Family Handbook 2025

Family Handbook

A history of improving the lives of children and families through a family-focused ABA approach.

Table of Contents

Introduction

5 11

Clinical Services

The Parent’s Role

24 26 34

Important Policies

Next Steps

Family Handbook 3

Introduction Hello and welcome to Butterfly Effects! Since 2018, I have been humbled and honored to be the President of Butterfly Effects. Most of my 30-year career has been dedicated to working with families and children affected by Autism Spectrum Disorder (ASD). During my professional history I have held almost every job in the field of Applied Behavior Analysis (ABA) (Behavior Technician, BCBA clinical supervisor, and business operations). Butterfly Effects has been able to attract and retain a team of committed and compassionate treatment professionals that are responsive to the individual needs of families affected by ASD. I am very proud of the services we provide as they make a meaningful difference in the lives of children and families. Since our inception in 2005 Butterfly Effects has serviced over 14,000 families. We are a national leader in ABA-based treatment and serve 12 states all supported by locally by Regional Directors and BCBAs. Our corporate office, located in Deerfield Beach, Florida, is home to our leadership team and administrative staff who assist with daily operations, including client services, human resources, talent acquisition, finance, revenue cycle management, quality assurance/compliance, professional development, treatment quality, and professional ethics. Our butterfly logo was chosen as a symbol of love, rebirth, and metamorphosis. Together, the name and logo represent our common purpose and deep commitment to helping families create lasting change through individualized ABA informed treatment.

Helping families create lasting change through individualized ABA informed treatment.

Thank you for being part of the Butterfly Effects family,

Steve Woolf, PhD., BCBA-D, LABA President

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Introduction

• Served over 15,000+ families since 2005 • 215+ BCBAs and 2,300+ Behavior Technicians • Serving 12 States and 34 markets • Services provided across multiple settings: Home, School, and ABA Centers • A family-centered service model that combines the science of behavior change with family participation • 96% parent service satisfaction rating • Services provided to toddlers, children, adolescents, and adults • Founding member of the Louisiana and National Coalition for Access to Autism Services • Professional Reputation: BE staff publish scholarly papers, invited to speak at multiple local/national ABA conferences, and participates in select committees to increase ABA quality. • Local management and support Who is Butterfly Effects?

World-class team of experts Steve Woolf President

Dr. Woolf has been working with individuals and families affected by autism spectrum disorder (ASD) for over 30 years. He is the President of Butterfly Effects, one of the largest nationwide ABA-based providers in the nation. Dr. Woolf has authored publications and regularly presents ABA research at state and national conferences. He was formerly President of MassABA, 8-year executive committee member for CTABA, and ABAI Chapter leadership coordinator. Dr. Woolf’s specialty area is managing large-scale service delivery operations to increase access to evidence-based services for families affected by ASD. He served on the Massachusetts State Licensure Board and was the 2018 recipient of the MassABA outstanding contributions award.

Molly McGinnis VP of Clinical Services & Practice Development

Molly McGinnis joined Butterfly Effects in April 2018 as the Vice President of Clinical Services and Practice Development. She has been a practicing BCBA for over 12 years. Molly oversees the day- to-day operations of all center and field-based programs as well as focuses on the delivery of high-quality family-centered services. She is frequent speaker at ABA conferences.

Our mission is to make socially meaningful change in the lives of children and families.

Founded in 2005

Over 215 BCBAs trained in the BE way

Operational in 12 states

Local management to support families

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We understand the importance of the role the family plays in a child’s life. We listen and collaborate to identify goals that are meaningful to each family.

Introduction Multi-level support to meet family & staff needs

Butterfly Effects has a multi-level support structure. You may not always meet everyone on your care team, but rest assured there’s a group of highly- qualified individuals who work behind the scenes to ensure we maintain the highest standard of customer care. Our Talent Acquisition team searches the nation to select the most qualified team members available. Our professional development department provides up to 60 hours of training prior to a behavior technician working with a family. Your treatment team are managed by our local Regional Directors (RDs). These RDs have extensive clinical and operational experience to support local families and the treatment team.

Client Experience Department

Regional Director

Quality Assurance & Compliance

Senior RD

BCBA

Human Resource Department

VP Clinical

RBT

Professional Development

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Introduction Butterfly Effects relies on six treatment principles 1. Services are individualized

Clinical services

Butterfly Effects clinicians review all aspects of your child’s treatment plan often. Updates are made as needed based on the family’s priorities for treatment as well as the data that is completed each session.

2. Butterfly Effects learns from the family Services are planned in partnership with you and your family throughout treatment. It is important that BE clinicians are always partnering with the family to develop the treatment plan that best supports your needs and priorities. Trust and rapport is key for Butterfly Effects to provide the best services to your family.

3. Teaching essential skills Butterfly Effects teaches developmentally appropriate, essential skills that are needed for future learning, such as:

What is ABA?

Imitation

Waiting

Functional communication

Cooperation Social skills Safety skills

Applied Behavior Analysis (ABA) is recognized by the Academy of Pediatrics and Surgeon General as the most effective treatment available for individuals affected by autism spectrum disorder (ASD). ABA is the science of understanding and improving human behavior. ABA focuses on behaviors that are important to each client, family, & their community and uses research-based strategies to modify behavior. Behaviors targeted for improvement are clearly defined, measured, and regularly evaluated to determine if the ABA-based strategies are effective in meeting treatment goals.

Attention Tolerance

4. Teach where services are most needed Clinicians partner with families to teach in natural settings. Work with your clinical team to determine where services should be occurring based on the needs of your child and family: Home, center, school, or other community locations such as the park, grocery store, or local restaurant. 5. YOU are your child’s BEST teacher You are your child’s most constant teacher across their lifetime. BE clinicians focus on empowering the family by encouraging participation in treatment sessions and also through family coaching sessions. 6. Collaboration of care with all team members Butterfly Effects communicates with the child’s entire care team including physicians, other therapists, teachers, additional family members, etc. We understand that it is important to collaborate to create and teach the most meaningful goals that most benefit the child and family.

Research Comprehensive ABA treatment

Treatment addresses a wide range of skill deficits across multiple affected developmental domains, such as cognitive, communication, social, emotional, and adaptive functioning. Maladaptive behaviors, such as noncompliance, tantrums, and stereotypes are also typically addressed through treatment. Comprehensive ABA treatment is typically provided for a higher number of hours each week (approximately 30-40 hours per week). Focused ABA treatment Treatment addresses a narrow range of skill deficits and behavioral targets (e.g., challenging behavior, coping skills, and communication) and are provided for a lower number of hours each week (up to 20 hours per week).Treatment addresses a limited number of key functional skills and acute problem behavior, ensure that the participant’s caregivers are able to maintain progress through caregiver training, then ABA supports are faded out.

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Clinical services ABA teaches through small steps

Clinical services How does the ABA process work?

ABA teaches children by breaking down complex tasks into small and discrete instructional steps. These small steps build on each other toward mastering a more complex goal.

Understanding how the ABA process works allows your family to maximize treatment outcomes. Below are the major steps involved in delivery of ABA services.

ABA programming focuses on: • Replacing problem behavior with a socially acceptable behavior

What happens during the initial assessment? • We get to know your child and family • The family’s concerns are identified • Formal assessment, parent interview, and observation of the child and family occur • Information obtained during the Initial Assessment allows the BCBA to write the Treatment Plan which outlines specific goals to be taught through the delivery of ABA services • The BCBA reviews the Treatment Plan with the family, answers any questions, and obtains consent for services What is a treatment plan? A treatment plan is an important (and required) document that outlines relevant information about your child and the goals that have been identified and agreed upon by your child’s Care Team. Treatment plans include information such as: • Medical and background information about the child and family • Why ABA services are needed (e.g. medically necessary) • Goals related to the core deficits of ASD (including how goals will be taught and generalized) • Functional Behavior Assessment and Behavior Intervention Plan (if appropriate) • Coordination with other care team members (e.g. School teacher, Speech Therapist, Physician) • Caregiver Involvement • Transition and Discharge Plan • Recommendation for service intensity

• Teaching functional communication skills • Developing age-appropriate social skills • Teaching adaptive skills needed for daily living

Variables in determining service intensity include: • Child’s age • Child’s individual learning needs • How many hours the family can support each week (given other siblings, family schedule, etc.) • Number of services hours conducted by non-ABA providers (e.g. speech, OT, PT) • Parent/Caretakers’ goals for their child • Number of service hours that will maximize the child’s treatment outcomes while maintaining a high quality of life for the child and family (e.g. balance)

Research supports that children affected by ASD have the best outcomes when services are greater than 20 hours per week. However, rather than focus solely on the quantity , Butterfly Effects focuses on the quality of the service. We believe the weekly number of treatment hours should be individualized per family.

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Clinical services

Who makes up my ABA team? Clinical services

Who is Butterfly Effects?

Starting ABA services can be a very confusing time. All services must start with a service approval from your health insurance provider. The process from obtaining an initial assessment to ABA treatment may take up to 45 days. The best outcome research tells us that ABA therapy as early in a child’s development as possible and provide an enough regular treatment hours to produce improvement. The graphic below shows the treatment process form initial assessment to discharge.

Senior Regional Director (SRD) • Organizes and grows entire regions. • Responsible for overseeing and supporting a team of regional directors. • Provides guidance and consultation to assigned field team members when needed. Regional Director (RD) • Responsible for the overall clinical performance, operation and development of assigned region. • Ensures quality care, appropriate staffing, as well as clinical oversight of all cases. Board Certified Behavior Analyst (BCBA) • Responsible for the design and implementation of individualized behavior treatment programs for clients. • Conducts assessments, develops treatment plans, monitors treatment progress, makes program updates, conducts caregiver training, and provides evidence-based treatment to improve a client’s personal independence. • Supervises behavior technicians (BT’s) to ensure all treatment goals are being targeted appropriately and ethically according to the Behavior Analyst Certification Board (BACB). • Provides guidance to team members in establishing programs, as well as train and mentor the team members. Mid-Level Supervisor (CA Only) • Coordinates with the BCBA complete assessments, supervise BTs, develop the treatment goals, and design treatment programs to meet the goals of families. • Partners with the family unit to implement treatment plans, training, and opportunities in the school, home, and community setting to advance the goals prioritized. Registered Behavior Technician (RBT)/Behavior Technician (BT)/ Paraprofessional (CA) • Implements the individualized treatment goals and behavior programming in a child’s home, school, or other natural environment. Teaches new behavioral, social and daily living skills under the direction of a Board Certified Behavior Analyst (BCBA). • Effectively responds to and minimizes difficult or disruptive behaviors, creating a fun, motivating experience to generate the highest level of performance for every individual. • Collects data on programming targets, tracks progress and provides support to parents, teachers, and caregivers.

Initial/subsequent assessment

Insurance approval

Ongoing treatment plan updates & data analysis

Work toward transition planning & discharge

Treatment plan

Direct services

Why does my child need an assessment before receiving ABA services? Understanding the initial steps in the ABA process allows your family to maximize on treatment outcomes. Your collaboration with your BCBA during the initial assessment and development of the treatment plan will ensure your priorities are being incorporated into your child’s ABA treatment. Healthcare providers also require an assesment to authorize ABA treatment.

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Clinical services

What is the BCBA’s role? The BCBA will oversee the Mid-Level and Behavior Technician (BT) to ensure that the goals in the treatment plan are carried out accurately to ensure progress for your child. • BCBAs will conduct protocol modification each month with the technician for 5% of BT service hours in the settings that your child receives services (you will typically see your BCBA 1-2 times per month). • During protocol modification, the BCBA will observe your child & BTs interactions, review data that has been collected, analyze how much progress your child has made since the last protocol modification and work with your family to address any concerns. • Additionally, the BCBA will support the family in practicing new skills that your child has learned and incorporate these skills into your family’s daily routines. What is the Mid-Level’s role? The Mid-Level works under the guidance and direction of the BCBA to oversee the BT, review and analyze data, address family concerns, and support the family in practicing and incorporating new skills. • Mid-Levels will conduct protocol modification for 10-15% of BT provided services hours (typically, you will see your Mid-Level 3-4 times a month). California Families: The clinical team in some sections of California may include a Mid-level and BCBA Clinical services

Who will be working with my child? Behavior Technicians and Registered Behavior Technicians Behavior technicians are responsible for providing the majority of your child’s services. • The BT must complete 40 hours of training and pass a competency-based exam prior to working with children affected by ASD. • BTs are trained to implement the goals in the treatment plan and will play a major role in helping your child learn new skills. • The BT will assist your child with day-to-day activities, monitor their behavior, record and collect data on progress, and communicate questions or concerns What is the BCBA’s role? The BCBA will complete Protocol Modification during session with the Behavior Technician (BT) and ensure that the goals in the treatment plan are carried out accurately to ensure progress for the child. • BCBAs will conduct protocol modification each month with the technician in the settings that your child receives services. • During protocol modification, the BCBA will observe your child & BTs interactions, review data that has been collected, analyze how much progress your child has made since the last supervision, and work with your family to address any concerns. • The BCBA will schedule monthly caregiver training meetings to review your top concerns, train on ABA skills to use outside of session and help to increase the family’s overall wellbeing by providing needed behavior supports. • Additionally, the BCBA will be your primary point of contact to address questions regarding your child’s progress, new goals, and guidance for implementing ABA skills outside of session. Your BCBA is here to provide ongoing support and insight for anything related to your child’s ABA therapy.

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Clinical services

Hiring staff to work with families Butterfly Effects wants to ensure that we are sending the best clinicians to work with your child. We do this first during onboarding by completing comprehensive background checks. All clinicians are required to complete a comprehensive training upon hire regarding clinical standards, safety protocols, and BE procedures and are refreshed on these on an ongoing basis. Butterfly Effects BCBAs also attend a monthly Professional Speaker Series and monthly company-wide clinical case meetings so that they remain most up-to-date on how to best serve families. Additionally, all Butterfly Effects clinicians are required to adhere to the Behavior Analyst Certification Board (BACB) Code of Conduct and Butterfly Effects’ Employee Disciplinary Standards, ensuring the highest level of professional integrity and service quality.

How are staff trained?

How are technicians trained? • BE’s behavior technicians (BTs) receive a combination of 40 hours of web-based training and two live trainings with their mentor. • BT Training was developed by behavior analysts to meet the BACB RBT requirements. BTs are supported by company trainers, called Mentors. All training is supervised by BE’s Professional Development Department. • BTs graduate training by completing a comprehensive final exam on our online training platform as well as passing an in-person competency assessment. • All new behavior technicians receive an additional 6-hours of web-based training on Butterfly Effects Core training material, as well as ongoing direct oversight and training conducted by their supervising BCBA. How are BCBAs trained? Our Board Certified Behavior Analysts (BCBAs) join Butterfly Effects with a minimum of a Master’s degree and successful completion of the national board (BCBA) exam. Beyond their initial qualifications and field experience, we recognize the importance of continuous learning and growth. As such, we dedicate ourselves to ongoing education! A BCBA’s initial weeks at BE encompass both asynchronous and synchronous online training, in person hands on training, and ongoing training each week as they meet with their direct supervisors, who are also BCBAs. In addition, BCBAs also participate in monthly meetings to provide regular and ongoing opportunities for guidance and learning.

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Clinical services

What does a session look like? • At the start of each session, the BT will check in with the family and obtain an update on how your child is doing on that particular day (i.e., are there any new reports from school, or any new behavioral concerns), and work with the family to identify primary goals for the day’s session. • The BT will work on goals from the treatment plan in a fun and interactive way prioritizing your child’s engagement throughout session. • The BT will create learning opportunities for family participation throughout the session. Parent participation in session is crucial in helping your child generalize what they learn for life-long success. • The BT will collect data and take notes throughout session, which will assist the BCBA in making any needed changes to the treatment plan to better assist your child in learning new skills. • At the end the session, the BT will clean up session materials, complete a session note for insurance reporting and documentation purposes, and ask you to sign their timesheet. • The BT will speak with you briefly prior to leaving. They will summarize the highlights of the day’s session, any progress made towards goals and confirm the next scheduled session date and time. • Teaching new skills can best occur during everyday experiences and activities, such as playtime, mealtime and bath time. • You and your BCBA will collaborate to determine the most challenging parts of your child’s day and discuss areas for growth. • This information will be used to inform the development of goals and the most natural opportunities to target them. • This table is an example of a daily lesson plan, or session structure.

Where can sessions occur? Families may have a variety of options when deciding where they will receive ABA services. • Service settings may include home, school, childcare, clinic, or community locations. • Staff may provide services in the community if specified in the child’s treatment plan. • Butterfly Effects does not transport children in personal staff vehicles.

How can I see my child’s progress? As a client of Butterfly Effects, you will have access to CentralReach, a secure online platform to use to track your child’s progress. Using CentralReach, you can access behavioral plans, assessment results, intervention instructions, therapy session notes, and much more, 24 hours a day, 7 days a week. • Portal allows families to access their child’s progress at any time. • BCBAs can monitor data from anywhere, anytime, which supports regular and ongoing treatment programming to maximize outcomes. • CentralReach can also be used as a tool to collaborate with other providers, caregivers, and family members on your child’s ABA therapy treatment program and progress. You will receive Central Reach login information from our Client Services Department upon start of care with Butterfly Effects.

Time

Goals

• Social interaction (play with sibling rather than play alone) • Appropriate behavior with sibling • Turn taking

Intervention

Baseline

Intervention

Baseline

4:00 - 4:30 | Outside/Play time

10 20 30 40 50 60 70 80 90 100

• •

Hand washing task analysis

4:30 - 5:00 | Dinner Prep

Setting the table

• • •

Using utensils appropriately Using a napkin during mealtime Eating with mouth closed

5:00 - 5:30 | Dinner time

• •

Loading dishwasher Game with sibling

5:30 - 6:00 | Clean up, leisure time

• • •

Putting on pajamas independently

3 4 5 6 7 8 9 1011121314151617

6:00 - 6:30 | Bedtime routine

Toothbrushing

Toileting

Sessions

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Clinical services What happens if my child does not make progress? At Butterfly Effects, we understand that every child’s journey is unique, and our goal is to ensure each child receives the individualized support they need to succeed. Recognizing that every child’s timeline for mastering skills varies, we acknowledge that progress may look different from one child to another. If you feel that your child is not making progress, please communicate your concerns with your BCBA. We will take the following steps to address your concerns: • Review Programs: Conduct a thorough review of your child’s current programs and identify any barriers or challenges. • Team Collaboration: Our clinical team will collaborate during a high-risk meeting to brainstorm and implement new strategies. • Parent Involvement: Your insights are invaluable. We will schedule a meeting to discuss your concerns, review our high-risk findings, and outline potential changes to your child’s therapy plan.

Clinical services

When is the treatment plan updated? Most insurance companies require a new authorization for ABA services every 6 months. This is an opportune moment for the BCBA to reevaluate your child, allowing for the collection of comparative data since their last assessment, and to review the continued priorities of the family for ongoing services. Based on the reassessment and analysis of your child’s goals, the treatment plan is formally updated to reflect current information. This updated treatment plan will display progress the child is making and areas that may need to be addressed more specifically. As noted in Butterfly Effects Treatment Philosophy, caregivers are a key component to this process. Will my child “graduate” from ABA? The ultimate goal of ABA is to teach a child skills to live a high quality of life with as much independence as possible. Transition & discharge criteria will be discussed at least every six months (i.e. during treatment plan updates). All members of your child’s care team should understand how and when ABA services will be decreased and discontinued. When data and treatment priorities indicate that your child is meeting criteria to successfully begin systematically decreasing ABA services, the BCBA will work with your family and other care providers to ensure proper generalization of skills in preparation for transition/discharge. The BCBA will continue to provide support and require caregiver participation until the last session to ensure a smooth transition out of services.

Office (888) 880-9244 Fax (844) 364-1272 ButterflyEffects.com

Will Butterfly Effects collaborate with other providers on my child’s care team? Yes! With your consent, your BCBA will regularly share important information regarding your child’s progress with other care team members. One of the ways that we do this is by creating a Care Coordination Summary Report, which is shared with participating providers and care team members at each 6- month treatment plan. Butterfly Effects developed this innovative and individualized method to easily update team members on mutual clients’ progress.

Care Coordination Report Maintaining regular communication with our community partners is a key part of the Butterfly Effects pro - tocol. Our bi-annual Care Coordination Report allows us to keep medical professionals informed of their patient’s progress throughout the ABA treatment process. If you have questions regarding your patient’s progress, please contact your BCBA partner directly.

Patient Information Name

DOB

Parent/Guardian

Diagnosis

Domain Area

Progress

BCBA Comments

☐ Limited progress ☐ Steady progress ☐ Exceeding expectations

Communication

☐ Limited progress ☐ Steady progress ☐ Exceeding expectations

Social

☐ Limited progress ☐ Steady progress ☐ Exceeding expectations

Behavioral

BCBA Information Name:

Date:

Email:

Phone:

Have a new patient to refer? We make it easy! Simply call (888) 880-9244 or visit ButterflyEffects.com to submit a HIPAA compliant referral.

Openings now available for new patients!

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What is my role as a parent? The Parent’s Role

Parent Participation The ideal in-home ABA services emphasize extensive, high-quality parent participation during sessions. We expect the same level of active parent involvement in other environments as well. To ensure parents are successful in the teaching process, our team starts with smaller, previously mastered goals, allowing parents to leave the interaction confident in their ability to promote behavior change in their child. Our caregiver education practices include modeling, rehearsal, and feedback. These valuable opportunities to observe and practice teaching new skills to your child will support sustained behavior change. Parent’s Role Butterfly Effects understands the important role a family plays in a young child’s life as they are the constant and most important teachers. We individualize strategies based on the strengths and needs of families to empower caregivers to confidently carry over our recommendations outside of sessions, and after services have ended. Butterfly Effects uses capacity-building practices in caregiver coaching. Although our behavior technicians provide most direct services, family involvement is a major variable in meeting goals. Remember-your family spends the most amount of time with your child, therefore, it is important to remember that services do not begin and end with our presence; services are most effective when the family is able to continue the work outside of session. What will I be doing during a session? You may start services in the role of a cheerleader, where your child works to earn praise, affection, & attention from you. We request that parents observe and participate in at least 40% of all sessions. Once your child learns a new skills with BT, you will be asked to actively participate in session to ensure that your child can generalize the newly acquired skills to a new person (i.e. you!). Your BCBA may ask you to play the role of a data collector during times outside of session, to gain more insight to any problem behaviors your child may be exhibiting outside of the session. Parents are expected to participate in at least 1 hour of parent education per monthly. The frequency of parent education will be agreed upon prior to services starting by the BCBA & the family. During parent education sessions, your BCBA will provide active coaching using strategies that have been found to be very effective with your child. Remember-your family spends the most amount of time with your child, therefore, it is important to remember that services do not begin and end with our presence; services are most effective when the family is able to continue the work outside of session.

Parent Responsibilities To maximize your child’s treatment outcomes, it is strongly recommended that caregiver(s) will: • Be physically within 25 feet of your child during sessions (*BE requirement) • Make best efforts to limit session cancellations • Participate in the sessions at least 40% of the time. • Make best efforts to limit session cancellations and providing 24 hours notification • Plan at least one hour of parent training with your BCBA • Provide a designated safe and comfortable work area for sessions, free of obvious distractions • Be actively involved in goal development, parent education, communication related to progress, treatment plan updates and steps toward transition/discharge planning. • Have regular touchpoints and communication with your BCBA

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Important Policies Billing & insurance information

Important Policies

Butterfly Effects uses an electronic billing system within Central Reach. Invoices will be emailed to the designated email approximately every 3-4 weeks. The designated email associated with your child’s account will include an invoice number and details of charges that have been billed. A web link will be sent to you that will direct you to BE’s secure portal. This portal allows you to review invoice information and make secure payments. Should your insurance or benefit coverage change, please immediately notify Butterfly Effects billing department at (888) 880-9270, press 1. Please provide a copy of your new insurance information as well as the date in which the plan will change. Failure to communicate changes in insurance will result in the full balance of charges becoming the client’s responsibility during the transition of coverage.

Important policies

Family & client rights policy

Butterfly Effects strives to provide the best clinical services possible, while maintaining client and staff safety and satisfaction. Our policies are designed to improve treatment outcomes, staff retention, and family and staff satisfaction; as well as ensure adherence to ethical guidelines. If you would like additional information about any of these policies, please contact your BCBA or the Quality Assurance Department at qualityassurance@butterflyeffects.com.

Butterfly Effects Butterfly Effects is dedicated to helping children achieve their full potential in family, community, and school life. It is the goal of Butterfly Effects intentions to support a treatment setting which free from coercion, fosters self-respect, self-esteem, and encourages growth to the best of everyone’s ability. Butterfly Effects adheres to the following policy on client rights:

• Child & family rights • Professionalism • Attendance (includes scheduling, sick, & medical info)

• To be treated with respect and compassion. • Provide competent care teams. • Allow freedom of movement. • Provide the least intrusive form of treatment

• Mandated Reporting • Video & surveillance • Grievance procedures • Ethics hotline

• Professional approach when responding to inappropriate or dangerous behavior. • Receive relevant information regarding the individuals’ providing services • Personal freedom and expression in areas such as personal appearance, participation in social activities, and access to community resources. • Consent and explanation of the treatment program. • Formal system to communicate grievances to the corporate leadership at Butterfly Effects • Receive services in a manner free from abuse, retaliation, humiliation, neglect and financial or other exploitation • Services that are sensitive to culture, disability, age, gender, sexual orientation, race, cultural or religious preference, health status and physical ability • Receive relevant information regarding the individuals’ providing services

Making socially meaningful change in the lives of families.

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Important Policies Professional policy

Important policies

Butterfly Effects strives to develop professional, positive working relationships with all families. Staff are required to adhere to a specific set of professionalism and attendance requirements, and we ask that families support a positive working relationship by:

• Showing kindness and respect • Maintaining session appointments as scheduled • Maintaining professional boundaries (i.e. limiting discussion of personal topics, refrain from purchasing gifts) • Providing a clean, safe working area for therapy • Dressing appropriately • Active involvement in goals targeting activities of daily living such as toileting and dressing. Staff are not permitted to be in the bathroom with children without an adult.

Attendance Policy High rates of treatment session cancellations have negative effects on children, families, and service providers. Schedules are developed based on service hours recommended and mutually agreed upon accommodations between the clinical team and family. Both families and staff are expected to maintain consistent attendance to scheduled sessions. Butterfly Effects monitors the number of treatment sessions canceled by families and staff. To maintain high quality, evidence-based treatment for families affected by ASD, Butterfly Effects has employed the following Attendance Policy. Families must maintain 80% of scheduled sessions to avoid being discharged for not complying with the agreed upon treatment schedule. Families will be sent written warnings paired with verbal exchanges in situations where cancellations exceed 20% per month. These warnings offer an opportunity to make changes to the current treatment schedule while maintaining the clinically recommended treatment hours. If further cancellations continue, your child may be discharged from service. Cancellations that occur within one hour prior to the start of the ABA session will be defined as a “late” cancellation, and will prompt a letter notice after each instance. Instances where a family/caregiver is not at home or on site within 15 minutes of the start of session time, and subsequently prompts Butterfly Effects staff to leave, will also be considered as a late cancellation. The third notice will alert the family that an additional late cancellation or No-Call/No-Show will result in immediate discharge in accordance with payer requirements. A family is allowed only three (3) No-Call/No-Show or late cancellations during a 12-month period.

If you ever feel that your questions or concerns are not being answered, you can always contact your BCBA, Regional Director, Senior Regional Director, or Quality Assurance Department at any time.

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Important Policies

Important policies

Grievance policy Butterfly Effects defines a grievance as a written complaint or objection related to their services that cannot be promptly resolved at the point of service or is raised after the initial care. Grievance forms are available at butterflyeffects.com/grievance. Staff members must escalate any grievance, whether verbal or written, to the Quality Assurance Department or President within 24 hours. Grievances are reviewed and documented within two business days, and Butterfly Effects may conduct a formal internal review. Grievances or potential ethical violations that warrant further review will be escalated to BE’s Ethics Committee as deemed necessary. The individual reporting the grievance will be informed of the outcome within 15 business days, either verbally or in writing. If external review is necessary, the Leadership team will make appropriate referrals to entities such as the Behavior Analyst Certification Board, state and federal agencies, or legal representatives. Grievances are tracked and reviewed annually to identify trends and opportunities for performance improvement, with the Professional Development Department using this information to develop relevant staff training. The formal grievance process ensures a fair hearing for conflict resolution and can address issues related to care coordination, treatment quality, staffing, professionalism, communication, or billing concerns. Ethics Hotline Policy The Ethics Hotline Policy at BE gives families and staff a safe, confidential way to report concerns about possible violations of company policies, ethical standards, or laws. Reports can be made anonymously through a secure hotline or website. BE ensures that anyone who reports in good faith is protected from retaliation. Concerns may include billing issues, policy violations, or other ethical matters. All reports are carefully reviewed, escalated to BE’s Ethics Committee as necessary, and appropriate actions are taken as deemed necessary. The hotline is available 24/7 at SAFEHOTLINE.COM or 1-855-662-7233, providing a simple way to voice concerns and help maintain ethical clinical practices. Discharge policy Clients and families may be discharged based on the professional discretion of the company. A client discharge may be based on, but not limited to, the following: a client is no longer benefiting from treatment, a situation has occurred in the treatment setting that has severely compromised the therapeutic relationship or treatment outcomes, the treatment is judged to be dangerous to staff, the client is no longer eligible for services, the client may be harmed by continued treatment, the client service delivery cannot be effectively staffed, or the client’s needs fall outside the scope of practice of the assigned BCBA. All efforts will be made to facilitate an appropriate and timely discharge (i.e., a minimum of 45-90 days). Butterfly Effects reserves the right to an immediate discharge of a client should extreme events occur that jeopardize the safety and well-being of a treatment staff.

Mandated reporting policy Children with disabilities are at least three times more likely to be abused or neglected than their peers without disabilities (Jones et al., 2012). Therefore, it is vital that your child learn skills that will allow them to protect themselves and communicate if they are ever in an unsafe situation. Similarly, it is essential that BE staff are trained on how to respond to situations in which abuse or neglect may be Occurring. Who is a Mandated Reporter? A person who, because of his or her profession, is legally required to report any known or suspected instances of child abuse or neglect to relevant authorities. All Butterfly Effects’ staff are considered mandated reporters. Should one of our staff witness any incident that they believe to meet the requirements for reporting, staff have been trained to contact the appropriate local authority to further discuss the concern. Video surveillance policy Butterfly Effects permits real-time video surveillance monitoring of staff in the family’s home. However, families must inform and obtain permission from the BCBA and Behavior Technician that video surveillance monitoring is occurring. Families are not permitted to video record or take pictures of BE staff. In some states, video recording a person without their consent is illegal. If families notice any questionable staff behavior through video surveillance, they agree to use the Butterfly Effects grievance process (discussed on next page) to initiate an internal company review. Hands-on/restraint policy Butterfly Effects (BE) adheres to a strict zero tolerance policy in relation to the use of any form of physical punishment/restraint. At no time are BE staff members approved to use any form of physical management/restraint unless the following criteria has been met: • There is imminent risk of serious harm to the individual or someone else. • There must be no other practical way to prevent the harm without the use of physical management. • The risk of not intervening must be greater than the risk of intervening. If physical restraint/management is used in this type of emergency an incident form should be completed and notice must be provided to the Regional Director and Senior Regional Director within 24 hours of the incident. BE provides specialized training in the event hands-on procedures are needed on a planned basis. These services must be requested by the cases assigned BCBA.

Diversity, Equity, Inclusivity, and Belonging (DEIB)

Our Diversity, Equity, Inclusivity, and Belonging (DEIB) mission is to explore, understand, and cultivate means to empower Butterfly Effects staff to create an inclusive environment that promotes and embraces diversity, equality, and belonging to all. By empowering our staff to foster a culture of respect, belonging, and understanding, we create an environment where every voice is heard and every perspective matters.

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We are dedicated to fostering lasting change through a family-centric applied behavior analysis (ABA) approach tailored to meet the unique needs of each child , promoting their independence, and supporting their families every step of the way.

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Next Steps