HB 1919
At the September 2007 FEAT-Houston meeting Cynthia Singleton, FEAT-Houston Vice President and Legislative Liason along with Christie Enzinna, BCBA presented information on House Bill 1919 which became effective on September 1st 2007. Under HB1919, some children between the ages of two and six will eligible to receive insurance coverage of therapeutic treatments for autism, including ABA. The meeting addressed (1) the provisions of HB 1919, (2) which types of insurance plans will be required to cover ABA therapy, (3) how parents will need to advocate with insurer's and physicians, and (4) what consumers need to consider before selecting an ABA service provider.
Below you will find the Question and Answers from that meeting.
You can also download the following handouts directly as well.
FEAT-Houston Flow Diagram for HB
1919 Eligibility
Insurance Contact Log
BCBA and BCABA registry for the Houston Area
ABA Overview and Summary of
Scientific Support
New York Times Article on
Battling Insurer's over Autism Treatment
HB 1919 actual bill text
HB 1919 representative and senator voting
record
1.
I’ve heard that ABA is the best treatment for kids with autism.
How do I get some ABA for my child?
ABA, Applied Behavior Analysis, programs have made remarkable differences in
many children’s lives. Finding a good ABA program is a bit like finding anything
else—ask around, get recommendations, and check out the program to see if it
seems like a good match for your child.
However, as a consumer of ABA services, you need to learn what to look for in
an ABA program in order to find the best fit for your child.
This list of questions was written to give you important tips on what to
ask, what to look for, and how to choose an ABA professional to best benefit
your child.
2.
Where do I find a program?
ABA programs can be offered in various locations such as universities or
hospitals or clinics, mental health services centers, schools or in the home.
Unless you live in a really large city, choices will be very limited.
Some rural areas may only have the option of a consultant traveling in to
supervise a program in the home. To
get started, look at www.bacb.org.
This is the website for the behavior certification board.
Look under the consumer section for a list of consultants near you.
You can also go to www.abainternational.org/chapters/uschapters.asp
to find a local professional group. Attending
a regular chapter meeting can be a very good way to meet some of the local
consultants.
3.
How do I tell if a program will be good for my child?
To assure the best outcomes, the program director should have the proper
training, skills, experience, and certifications to run a program. To see the
specific, recommended skills in great detail look at FAQ 7.
In addition, the person should have experience working with children
whose challenges are similar to your child’s challenges and should run the
program in a way which is sensitive to the needs of your child.
As the consumer, it is your responsibility to find the best professional for
your child. This means you must ask
the questions that will give you the information you need to make a decision.
The first step is developing a clear picture of your child’s main
needs. A three year old learning to
talk needs different kinds of programming than an eight-year-old child who has
severe self-injurious behavior. Does
your child need a focus on social understanding in the classroom or need to stop
hitting his head against the floor? You
should make sure that the person running the program has experience in the area
that your child needs.
Teaching children with autism can be so challenging that a behavior
professional who develops wonderful programs for a child with one set of needs
may not be as effective working with children with other needs.
It is only by asking specific questions that you will know.
4.
What credentials should a behavior professional have to direct an
ABA program for children with autism?
A professional who is in charge of an ABA program should be either a
1.
Board Certified Behavior Analyst (BCBA),
2.
Professional with an advanced degree in a closely related field like
psychology
However, if you are considering a professional who
does NOT have a BCBA you need to ask:
a.
Does she have a Master’s or PhD in behavior analysis or a closely
related field like psychology?
b.
Is she a current “Full” member in the Association for Behavior
Analysis (ABA) and possibly one of its regional chapters? (to
see a list of regional chapters, go to this link:
http://www.abainternational.org/Chapters/USchapters.asp)
c.
Does she have at least ten years experience starting, designing,
overseeing ABA services for individuals with autism?
d.
Has she published research articles in a peer reviewed journal like
Research in Developmental Disabilities? Publishing
a book or articles on a website or blog do not count as published, peer reviewed
research.
e.
Has she made presentations about ABA treatment programs at state or
national ABA conferences? Please note that conference presentations do not
substitute for published articles in a peer-reviewed journal.
5.
What’s the difference between a behavior analyst (BCBA) and an
associate (BCABA)?
A BCBA has a more education (a master’s degree rather than a bachelor’s),
more experience, more supervised time working directly with individuals with
autism and a great knowledge of how the principles of behavior work in real
time.
Specifically a BCBA, or behavior analyst, has:
v
Master’s degree
v
225 hour of graduate level coursework in approved courses
v
Supervised independent experience in designing and using behavior
interventions
v
Passing score on BCBA exam
A BCABA, or associate, has:
v
Bachelor’s degree
v
135 of undergraduate coursework in approved courses
v
Supervised, independent experience in using behavior interventions.
v
Passing score on the BCABA exam.
You can find out more about the differences by going to the www.BACB.com.
In the consumer guidelines section there is a very detailed description
of standards for certification for both behavior analysts (BCBAs) and associates
(BCABA)s. It’s a good idea
to check the website periodically because standards do change over time.
You can also check on a specific person by e-mailing info@BACB.com
to request their certification status.
6. What
kinds of questions are important to ask a potential provider?
You can and should ask about the following:
v
Do you have your certification as a behavior analyst (BCBA) or associate
(BCABA)?
v
How much time on average do you spend supervising each of the people who
will work directly with my child?
v
How will you supervise them?
v
Are you a member of the Association for Behavior Analysis (ABA), the
national professional organization?
v
Are you a member of the local ABA chapter?
In Texas, the chapter is called the Texas Association of Behavior
Analysts-Autism Special Interest Group (TxABA-SIG, for short).
To find a local state chapter, go to http://www.abainternational.org/Chapters/USchapters.asp
v
When was the last local chapter meeting that you attended?
v
What undergraduate, graduate, and post-graduate training in behavior
analysis do you have? (Coursework
focusing on behavior theory and practice is different from coursework in general
psychology, special education, education, etc.)
v
Do you have letters of reference from supervisors and/or client families?
(note whether privacy and confidentiality are assured)
v
Have you published any peer-reviewed research articles in behavior
analysis? (Look for a recognized
journal, like the Journal of Applied Behavior Analysis.)
7.
So does having a BCBA or BCABA certifications guarantee that the
person is an expert in treating autism using ABA?
Absolutely not. The field of
behavior analysis is very broad. Some
behavior analysts (BCBAs) may still have little or no experience providing
services to a person with autism. The
Autism SIG (Special Interest Group of behavior analysts) insists that
certification of BCBA is only a part of the training.
This section is a long list of skills that a program director should have
to be effective. Please use the
items on this list—A-S--as a basis to develop questions that you will ask a
potential program director when interviewing them.
You must determine whether the behavior analyst (BCBA) has the training
and experience to create a great ABA program based on proven methods or is just
running a little clinic because there are lots of parents ready to pay for ABA
programming.
A BCBA who wants to direct an ABA program for persons, especially children,
with autism also needs:
v
five years experience in ABA programming for persons with autism
v
an additional year (1000 clock hours) of supervised, hands-on training
while providing ABA to persons with autism
During these minimum six years working directly with persons with autism, a
program director should have learned how to:
A.
Use proven interventions and evaluate
newly developed and as yet unproven interventions.
New methods are continuously being studied and article about these new
methods are published in an accepted journal like the Journal of Applied
Behavior Analysis.
B. Take the
lead in designing and using comprehensive programming specifically for persons
with autism that builds skills and teaches
independence in
v
Learning to learn. Teaching
the person to observe, listen, follow directions, and imitate for example
v
Communication, both verbal and non-verbal.
v
Social interaction
v
Self care
v
School readiness
v
Academic
v
Safety
v
Gross and fine motor
v
Play and leisure activities
v
Community living
v
Self-control or self-monitoring
v
Pre-vocational and vocational skills
C.
Provided ABA programming to at least eight individuals with autism who
represent a range of ages, abilities, and needs.
§ NOTE:
Items D through P contain many technical terms specific to ABA.
Consumers of ABA services should at least know the meaning of these words
this list in order to know understand their child’s program.
D.
Use a variety of behavior analytic teaching procedures: discrete
trial instruction, modeling, incidental teaching, natural environment teaching,
discrimination training, activity-embedded instruction, task analysis, and
chaining—just to name a few.
E.
Teach with different techniques such as prompting, errorless teaching and
error correction, maximizing learning opportunities, effective reinforcement and
motivation techniques, techniques for establishing stimulus control, preference
assessments and choice procedures.
C. Use ABA
methods in a variety of settings: one-to-one
instruction, small and large group instruction, and in transitions across these
situations.
D. Use a wide
range of strategies to best address skill acquisition and generalization over
time and across people, settings, situations, and materials as needed by that
individual’s level of skill.
E. Systematically
evaluate data to modify instructional programs.
F. Conduct
functional assessments of challenging behavior and being able to select the
appropriate assessment methods suited to the behavior and situation.
G. Design and
implement programs to reduce stereotypic, disruptive, and destructive behavior,
based on systematic analysis of the antecedents and consequences that cause and
maintain the behavior. Match
treatment to the determined function(s) of the behavior.
H. Incorporate
extinction and the full array of differential reinforcement procedures into
behavior reduction programs.
I.
Modify behavior reduction programs based on frequent, systematic
evaluation of direct observational data.
J. Provide
training in ABA methods and other support services to family members of at least
five individuals with autism.
K. Provide
training and supervision to at least eight professionals, paraprofessionals, or
students providing ABA services to individuals with autism.
L. Collaborate
well with professionals from other disciplines and with family members to
encourage consistent intervention across settings and to encourage better
outcomes. Collaboration should not
lessen a commitment to scientifically proven interventions and data-based
decision making.
A program director should also have on-going training in directing and
supervising ABA programs. Formal
training and/or self-study should strive to develop:
M.
. . . a knowledge of trends in the latest research on the
characteristics of autism and related disorders.
How do these discoveries affect program design and implementation?
How does the research impact family and community life?
N.
. . .a knowledge of at least one curriculum for learners with autism
consisting of:
§
a scope and sequence of skills based on normal developmental milestones. The sequence breaks down milestones into component skills
based on research of teaching individuals with autism and related disorders;
§
prototype programs for teaching each skill in the curriculum, using
behavior analytic methods;
§
data recording and tracking systems; and
§
materials that go along with the curriculum.
O.
. . .skills in using proven, behaviorally-sound methods to assess
and build verbal and nonverbal communication repertoires in people with autism.
This includes individualized augmentative and alternative communication systems
for individuals with limited vocal repertoires.
P.
. . . a knowledge of the best available research from behavior analysis
and other scientific disciplines as it relates to autism treatment. The Autism
SIG encourages consumers to ask prospective directors of ABA services for
evidence that they have recently participated in continuing education activities
relevant to the treatment of individuals with autism like those they will be
serving (e.g., preschoolers, adults, individuals with limited vocal-verbal
repertoires, etc.).
8.
Why are some professionals who don’t have a BCBA or BCABA
certification okay to run an ABA program for a person with autism?
The Behavior Analyst Certification Board (BACB), the national organization
that issues the certifications, is a relatively new entity.
There is a small group of competent and well-trained professionals who
completed their training and education long before the BACB certification
program began and are in the later stages of their careers.
Some of these professional have served hundreds of individuals with
autism. The Autism SIG
recognizes that it can be tricky to make certain that a professional without a
behavior certification from the BACB is has the necessary skills and experience
to provide good programming.
9.
Why must an associate (BCABA) always be supervised by a
behavior analyst (BCBA)?
The Certification Board (BACB) does not consider the requirements for earning
a BCABA to be enough to take responsibility for all aspects of running a
behavior program. If you hire a
BCABA, the Autism SIG encourages you to ask the very specific questions about
who, what kind, and how much supervision the BCABA gets.
10.
What type of supervision should I expect to see the
associate (BCABA) getting?
There should be a behavior analyst (BCBA) who oversees and takes full
responsibility for any programming started by the BCABA.
The BCBA should directly and closely observe the client either in person
or via video, meet frequently in person or by phone with the BCBA and take the
lead in a clinical decision-making. If
the BCABA is working towards full certification, you should ask the BCBA about
the BCABA’s progress on a regular basis—even asking to see course
transcripts and how many of the required supervised field hours have been
completed.
11.
Can BCABA develop programming for persons with autism?
Not without a behavior analyst (BCBA) overseeing their programs.
An associate (BCABA) usually has a less education and less supervised
time in the clinic. The Autism SIG strongly recommends that BCABAs only develop
programming for persons with whom they are familiar ONLY with a BCBA supervising
and taking responsibility for their work. If
you decide to hire a BCABA to provide for your child’s program, you should ask
for the name and contact information of the BCBA supervisor and check with that
BCBA periodically regarding your child’s case. Ask that BCBA detailed questions about how much and
what kind of supervision they are giving the BCABA.
If the BCABA currently doesn’t have a BCBA to regularly supervise his
work and isn’t actively working towards getting a BCBA certification, then you
may want to look elsewhere for someone to direct your child’s programming.
12.
How do I know what kind of training the BCBA has?
You have the right to and should always ask the BCBA.
A good BCBA has a resume prepared to give to potential clients who do
ask. If they don’t, that may be
an indicator that you may need to look elsewhere.
13.
How do I find a BCBA in my area?
The Behavior Analyst Certification Board maintains a list of everyone who has
earned his certification. If you go
to www.BACB.com, there is a section for
consumers where you can type in your address and locate the name of a certified
behavior professional near you. Behavior
analysts interested in working with children with autism often meet together in
a SIG or Special Interest Group. To
see if there is one in your area that you could attend, go to http://www.abainternational.org/Chapters/USchapters.asp.
14.
Certified? Aren’t
BCBA’s and BCABA’s licensed?
No. The field of behavior analysis is relatively new (since the
1960’s). Only in the last ten
years has there been a tremendous increase in demand for behavior professional.
There are not enough behavior professionals to support the costs of a
state licensing board, which can run over $100,000 a year.
License fees pay for the cost of operating a licensing board.
However, the certification board has established rigorous and uniform
professional standards so that someone who has earned their certification can be
counted on to have a minimum knowledge about the principals of behavior.
Currently there is a national certification board that gives the examinations
and sets the requirements for certification.
15.
What is the difference between getting a certificate and getting a
license?
When a profession is licensed, a licensing board is created at the state
level that oversees the profession. Anyone
who wishes to practice a profession, like a lawyer or a doctor, etc. MUST obtain
a license in order to conduct business as a lawyer or a doctor, etc.
Also, anyone that is not a lawyer or a doctor etc. and who does practice
law or medicine without first earning their license, can be charged with a
crime.
Behavior analysts are certified instead of licensed.
Certification is not mandatory in order to design and use behavior
programming. Also anyone can call
themselves a behavior analyst despite having very little relevant training or
experience and very little can be done about it formally.
The Behavior Analyst Certification Board (BACB) is based in Florida, and
maintains nationwide standards. Go
to www.bacb.com.
16.
Do behavior analysts
only need to earn their certification once?
No, it is an on-going process because the field of behavior analysis keeps
improving as more research is done. The
certificate must be renewed annually by taking continuing education courses. BCBAs and BCABAs must be recertified every three years by
retaking the exam.
17.
I recently saw a workshop from a person with a PhD.
Is that the same as a BCBA?
No. Though some BCBAs might also have PhDs, a PhD alone is not
necessarily equivalent to the knowledge required to earn BCBA certification.
The BCBA certification assures that a behavior consultant has a minimum
level of understanding of and experience using the principles of behavior.
A PhD in another subject area may have a different area of focus.
Please refer to FAQ #4.3 to learn more about what you should look for in
a PhD who does not also have a BCBA.
18.
My children’s teacher recently attended an all day workshop. Is
that enough for her to develop my child’s programs at school?
No. It gives her enough training and experience to begin to
understand and use programs under the regular weekly, bi-weekly or monthly
supervision of a BCBA. Attending or
delivering some workshops, taking some courses, or getting brief hands-on
experiences does NOT qualify anyone to practice applied behavior analysis
effectively and adequately. Unfortunately, there may be some individuals who
either don’t understand how much training they need to use ABA programming for
a child with autism or they misrepresent their training, skills, and experiences
or inappropriately guarantee certain outcomes.
If all the prospective behavior consultant talks about is attending meetings
and conferences, then you need to ask more questions.
Have they published a research article?
While it’s great that the BCBA attends conferences in behavior analysis and
gives presentations at professional meetings, that is not enough by itself to
prove that the person is continuing his own training in behavior analysis. Conference and/or workshop presentations are not equivalent
to publications in peer-reviewed professional journals. Presentations typically are not reviewed carefully by a
number of other behavior analysts and do not have to meet scientific standards.
Therefore, it is important for consumers to understand the difference between
getting training and giving presentations at conferences and workshops.
20.
I had a bad experience with a behavior consultant.
What can I do?
The Behavior Analyst Certification Board (BACB) does not enforce the Guidelines for Responsible Conduct for Behavior Analysts©
that behavior analysts (BCBAs) and associates (BCABAs) are on their honor
to follow. However the BACB does enforce Professional Disciplinary
Standards© for BCBAs and BCABAs.
Consumers are encouraged to become familiar with those Guidelines and Standards,
available at www.BACB.com.
If you have concerns about the ethical behavior of individuals providing ABA
services, you are strongly encouraged to contact the BACB if the individual is a
BCBA or BCABA. If the
individual has other licenses (ex. Psychiatrist, speech pathologist, doctor
etc.), you are encouraged to contact the other licensing boards.
21. How
can I be sure the behavior consultant will be available for my family?
There is a lack qualified behavior analysts to work in the area of autism,
and many providers are overextended. The Autism SIG believes that professionals
should ensure that they do not accept more clients than they can handle. Although neither the Autism SIG nor the BACB have
developed guidelines for how many clients is the right number per BCBA, we
encourage consumers to ask prospective providers of ABA services about their
availability and responsiveness. Important questions include:
v
How much hands on time each week will a qualified behavior analyst
dedicate to the individual with autism?
v
How will this change if we have a behavior crisis?
v
What is the typical response time (in hours) to a crisis?
v
Is the amount of available time adequate to meet the needs of the
individual?
v
How often will the behavior analyst communicate directly with the
consumer rather than through the lead therapist or BCABA?
v
How will the behavior analyst communicate (i.e., face-to-face
meetings, phone conversations, email)?
22.
Where can I go to learn more?
Check out the following websites:
v
The Association for Behavior Analysis www.abainternational.org
v
The Association for Science in Autism Treatment www.asatonline.org
v
The ABA Autism Special Interest Group
www.autismsig.org
v
The ABA Parent Professional Partnership Special Interest Group www.pppsig.org
v
The Behavior Analyst Certification Board www.bacb.com
v
The Cambridge Center for Behavioral Studies www.behavior.org
Behavior Analyst Certification Board®
The following three documents are available free online at www.bacb.com:
BCBA® and BCABA® Behavior Analyst Task List© (3rd Ed.)
Guidelines for Responsible Conduct for Behavior Analysts
Professional Disciplinary Standards©
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