Handbook for Families

Compassionate, thoughtful, and evidence-based intervention

Patterson Behavior Services' overall mission is to improve quality of life through compassionate, thoughtful, and evidence-based intervention.

• Our primary clients are children and adults who have developmental disabilities, delays, or social challenges. For these people, we strive to teach the skills required to stay safe and become as happy and independent as possible. 
• Our secondary clients are parents or other caregivers. For these people, we strive to identify achievable steps toward progress and to offer honest and individualized feedback.

Susan Thomson

• Susan is our Clinical Administrator and handles intake, scheduling, billing, communication with insurance companies, and human resources tasks.
• Contact Susan if you have questions about scheduling or about your insurance authorization, benefits, or claims.

Ally Patterson, PhD, BCBA-D, LBA

• Ally is the founder and sole owner of Patterson Behavior Services. 
• She supervises all cases as our Clinical Director and also maintains a caseload as a supervising Behavior Analyst. She creates assessment reports and treatment plans, meets with families, and supervises therapy programs.
• Contact Ally with any feedback or concerns regarding your therapy program, staffing, or progress.

Katelyn Gruber, MEd, BCBA, LBA

• Katelyn is a supervising Behavior Analyst. She creates assessment reports and treatment plans, meets with families, and supervises therapy programs.

Hannah Alejandria, BCBA, LBA

• Hannah is is a supervising Behavior Analyst. She creates assessment reports and treatment plans, meets with families, and supervises therapy programs.

Hannah Morgan, RBT

• Hannah is a Registered Behavior Technician and Graduate Intern. She carries out treatment plans under the supervision of a Behavior Analyst. She also assists our BCBAs as they create treatment plans, assess skills, and teach caregivers.

Rebeccanne Ruddell Cass, RBT

• Rebeccanne is a Registered Behavior Technician and Graduate Intern. She carries out treatment plans under the supervision of a Behavior Analyst. She also assists our BCBAs as they create treatment plans, assess skills, and teach caregivers.

Jessica Dwyer, RBT

• Jessica is is a Registered Behavior Technician and Graduate Intern. She carries out treatment plans under the supervision of a Behavior Analyst. She also assists our BCBAs as they create treatment plans, assess skills, and teach caregivers.

Kait Morgan

• Kait is a Registered Behavior Technician and Graduate Intern. She carries out treatment plans under the supervision of a Behavior Analyst. She also assists our BCBAs as they create treatment plans, assess skills, and teach caregivers.

Maria Martinez, RBT

• Maria is a Registered Behavior Technician. She carries out treatment plans under the supervision of a Behavior Analyst.

Grace Hernandez, RBT

• Grace is a Registered Behavior Technician. She carries out treatment plans under the supervision of a Behavior Analyst.

Intake, treatment, and discharge

1. Our intake process includes an introductory phone call, insurance authorization, assessment, and a written treatment plan.
2. Our treatment process includes child and caregiver sessions as well as 6-month assessment updates.
3. Our discharge process includes a written transition summary and a celebration of the child's progress.

Please see this page for a detailed description of our process from intake to discharge.

Initial scheduling

• The Clinical Administrator creates each family's schedule on the basis of clinical recommendations, provider availability, and family availability.
• If there are any issues with the proposed schedule, please inform the Clinical Administrator before initiating therapy services.
• In most circumstances, families should plan to commit to therapy on either Monday/Wednesday/Friday or Tuesday/Thursday. Some children receive therapy 5 days per week, Monday through Friday. 
• We schedule therapy in the following time blocks, with some flexibility for client and employee availability:
  • Morning (between 8:30am and 12:30pm)
  • Afternoon (between 1:00pm and 5:00pm)
  • After-school (between 3:00pm and 6:00pm)
• In most circumstances, families should plan to commit to at least 6 months of therapy.
• Consistency is important for both our employees and the clients we serve.

Staffing

• Staff are assigned to clients on the basis of clinical recommendations and provider availability.
• Staffing changes may occur due to changes in provider availability, client availability, or provider expertise.
• You are welcome to request a particular staff member. However, we may not be able to grant your request.

Schedule changes

• Please do not attempt to add or remove sessions directly with an RBT. Contact your BCBA if there is a temporary scheduling issue such as a medical appointment, school event, or travel.
• The Clinical Administrator takes requests for major schedule changes twice per year. A major schedule change is a recurring change to the time or day of the week of any scheduled session.
• In May, we accept requests for major schedule changes for the summer.
• In August, we accept requests for major schedule changes for the school year.
• It is unlikely that we will be able to make a major schedule change at other times of the year.

Cancellations

• We request at least 24 hours notice of cancellation in all circumstances, and more notice is always appreciated. In the case of illness or emergency when advance notice is unlikely, please notify your providers directly (both RBT and BCBA) and as soon as possible. 

• Please respect your health and the health of our employees. If you or anyone in your home has a fever or contagious symptoms of any illness (persistent coughing, sneezing, vomiting, etc.), please cancel sessions for that day.

• If the client has experienced vomiting or a fever of 100°F or higher, please cancel sessions until the client has been free of those symptoms for 24 hours.

• For cancellations occurring less than 24 hours in advance and unrelated to illness or emergency, the $75 cancellation fee will be assessed. Our definition of a cancellation includes:

  • The client and/or caregiver is 15 minutes late to a scheduled session.
  • The caregiver ends a session 15 or more minutes early.
  • The client is engaged in activities incompatible with participating in a therapy session (sleeping, bathing, undressed, etc.). In this case, the caregiver will have 15 minutes to resolve the issue.
  • The caregiver engages in inappropriate behavior toward the client, provider, or any other person present for the session. Inappropriate behavior includes but is not limited to yelling, physical punishment, aggression, domestic disputes, and sexual harassment. In this case, the provider will leave the home immediately.
• Following 3 cancellations of any kind, the client's scheduled appointments will no longer be reserved. Families may initiate a conversation with the owner in order to reinstate sessions. However, continued cancellations will result in a permanent discharge from services.
• Please be respectful of our providers and their time. Our BCBAs and RBTs drive from across Northern Virginia in order to work with your children. With very few exceptions, it is disrespectful to inform a provider of cancellation after they have already arrived to the session location.
• We are unable to reserve a place in our programs for absences longer than two weeks. In this case, the client will return to the waiting list and the family will be provided recommendations for other resources.

Inclement weather 

• In the event of inclement weather, we request that sessions be rescheduled or canceled as appropriate. This is to ensure the safety of our employees. 
• We will follow the guidelines of our local school districts. For example, if Fairfax County Public Schools are closed due to weather, sessions in Fairfax county will be canceled. If your child’s school is closed, plan for any sessions that day, unless they are virtual, to be canceled. 
• If you need to cancel or reschedule a session due to a weather emergency (power outage, flooding, hazardous road conditions in your neighborhood), please notify your providers directly and as soon as possible.

Patterson Behavior Services recognizes several holidays each year. We request that regularly planned sessions that fall on the following dates be rescheduled or canceled.

• New Year’s Day: Thursday January 1, 2026
• Memorial Day: Monday May 25, 2026
• Juneteenth: Friday June 19, 2026
• Independence Day: Friday July 3, 2026 
• Labor Day: Monday Sept. 7, 2026
• Thanksgiving break: Wednesday November 25 through Friday November 27, 2026
• Christmas break: Monday December 21 through Friday December 25, 2026

We recognize that families may celebrate other religious and cultural holidays throughout the year. We encourage you to share those dates with your BCBA as early as possible. 

Insurance-funded services

• Billing is submitted to insurance companies each week. You will receive an explanation of benefits (EOB) from your insurance explaining the charges.
• Some families will be responsible for insurance deductibles, copays, or co-insurance amounts. We are required to collect these amounts per the terms of our insurance contracts.
• Most insurance plans charge only one copay per day, even if multiple providers from the same company are seen on the same day. Check with your insurance provider to confirm this.
• The Clinical Administrator will send invoices for deductible, copay, coinsurance, and cancellation fee payments approximately each week. 
• Payment is due within a week of the invoice date. If you are unable to make payment, please let us know in advance. We will work together to create a payment plan.

Private-pay services

• We send invoices via email each week.
• Payment is due within a week of the invoice date. If you are unable to make payment, please let us know in advance. We will work together to create a payment plan.
• Your receipt will include information necessary for you to submit claims for out-of-network insurance reimbursement. 

Methods of communication

• Email is our preferred method of communication. Providers are usually with other clients during the workday and unable to answer phone calls or respond to texts.
• Please do not communicate with your providers via text message unless for time-sensitive issues: cancellations less than 24 hours in advance, running late to a session, location change, etc.
• Please be respectful of providers' boundaries regarding communication outside of scheduled session times. Refrain from sending multiple communications in a row.

Communication with other providers

• We are happy to coordinate care with doctors, therapists, teachers, or other professionals who work with your child. We will need a signed consent form in order to do this.
• If your child attends school or daycare, we recommend that your BCBA observes your child in that setting as part of each assessment.
• We are available to provide information on therapy goals and techniques where consent is granted. We have found that teachers, psychologists, and speech-language pathologists are most likely to participate in this sort of collaboration.

Points of contact

• Communication regarding your therapy program should be directed to your BCBA.
• Communication regarding scheduling and billing should be directed to the Clinical Administrator.
• Concerns or complaints should be directed to your BCBA and/or the Owner.

Cultural sensitivity

• We do our best to acknowledge and celebrate each client’s culture and customs. Please inform your BCBA of your preferences.

Safeguarding

• A caregiver over the age of 18 must remain in the home during session times. 
• We prefer not to work with clients behind closed doors. Please arrange for the therapy space to be in an area where at least one door can remain open.
• Providers may not work with clients who are fully undressed. Ensure that your child is wearing, at a minimum, underwear or a diaper prior to beginning the session.
• Providers will not tolerate any discipline strategies that include yelling or physical punishment. If these are part of your family's routine, you will need to make changes. If you need help with this, we can create a plan together.
• If a caregiver becomes emotionally escalated while working with a client, the provider will ask that caregiver to take a break from the situation.
• BCBAs are mandated reporters, meaning that they must report child abuse and neglect to Child Protective Services and abuse or neglect of a vulnerable adult to Adult Protective Services.

Data collection software

• Providers use HIPAA-compliant software on tablets, computers, and/or smartphones to track client progress and write session notes. 

Privacy

• Providers may not take photos or videos of clients without written consent. If you would like a photo or video of a therapy technique, please capture it using your own device.
• We request to be informed if providers will be recorded while in the home (nanny cams, security cameras, voice recorders, etc.)

Therapy area

• Please maintain a tidy learning space free of distractions. We recommend a table and chairs in a quiet area of the home.
• We will honor the child's requests to leave the therapy area and follow their preferences to other parts of the house.
• Therapy necessarily involves noise: we will be talking, playing, and having fun! With this in mind, please ensure that your therapy area is removed from any areas of the house where noise will be disruptive (sibling nap areas, parent offices, etc.)
• Please maintain a temperature between 68-76° F.
• Please do not smoke or use strong-smelling products in the therapy area.

Routines

• Make sure to establish consistent household rules, routines, and limits. Bedtime, wake up time, mealtimes, playtime, exercise, learning time, and screen time (if allowed) should be predictable each day. Set clear expectations regarding acceptable versus unacceptable behavior. These rules and routines will be different for each family. However, all adults living in the household should stick to the plan. If you need help, we can work on this together.
• On therapy days, stick to your usual routines whenever possible. We can incorporate snack time, meals, breaks, time with siblings, etc. into our therapy sessions. 
• Encourage age-appropriate habits with regard to sleeping, eating, and self-care.
  • We recommend that children age 3 and up use age-appropriate eating and drinking utensils, sit at a table to eat, refrain from pacifier and bottle use, transition away from stroller use, fall asleep independently, sleep in their own beds, and do not take naps past 3:00 pm.
  • We recognize that making these changes can be very challenging. If you need help with this, we can create a plan together.
• Please do not allow unrestricted access to tablets, phones, or other addictive technologies. Screen time, especially on a personal device, is detrimental to social development. If you need help to decrease technology use, we can create a plan together.
• If a client uses Augmentative and Alternative Communication (AAC) software on a tablet, this should be the only software accessed on the tablet. The client should not watch videos or play games on their AAC device.
• If your child is allowed screen time, please avoid allowing access immediately prior to or following a session. We do not want the client to associate the provider's arrival with removal of screen time, or the provider's departure with access to screen time.
• Ensure that your child gets enough sleep, exercises regularly, eats an appropriate diet, and visits a physician for medical issues. Challenging behavior occurs when these basic needs are not met. If you need help with this, we can create a plan together.

Avoid dual relationships

• Your provider's only role in your home is to facilitate the client's therapy program. We love the families we work with, but we must maintain boundaries.
• Please do not:
  • offer food, drinks, or any other items or services to your provider.
  • ask your provider to drive a client or other family member anywhere.
  • attempt to engage in a social relationship with your provider.
  • rely on your provider to entertain or keep your child quiet.
  • attempt to task your provider with childcare or housekeeping tasks such as food preparation or changing diapers (except for during toilet training that is part of the therapy program).
  • leave siblings unsupervised with your provider.
  • solicit your provider for employment (nannying, babysitting, respite, etc.).
  • apply to be employed by Patterson Behavior Services.
  • request to follow your provider's personal social media pages.
• We understand that caring for a person with special needs can be stressful. Your provider is interested in all challenges and barriers to progress as they relate to the client's therapy program. However, we must all be careful not to allow a caretaker's emotional needs to dominate session time. If necessary, your provider can help set communication boundaries and offer recommendations for individual counseling services.

Communication

• Please inform your providers of any house rules (shoes off, off-limits areas of the house, which bathroom to use, etc.).
• Please avoid criticizing your child when the child is present. It is best for the rapport between the child and provider if these conversations take place privately.
• Please speak up if you have questions about why your provider is doing something or if you are ever uncomfortable. We are happy to answer all questions and accommodate family preferences.
• You are always welcome to watch, participate, and/or ask questions during sessions.
• Keep in mind that providers are in a vulnerable position while inside of a client's home. Caregivers may not engage in disrespectful, aggressive, predatory, or inappropriate behavior toward providers or any other members of the household. This will result in an immediate discharge from services for the safety of our employees.

Therapy outside the home

• Progress generalizes more easily when skills are practiced in schools, daycares, camps, extracurriculars, social groups, etc.
• If providers cannot access these settings, please arrange for coordination with the staff who work there.
• Providers are available to complete school observations, participate in IEP meetings, conduct sessions in community programs, facilitate playdates, accompany your family on community outings, etc.

Therapy in schools and daycares

• Prior to initiating services within a school or daycare, it is recommended that our team meets with the school team. Without a conversation, school staff may misunderstand or incorrectly implement behavior plans or other written documents.
• Please see this page for information about our school-based services.

Parking in home and community settings

• It is the family's responsibility to ensure that their child's provider has somewhere to park during sessions.
• If free parking is not available, the family may choose to contact the management of the building or parking garage to request a disability accommodation for parking. This comes up most often when working with children in urban apartment buildings, condo buildings, or daycares.
• To request an accommodation, the family should reach out to a high-level manager who is likely to have knowledge of the Americans with Disabilities Act. The initial request could be something like, "My child's therapists will need access to a parking spot when they come to our apartment building to work with him. Are you able to provide access to an additional parking spot as a disability accommodation?” 
• If the accommodation is not granted, or if the family does not wish to request an accommodation, parking fees will be invoiced to the family.

Your involvement is key!

• An adult age 18 or older must be present in the assessment and treatment locations. The adult is not required to participate in the session, but must remain on the property.
• Therapy is a process that takes time and effort. Challenging behaviors will decrease as communication and social skills develop. There is no "quick fix." Please be patient and consistent. 
• You are always welcome to watch or participate. However, you are not required to watch or participate. We will give you an update on progress and challenges at the end of the session.
• Your BCBA will create a written program of readings and assignments to help you make progress outside of session times. Depending on your child's skill level, you will first read either The Verbal Behavior Approach or ABA Visualized. We recognize that some parents do not have much spare time. However, the sooner you read these, the faster your child will make progress!
• Your BCBA will work with you to create specific action plans. You should follow the plan both during and outside of scheduled session times. It will be obvious if you don't; so please ask for help if you need it!
• All caregivers who will be regularly present and providing caregiving duties during therapy sessions (grandparents, nannies, extended family members, etc.) should participate in family training with the BCBA. This is to ensure consistent responding and decrease the possibility that challenging behavior will be reinforced.
• With your consent, we are happy to train your child's other caregivers who may not be present for sessions: nannies, babysitters, grandparents, older siblings, teachers, etc.

Behavior intervention plans

• Most clients need help to replace challenging behavior with communication. To support this, do not offer bribes during episodes of challenging behavior. Instead, model calm behavior and follow the advice of your BCBA.
• Providers are trained in crisis prevention and management procedures. Please follow your provider's lead during episodes of challenging behavior so as to avoid escalation. In general, you will need to remain calm and maintain safety. Avoid talking too much, raising your voice, making sudden movements, or giving additional directions.
• For clients with a history of elopement, physical aggression, or other dangerous behavior, we may ask you to use interventions such as door alarms, gates, locks, security cameras, or removing certain objects from the home. Safety is our highest concern. We will help you create a plan to transition away from these interventions as soon as it is safe to do so.
• Implementing extinction procedures (removal of reinforcement from challenging behavior) always carries the risk of temporary increase in frequency and intensity of challenging behaviors. Full extinction procedures are not recommended until replacement behavior skills are better developed.
• Following an episode of challenging behavior, your provider will help you debrief and come up with a plan moving forward.

Injury and illness

• Providers are trained in CPR/First Aid. The exception to this is a new employee who is currently in the process of completing their initial training. 
• Providers are directed to call 911 immediately if they suspect a seizure. Some seizures may not be life-threatening, but we do not have the training to differentiate. If your child has recurrent seizures, please provide a written seizure plan.
• If your child has a history of anaphylaxis, please walk your provider through your emergency procedures, including where the EpiPen is stored. 
• If emergency medical services (EMS) arrive, providers may disclose basic identifying information and other information about how to best help your child. For example; the child's name, communication limitations, potential for aggression, preferences or phobias, etc.
• HIPAA allows for exceptions to client privacy in interactions with EMS. See this page for information about the law.

• In general, providers are discouraged from accepting gifts. If you would like to give your provider something for a holiday, a drawing or card made by the child is always appreciated!
• We recognize that our therapy programs may be one of many competing family priorities including school, extracurriculars, leisure time, and other therapies. This post was written to help families who must choose between individual therapy and school or other group-based learning opportunities. 
• We hold our clients and caregivers to a high standard in terms of out-of-session involvement and practice. This means that we are not the right fit for everybody. Let your BCBA know if you have difficulty completing your responsibilities.
• Your feedback is always welcome! Contact the owner with written feedback or to request a meeting. We also appreciate testimonials. Please let us know if you would like to submit a review or comment to be featured anonymously on our website or other marketing materials.