training should include a balance of information that focuses on the child’s strengths and meets the individual needs of the parents.
Few curriculums include information about skill acquisition, reinforcement, or motivation. The ACHIEVE Parent Training Curriculum includes 26 lessons, homework assignments and quizzes that cover both important skill acquisition strategies and important information to understand challenging behavior.
ACHIEVE is available on Amazon, but if you buy through Master ABA, you receive a substantial discount. Click here to learn more.
Understanding Parent Stress
You can’t control all parent stress, but you can influence many aspects of it. Ask yourself if your parent training is decreasing parent stress…or increasing it.
A study by Baker et al. (2005) looked at the stress experienced by parents of toddlers with and without ASD. They highlighted many sources of stress for parents of autistic children, including their child’s intellectual deficits, especially if they had difficulties with verbal expressive language or cognitive inconsistencies. Their child’s personal characteristics including adaptability, demandingness and level of distractibility also impacted parent stress.
Other factors that impact parent stress included:
- Disruptive behaviors
- Expectations for long-term care
- The severity of their child’s impairments
- Difficulties with relating to their child
- Overwhelming care-taking demands
- The need to interact with a large pool of professionals or difficulties with accessing services
- The need to gather and make sense of an overwhelming amount of information about diagnosis and interventions
- Sorting through alternative treatments some of which might provide conflicting information
- Monetary stress due to a loss of time at work or additional costs of therapies
- A limit on family opportunities which might evoke a sense of loss over what the parent expected they would be able to do with their child
Parent stress interferes with relationships and often leads to failure to follow through with BCBA recommendations.
Imagine being a parent under the constant watchful eye of different providers, all looking to tell you how to parent your child. You don’t spend time with family or friends and can’t take your child to Disney like you had once envisioned because of your child’s behavior. You’re essentially trapped at home, unsure what to do. How would you respond to someone coming in to teach you how to parent when you’re under such extreme stress?
According to Allen and Warzak (2000), one of the reasons parents fail to follow through with recommendations are faulty establishing operations. Parents may not be motivated to use the interventions we recommend. This might be because we fail to identify intermediate outcomes and parents have trouble keeping up momentum toward a long-term goal. Parents also encounter competing social approval when family and friends express disapproval of the therapist’s recommendations.
Take time to carefully consider the establishing operations impacting the parents’ motivation to follow through with your recommendations. What variables can you alter to reconfigure the establishing operations to increase the likelihood the parents will follow through with recommendations?
Steps To Providing Effective Parent Training
As a behavior analyst, you probably understand the basic steps to behavioral skills training (BST) which is an evidenced-based teaching methodology. Your coursework probably taught you the importance of using BST to train others to implement ABA interventions. BST alone is generally not enough to ensure the skills are used when you’re not there. Your parent training must include other fundamental components to achieve the outcomes you and the family need.
The steps to providing effective parent training are:
- Form a partnership with the parent(s)
- Conduct an initial assessment of the skills needed to reach goals identified in step 1
- Use BST to teach skills
- Conduct a re-assessment to determine the effects of training
Much of your education focused on the science of ABA and the fact that this science is used with real, genuine human beings might have been overlooked. Your masters degree coursework provided you with the groundwork. Your supervised field experience should have provided you with the additional tools you need for successful parent training.
You must understand the science to help the people you serve but the science alone leads to failure and frustration. Before you begin using BST to teach skills, you must create a partnership and conduct an assessment.
Creating a partnership goes beyond “pairing yourself with reinforcement” as you might have learned to do with your clients. It’s about truly bringing the parents into the process as an equal. If this step is new to you or you want to practice, take our Partnership Language 5-Day Challenge for a deeper dive and earn 2 CEUs while you do it!
Parent Training Assessment
Before beginning any parent training, you must understand the parents’ current knowledge and skills. Many parents you encounter have some previous experience with ABA either from a different provider or from videos and information available online. Some parents want a deep dive into ABA technology and others need just the most basic information. Either way, you must first get a sense of what they already use in their everyday interactions with their child.
Most often, an informal assessment conducted during observations of the parent interacting with their child provides enough information to set appropriate goals and guide your parent training. Start by building a relationship with the parents to get a sense of their values and daily struggles.
Observe how the parents naturally engage and interact with their child without putting pressure on them to perform. Lead the parents to different interactions by asking relevant questions such as “how do you know what your child wants?” or “how do you respond when your child has a tantrum?” Then follow up by asking the parent to show you what that looks like.
Create fidelity checklists like the one below that break down the most common parent training skills into smaller components. This is an example from our ACHIEVE Parent Training Assessment available through Teachers Pay Teachers.
Using the fidelity checklist allows you to determine which components of the skill you need to teach and provides opportunities for you to provide positive feedback to parents for the components they use consistently. Using fidelity checklists like this also provide a means to graph parent training data to submit to insurance companies. They allow you to quickly see progress toward mastery.
The image below provides a description of how to collect data using the fidelity checklist and enter that data into a graph.
Parent Training Goals
Most insurance companies require parent training goals as part of a comprehensive treatment plan. Goals help determine direction and identify progress. They keep parent training on track and allow you to redirect conversations that start to go off course.
When writing a treatment plan, you focus on your client and helping them achieve their goals and overcome obstacles. Parent training goals, unfortunately, often become an afterthought. Many companies encourage efficiency by providing stock parent training goals already plugged into treatment plan templates. It’s tempting to utilize this resource but avoid this temptation.
Take the time to write parent training goals that have true meaning for the parents. Incorporate the family’s culture and values, their hopes and dreams. Consider the following list of Do’s and Don’ts when writing parent training goals:
|Do This||Don’t Do This|
|Write goals that align with the family’s values||Write goals based on what you believe the learner should do at home|
|Approach parent training goals flexibly||Use stock parent training goals|
|Create goals to address quality of life for the family||Prioritize goals to generalize skill acquisition programs|
|Write goals to address a variety of the family’s needs||Create goals that focus only on behavior reduction|
|Encourage parents to set their own goals||Write goals you think are important|
|Ensure the goals are realistic given the burdens and responsibilities of the family||Set ambitious goals that you hope will “stretch” the family|
Parent training addresses many different aspects of the family’s life and interactions. Include goals that address any of the following parent training topics:
- Participation in parent training
- Understanding the context of behavior using the ABC framework
- Delivering reinforcement
- Following through with utilizing interventions
- Collecting data
- Understanding functions of behavior
- Demonstrating prompting techniques
- Utilizing generalization and maintenance procedures
Of course there is an endless list of possibilities and you should individualize goals for each parent since each situation is unique. Get our Parent Training Example Goals PowerPoint for free when you purchase the ACHIEVE Parent Training Curriculum. The PowerPoint includes 32 sample goals and uses questions to guide decision-making. Alter the goal to specifically address the need of your individual learner and his or her family.
Sample ABA Parent Training Goals
Write parent training goals that are both meaningful and achievable. If the parents never participated in parent training in the past, consider including participation goals. If the parents understand some basic ABA principles, set more ambitious goals. Here are some examples to get you started:
- Father will provide necessary materials for skill acquisition each session (i.e. novel food item, sippy cup or cup, etc.).
- Mother will identify relevant antecedents and consequences for 5 behavioral episodes that occur during session with 80% accuracy.
- Parent/caregiver will provide reinforcement in the form of tangibles, edibles, positive attention, escape/break, etc.; when learner engages in a pre-identified desired behavior during 80% of observed opportunities.
- Caregiver will implement 1 antecedent and 1 consequent strategy listed in the behavior intervention plan with 80% accuracy during 5 consecutive sessions.
- Father will collect maintenance probe data for 10 different skill acquisition programs during the current authorization period.
- Mother will describe a behavioral incident by including a possible function with 80% accuracy during 10 separate incidents.
- Parent/caregiver will demonstrate the use of physical prompts during 10 separate opportunities with 80% accuracy.
- Mother will use a VR schedule to reinforce 10 skills that have been mastered during direct ABA sessions during this authorization period.
Curriculums For Parent Training
Several high quality parent training curriculums are commercially available. The right curriculum depends on your learner and his or her family’s needs as well as your values, skills and experiences. Look for the curriculums on Amazon or Google them to find them online.
|ACHIEVE Parent Training CurriculumACHIEVE Parent Training Curriculum: Effective ABA Training through Partnership||~29 lessons for parents, 2 for BCBAs|
~Includes goals, teaching materials, homework assignments, and quizzes
~Topics include information to address both behavior reduction and skill acquisition goals
|RubiParent Training for Disruptive Behavior: The RUBI Autism Network (Programs That Work)||~11 core lessons with supplemental lessons|
~Includes therapist scripts, handouts, activities and checklists
~Topics exclusively focus on challenging behavior
|One-Year ABA Parent Training Curriculum: Parent Training Manual for Behavior Analysts & Other Human Service Professionals||~26 lessons plus 1 bonus lesson|
~Includes reading material, handouts, and homework assignments
~Topics focus on ABA instructional and behavior reduction techniques
|ABA Parent Education and Training||~50 lessons with free downloadable worksheets|
~Includes reading material and downloadable worksheets
~Topics address both skill acquisition and behavior reduction needs
Do I Need An ABA Parent Training Curriculum?
Whether you’re fresh out of school or a seasoned professional, you might wonder if an ABA parent training curriculum is right for you. You might enjoy using a curriculum if you want:
- New ideas
- More structure
- Ready-made materials
- Parent-friendly language for explaining ABA terminology or technology
Many professionals choose to use a parent training curriculum to generate ideas for structuring sessions, discussion topics, or words to explain complex topics. Curriculums provide credibility for newer BCBAs. They reduce time spent preparing for sessions and creating materials.
Use an ABA parent training curriculum as a guide and resource. Incorporate the lessons that make sense for your learner and his or her family. Skip the lessons that don’t align with the learner’s treatment goals or your values.
References and Related Reading
Abidin, R., Flens, J. R., & Austin, W. G. (2006). The Parenting Stress Index. In R. P. Archer (Ed.), Forensic uses of clinical assessment instruments. (pp. 297–328). Lawrence Erlbaum Associates Publishers.
Allen, K.D. & Warzak, W.J. (2000). The problem of parental nonadherence in clinical behavior analysis: Effective treatment is not enough. Journal of Applied Behavior Analysis, 33, 373-391. doi: 10.1901/jaba.2000.33-373
Baker-Ericzén, M. J., Brookman-Frazee, L., & Stahmer, A. (2005). Stress levels and adaptability in parents of toddlers with and without autism spectrum disorders. Research and practice for persons with severe disabilities, 30(4), 194-204.
Berry, JD, & Jones, W,H, (1995). The Parental Stress Scale : initial psychometric evidence. Journal of Social and Personal Relationships, 12, 463 – 472.
Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., … & Scahill, L. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. Jama, 313(15), 1524-1533.
Daniels, A. C. (2009). Oops!: 13 management practices that waste time and money (and what to do instead). Performance Management Publications.
Helton, M.R., & Alber-Morgan, S.R. (2018). Helping parents understand applied behavior analysis: Creating a parent guide in 10 steps. Behavior Analysis in Practice, 11, 496-503. doi: 10.1007/s40617-018-00284-8
Koegel, R. L., Bimbela, A., & Schreibman, L. (1996). Collateral effects of parent training on family interactions. Journal of autism and developmental disorders, 26(3), 347-359.
Strauss, K., Vicari, S., Valeri, G., DElia, L., Arima, S., & Fava, L. (2012). Parent inclusion in Early Intensive Behavioral Intervention: The influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes. Research i n Developmental Disabilities, 33, 688-703. doi: 10.1016/j.ridd.2011.11.008
Taylor, B.A., LeBlanc, L.A., & Nosik, M.R. (2019). Compassionate care in behavior analytic treatment: Can outcomes be enhanced by attending to relationships with caregivers? Behavior Analysis in Practice, 12, 654-666. doi: 10.1007/s40617-018-00289-3
Zelman, J. J., & Ferro, M. A. (2018). The parental stress scale: psychometric properties in families of children with chronic health conditions. Family Relations, 67(2), 240-252.