Patty Romanowski Bashe

In the wake of autism insurance reform, more states are requiring that health insurance policies cover health care services for individuals with autism spectrum disorders. (Each state covers this differently; consult Autism Speaks's Advocacy page: http://www.autismspeaks.org/advocacy. I cannot respond to insurance questions.) While some states have chosen--prudently, in my view--to specify Board Certified Behavior Analysts (BCBAs) as providers, others have deemed virtually any "licensed professional" in a "related" profession to be qualified.

First, a personal note: Before I entered this field, three young women, "behavior therapists" state licensed in other professions came to our home. They were highly recommended by a pediatrician known for treating kids with ASDs; only after I finished my own training in ABA did I realize that she knew less about ABA than I expected. Within an hour, they had dismissed the advice of other professionals (namely, MDs), informed me that my husband spoke to our son "the wrong way," and vowed to "break" my son's "train habit" (even though we did not cite this as a "problem"). Fortunately for our son, our home program ended abruptly the day one of them literally cornered him in his room and shouted at him until he began crying and engaging in loud, panicked echolalia (which was rare for him otherwise). As a BCBA and someone who supervises students pursuing their BCBAs, I know now that they were inexperienced and poorly trained. They believed that behavior interventions work on a frighteningly basic calculus of "reward" and "punishment," and that the more intensely a client reacts to your behavioral intervention, the more assured you can be that you "hit the spot." Or, as one equally inept "therapist" told a parent I worked with later--while a two-year-old, nonverbal toddler with autism was strapped into a high chair crying to the point of vomiting--"ABA is letting your child know who is the boss."

No, it is not!

In response to various incidents of individuals being treated with "behavior modification" strategies ranging from ineffective and unethical to physically and psychologically harmful, the Behavior Analyst Certification Board was founded. You can learn more about the BACB, its mission, and professional behavior analysis here: http://www.bacb.com/.

Right now, in New York State and many other places, the practice of applied behavior analysis is permitted by professionals who may not have the education, experience, or training to do so safely, effectively, and ethically. There appears to be a general misunderstanding among some regulators, insurance professionals, and professionals in other disciplines regarding what ABA is. The idea that one can attend a handful of conference presentations, take a course or two on autism, work in a classroom or other setting where one carries out (but does not design, monitor, or scientifically analyze) ABA interventions, and then be considered qualified to provide ABA is misinformed and dangerous.

Those of us who have chosen to obtain a BCBA recognize the awesome responsibility we have to the individuals we treat, their families, and the community at large. Despite having practiced ABA in the field for years, my colleagues and I recognized that there was more to learn. We also recognized that when dealing with vulnerable populations and addressing issues with serious health, psychological, safety, and ethical dimensions, there was a need for not only professional guidance, but a structure in place to address consumers' and practictioners' questions and complaints. That place is the Behavior Analyst Certification Board.

We voluntarily submitted to the rigorous, intensive five (now six) graduate-level, BACB-approved courses and the 1,500 hours of supervised practice (which may cost an additional $3,000 to $7,500 to hire a supervisor) for the privilege of sitting for a written exam that currently just over 50% pass. After that, there are annual renewals, triannual recertification, and continuing education credit requirements to meet to maintain certification. If you want to get some idea of what the training and requirements look like, check out the Fourth Edition Task List--which dictates what BACB-approved coursework must cover.

As a parent, I would not ask my child's pediatric psychiatrist for advice on improving his fine-motor skills, nor expect his speech therapist to explain to me why one SSRI might work more effectively than other. I would not consider his social worker my best resource for an answer to how to teach personal care, or think that his psychologist was any way "lacking" because she failed to produce a functional behavior analysis that included quantitative data: numbers (and, believe me, after my son's twelve-plus years of public special education, I have a dozen of those in my files). Interestingly, however, in some states--such as New York--every one of these professionals is deemed to be as prepared to provide applied behavior analysis as a BCBA. And, in some cases, further qualified to be reimbursed by health insurance companies to do so. Yes, there are professionals in those fields who have extensive experience with children like yours, who have worked with ABA. In fact, there are some among them who do hold BCBAs in addition to their other credentials. And not having a BCBA does not necessarily mean that one is not qualified. What it does do, however, is leave every parent on his or her own to determine how skilled, experienced, and knowledgeable someone really is.

Coming next week: Ten Key Questions to Ask Your ABA Provider