Inside Cardinal’s In-Clinic ABA Therapy Services

Inside Cardinal’s In-Clinic ABA Therapy Services

Our BCBA Alice Okamoto walks through a day in our ABA clinics, what a clinic can do that home can't, and why it isn't daycare.
October 20, 2026
 
6 min read
Dr. Mike Henderson
Regional Operations Director @ Cardinal Pediatric Therapies
Mike Henderson, PhD, LBA, BCBA-D, is the Regional Operations Director at Cardinal Pediatric Therapies. With over two decades of experience in behavior analysis and organizational leadership, he focuses on mentoring teams and fostering a culture of collaboration, growth, and excellence in client care.
In conversation with
Alice
MA, BCBA, LBA, Chief of Staff @ Cardinal Pediatric Therapies
Alice has spent more than six years at Cardinal, supervising behavior analyst trainees and working with families as a whole unit. She first worked with ABA as a teenager, supporting twins with autism at home and later at school.
In-Clinic ABA Therapy Services

In-clinic ABA therapy services give your child a predictable day in a space set up for learning.

There’s a daily schedule, a fun start with their therapist, focused time on goals, and social practice like group games and lunch with other kids. And it’s a medically indicated, insurance-funded service. Not daycare.

Alice Okamoto, a BCBA and Cardinal’s Chief of Staff, explains how Cardinal’s clinics work and answers the worry parents bring up most.

Key takeaways

  • Lunch and group games are part of the therapy, not a break from it.
  • Clinic rooms get set up around what each child is working on.
  • For some kids, that structure means picking up new skills faster.
  • Peers and other adults in the clinic help new skills carry over to everyday life.
  • Every hour works toward goals in your child’s plan, which is what makes it therapy and not daycare.

Clinic or Home: Where Families Start

Maybe you’ve booked a clinic tour and you’re still reading up on in-home ABA therapy. Totally normal. Cardinal offers both as part of its ABA therapy services, and the right one depends on your kid, not on which one sounds better.

What usually decides it:

  • Your child’s age and goals. A BCBA recommends a setting after assessing your child.
  • Whether your child needs practice with other kids.
  • How busy your house is during the hours therapy would happen.
  • Your family’s schedule.

If a clinic is on your list, here’s what the day looks like and why it works so well for some kids.

What a Day of In-Clinic ABA Therapy Looks Like

A day of in-clinic ABA therapy at Cardinal runs on routine: your child arrives, starts with something fun alongside their therapist, works on the goals in their plan, then joins group games and lunch with other kids. Kids walk in to the same routine every day, and that’s on purpose.

“We try to really create as much routine and consistency as possible.”
Alice Okamoto

The details shift with your child’s age and goals. Most days move through four parts:

  • Arrival. Belongings go away, the same way every time.
  • Pairing. The day opens with something fun with the therapist. Alice calls it “starting the session off in a fun and engaging way,” and it keeps the relationship strong before any work starts.
  • Goals. Then it’s into the goals written into your child’s program, with data taken as they go.
  • Group time. Social skills practice, like a group game, and lunch together with other kids.

That last part is hard to copy at home. Lunch with friends is therapy too. It just doesn’t look like it.

What a Clinic Can Do That's Harder at Home

A clinic can do two things that are harder at home: therapists can set up the room so your child’s target skill keeps coming up, and they can keep out everyday distractions. We asked Alice what a clinic offers that home doesn’t. Her first answer was control over the room.

“We’re able to really manipulate the environment to contrive opportunities for running goals and working on the program the best that we need to.”
Alice Okamoto

Put simply, therapists can arrange a room so the skill your child is working on keeps coming up. Some clinic rooms are even set up like a classroom, with the kind of structure you’d see in preschool classroom activities for kids with autism.

The other half of her answer was about what a clinic leaves out. At home, therapy shares the space with:

  • The TV on in the next room for a sibling
  • Parents coming in and out
  • The dog barking

None of that means something is wrong with your home. In Alice’s words, “It’s just all very natural things that happen at home. And we’re able to limit, obviously, some of those things in the clinic.” For a child learning something brand new, every interruption is a chance to practice that gets lost.

Clinic-Based ABA Therapy

Why Structure Helps Some Children Learn

Structure helps some children learn because a predictable day leaves more time and attention for practice. With fewer surprises and interruptions, a child gets more repetitions on each goal. Asked what all that structure gives a child, Alice didn’t hesitate: “the potential to be able to pick up new skills, maybe faster.”

A kid who knows what comes next isn’t spending the morning watching the door, so more of the day goes to learning. Alice listed what a structured clinic day adds:

  • More repetition
  • More consistency
  • More of the routine and schedule worked through
  • More of the goals and targets reached each session

Hours matter too. A National Research Council report set a recommended weekly minimum of intervention for young children with autism (National Research Council, 2001).

25 hours
Recommended weekly minimum, year-round

That’s a guideline, not a prescription. Your child’s BCBA recommends hours after an assessment, so the right number for your child may be different.

Wondering what a clinic day would look like for your child? Talk with our team and we’ll walk you through it.

Center-Based ABA Therapy

Does In-Clinic Mean Less Individual Attention?

No. Most children in Cardinal’s clinics still have their own one-on-one therapist for the whole session, and that therapist stays focused on your child’s goals. It’s a fair worry, since more kids in the building can sound like less time for yours. Alice’s answer is short.

“So most of our clients do have the one-on-one therapist... they’re getting that one-on-one attention throughout their session and throughout their day.”
Alice Okamoto

A clinic adds people to your child’s day. It doesn’t take away the one-on-one ABA services at the center of every session.

Those extra people turn out to be useful. Alice pointed to “opportunities to provide generalization to other adults, more peers.” Generalization means a skill your child learned with one person shows up with other people and in other places too. In practice, that’s a skill being used:

  • With a different adult, not only their own therapist
  • With peers, during group games and lunch
  • Back home, during family time and playdates

A skill that only works with one person in one room isn’t finished yet. A clinic gives it more places to get tested.

ABA Clinic

In-Clinic ABA Is Not Daycare

In-clinic ABA is not daycare because every hour works toward goals in your child’s treatment plan, with data taken and progress reviewed by a BCBA. Alice is kind about this one. She gets why it can feel that way. Parents want to know their child is “in a safe environment with people that they trust.”

But, as she put it, “we are much more than daycare and babysitting.”

What makes it therapy, according to Alice:

  • It’s an insurance-funded, medically indicated service.
  • It needs consistency in services, so your child keeps building on the last session.
  • It depends on “communication and transparency with parents, school teams, other related providers.”

At Cardinal, your child’s goals and progress get reviewed every six to twelve weeks. In Alice’s words, kids in the clinic “are working on really, really important things throughout their day at therapy.”

In-Clinic ABA Therapy Services at Cardinal

Cardinal offers in-clinic ABA therapy services in four clinics across North Carolina and Arizona, each set up for structured learning and group practice, and every child there has a BCBA guiding their plan and a therapist working with them directly. Here’s what that looks like across our locations:

  • Clinics: Cary, Clayton and Wilmington, North Carolina, and Phoenix, Arizona
  • The team: BCBAs, RBTs and specialists trained in early childhood and autism
  • Getting ready for school: the Classroom Readiness Program
  • Rather stay home? In-home ABA therapy is an option too

Each clinic’s address is listed on our in-clinic ABA therapy page.

Thinking about a clinic for your child? Call (919) 705-0668 and we’ll help you figure out if it’s the right fit. No pressure, just answers.

Get started
→

Frequently Asked Questions

Center-based ABA therapy, also called in-clinic or clinic-based ABA, is ABA delivered at a therapy center instead of at home. Your child follows a daily routine with a trained therapist, works on goals from their treatment plan, and practices social skills with peers in rooms set up for learning.

At Cardinal, your child’s goals and progress get reviewed every six to twelve weeks. The BCBA looks at the session data, updates goals your child has met, and adjusts anything that isn’t working, so the plan keeps up with your child as they grow.

Often, yes. Some kids get their therapy at the clinic while parent training happens at home. Alice told us the team stays flexible about “going in home and also working with parents in that natural environment.” What’s possible also depends on your plan and your BCBA’s recommendation.

Cardinal has ABA clinics in Cary, Clayton and Wilmington, North Carolina, and Phoenix, Arizona. If a clinic isn’t close by, in-home and community ABA is available across North Carolina, Arizona and Texas, so your child can still get care in the setting that fits your family.

Often, when ABA is medically necessary. Plans differ on what they cover, including which settings and how many hours. Cardinal can give you a quote of benefits so you know what your plan covers, and what you might owe, before your child starts.

In this article
Want to see one of our clinics?
Dr. Mike Henderson
Regional Operations Director @ Cardinal Pediatric Therapies
Mike Henderson, PhD, LBA, BCBA-D, is the Regional Operations Director at Cardinal Pediatric Therapies. With over two decades of experience in behavior analysis and organizational leadership, he focuses on mentoring teams and fostering a culture of collaboration, growth, and excellence in client care.
Alice
In conversation with
MA, BCBA, LBA, Chief of Staff @ Cardinal Pediatric Therapies
Alice has spent more than six years at Cardinal, supervising behavior analyst trainees and working with families as a whole unit. She first worked with ABA as a teenager, supporting twins with autism at home and later at school.

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What One-on-One ABA Services Actually Look Like

What One-on-One ABA Services Actually Look Like

Our BCBA Alice Okamoto explains what happens in a one-on-one ABA session, who it fits best, and what to expect in the first weeks.
October 6, 2026
 
5 min read
Dr. Mike Henderson
Regional Operations Director @ Cardinal Pediatric Therapies
Mike Henderson, PhD, LBA, BCBA-D, is the Regional Operations Director at Cardinal Pediatric Therapies. With over two decades of experience in behavior analysis and organizational leadership, he focuses on mentoring teams and fostering a culture of collaboration, growth, and excellence in client care.
In conversation with
Alice
MA, BCBA, LBA, Chief of Staff @ Cardinal Pediatric Therapies
Alice has spent more than six years at Cardinal, supervising behavior analyst trainees and working with families as a whole unit. She first worked with ABA as a teenager, supporting twins with autism at home and later at school.
One-on-One ABA Services

One-on-one ABA services pair one trained therapist with one child for the whole session.

Sessions start with something fun to build trust, then move through the child’s schedule and their own goals: communication, social skills, daily living. It’s medically indicated therapy, with goals sent to insurance.

Whether it’s the right fit comes down to your child’s age and goals, and progress takes time.

Key takeaways

  • One-on-one ABA means one therapist working on one child’s goals for the whole session.
  • Every session starts with pairing, a fun stretch that builds trust before any goal work.
  • Every child’s plan is written by a BCBA and built from an assessment.
  • Younger kids often do best one-on-one. Teens working on friendships may fit a peer group better.
  • Progress comes in small steps, so the early weeks can look like a lot of play.

Why Families Ask About One-on-One ABA

For a lot of families, the ABA recommendation shows up in a stack of diagnosis paperwork. What it means for an ordinary weekday at home or at the clinic tends to get skipped. Families want to know who will be in the room, what their child will do, and whether it will help.

You’re in big company. Autism is common, and the CDC tracks how often it is identified in U.S. children.

1 in 31
Children identified with autism by age 8
And ABA is often one of the first services families hear about. The American Academy of Pediatrics lists ABA-based interventions among the evidence-based options for children with autism (AAP clinical report, Pediatrics, 2020).

Numbers don’t tell you what a session feels like, though. So we sat down with Alice Okamoto, a BCBA and Cardinal’s Chief of Staff. She’s spent more than six years helping families get started with ABA therapy services.

What One-on-One ABA Services Mean

One-on-one ABA services mean one trained therapist works with one child for the whole session, following a plan written for that child and nobody else. At Cardinal, therapists hold certifications such as Registered Behavior Technician (RBT) and Board Certified Behavior Analyst (BCBA), and each child’s plan is written by their BCBA.

It sounds simple, and it mostly is. But “one-on-one” makes some parents picture a sitter watching their kid play. When we asked Alice what parents get wrong most, she didn’t hesitate: people think it’s babysitting. “We hear that a lot,” she said.

Here’s what’s actually going on in a session:

  • It’s medically indicated. ABA is recommended because of your child’s specific needs, not as a place to drop them off.
  • It runs on goals. As Alice puts it, “we’re working on things and goals that we send to insurance.”
  • Progress gets measured. Therapists track data on each goal every session, and when something isn’t working, the plan changes.

Babysitting doesn’t come with data sheets.

One-on-One ABA Therapy Services

What Happens in a One-on-One ABA Session

A one-on-one ABA session at Cardinal follows a predictable pattern: the same arrival routine, a fun warm-up called pairing, then focused time on your child’s goals. Kids do better when they know what’s coming, so the start stays the same every time. Then the day unfolds from there.

Alice explains why it starts with play.

“Usually we try to start a therapy session with what we call pairing... Doing something fun, doing something engaging.”
Alice Okamoto

In practice? Blocks, bubbles, whatever your child is into.

The setting matters some. In-clinic ABA therapy mixes group games and lunch with other kids into a typical clinic day. In-home ABA therapy works around whatever’s going on at your house, siblings and the dog included.

The basic routine doesn’t change.

Step What it looks like
1. Arrival Belongings away, same routine every time
2. Pairing A fun activity with the therapist to build trust
3. The day's schedule Group readiness work, snack, lunch, play and social time
4. Individual goals Focused time on the goals in your child's plan
5. Consistency Sessions look similar day to day, with room to adjust

Skills Children Build in One-on-One ABA

Children in one-on-one ABA build the skills they need most at home, at school and with friends, starting with communication. “We do so many things,” Alice told us. But communication comes first, and she says it carries into “really everything else too.”

A child who can ask for a break has an easier time with every other goal on the list, which is why building communication skills usually comes first. From there, sessions usually include:

  • Social skills, like turn-taking and joining play
  • Daily living skills, from routines to self-care
  • Fewer challenging behaviors, when that’s part of the plan

No two programs match. Your child’s BCBA builds goals from an assessment of where your child is right now.

For kids heading toward school, Cardinal’s Classroom Readiness Program takes those same skills and practices them in a small group.

Why One Therapist for One Child Matters

The biggest benefit of one-on-one ABA is trust. When one therapist works with your child session after session, your child learns that person is safe, and new skills get easier to try. We asked Alice for the biggest benefit, and her answer wasn’t about skills at all.

“When they’re able to build that rapport, it’s easier for the child to... trust that that therapeutic relationship is there.”
Alice Okamoto

A child who has met someone twice acts differently around them than a child who knows that person well. One-on-one gives the therapist enough time with your child to get to the second stage, and a few things follow from that:

  • Your child tries new things more easily
  • The therapist picks up on your child’s cues, like when frustration is starting to build
  • There’s no group to wait on, so teaching can happen right when the moment comes up

Curious what a session would look like for your child? Talk with our team, and we’ll walk you through it on a short call.

Is One-on-One ABA Right for Every Child?

Not always. One-on-one ABA tends to fit younger children building their first skills, while some teens do better in a social skills group with one therapist and a few peers. The right format depends on your child’s age and goals, and a BCBA recommends it after an assessment.

1 on 1 ABA Therapy

Alice is refreshingly direct about it. For younger kids, she says one-on-one is “very beneficial.” Teens working on friendships often get more out of practicing with peers, so the format shifts as a child grows.

That’s also why starting early matters, and a big reason families ask about the best age to start ABA. These are the milestones the CDC points to:

18 months
First recommended autism screening
Age 2
When a diagnosis can be reliable
47 months
Typical age kids are diagnosed

Hours depend on the child too. National guidelines split ABA into two rough types (CASP ABA Practice Guidelines, 2024), and the right number of hours of ABA therapy a week comes out of your child’s assessment.

Program type Typical weekly hours Usually for
Focused ABA About 10 to 25 hours A few specific goals
Comprehensive ABA About 30 to 40 hours Goals across many skill areas

What to Know Before the First Session

Before the first session, know that progress takes time. Most of the first two weeks go to pairing, so your child’s therapist is building trust through play before diving into program goals. Progress tends to come in small steps rather than a straight line, and that’s normal.

“Progress is not immediate. It does take time, and it’s really worth trusting the process.”
Alice Okamoto

Cardinal focuses on rapport “for like two weeks before diving into some of the program goals,” Alice says. And her description of progress is the most honest one we’ve heard: “little nuggets here and there instead of very linear.”

So if the first two weeks look like a lot of play, that’s the point. The relationship comes first.

ABA Therapy Services

One-on-One ABA Therapy Services at Cardinal

Cardinal offers one-on-one ABA therapy services in clinics, at home and in the community, and every child gets a BCBA guiding their plan plus a therapist who works with them directly, session after session. Where that happens is up to your family:

  • In the clinic: Cary, Clayton and Wilmington, North Carolina, and Phoenix, Arizona
  • At home and in the community: across North Carolina, Arizona and Texas
  • Getting ready for school: the Classroom Readiness Program

Our tagline is “Families first.” In practice that means if the schedule stops working for you, or a goal doesn’t line up with what matters at home, we change it.

Wondering whether one-on-one is right for your child? Call (919) 705-0668. No commitment, just a conversation.

Get started
→

Frequently Asked Questions

A Board Certified Behavior Analyst (BCBA) does. The BCBA writes your child’s treatment plan, trains and supervises the therapist who runs each session, reviews the data, and updates goals as your child progresses. That supervision is what makes one-on-one ABA structured treatment rather than general childcare.

Pairing is how a therapist earns a child’s trust before teaching anything new, mostly through play the child already loves. It opens every session and carries the most weight early on, so your child sees the therapist as someone safe and fun before goal work begins.

It depends on your child. A BCBA recommends hours after an assessment, based on age, goals and setting. National practice guidelines put focused programs around 10 to 25 hours a week and comprehensive programs around 30 to 40, and hours can change as your child progresses.

Often, when it’s medically necessary, though coverage, copays and approved settings vary by plan. Cardinal can walk you through a quote of benefits before you start, so you know what your plan covers, how many hours are approved, and what you might owe.

At Cardinal, one-on-one ABA can happen in a clinic, at home or in the community. Clinics are in Cary, Clayton and Wilmington, North Carolina, and Phoenix, Arizona, with home and community sessions across North Carolina, Arizona and Texas. A BCBA helps your family choose the setting that fits your child’s goals.

In this article
Not sure if one-on-one fits your child?
Dr. Mike Henderson
Regional Operations Director @ Cardinal Pediatric Therapies
Mike Henderson, PhD, LBA, BCBA-D, is the Regional Operations Director at Cardinal Pediatric Therapies. With over two decades of experience in behavior analysis and organizational leadership, he focuses on mentoring teams and fostering a culture of collaboration, growth, and excellence in client care.
Alice
In conversation with
MA, BCBA, LBA, Chief of Staff @ Cardinal Pediatric Therapies
Alice has spent more than six years at Cardinal, supervising behavior analyst trainees and working with families as a whole unit. She first worked with ABA as a teenager, supporting twins with autism at home and later at school.
Not sure if one-on-one fits your child?

Dr. Mike Henderson, Ph.D., BCBA-D, LBA

Regional Operations Director

North Carolina

Mike Henderson, PhD, LBA, BCBA-D, is the Regional Operations Director at Cardinal Pediatric Therapies. With over two decades of experience in behavior analysis and organizational leadership, he focuses on mentoring teams and fostering a culture of collaboration, growth, and excellence in client care. Mike believes strong leadership and supportive systems are essential for helping clients, families, and providers succeed together.

Felicia Freeman

Clinic Manager

I am Felicia Freeman, the Clinic Manager for Cardinal Pediatric Therapies. I have been in ABA for several years now and am passionate about the community that we serve. I started out as an RBT, decided to go the administrative route, and worked my way up to managing clinics. I choose this field every day because I enjoy making a meaningful impact in the lives of our clients and building strong teams that change lives.

Amanda Dean, MA, BCBA, LBA

Johnston County, NC

Amanda graduated from The Chicago School of Professional Psychology in 2018 with her Masters in Psychology. She proceeded to complete her graduate certificate in ABA and became a BCBA in November 2020. Amanda has a passion for behavior reduction, tolerance training and functional communication training. She enjoys spending as much time as she can with her 3 children and husband. When she’s not working, Amanda is very involved in her local Pop Warner Cheerleading program where she is the Assistant Cheer Director and a head coach.

Becky Fronheiser

Operations Director

Arizona

Becky has worked in behavioral health for 7 years. She joined Cardinal in the spring of 2024.  Becky is grateful for the opportunity to work with such a passionate group of people and looks forward to supporting families with their specific ABA needs.  In her personal time, she enjoys spending quality time with her husband, 6 kids and 4 grandkids and loves to travel and relax on the beach.

Matthew Wilkinson

Operations Director

Cary, NC

Matthew holds a bachelors degree from the University of Utah, Medical Degree from the Autonomous University of Guadalajara and an MBA from Western Governors University. He has worked in the pediatric field for the majority of his professional life and has a passion for helping bring the best care to children in need. He enjoys spending time with his wife and three children and day trips to the coast.

 

Trisha Iannotta Bieszczad, PsyD., BCBA

Triad, NC

Trisha is a Board Certified Behavior Analyst (BCBA) with extensive expertise since 2016 in applying behavior analytic principles to improve the lives of children and adolescents. Her professional journey began with a doctoral degree in clinical psychology, emphasizing child and adolescent development. This foundation has equipped her with a deep understanding of psychological theories and practices, which she seamlessly integrates into her work as a BCBA. Outside of her professional endeavors, Trisha enjoys reading, spending time outdoors with her family & trying out new restaurants. Trisha’s dedication to both her career and personal interests reflects her commitment to continual growth and enrichment, both professionally and personally. Her multifaceted background allows her to approach each aspect of her life with a blend of expertise, enthusiasm, and a genuine appreciation for learning and exploration.

Tina Lee

Director of Finance

Tina Lee is the Finance Director for Cardinal with a variety of experience in the Healthcare Industry for over 13 years. She is compassionate and always eager to assist where she can. In the ever-changing Healthcare environment, Tina has played a vital role in putting processes in place to obtain high efficiency outcomes to help our clients get the care they need. Tina enjoys the outdoors and loves spending time with her family.

William Evans

Director of Outreach and Recruitment

William is a UNCW Graduate who started his professional career working in Marketing and Recruiting for a local technology company before looking for an opportunity to take those skills and help others. In his spare time he plays hockey, including annually for the North Carolina Autism Hockey Tournament, which is dedicated to the raising money and awareness for organizations helping local families with children diagnosed with autism.

Alice Okamoto, MA, BCBA, LBA

Chief of Staff

Alice has been with Cardinal for over 4 years and has worn many hats along the way!  Alice has a passion for working with clients and families as a unit, supervising behavior analyst trainees, and collaborating on strategic initiatives to ensure clinical efficiencies.  Alice‘s professional experience began with ABA in a school setting, and has worked in schools, homes, and clinics throughout the years while enjoying collaboration with related providers.  In her free time, Alice enjoys traveling, exploring parks with her dog, Oliver, and trying new restaurants. 

Darrin Miller

CEO

Darrin has dedicated his education and career to the field of behavioral health. As a licensed therapist and master’s in clinical counseling he works to create solutions that improve the lives of those impacted by Autism Spectrum Disorder at a local, state, and national level. He strives to create a culture of caring and empathy while innovating solutions for improving families’ access to quality care as quickly as possible.