Coronavirus (COVID-19) Health and Safety Guide
ASERT has compiled resources for those with autism and those who care for people with autism relating to the current COVID-19 outbreak.
This collection of resources provides information on Applied Behavior Analysis (ABA) including: an introduction to ABA, how you can tell if your child is receiving ABA services, what to consider when choosing a provider, information on insurance coverage for ABA services and more.
ABA is a scientific approach to behavior. Its principles are used to change and improve behaviors. The effectiveness of these principles has been confirmed by many experimental studies and can be applied in a variety of ways with different types of people – infants to adults.
By analyzing the relationship between the antecedent (what happened before the behavior occurred), the behavior (what behavior actually occurred), and the consequence (what happened after the behavior occurred), educators or educational teams (teachers, principals, counselors, therapists) can begin to develop a comprehensive plan for changing behavior.
An essential element of ABA involves analyzing the function of the behavior (the purpose the behavior serves). A behavior’s function can be categorized in two ways: to get something or to avoid something. Determining the function of the behavior is essential in designing an effective plan for behavior change. Knowing why a behavior is occurring helps educators choose an intervention that will eliminate or change that behavior.The following example illustrates the relationship between the antecedent, the behavior, the consequence, and the function:
During math class, a teacher presents a new strategy and gives an assignment for students to complete independently (antecedent). David is having difficulty with the assignment, so he:
a) Asks the teacher if he can use the bathroom
b) Tells the teacher he doesn’t feel well, or
c) Punches the student next to him.
The teacher responds to David’s behavior by:
a) Sending him to the bathroom
b) Sending him to the nurse, or
c) Sending him to the principal’s office.
It can be hypothesized that avoiding a difficult task (in this case by leaving the classroom) is the function of David’s behavior.
ABA principles and procedures can be used with all students to provide positive reinforcement, to teach and maintain appropriate behaviors, and to provide immediate feedback during instruction.ABA principles and procedures are also used to help students whose behaviors interfere with their learning or the learning of others. This involves identifying the problem behavior, observing and measuring the behavior, developing a comprehensive plan to change the behavior, and monitoring the behavior to make sure the plan is working.
An educational team (for example, the student’s teacher, the principal, the guidance counselor, the school psychologist, the speech therapist) collects specific, observable, and measurable information regarding the problem behavior. To collect specif-ic, observable, and measurable data, the team must define the behavior. For example, it would be difficult to collect reliable data on what might be described as “tired” or “lazy” behavior. Each team member may have a different idea of what “tired” or “lazy” behavior looks like. To be observable and measurable, the behavior must have a specific definition such as, “The student puts his head down on his desk and closes his eyes.” In this way, each team member can observe this behavior and measure how many times he puts his head down and the length of time he keeps his head down. The educational team collects observable and measurable information about the antecedent, behavior, consequence, and function of the problem behavior.
The team can then begin to develop a comprehensive plan. A comprehensive plan addresses all the component areas (antecedent, behavior, consequence, and function) and pro-vides strategies for:
Once the plan has been implemented, the team monitors the student’s behavior by regularly collecting data. This data is recorded and presented on a graph to see whether the intervention is working (the student’s behavior is changing), or whether the plan needs an adjustment or another intervention.
This website provides information about certification programs avail-able nationally and internationally for those seeking to become Board Certified Behavior Analysts, as well as information for consumers interested in finding professionals in the field.
This website provides resources for those seeking information about the science of behavior. Links to an online self-instruction course are provided.
This website provides information and resources related to many aspects of behavior, including information about how to manage and change behavior in the home, school, and workplace.
The primary journal for the field of Applied Behavior Analysis provides articles on current scientific research.
This website provides extensive lists of resources in a variety of interest areas for both parents and professionals.
The Behavior and Autism sections of this website have links to many websites related to behavior analysis and autism topics.
“ABA” stands for Applied Behavior Analysis. ABA is a set of principles that form the basis for many behavioral treatments. ABA is based on the science of learning and behavior. This science includes general “laws” about how behavior works and how learning takes place. ABA therapy applies these laws to behavior treatments in a way that helps to increase useful or desired behaviors. ABA also applies these laws to help reduce behaviors that may interfere with learning or behaviors that may harmful. ABA therapy is used to increase language and communication skills. It is also used to improve attention, focus, social skills, memory, and academics. ABA can be used to help decrease problem behaviors.
ABA is considered an evidence-based “best” practice treatment by the US Surgeon General and by the American Psychological Association. “Evidence based” means that ABA has passed scientific tests of its usefulness, quality, and effectiveness.
ABA therapy includes many different techniques. All of these techniques focus on antecedents (what happens before a behavior occurs) and on consequences (what happens after the behavior). One technique is “positive reinforcement.” When a behavior is followed by something that is valued (a reward), that behavior is more likely to be repeated. ABA uses positive reinforcement in a way that can be measured in order to help bring about meaningful behavior change.
ABA focuses on positive reinforcement strategies. It can help children who are having difficulty learning or acquiring new skills. It can also address problem behaviors that interfere with functioning through a process called “functional behavioral assessment.”
The principles and methods of behavior analysis have been applied effectively in many circumstances to develop a wide range of skills in learners with and without disabilities.
is based on the understanding that practice helps a child master a skill. It is a structured therapy that uses a one-to-one teaching method and involves intensive learning of specific behaviors. This intensive learning of a specific behavior is called a “drill.” Drills help learning because they involve repetition. The child completes a task many times in the same manner (usually 5 or more). This repetition is especially important for children who may need a great deal of practice to master a skill. Repetition also helps to strengthen long-term memory. Specific behaviors (eye contact, focused attention and facial expression learning) are broken down into its simplest forms, and then systematically prompted or guided. Children receive positive reinforcement (for example: high-fives, verbal praise, and tokens that can be exchanged for toys) for producing these behaviors. For example, a therapist and a child are seated at a table and the therapist prompts the child to pay attention to her by saying “look at me.” The child looks up at the therapist and the therapist rewards the child with a high-five.
is based on the understanding that it is important to give real-life meaning to skills a child is learning. It includes a focus on teaching skills in settings where your child will naturally use them. Using a child’s natural everyday environment in therapy can help increase the transfer of skills to everyday situations and helps generalization. In Incidental Teaching, the teacher or therapist utilizes naturally occurring opportunities in order to help the child learn language. The activity or situation is chosen bythe child, and the caregiver or teacher follows the child’s lead or interest. These teaching strategies were developed to facilitate generalization and maximize reinforcement. Once naturally occurring situations in which a child expresses interest are identified, the instructor then uses graduated prompts to encourage responses from the child. For example, a child is playing on the swings and needs the therapist to push him so that he can swing higher. The therapist waits on the child to ask for a push. Only after the child asks does the therapist push the swing. The therapist waits for the child to ask each time before he/she pushes the child again.
is similar to discrete trial training in that it is a structured, intensive one-to-one therapy. It differs from discrete trial training in that it is designed to motivate a child to learn language by developing a connection between a word and its meaning. For some children, teaching a word or label needs to include a deliberate focus on teaching them how to use their words functionally (E.g. What is this? A cup. What do you use a cup for? Drinking. What do you drink out of? A cup.)
is a naturalistic, loosely structured, intervention that relies on naturally occurring teaching opportunities and consequences. The focus of PRT is to increase motivation by adding components such as turn-taking, reinforcing attempts, child-choice, and interspersing maintenance (pre-learned) tasks. It takes the focus off of areas of deficits and redirects attention to certain pivotal areas that are viewed as key for a wide range of functioning in children. Four pivotal areas have been identified: (a) motivation, (b) child self-initiations, (c) self management, and (d) responsiveness to multiple cues. It is believed that when these areas are promoted, they produce improvements in many of the non-targeted behaviors. The “Early Start Denver Model” is an early behavioral intervention model appropriate for children as young as 18 months of age. This model has a strong emphasis on Pivotal Response Training.
is based on the understanding that learning can be helped by deliberate arrangement of the environment in order to increase opportunities to use language. NLP emphasizes the child’s initiative. It uses natural reinforcers that are consequences related directly to the behavior, and it encourages skill generalization. For example, a child who is allowed to leave after being prompted to say “goodbye” has a greater likelihood of using and generalizing this word when compared with a child who receives a tangible item for repeating this word. NLP transfers instruction from the therapy room to the child’s everyday environment with the interest of the child serving as the starting point for interventions.
ABA is such a broad approach that it is difficult to define what a typical program will look like. The amount of therapy and level of parent involvement varies, often according to the specific needs of the child. ABA skills training programs (such as discrete trial training, incidental teaching) can require several hours each day. While skills training programs are usually implemented by behavior therapists or teachers, parents are often taught critical skills to help their children transfer what they have learned in therapy to everyday life.
ABA skills training programs for young children are often based in the home and require special materials and a dedicated area for working. ABA behavior modification therapy may include 1-2 hours of parent training per week with the parents using strategies they learn in between visits. An ABA therapist may also consult with teachers to help support positive behaviors in the classroom.
A first step in skills training during an ABA session is usually includes an in-depth parent interview and an assessment measure such as: the Assessment of Basic Language and Learning Skills “ABLLS-R”or Verbal Behavior Assessment and Placement Program “VB-MAP
ABA providers may vary in training, experience, and certification:
Therapists may be certified through the Behavior Analyst Certification Board. If they are board certified and have at least a Master’s degree, then they will have the letters BCBA after their name. BCBA-D means they have a doctoral degree. Other therapists may have BCABA credentials. This means education in ABA at a Bachelor’s level.
Some ABA therapists may have years of experience providing ABA but may not be formally “certified.” Uncertified ABA therapists may have trained under and had their work supervised by a certified ABA therapist. While uncertified therapists may provide individual ABA skills instruction, they should be supervised by someone with credentials or similar experience.
ABA can be provided at school, at home, or in the community depending on the needs of the child and the services that are available in a particular area.Some school programs use ABA strategies within the classroom. They may also be used as part of a child’s individual education plan (“IEP”). In addition, community-based therapists may provide ABA in the home to children diagnosed with autism.
Most large to medium sized cities will have certified ABA therapists. Smaller towns and rural areas may not. This is why asking about experience of the provider is important.
The Autism Speaks Family Services Department offers resources, tool kits, and support to help manage the day-to-day challenges of living with autism (www.autismspeaks.org/family-services). If you are interested in speaking with a member of the Autism Speaks Family Services Team contact the Autism Response Team (ART) at 888-AUTISM2 (288-4762), or by email at email@example.com.
ART En Español al 888-772-9050.
Read about evidence-based treatments for autism at:
This publication was developed by members of the Autism Speaks Autism Treatment Network / Autism Intervention Research Network on Physical Health-Behavioral Health Sciences Committee. Special thanks to Nicole Bing, PsyD (Cincinnati Children’s Hospital), Erica Kovacs, Ph.D. (Columbia University), Darryn Sikora, Ph.D. (Oregon Health & Science University), Laura Silverman, Ph.D. (University of Rochester), Johanna Lantz, Ph.D. (Columbia University), Benjamin Handen, Ph.D. (University of Pittsburgh), Rebecca Rieger, BA (Columbia University), Zonya Mitchell, Psy.D., (Columbia University), and Laura Srivorakiat, M.A. (Cincinnati Children’s Hospital) for their work on the publication.
It was edited, designed, and produced by Autism Speaks Autism Treatment Network / Autism Intervention Research Network on Physical Health communications department. We are grateful for review and suggestions by many, including families associated with the Autism Speaks Autism Treatment Network .This publication may be distributed as is or, at no cost, may be individualized as an electronic file for your production and dissemination, so that it includes your organization and its most frequent referrals. For revision information, please contact firstname.lastname@example.org.
These materials are the product of on-going activities of the Autism Speaks Autism Treatment Network, a funded program of Autism Speaks. It is supported by cooperative agreement UA3 MC 11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program to the Massachusetts General Hospital. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the MCHB, HRSA, HHS. Images for this tool kit were purchased from istockphoto®. Written May 2012.
People use the acronym ABA in many ways so it is sometimes confusing to know exactly what someone means when they say ‘ABA.’ If you are confused about this, you are not alone!
When investigating providers or centers, we strongly encourage you to see if they have a Board Certified Behavior Analyst on staff. If the provider or center serves a lot of clients, they should have more than one BCBA on staff. ABA as a treatment approach cannot be done properly if you have one Board Certified Behavior Analyst who is responsible for making sure a lot of people are getting appropriate care. Some centers will also have Board Certified Assistant Behavior Analyst’s (BCaBA) on staff. These are bachelor degree level professionals who have received some training, but who cannot supervise programs without frequent oversight from a BCBA. While a variety of factors impact caseload size, BACB Guidelines note that oversight of 6-12 clients is the average, with a higher range possible based on circumstances (see page 31 of https://www.bacb.com/wp-content/uploads/Clarifications_ASD_Practice_Guidelines_2nd_ed.pdf).
You can check the website at https://www.bacb.com/page/100155/ to find a BCBA provider in your area. If the provider or center you are investigating does not have a Board Certified Behavior Analyst on staff, ask questions about the credentials of staff that are working there. For example, some psychologists have received a lot of training in ABA but do not have a BCBA credential. Other psychologists have received a smaller amount of related training, but they do not have the precise training required for ABA. Don’t be afraid to ask a lot of questions! Also, realize that any credential only shows that the professional has passed a test and has met a minimum standard of supervised practical training. So make sure you find out about all of their experience with children like yours. For example, how many children have they worked with, what type of children, and how long have they worked in their field. Ask for references and talk to other parents who have used their services.
Often, people receiving ABA services work directly with ‘front line therapists.’ Front line therapists typically are not a BCBA; some may be a BCaBA or have no certification. If your child will be working with a front line therapist, find out about how and how often they are supervised. Is a BCBA providing supervision? Are they providing training on how to help your child more effectively? Ask for examples of their training procedures as you are deciding about a provider or center. Be sure to ask for examples of training procedures once your child is getting services too.
Your child is precious and you need to know that they are in safe hands. Background checks should be considered standard practice and are typically done by schools, centers, and most providers. If your child is young, an adolescent or an adult, a background check is always appropriate. If you hire your own front line therapist or are bringing a provider into your home, you should do a background check. Know that schools routinely require a background check of teachers and paraprofessionals. This is a standard procedure in many professional situations that involve children. You should absolutely not feel uncomfortable asking for a background check to be performed. Typically, the organization that provides the front line staff conducts the background check, and covers the costs. If they do not, that should serve as a red flag. The only time a parent might have to pay for a background check is if they are hiring their own front line staff apart from an organized ABA provider.
Watch how your child interacts with the therapist. Your child just might be the best judge of character. If your child always resists requests to focus on important materials, do not misread or overly focus on negative reactions to a particular therapist. However, you should still monitor your child’s reaction over time to the therapist. f your child’s therapist seems to be unnecessarily or harshly punishing or overly aversive (e.g., excessive restraints, sprays in the face, mouth swabs, etc.), don’t hesitate to question their professional behavior. ABA should not be aversive. In truth, the most effective therapists are those who can establish a positive rapport with your child. Trust your gut instinct. If your child becomes upset in the presence of the provider, they will probably be less effective with your son/daughter. You know your child best and you should make the decision about how your child responds to new people or situations.
Ask to about policies and practices of the agency/provider, including those related to preventing abuse, taking advantage of parents, and protecting parent privacy. What is the approval process for any treatment plan that may contain questionable practices? All parents are encouraged to ask these questions. Any strategy that has the potential to harm your child is inappropriate.
Ask how frequently you are allowed to observe your child in therapy. While an agency/provider may have basic protocols on how to schedule an observation, the ability or inability to easily access your child at any time may be something worth considering. Also, if at any time you notice a procedure with your child that makes you uncomfortable, you have every right to stop the procedure and/or ask for more information about why the procedure is in place, the potential harm and good of the procedure, and about potential alternative procedures. There is seldom, if ever, only one way to change a behavior. If you and an agency/provider don’t agree on the procedure to use, it is the provider who needs to change or you who need to seek out a new provider.
ABA may be used for many hours across long periods of time, especially in the early stages of treatment. There is no ABA magic wand. It takes a lot of work by a lot of people (including you) to help your child reach his or her potential. So be very careful of grandiose promises about unrealistic outcomes. Providers who promise instant cures should be questioned. None of us can say with certainty what a child will be able to do in the future. Most children will make progress when provided with effective instruction and support, but each child will progress at a different pace. There are many factors that may impact progress. Factors like your child’s health, behavioral challenges, quality of program, and how challenging it is for them to carry over their skills to important settings (like your home or in the community) all influence how quickly progress is made. Any provider or center that promises your child will be “just like kids without ASD” in a few years is making promises they can’t keep.
You will notice that the definition of ABA we agreed to in Indiana says that programs should teach socially significant behaviors. In the plan developed for your child, skills should be taught that are valued by you and that facilitate skills that can be used in real world settings and that lead to meaningful adult outcomes. For example, if your child has worked on colors for 2 years and still does not have the skill, then move on to something else. Much can be achieved in life without mastery of this specific skill. Programming should facilitate achievement of outcomes that make it easier for your child to go to school, spend time with family, and go out into his or her community. Be prepared to make a list of skills that you and your family value. Be specific in outcomes you want to see.
Plans should address generalization (being able to use a skill in all appropriate situations) and maintenance (keeping a skill once you learn it). The ability to perform a skill in a clinical setting with one person using only one type of instructional material is only the first step in the process. If the program does not expand the skill into other settings with other people, including family members, then the skill has not been truly learned and may be useless. Likewise, there should be a plan for revisiting or building on important skills, so that skills are maintained over time.
There should be a plan to transition the child out of therapy and into less restrictive settings. The ultimate goal everyone should have for your child is that they can learn skills and are maximally successful in real world settings. You should also ask what the criteria for transitioning to a different setting – like school – will be for your child. How are transitions handled? What is their success rate of transitioning? Often, different people need different transition plans, but a provider or center should be able to discuss their process for handling transitions and why successful transitions are a critical goal for your child.
Data collection is a critical component of ABA programs. All providers and centers should be able to regularly provide you data in a format that is understandable. They should explain how to interpret the data. Some professionals become so accustomed to using data that they hand you reams of data that simply don’t make sense to anyone. Providers and staff at centers should be able to summarize data so you can see trends that show if your child is improving or not. They should be able to discuss the data and your child’s progress in understandable terms. They should use data to make program adjustments so that your child can progress most quickly – and they should help you understand this process too. It’s ok to ask for clarification, because if you don’t understand what they are telling you, it will be difficult for you to understand if progress is truly being made.
Each provider should have a clear plan and documentation that shows whether progress is being made and be able to clearly explain that plan to you. When you are still in the investigation phase, ask the provider or center how this is done in their organization. Ask for examples. They can remove identifying information for others they serve to provide you an example. After you have selected a provider or center, keep asking about their plan and the documentation they have about your child’s progress. Once your child is in a program, you should have regularly scheduled meetings with your child’s BCBA or supervising provider to review progress, make updates to the program, and to provide you with the skills to help maintain and generalize your child’s mastered skills at home or in the community.
Although ABA providers hold many core beliefs in common, you will also find that they have differing approaches and philosophies. For example, some embrace sensory and medical conditions impacting behavior; others do not. Some consider the use of visual supports as very important and others do not. Some believe it is best to start with augmentative communication systems in some cases; others only believe in verbal communication. Some focus on constantly creating new and novel situations so your child is motivated; others provide extremely rigid environments. Regardless, know what your child needs and what works for your child. You can find a list of evidence based practices at the website for the National Professional Development Center on ASD at https://autismpdc.fpg.unc.edu/node/1. Some of these strategies are strictly associated with ABA; others are not. This list includes strategies that have also been validated for schools.
ABA providers and centers charge different rates. Costs will vary greatly. Please do not assume more expensive programs or providers always provide better services. Like other businesses, buildings, marketing and salaries impact costs. Also look at the stability of staff – does the provider or center keep staff for a long time? The faster the turnover the more training they have to provide staff and this can affect both costs and the quality of services that are provided. Make sure you ask about costs of various providers and centers before you make any decisions. And be aware of billing and insurance practices.
The number of hours recommended may differ for each child and will impact costs. The National Research Council recommends a minimum of 25 hours a week for young children ( http://www.nap.edu/catalog.php?record_id=10017). Like all therapies/treatments, the number of hours will differ depending on the child’s and family’s needs. Hours of services should be based on getting your child the level of help that is necessary so he or she makes progress in all important areas. Communication, taking care of oneself, spending time with others in play (for younger children) or other activities that happen in adolescents or adulthood are all important because they help your child become happier and more successful in real world settings. Remember that ABA should be individualized and a single program should never be applied to every case in the same way. The cost of your child’s program is likely to vary depending on how many skills they need to develop and how long it takes them to use these skills in everyday life. It will also depend on the setting in which these services are provided.
ABA providers, like all professionals, may use words and language that are not common and that you may not understand. Request that your ABA providers explain things in common terms. Do not be embarrassed to say you do not understand. It is their responsibility to explain things in a way you understand. All professionals have to be careful not to overly use jargon. A lot of ABA providers use many acronyms and may lose sight of how confusing this terminology may be to families. Feel free to remind them!
Parents will often complain about the fragmentation in services for their sons/daughters. If your child attends a school or other program, there should be a discussion about how collaboration will occur. Be cautious of providers, schools, or centers that condemn others to raise their own status. Schools and ABA programs are very different, and function under different laws and regulations. ABA therapy programs are used to treat students who have a medical necessity. Educational programming is based on educational (and not medical) need and programs are collaboratively designed by the student’s school team, including you. The goal is that all of your child’s team work together (and with you) peacefully to ensure maximum progress for your child. Consider signing a mutual exchange of information to allow all parties to share information about current assessments and goals.
Sometimes a combined program (some time in school and some time with ABA providers or centers) is suggested. Be aware that there are state laws about a student’s attendance at school that may have to be acknowledged. Realize that a single approach (reinforcement, token economies) can be done in both settings, but will look different. Another thing that sometimes looks different is the ratio of staff to children. Some children benefit from more individualized attention, but many of them do not require this all day long and will still make progress when the ratio is different.
Most school professionals receive some training in ABA and some school districts are now employing BCBAs. Most schools have an autism consultant on staff that can assist with the transition and development of school programming. Realize that ABA strategies can be done by teachers in schools; it just may look different. Be prepared to ask relevant questions about educational programming in these settings.
Our hope is that these guidelines can assist in your decision-making process. Remember that you play a critical role in making a choice about the setting or provider from which your child receives services. Anyone in any setting that makes you feel your perspective is unimportant or, worse still, interfering is approaching your child’s needs with the wrong attitude.
This list is not exhaustive. The bottom line is that you trust your common sense and ask a range of people about the services provided. Take both positive and negative comments, and then make a decision based on what will benefit your entire family. Look for a provider that seeks parent perspective and involvement, and that is able to make documented progress in teaching your son/ daughter skills that are important for a lifetime.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance, Medical Assistance (MA), or the Children’s Health Insurance Program (CHIP) under Pennsylvania’s Autism Insurance Act (ACT 62). ACT 62 is a statewide insurance mandate specific to services provided to children and adolescents with Autism Spectrum Disorder (ASD).
The Department of Human Services (DHS), Pennsylvania Insurance Department (PID), and Department of State (DOS) are working together to fully implement Act 62. A number of new resources have been developed to provide guidance to families about ACT 62.
The documents on this page provide important information and resources about the Autism Insurance Act, and new resources continue to be developed. We encourage you to visit this page regularly for the most up-to-date resources.
What to do if your child is enrolled in Medical Assistance and you have concerns about Applied Behavioral Analysis: If you are having a problem getting Applied Behavioral Analysis (“ABA” ) for your child that you have not been able to resolve with your Behavioral Health Managed Care Organization or the county, you may contact 717-409-3791 or ABA@pa.gov.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance or Medical Assistance (MA) under Pennsylvania’s Autism Insurance Act (ACT 62).
The Department of Human Services (DHS), Pennsylvania Insurance Department (PID), and Department of State (DOS) are working together to fully implement Act 62. The Departments worked together to identify the billing codes for providers to use to bill private insurance and MA for services to diagnose and treat ASD for children and adolescents. Beginning September 30, 2016, private insurance companies may approve services and claims that they may have denied in the past.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance, Medical Assistance (MA) or the Children’s Health Insurance Program (CHIP) under Pennsylvania’s Autism Insurance Act (ACT 62). ACT 62 is a statewide insurance mandate specific to services provided to children and adolescents with Autism Spectrum Disorder (ASD).
Children and adolescents under age 21 with ASD who:
*Act 62 does not apply to policies issued outside of PA or that are “self-funded” or “ERISA” policies.
Medically necessary services that are for the assessment and treatment of ASD, including:
Accessing autism services through private insurance results in significant cost savings to publicly-funded state programs.
The maximum amount private health insurance companies are required to pay as a result of Act 62 for the diagnostic assessment and treatment of ASD is known as the “cap.” The amount of the cap is adjusted annually. Coverage is subject to copayment, deductible, coinsurance, and
other exclusions or limitations to the same extent as other medical services covered by the policy. Some plans do not impose any cap. Be sure to check your plan.
In Pennsylvania, your child’s autism-related services may be covered by private health insurance,
the Medical Assistance program (Medicaid) or the Children’s Health Insurance Program (CHIP) under Pennsylvania’s Autism Insurance Act (ACT 62).
Most private insurance plans are provided through an employer or purchased through the Health
Insurance Marketplace. Under the Affordable Care Act (ACA), individuals may be covered under their parent’s insurance until age 26.
Premiums: An insurance premium is the amount of money that an individual or business must pay for an insurance policy.
Copays: A copay (copayment) is a fixed amount you pay for covered services, typically when you receive the service.
Coinsurance: Coinsurance is the percentage of costs of a covered health care service that you pay after you’ve paid your deductible.
Deductibles: The amount you pay for covered health care services before your insurance plan starts to pay.
Out-of-Pocket Maximum: The most you have to pay for covered services in a plan year.
Provider Network: The doctors, other health care providers, and hospitals that a plan has contracted with to provide medical care to its members.
Medicaid is the payer of last resort, meaning any other insurance coverage you may have should be billed first. You should always show your private insurance card, if you have private insurance, as well as your Medicaid card.
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources.
Your child may qualify for Medicaid, better known as Medical Assistance (MA) in PA, if you meet income and other eligibility requirements.
Some children or adolescents (under age 18) may qualify on the basis of their disability, without regard to parental/guardian income or resources.
You may apply online using COMPASS. You can also contact your local county assistance office for an application or you may download an application from the Department of Human Services website to send to your county assistance office. If you need help completing the application form, trained county assistance staff members can help you.
For more information on qualifications, or to download an application visit: www.dhs.pa.gov
When children under age 18 have Medicaid and see a Medicaid participating provider, private
insurance costs such as copays, deductibles, and out-of-pocket maximums are not paid for by
the family. Certain Medicaid services provided to children ages 18-20 may be subject to a small MA copay amount.
The ABA in PA Initiative is a 501 (c)(3) nonprofit advocacy organization made up of parents, industry professionals, and lawmakers dedicated to change the future for all children in Pennsylvania with Autism Spectrum Disorder (ASD) by ensuring access to Applied Behavior Analysis (ABA) therapy via Medical Assistance.
The ABA in PA Initiative aims to bring the autism community together as one united voice to urge Pennsylvania and private sector to listen to our concerns and take immediate action to address the service gap for ABA. It is our firm belief that, working together, we can assure that our children get the care they need, when they need it!
The Better Access to Treatment Act – “BAT ACT“
Our mission within the ABA in PA Initiative has always been: to increase access to qualified professionals, increase access to behavior analytic services and ensure that our ABA providers have the highest level of expertise.
We are excited and pleased to announce that the ABA in PA Initiative, in conjunction with Rep. Tom Murt and Rep. Tom Mehaffie are putting forth legislation for licensing Behavior Analysts! The Better Access to Treatment Act will differ from the current “Behavior Specialist” licensure created in Act 62. The Act 62 licenses focuses on providing treatment to children with Autism, however the Better Access to Treatment Act will provide help to the millions of individuals that need quality ABA treatment regardless of diagnosis or age
Let’s face it, getting access to quality Applied Behavior Analysis (ABA) in Pennsylvania can be difficult. Although Act 62 was aimed at protecting individuals with autism so that they could access ABA therapy, medical assistance was not recognizing it, nor covering it as a discrete service.
Over the past year, however, there is progress to report:
– ABA will be reimbursed as a specific treatment modality by Medical Assistance (MA).
– BHRS will also begin to directly address the development of self-care skills (otherwise known as “ADLs” or activities of daily living skills).
– Pennsylvania is increasing training expectations to ensure that ABA is delivered by qualified individuals.
Although we are pleased by this progress, there are still significant gaps and challenges that make it difficult for families in PA to access quality ABA. The ABA in PA initiative have set our sights on the following needs:
We believe that families have a basic right to treatment by a competent professional. Each tier of the ABA service delivery model should include staff who meet the minimal training suggested by the Behavior Analysis Certification Board (www.bacb.com) and the Autism Special Interest Group of the Association for Behavior Analysis International (www.abainternational.org). Unqualified and under qualified individuals are now providing ABA. The state developed a Behavior Specialist License which increased the number of available Master’s level clinicians (referred to as “BSC”) but did not ensure that those who hold this license are properly trained to be an ABA therapist. This is not just irresponsible, it’s unethical. Holding this license might provide you with an edge over someone who does not hold this license but by no means affords you the expertise, training or experience to provide ABA therapy and we want the public to know and understand this. We want Pennsylvania to have enough ABA therapists but lowering standards is not the way to do it. Would you want your child’s surgery done by a general pediatrician because there wasn’t a surgeon close by? Neither would we!
We need to attract highly-qualified individuals to Pennsylvania, and encourage those already practicing under state regulations to stay here. Lowering the qualifications doesn’t just discourage highly trained professionals (i.e. BCBAs, BCaBAs) from participating in state-funded programs, it pushes them away, and further opens the door for “bad therapy” hiding under the guise of ABA and harming those the law is meant to help.
Access to ABA
Pennsylvania is made up of many rural communities. Encouraging professionals to seek out and service these underserved populations is the responsibility of any state-funded program. Individuals and their families sitting on waiting lists not only wastes precious time during which opportunities for growth are lost, it threatens that individual’s chance for future independence. We cannot both acknowledge an individual’s need for service while also denying them access to those who can help them. We believe that incentives can help providers from more populated areas work in underserved areas to meet that need. If someone wants to earn their BCBA but can’t afford to pay for the degree, why not offer loan forgiveness if that person agrees to work in an underserved community for a period of time? A win – win for everyone!
Pennsylvania MA-funded ABA professionals need access to ongoing training by qualified professionals. PennABA, ABAI, APBA and the National Autism Conference offer quality training. However, MA funded ABA professionals need regular access to these training opportunities. Large caseloads and high billing expectations put professional development on the back burner which leads to staff burnout and stagnant therapeutic practices. It leads to valuing quantity over quality, and turns mental health into a commodity to be traded. We cannot allow this to happen. The expertise of our ABA colleagues needs to be valued, their continuing education protected and the quality and integrity of program delivery enforced.
Applied Behavior Analysis (ABA) is a science in which processes are systematically applied to improve socially significant behavior to a meaningful degree. An ABA program is a systematic teaching approach that involves breaking skills down into small, easy-to-learn steps. Praise or other rewards are used to motivate the child, and progress is continuously measured so the teaching program can be adapted as needed. ABA is endorsed for autism by the American Academy of Pediatrics and the US Surgeon General.ABA is widely recognized as the single most effective treatment for children with autism spectrum disorder and the only treatment shown to lead to significant, lasting improvements in the lives of individuals with autism.
Studies have shown that children with autism who participated in intensive ABA programs showed significant improvements in IQ, language skills, and academic performance. Some children in these studies were able to move successfully to mainstream public school classes, where they can learn alongside typically developing peers.
ABA based treatment strategies maximize the learning potential of persons with ASD, and are flexible, individualized and dynamic.
With ABA, every child can benefit by learning new skills and reducing problem behaviors
Evidence-based practices (EBP) for individuals with autism are therapies and treatments that have undergone a thorough research and review process by professionals in the field, and have been found to be effective for treating various symptoms of autism. Choosing treatments that are evidence-based provides the best chance for improving outcomes for an individual with autism. Knowing the difference between treatments that are established as evidence-based compared to emerging treatments or those that are unestablished, can help parents, family, caregivers, teachers and other professionals choose the best possible treatment options.
There are two main organizations who have independently reviewed the scientific literature and research on treatments for autism, and provided reports on treatments that are considered evidence based.
The National Standards Project published their first report in 2009 based on research and data from 1957-2007. They updated this report in 2015 to include research and data from 2007-2012. They are currently in the process of reviewing research and data from 2012-2018, with a plan to release that report in 2021. In their second report, they also included research on treatments for individuals age 22+.
The National Professional Development Center on Autism Spectrum Disorder, also reviewed scientific literature and research, publishing a report based on data from 1997-2007 in their initial report. This was updated in their second review to include research from 1990-2011, with plans for a third report including data through 2017 to be released in the coming year. These reports only provide information on evidence-based treatment for individuals age 0-21.
The National Standards Project, conducted by the National Autism Center at May Institute, is a comprehensive review of the scientific evidence for autism treatments. The goal of this project is to reduce uncertainty around autism treatment, and provide guidelines for how to make choices about interventions.
The first phase of the National Standards Project looked at educational and behavioral intervention literature for the treatment of autism between 1957 and the fall of 2007. All of this literature was put through a standardized review process, and a list of established, emerging and unestablished treatments for individuals with autism was created. The Phase 1 report was released in 2009.
In 2015 the National Standards Project released Phase 2, which included research that was conducted between 2007 and 2012, essentially providing an update on treatments from when Phase 1 was completed. Findings from the Phase 1 report were updated, and the “emerging” treatments were reviewed to determine if they now met criteria for “established” treatments, or should fall into the “unestablished” treatments. Additionally, interventions for individuals age 22 and older were also reviewed and categorized as established, emerging, or unestablished, which was never done previously.
Interventions that are described as “established” have been shown through numerous research studies over many years to be an effective treatment for individuals with autism. These treatments have been thoroughly studied, tested and reviewed and clearly demonstrate positive effects when used in the treatment of individuals with autism.
Interventions that are described as “emerging” have one or more studies that suggest they may produce favorable outcomes. However, before they can be described as “established”, there needs to be additional high quality studies to show that consistently show these interventions are effective for individuals with autism.
Interventions that are described as “unestablished” have little or no evidence in the scientific literature to determine if they are effective treatments for individuals with autism. Individuals should not assume that these interventions are effective in any way, and because there is little to no scientific evidence about these treatments there is no way to rule out the possibility that they are ineffective or even harmful.
There are 14 Established Interventions that have been thoroughly researched and have sufficient evidence to confidently state they are effective:
There are 18 treatments that have been reviewed and classified as Emerging Interventions, meaning there is need for further research before being considered established interventions:
There are 13 treatments that have been reviewed and classified as Unestablished Interventions. These treatments have little to no evidence to allow conclusions to be drawn about their effectiveness, and there is no way to rule out the possibility that these interventions are harmful or ineffective:
The only intervention to be identified as Established for individuals ages 22 years and older is Behavioral Interventions. The Behavioral Intervention category consists of applied behavior analytic interventions to increase adaptive behaviors and decrease challenging behaviors.
There is one treatment that has been reviewed and classified as an Emerging Intervention, meaning there is need for further research before being considered established interventions: Vocational Training Package
There are 4 treatments that have been reviewed and classified as Unestablished Interventions. These treatments have little to no evidence to allow conclusions to be drawn about their effectiveness, and there is no way to rule out the possibility that these interventions are harmful or ineffective:
The National Professional Development Center for Autism Spectrum Disorder, is a comprehensive review of literature and scientific research on treatments for autism. The initial report focused on research dating from 1997-2007, a ten-year time span. In this initial report, they found 24 focused intervention practices that met criteria for being evidence-based. They only classified treatments as evidence-based, and did not list those that were “emerging” or “unestablished”.
In the second review of the literature, research articles dating back to 1990, and up through 2011, were included in the review. Additionally, a broader and more rigorous review process was put in place, included a standard evaluation process for the research. This report was released in 2014 and includes 27 interventions considered evidence-based, with plans for an updated report to be released in the coming year.
These reports also only reviewed treatments for individuals with autism age 0-21, there is no review of literature on treatments for adults.
The following treatments are considered evidence-based:
These interventions either did not have enough studies to meet criteria to be considered evidence-based, were all conducted by the same research group, did not include enough participants across studies, or included idiosyncratic behavior intervention packages for participants:
|Introduction to applied behavior analysis||This booklet describes the principles of Applied Behavior Analysis (ABA), how ABA is used in education, and different educational approaches that use the principles of ABA.||Download file: Introduction to applied behavior analysis|
|Applied Behavior Analysis: A Parent's Guide||This tool kit is designed to provide parents with a better understanding of ABA, how your child can benefit, and where/how you can seek ABA services.||Download file: Applied Behavior Analysis: A Parent's Guide|
|How to know if your child's program uses ABA||Provides information regarding signs and standards for ABA programs such as environment, instructors and instruction.||Download file: How to know if your child's program uses ABA|
This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.