Maine’s RUBI Pilot Expands Access to Meaningful Autism Care Throughout the State 

Introduction

Parents and caregivers bring the deepest understanding of their child’s needs, patterns and daily life. Yet, they are not often trained on strategies that can help defuse difficult moments with a child who has autism or other intellectual or developmental disabilities (I/DD) – the moments that can transform behavior and confidence.

Support for children with autism and other I/DDs starts with parents’ awareness of the child’s skill building needs. Getting help for families via treatment is not simply handed over to treatment providers and shouldn’t stop when a treatment session ends. Parents working with daily routines represent opportunities to foster progress and are essential to the entire process.

The Challenge

Maine’s Section 28 program allows behavioral health professionals to spend about 12 hours weekly working directly with a child to build communication, daily living and social skills, and address challenging behaviors as they implement an individualized treatment plan. That treatment plan is created by a team of parents/caregivers, social workers, counselors and clinicians based on experience, data, existing diagnostic evaluations, functional assessments, comprehensive assessments and meetings. But in the practical, day-to-day service delivery, where the behavioral health professional works with the child up to 3 or 4 days a week for several hours each session, there was little formal opportunity to teach parents/caregivers to use behavioral strategies.

Behavioral health professionals in Maine do not have the required training under Section 28 to work with parents, meaning parents were not being taught the essential skills to help their child change behaviors or build routines.

That caused a gap. Parents and caregivers guide the routines and relationships that fill the rest of the child’s week when the behavioral health professionals weren’t there. Still, they had no structured way to understand why a behavior was happening, identify what their child might need, create target behavior goals or draw on helpful strategies. Without direct parent training and involvement, the behavioral health professional does not have the context of the child’s daily issues with certain behaviors.

A RUBI pilot program, supported by Catalight, offered the opportunity Maine needed to effectively reach children and families in the prevention and early intervention stages. RUBI is an evidence-based, parent-mediated program that helps caregivers understand why challenging behaviors occur and teaches them practical strategies to support communication, daily living skills and participation at home and in the community. Delivered through 11 structured sessions, RUBI brings clinical guidance together with caregivers’ knowledge of their child, helping families prevent difficulties, teach new skills and respond more effectively when challenges arise. RUBI, in complement to Section 28, gives parents tools to succeed while preventing that feeling of isolation in parenting.

The Solution

With RUBI training, behavioral health professionals are able to work directly with families as a unit.

“RUBI bridged that gap perfectly,” said Caitlin Carson-Gabriel, executive director of 10 Forward LLC, a Maine Section 28 provider. “It makes a world of difference for the family and the child.”

Carson-Gabriel’s organization entered a pilot in partnership with Catalight where RUBI was delivered to 20 families at her site.

“It represented the valuable opportunity for parents to learn the skills to help their child learn and practice, to reduce disruptive behaviors, and to build the bond with the child, as well as to have the behavioral health professional reinforce the parents’ role and to promote respect and happier compliance where goals are reached and lives are improved,” she said. “The parents were central to the child’s progress and family lives were changed slowly and with understanding that a child with special needs learns life skills at a different, sometimes special, pace.”

The total Maine rollout trained 399 providers at the introductory level, with 28 completing advanced RUBI certification. Seventeen pilot sites enrolled 165 families, creating a community-based pathway that could reach families across a geographically dispersed state.

Karen Bearss, Ph.D., vice president of caregiver-mediated solutions at Catalight and a leader in RUBI’s development and dissemination, describes the model as a partnership between two kinds of expertise.

“There’s more than one expert in the therapy room,” Bearss said. “The provider brings clinical knowledge, while the family brings expertise in their child, priorities and daily life. Together, they co-create a plan designed around outcomes that matter to the family.”

The Outcomes

The results ended up being significant for existing Section 28 client families.

Across studies examining RUBI’s efficacy, caregivers report high satisfaction, reduced parenting stress and less caregiver strain. Children experience a roughly 50% reduction in challenging behaviors, along with gains in adaptive skills such as dressing, teeth brushing, bathing and participating more independently in family and community routines.

In the Maine pilot,

• 88% of parents completed the program
• 90% reported using RUBI strategies much or most of the time
• 93% said they would recommend RUBI to another parent
• 79% reported a reduction in their child’s challenging behaviors
• 90% reported greater confidence managing challenging behaviors
• 40% total reduction in parent-reported challenging behaviors, on average

The numbers were reflected in daily life. Carson-Gabriel described a father who previously had to leave a restaurant within five minutes because his child became disruptive. After RUBI, the family remained for more than 30 minutes, and the child stayed regulated and engaged.

Caregivers also became better able to recognize that behavior is communication. They learned how to discern what behavior was saying, what the child was seeking by how they were acting, to test strategies and adjust when an approach did not work. It empowered parents to build skills that help their child and reduced a unfounded sense of shame that they were not good parents. Carson-Gabriel observed improvements in routines, communication, participation in daily activities and the bond between caregivers and children.

Significant outcomes in the implementation of RUBI Parent Training for Disruptive Behaviors:

• Parents gained skills and confidence to help their children improve
• Parents became regularly more engaged in the child’s positive behaviors and development, thereby building a better relationship with the child
• Parents could identify when progress became static and, through resilience built by the RUBI program, were able to try new strategies and get back on track instead of spiraling down
• The number of care hours needed were greatly reduced over time as skills were gained and goals were met
• Greatly increased parental independence

While some RUBI/Section 28 families did not see the need to continue Section 28, others found they could reduce the hours or participate in group support activities to continue to build their skills with the occasional touch base with a RUBI trainer. It has helped Maine meet a critical need where services can be sparse due to rural geographies and a shortage of behavioral health professionals, all while lowering costs and providing better outcomes.

Conclusion 

Maine’s experience demonstrates that a structured, lower-intensity intervention can be taught to a broad cross-section of the workforce and delivered with measurable benefits for families.

It also points out what is needed for lasting scale. Carson-Gabriel noted that reimbursement limitations still make it difficult to provide RUBI formally through Section 28 services. Sustainable expansion will require payment models that recognize caregiver training, ongoing implementation support and flexible delivery options for families facing geographic, financial or scheduling barriers.

RUBI gives families more than strategies for responding to difficult moments. It helps caregivers understand their child, prevent challenges and build routines that support greater confidence, participation and wellbeing.