Yes. Absolutely everything that we do at O.R.L. is rooted firmly within the discipline of behavior analysis. All of our clinical staff members are formally trained as behavior analysts, and they all specialize in applying principles from behavior analysis to the education and treatment of children with autism and related disabilities.
Yes. O.R.L. is a Licensed Behavioral Health Agency (#003) for ABA services licensed by Washington State’s Division of Behavioral Health and Recovery. All of ORL’s clinical staff members also hold licenses with Washington’s Department of Health.
At O.R.L. we work primarily with clients with Autism Spectrum Disorder from all points along the autism spectrum. We also work with clients with other challenges such as significant learning disabilities, attentional problems, and social (pragmatic) communication challenges. Our clients range in age from 18 months to 18 years old.
Yes, in treating misbehavior, we take a balanced, comprehensive, and positive approach based on the most current science available. If one of our clients exhibits misbehavior, we consider that misbehavior to be communicating something. We determine what the misbehavior is communicating by conducting an evaluation that helps us learn why the client is misbehaving and what he or she wants. Once we know what the client wants, we teach him or her a more socially appropriate way of communicating. We always emphasize building skills through positive approaches so that clients can participate fully in their lives.
We work with all areas of a client’s development including:
● motor skill development
● imitation skill development
● receptive language development
● expressive language development
● intermediate and advanced language development
● emotional development
● social development
● self-help skills development
● academic skills development
● behavioral development
Which areas we work on at any particular time vary from client to client according to his or her individual needs.
We currently supervise the intervention of approximately 65 clients in our private practice. We maintain such a small private practice because we believe in very closely supervising each client’s behavior analytic care. As an example, whereas some other consulting companies in our area assign approximately 15 clients to each staff person, our average staff person supervises only 6 clients. This low staff-to-client ratio allows us to provide our clients with the very close monitoring and supervision that our clients’ families and we expect.
Each program that we supervise is staffed with five types of clinical staff members:
● 1 Clinical Services Supervisor
● 1 Consultant
● 1 Program Manager
● 1 Lead Therapy Assistants
● 1 to 2 Therapy Assistants
The Clinical Services Supervisor administratively oversees each client’s behavior analytic care. The Clinical Services Supervisor is an O.R.L. staff member who will meet each client’s intervention team at least every three months, or more often if needed.
The Consultant is one of O.R.L.’s clinical staff members who designs and develops all aspects of each client’s individualized program. The Consultant also sets priorities for each client’s intervention program based on what that particular client needs to learn to advance in his or her development. The Consultant serves as the lead clinician for their clients and it is the Consultant’s responsibility to ensure that each client makes meaningful, robust, and lasting progress.
The Program Manager is one of O.R.L.’s clinical staff members who serves as the primary contact person for each client’s family and the professionals working with them. The Program Manager is responsible for ensuring that the people working in our clients’ programs (the Therapy Assistants) are very well trained and that they implement each client’s program as the Consultant prescribes. The Program Manager also reviews copies of graphs that show each client’s progress. The client’s graphs are reviewed each week at the team meetings. Between the team meetings and the data reviews, no more than four days ever go by before the Program Manager sees exactly how each client is progressing. The Program Manager also implements each client’s intervention program with each of their clients at least one time per month.
The Therapy Assistants are paraprofessional employees of O.R.L. who work directly with your child. They implement all the aspects of each client’s intervention programs that the Consultant designs in ways that are consistent with how the Program Manager trained them.
O.R.L. hires and assigns all of the staff who work in each of their client’s programs. Our clients’ family members have a great deal of input into which staff members work with their child.
No. O.R.L. does all of the work associated with recruiting, hiring, and training our Therapy Assistants.
Michael Fabrizio and Kelly Ferris (the owners of O.R.L.) assign all O.R.L. staff members to our clients’ cases. Michael and Kelly select a Clinical Services Supervisor, Consultant, and a Program Manager to work with each client based on the overlap between that particular client’s unique needs and the clinical strengths areas of our staff. We never admit a client based on a wait list; instead, we very carefully match each client with staff members who specialize in what that particular client needs.
Because all clients are different and because O.R.L. provides services that are highly tailored to each client’s individual needs, how often each client and his or her Therapy Assistants will see the Consultant and Program Manager varies slightly. However, intervention programs under our supervision tend to progress through three general phases. We can best describe these phases as follows:
● Phase 1: Consultant and Program Manager are with the client’s team each week.
● Phase 2: The Consultant is with the client’s team every other week, and the Program Manager is with the client’s team each week.
● Phase 3: The Consultant is with the client’s team each month, and the Program Manager is with the client’s team each week.
Regardless of how long each client is with O.R.L., we insist on being with them and each of their Therapy Assistants at least once each week. We supervise each of our client’s programs very closely so that we can ensure that our clients are progressing as quickly and happily as possible. While other consulting companies may not see each client as frequently as we do, we feel that weekly contact is essential to ensure that our clients receive the very best behavior analysis services possible, and to ensure that each client’s program always meets his or her ever-changing needs.
The Consultant and the Program Manager will meet with their clients, their clients’ family, and the Therapy Assistants during weekly team meetings that typically occur in each client’s home. These team meetings generally last for three to four hours and must occur every week. While we do not require that client family members attend all of the client’s team meetings, we very much encourage family members to attend as much as they would like so that we can receive as much feedback from them as possible. We value family input and view family members as vital members of each client’s intervention team.
Phase 1 of intervention usually lasts between three and six months.
During this phase, ORL trains each client’s Therapy Assistants to ensure that they are working with their clients exactly as we prescribe. Each client’s Consultant is also getting to know their client so that he or she can develop intervention programs that are perfectly tailored to that client’s needs.
When the Consultant feels he or she has developed a perfectly tailored program, and a given client’s Therapy Assistants are well on their way to being fully trained, the Consultant will contact the client’s Clinical Services Supervisor and ask that the Supervisor come in to review the client’s case. After the Supervisor review the client’s case, they will approve your Consultant to enter Phase 2.
Phase 2 of intervention usually lasts between three and six months.
During this phase, ORL is finishing the training of each client’s Therapy Assistants and further refining each client’s intervention program. When the Consultant feels a particular client’s program is ready to move into Phase 3, the Consultant will again schedule to have the client’s Clinical Services Supervisor come in and review that client’s program.
After the Supervisor reviews the client’s program, they will approve the client’s Consultant to enter Phase 3.
Phase 3 of intervention continues as long as the client is with O.R.L.
During this phase, the Program Manager continues to meet with the client and his or her Therapy Assistants every week while the Consultant meets with the team every month. The client’s team meetings can also shorten during Phase 3 because the client’s Therapy Assistants should be completely trained by that point.
We accept new clients infrequently. During an average calendar year, we will accept 2-4 new clients.
O.R.L.’s Clinical Services Supervisors oversee all matters related to intake for O.R.L.
If O.R.L. is accepting new clients, you will see a link that will take you to an online (short) form for you to complete. Once you submit that form, someone from O.R.L.’s intake committee will contact you to schedule an intake meeting.
If you would like to know whether O.R.L. is accepting new clients, please one of the general services areas below:
A member of O.R.L.’s intake committee will contact you to schedule an intake meeting or arrange for you to speak with our Intake Coordinator.
At the intake meeting (which occurs in your home), our Intake Coordinator will meet you, your child, and your significant other.
The purposes of this 2 -hour meeting are:
● to allow the Intake Coordinator to get a better sense of your child’s particular needs so that ORL’s Clinical Services Supervisors can match your child’s needs with the clinical strength areas of the ORL Clinical Services Supervisors, Consultants and Program Managers
● to allow the Intake Coordinator to answer any questions you might have
● to allow the Intake Coordinator to gauge the degree to which you understand all that is involved with Applied Behavior Analysis (ABA) intervention for your child
We base our decision as to whether or not to work with a child on a range of factors that include:
● Client characteristics including temperament, susceptibility to reinforcement, and a history of progress with intervention
● Family characteristics including agreement between guardians regarding the decision to proceed with behavior analytic intervention, and family understanding of the what impact ABA for their child may have on family life
● Staff variables such as availability of our professional staff and overlap between the needs of a particular client and our staff members’ clinical strength areas
Please know that we have never declined to work with a client because of the client. We have declined to work with clients because of family issues (such as disagreement between a client’s caregivers about their decision to proceed with behavioral intervention) and because of a mismatch between the needs of a given client and our available staff members’ clinical strength areas.
We only accept new clients when our staff has available time to adequately serve potential new clients at the very high quality levels we expect. We will not accept any new clients unless our staff have the time resources they need to do the job well.
If you would like to know whether O.R.L. is accepting new clients, please one of the general services areas below:
If we do not accept your child as a client of O.R.L., we do have several suggestions for you:
● We recommend that you seek and hire behavior analysts to supervise your child’s intervention program who are certified by the Behavior Analyst Certification BoardTM and who are licensed to practice in the State of Washington.
● In addition, we recommend that you seek out and hire behavior analysts who have clinical experience with children with autism outlined in the Revised Guidelines for Consumers of Applied Behavior Analysis Services to Individuals with Autism, which were written by the Autism Special Interest Group of the Association for Behavior Analysis.
We bill hourly for all of the services we provide on behalf of your child.
O.R.L.’s rate for clinical staff members’ time is $250.00 per hour. Our rate for our Therapy Assistants’ time is $150.00 per hour, although we are happy to negotiate substantially lower rates when families are paying out-of-pocket for our services rather than using a healthcare benefit to fund their child’s ABA intervention. We also negotiate rates with each insurance company we work with.
O.R.L. bills their clients between one and two times each month, depending on the funding source paying for a particular client’s intervention.
Yes. O.R.L. does bill insurance companies. As you are probably aware, the reimbursement landscape is changing quickly here in Washington State for ABA services. O.R.L. will conduct a preauthorization with your insurance company as part of the intake process.
O.R.L. also bills the State of Washington’s Developmental Disabilities Administration and holds current contracts with various school districts.
Yes. The staff of O.R.L. are approved providers for both Microsoft’s and Amazon’s ABA/Autism benefit.