Applied Behavior Analysis: Educational or Medical?
Given that ABA is not a panacea, and that it works better for some people than for others, it is still considered the gold standard for autism treatment.
The problem: when ABA is provided as prescribed (up to 40 hours per week of 1:1 therapy), it can cost as much as $70,000 per year. As a result, insurance companies are balking at the cost. An article in the LA Times describes a mutiny on the part of California health insurer who refuse to cover the treatment.
The argument made by the health insurers is that ABA therapy is not medical, but rather educational.
Of course, ABA does much more than teach academic content - and parents feel strongly that a therapy intended to build functionality should be considered medical. But it's understandable that medical insurers would make the "educational" argument to save money, and expect to be heard by the courts. Here's why:
- ABA is often provided by school districts. In fact, many kids with autism are placed in "ABA classrooms."
- ABA is often used to teach academic, social and life skills - none of which are, strictly speaking, medical concerns.
- ABA does not directly treat medical symptoms sometimes associated with autism, such as motor issues or mood disorders.
Comments
Some one correct me if I’m wrong, ABA providers are not licensed like psychologists or other medical professionals, but have certification. There is also no national standard certifying or licensing that I ever heard of. Although some states are passing laws that insurance companies cover a certain amount of ABA, one could see the possible argument that it is educational, not medical. Of the schools that offer ABA, it’d be interesting to know of the person providing that service is certified, many times they are not and just went to some classes. One could also see the argument that ABA therapists are not academic teachers nor had that teaching education in order to teach children academics even via ABA. Behavioral is not academic, or they’d be termed AAA Applied Academic Analysis. However they are Behavioral Analysis.
So my first option would be to suggest it is medical, except it doesn’t have the licensing or a national standard or a safe guard to ensure the therapist even has certification.
Sandy – there is a certification process – Board Certified Behavior Analyst. Some health insurances will only cover ABA therapy IF there is a BCBA supervising the therapist.
I know what BCBA is, and how that came about. Of the history of ABA, there was a lot of controversy over this and they then came up with BCBA and I believe yearly cert. but again, this is one area that is not state regulated to ensure these therapists are certified.
A number of states are moving towards state licensure or state recognition of the BCBA certification. I am absolutely not in favor of insurance companies reimbursing for services provided by non certified professionals.
As for the issue regarding whether ABA is medical or educational, some have argued that the intensive teaching used may help the brain to function better just as Occupational Therapy may do for rehabilitaion of brain injured people. To date, however, there is no hard evidence to suggest this is what ABA can do. My take of it is this: if “talk” therapy can be reimbursed as a “medical” treatment, then how is this any different from ABA services being reimbursed? Talk therapists use a different methodology than ABA, of course, but it all comes down to teaching skills to help a person live a more happy and productive life.
“ABA providers are not licensed like psychologists or other medical professionals”
Some providers do double duty or practice under the Psychologist, LPC, SLP-CCC, MFT (or other) license. As a separate standalone, licensure status has been passed in PA, AZ, and recently in OK and NV either separately or part of an insurance bill. Some others practice under prescription or supervision of a licensed professional specified in statute. Additional accountability can be specified in regulation and statute.
One aspect that is the dividing line for me is that the purpose of special education is not to ameliorate disability or necessarily to restore function, but to provide FAPE in LRE. You can do that at an intensity of service far below that recommended for best outcome. There was a recent ruling related to Medicaid in Ohio where the decision of the court was that ABA was medical and met the rehabilitative criteria for EDPST. There was also the widely disseminated ruling re: MI BC/BS that deemed that ABA was not experimental. The passage of insurance bills, as well as TRICARE/ECHO seems to also infer that some state legislatures and the US DOD agree with that assessment. A scan of the recent insurance bills passed show that those state legislatures often agree that reimbursement is suitable for BACB certificants
Would I rather have a licensed professional who was not specifically and extensively trained in ABA (especially in some of the subtlties and ethics of such as use some procedures and such as countercontrol and contingency management) delivering behavior analytic services, or one who holds a national certification (one that is accredited BTW)? Depends, but my tendency is to the latter (see the recommendations of the Autism Special Interest Group of ABA International for what they recommend in training and experience), but the certification does specify minimum competencies and experience in the application of applied behavior analysis.
Take care.
I think it crosses over… It’s medical as a behavioral treatment (that’s how they learn to cross the street, potty train, etc) and educational when the ABA program teaches school skills and follows the child as an aide in school.
I have a hard time differentiating b/w the goals of talk therapy and ABA. Since health care providers tend to cover one, i’m hard pressed to understand (other than cost) the justification for not covering the other. Until autism insurance reform is passed in my state, I help raise funds for families who can’t afford ABA treatment at http://www.autismgrant.org.
ABA of course is both “educational” and “medical”. It can be used to educate our children but it’s also a very effective tool for addressing challenging behaviors (no school would consider reducing/eliminating “self injury” or “aggression to others” as academic studies). Unfortunately, when it comes to covering the expense, it seems ABA is considered neither “educational” nor “medical” (at least here in Canada). Our public schools do not use ABA, even in “autism classrooms” and health insurance/company benefit packages do not cover anything towards it. The average family cannot foot this bill on their own, especially if one parent has to quit their job to care for their high needs child (assuming they’re not a single income family to start with).
For some of our children, ABA is not just “one option”, we should try if we have the money. For some, it’s the only chance we have that our children may ever speak, go through a day without potentially giving themselves a concussion in a fit of rage and maybe one day live a life with some kind of independence. For many ABA is a lifeline. For hope to be available and denied to those in need seems cruel and unfair. But I know, life’s not fair and sympathy for others runs shallow when money’s involved.
Just as speech or occupational therapies can be educational AND medical, so can behavioral therapy (ABA). The goals and amount necessary to teach those goals are the deciding factor.
In any case, the people proving the therapy must do it with the proper training, support, and consistent implementation – as well as updating it with the person’s response / learning.
YES I have seen ABA work and the education of the persons implementing it have been exactly what was missing and needed to problem solve a behavior and design an effective solution.
My son has overcome problems sometimes with a few weeks of practice, prompt fading, and opportunities to generalize.
I cannot believe the progress he makes when I can afford this therapy and pay for the training for his teachers. Worth every penny – too bad it is not covered by insurance or education without legal intervention – cause I can’t afford that either!
Autism is a medical condition. A proven treatment for a medical condition that can be shown to have efficacy in relieving the symptoms of the condition, is a proven medial treatement. Psychotherapy is covered by medical insurance for a wide variety of issues, which, strictly speaking, are also not medical.
As to the costs, there are many drug therapies for chronic medical disorders that rival the costs of ABA, and ABA has a fixed duration; no one has yet suggested that the therapy should be used beyond the teenage years.
That’s also exactly it. ABA is only targeted towards very young children, more so prior to school age. At age 8 at least, kids age out of the benefit of ABA and it being used within a class room setting still boggles the mind.
[for what it's worth...]
According to the IRS, ABA therapy for autism is a deductible medical expense. (see IRS Pub 502).
Actually, while ABA is generally prescribed for young children, there’s no age limit on its effectiveness. Folks at the Lovaas Institute assure me that it is very effective for teens and adults — which makes perfect sense to me!
Lisa (autism guide)
Autism is a medical condition.
http://abama.webs.com
Feel free to visit this site for information about what ABA is and what it isn’t as well as literary sources and links to other pertinent sites.
The best decision to make is an informed decision.
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