COVID has provided challenges and perhaps opportunities as well. Family members who are trying to balance work, family and life have turned to ABA (Applied Behavior Analysis) centers to assist with virtual/e-learning. While this choice is understandable, COVID has also blurred the lines between the role of ABA programs and the role of schools. Earlier this year, an article was released that highlights the differences between ABA in medical/clinical settings, and educational programming https://www.iidc.indiana.edu/irca/articles/applied-behavior-analysis-in-schools-and-in-clinics.html. Amid COVID, let’s further clarify that distinction.
ABA clinics/providers are often reimbursed for services via Medicaid or health insurance based on the development of a treatment plan that focuses on treating, ameliorating, managing or preventing the signs, symptoms and effects of the medical/neurological condition of an autism spectrum disorder. The goal is to prepare children for less restrictive settings and with important lifelong skills. On the other hand, educational programming provides a free appropriate public education (FAPE) in the least restrictive environment (LRE) driven by a child’s individualized education program (IEP). Program goals can address academic, communication, social, behavioral, life and emotional skills. Ultimate outcome is to assist in preparing students for post-school outcomes (e.g., employment, community membership, etc.).
While ABA programs and schools may use many of the same instructional tools, the reason or the “why” behind the use of the materials is an important distinction. In a school setting, math materials are used to teach math skills based on state standards and IEP goals. In the ABA setting, math materials are used as the opportunity to teach attending, sitting, following directions and other behavior skills that help prepare the child for a less restrictive setting. In truth, using common instructional tools helps to facilitate generalization. Generalization makes moving to a less restrictive setting possible. If the student can only exhibit positive behaviors in an ABA setting, and cannot generalize to home or school, then the job of the ABA center is not done.
During COVID, some families have enrolled their child in an ABA program to facilitate their virtual learning and to address any regression brought on by this pandemic. This may take the form of receiving virtual instruction from the classroom teacher at the ABA center or helping the child complete academic materials sent by the school. While this is understandable, ABA centers/providers are not and cannot be funded to provide educational programming. This makes delineating the lines between the two even more critical. However, they can be funded to help students stay on task, remain seated, follow directions and all the other behavior skills that facilitate learning.
If the child is enrolled in school, the teacher of record (TOR) is responsible for ensuring implementation of the IEP, delivering instruction and monitoring progress (collecting data) toward the IEP goals. They are also responsible for ensuring the quality of the academic work and that it meets state curriculum and graduation standards. The clinical ABA provider, who typically is not a licensed teacher, is not and should not be performing those functions as they would be providing educational services that are not billable to insurance. The ABA provider is responsible for taking data on and documenting clinical progress according to the goals in the treatment plan – the behaviors to increase or decrease, the signs, symptoms and effects of autism to address during the session. Only those activities are reimbursable by insurance.
Some of our schools are training paraprofessionals to be Registered Behavior Technicians (RBTs) or encouraging staff to become Board Certified Behavior Analysts (BCBAs). School districts realize that the content in these training programs is useful across a range of settings. However, if funded through Medicaid or insurance, schools also need to be a credentialed Medicaid provider for that child’s type of Medicaid, develop a treatment plan that focuses on desired medical/behavioral outcomes, and receive approval from the Medicaid or insurance carrier to perform clinical ABA treatment with that particular child (a prior-authorization). And while schools absolutely should utilize ABA techniques (e.g., reinforcement, shaping, chaining, discrete trial teaching), they should not profess to be ABA clinics unless they are meeting the standards of those programs as outlined by the Behavior Analyst Certification Board (https://www.bacb.com/), and are credentialed clinical providers under Medicaid and/or private insurance networks.
Ideally, all parties - parents, school personnel and ABA providers - should strive to work together to support students. This requires respecting each person’s discipline and working to establish a positive and proactive relationship. What is non-negotiable is the criteria under which programming is funded. Again, Medicaid and Insurance only cover programs that are based on a medical diagnosis, deemed medically necessary and require an approved treatment plan that is implemented by a provider credentialed with that child’s insurer or Medicaid. Special educational programming follows different legislation, is based on educational need, requires the development of an IEP (individualized education program) implemented by the TOR and is publicly funded. Each serve an important function.
The adversity of COVID can be an opportunity for a renewed focus on how parents, ABA providers and schools can work together respectfully. Our students deserve no less.
Pratt, C. (2020). The marriage of applied behavior analysis (ABA) and education during COVID. https://www.iidc.indiana.edu/irca/resources/articles/index.html.