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 for children with autism in our neighborhood: The mixed model.

Since our beginning, ABA Senegal's #1 priority has been maintaining flexibility. As we are 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. Adair's BCBA services have been flexible as well, crossing multiple settings, supervisory roles, and varied types of direct services.

We used to give families the option of home or center therapy (as well as school services). As time passed, something interesting happened: Most families became centered around our immediate district, or even our small neighborhood in Ouakam, Dakar. This was not intentionally done - It may have been due to common transportation difficulties facing families (Dakar public transport and traffic is quite intense). But it opened up a whole new world of possibilties!

(Hiring additionally began centering within a similar radius: Busses can often take much longer than anticipated to get a person here they need to - and most people do not have cars in Senegal.)

Below: a Senegalese car-rapide bus

As everyone was so close by for the first time, we saw an opportunity. Instead of one or the other, 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 regular sessions with interventionist supervision. Center sessions serve as good opportunities to get the child out of the house for a while (give 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, staff can bring the child to a new, nearby park or other area.

For families in the neighborhood, they all go everywhere by foot. We started taking walks with the kids, and sometimes with family, too.

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 without transport time, which means MORE families accepted, and Adair can run over to homes within 10 minutes when needed. Everyone can appreciate less time in the heat, exhaust, and dust.
More interventionist control over materials
- The interventionists know the child and their preferences better than the supervisor at this point
- The supervisor still must do the shopping (No amazon or online shopping here!), but the interventionist can choose from what is available in the therapy room independently 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
- There is no insurance coverage here in Senegal - We must account for this in pricing and length/frequency of sessions. Most children do not go past 15 hours per week, and many are at 10 or parent coaching only.
More direct parent coaching opportunities
- Coaching comes as (partial) replacement of interventionist services. Interventionist supervision and training within ABA Senegal is very hands-on. This mixed model opens up more time on the part of the supervisor for parent coaching, usually in PRT First Words methods and helping out with family routines.
- Child gains access to sensitive, child-led PRT communication methods outside of sessions through their own parents - 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 famous for their frequent greetings!)
- Seeing all the cars and animals in the street - Dakar has quite a lot of sheep, goats, cows, dogs, cats, and horses to look at and comment on
- (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 additionally offers 1-2x weekly parent coaching outside of Ouakam.

Below: A family's front door in Ouakam. Coffee and mangoes sold out front by the bus stop (photo by Gary Pascoe)

The challenges

None for the child, save for less frequent sessions for some children. The routine changes are often welcomed.
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 without affecting the therapy of the child)
- Smaller hiring field (though fewer staff are needed)