CONTACT US

Enriching the Lives of Children with Autism, Inc
1401 Parkmoor Ave Suite 150
San Jose, CA 95126

email: elcainc@yahoo.com
Phone: (408) 355-4200
Fax: (408) 297-0430

If you are interested in receiving services through ELCA, we would love to hear more about you. Please submit the following form.

ABOUT YOU

Name (required)

Relationship to Child (required)

Phone (required)

Email (required)

ABOUT THE CHILD

Child's Name (required)

Parent(s) Name(s) (required)

Date of Birth

School District

Address

Diagnosis

Date of Diagnosis

Clinic

Clinician

QUESTIONS

What is your understanding of Applied Behavioral Analysis (ABA)?

What do you see as your child’s greatest strengths?

What kind of things do you feel your child needs the most work on at this time (behavior, language, academics, play, social, etc.)?

When your child isn't actively engaged, what do they do typically?

What are your short-term goals for your child (3 months)?

What are your one year goals for your child?

What services are currently in place? (ST, OT, school placement, ABA)

Have you ever had a home program? If so, with whom, for how long, and what is the purpose of this evaluation?

If your child has had a home program before, describe some of the characteristics of prior therapists that you feel were well suited for your child. (Example: prior therapist had a mellow personality and naturally calmed my child.)

ABA is a home-based intervention that requires a high level of parent involvement to be successful. Are you willing and able to be an active participant in your child’s treatment by following through with Consultant developed behavior plans, parent homework, etc.?

Is the school district or regional center funding the program? How many hours have been approved?

Is your child in school? What is the educational placement (SDC, SH, MS, etc.)? Have you seen the classroom and the other students? Do you feel it is appropriate?

Specifically, what ELCA services do you feel would best fit yours and your child's needs (if known)? (Examples: ABA Home Program, School Aide Support, Social Skills Group, Parent Training, Consultation.)

What other information do you feel would be useful?