A mixed model in Senegal

Hello dear readers,

Today I will talk about a new change ABA Senegal has been making to how we deliver our services: The mixed model.

Since our beginning, ABA Senegal's #1 priority has been maintaining flexibility. As we our still considered to be within our pilot phase (prolonged due to COVID-19 heavily affecting the 2020 year), maintaining a high responsiveness to our families' and employees' needs has been vital in assuring that benefits are maximized for everyone. During natural transition phases, the current model is always scrutinized and modified. Adair's BCBA services have been flexible as well, crossing multiple settings, supervisory roles, and varied direct services.

As time passed, something interesting happened: Most families became centered around our immediate district, or even our small neighborhood of Ouakam in Dakar. This was not intentionally done, and may have self-selected - partially due to common transportation difficulties facing families. Hiring additionally began centering within a radius, this time intentionally done as public busses can often take much longer than anticipated to get a person from A to B (very few people have cars here in Senegal).

Below: a Senegalese car-rapide bus

As everyone was so close by, we saw an opportunity. Adair began offering to parents a mix of home services and "center" services within our small cabinet in Ouakam. Home services include parent training and/or interventionist supervision. Center sessions serve as good opportunities to get the child out of the house for a while (give them a changement d'air as they say) and see what new materials interest the child the most - to easily change toys, art supplies, etc. for the home. On other days of the week, the interventionist (if there is one) brings the child to a new, nearby park or other area. For families in the neighborhood, they all go everywhere by foot. For families with no interventionist, Adair does direct services herself up to 3 times per week, with heavier home parent involvement including coaching, usually centered on bi-directional, positive communication between parent and child.

Below: The new Ouakam park, at the base of the Monument de la Renaissance.

The benefits?

  • Less transport time for everyone

  • Best, since very few have regular access to a car, including the BCBA! More sessions can be scheduled in a day, and Adair can run over to homes quickly when needed.

  • More interventionist control over materials

  • They know the child and their preferences better than the supervisor at this point

  • The supervisor still must do the shopping, but the interventionist can choose from what is available in the therapy room themselves to bring back to the house. Easy to do before or after sessions.

  • Fewer days per week can often mean a lower cost and time commitment for families

  • More direct parent coaching opportunities

  • Coaching comes as (partial) replacement of interventionist services. Interventionist supervision and training in Senegal is very intensive. This mixed model opens up more time on the part of the supervisor for intensive parent coaching, usually in PRT First Words methods.

  • Child gains access to sensitive, child-led PRT communication methods outside of sessions, this time up to fidelity!

  • More community participation for the child

  • Children can practice using money, learn street safety basics, habituate to the outside environment, and practice social skills. Examples:

  • Stopping at the store or vendor tables for biscuits, peanuts, or yogurt on the way to park sessions.

  • Seeing and greeting neighbors (Senegalese are big on greetings!)

  • Seeing all the cars and animals in the street - Dakar has quite a lot of sheep, goats, cows, dogs, cats, and horses!

  • (Thankfully all of our current students love being out in the sensory-heavy street environment, often to the point where they don't want to go home!

  • Additional learning opportunities

  • Skills generalization

  • New language opportunities and vocabulary

Adair continues school support for some families (on a separate contract) and occasionally offers parent coaching outside of Ouakam.

The challenges

  • None for the child, save for less frequent sessions for some children

  • High parent buy-in is required

  • Not a challenge per se, but sometimes difficult as most families are working full-time, raising multiple children, overcoming transportation issues, handling school and other scheduling, and managing several household staff, all in a country where time management can often be fluid

  • For the cabinet

  • For the supervisor, less supervision flexibility for direct, non-interventionist services (can no longer easily change supervisory days week by week)

  • Smaller hiring field (though fewer staff are needed)

We believe it's worth it! More people, more places, more involvement.

Below: Walking around Ouakam

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