Hiring a Behavior Analyst

 




If you are unfamiliar with ABA services, you may first hear about it as a recommendation post-diagnosis. Or, from a school system recommending behavioral services. Or, you might seek out an ABA provider if persistent, challenging, or harmful behaviors are happening in your home, in the community, or at your child' school.


For most people, the process of starting up ABA services will involve multiple steps, an extensive timeline, and lots & lots of paperwork (seriously.... a mountain of paperwork). To briefly summarize, the child must be diagnosed, an ABA provider must be found/identified, an intake assessment must occur, insurance authorization has to happen, staff must be assigned to the case, and only then do services actually begin. I would say a best case scenario would be all of that occurring within 1-2 months. Unfortunately though, best case scenarios don't always happen.


Just like there are valid, honest reasons why ABA therapy isn't for everyone, there are valid reasons why starting services with the ABA agency/clinic up the street isn't the best idea. Sometimes it will make much more sense to work with a solo practitioner/BCBA.

If you aren't familiar with the title BCBA, a Board-Certified Behavior Analyst is someone trained in the science of Behavior Analysis, holding a Masters degree or higher, who has gone through roughly 1-2 years of highly regimented supervised experience and passed a rigorous exam. BCBAs can practice independently, so this means you do not need to go through a company or agency to work with one. Similar to physicians, BCBAs have specialties. All BCBAs will possess a standard skillset/range of knowledge on behavior, but the specialty will be a combination of an individuals post-certification experiences and training. For example, some BCBAs specialize in feeding disorders. Others have worked with early intervention populations exclusively, and others focus more on OBM (Organizational Behavior Management) rather than special needs populations. 


For most families, it seems like a simple equation: need ABA services ---> call up a local company ----> start services. But, there are some scenarios where this would actually be a bad idea:


  • Brief or Short Term Consultation - Most ABA companies are focused on servicing clients needing intensive, multi-year therapy for many hours each week. If you have a specific behavioral need or only need short term help, it actually would be faster, and simpler, to just work directly with a solo BCBA.  And on that note, lets talk about speed of services starting up....

  • Delay to Onset of Services - I regularly talk to families who are sitting on wait lists to access services. Or, their child completed an initial assessment with a company, but they haven't heard anything for 30, 60, days and counting. There could be many reasons why you experience a significant delay to start services, but the most common reasons would be staffing (no available staff), and funding issues (problems with getting services authorized or company is not in network with your insurance provider). If you need help now, I strongly suggest contacting a solo BCBA rather than a company/agency.

  • Wanting Highly Experienced Staff - As part of my role, I regularly conduct intake assessments with families new to ABA. Many times they will ask me if I will be the one working directly with their child, and I then explain that ABA treatment utilizes a tiered-service delivery model. In a tiered model, the supervisor/BCBA is usually the most degreed and experienced person on that case. The individual working directly with the client, is usually called an ABA Therapist, or Registered Behavior Technician (if they are credentialed). The education and experience of the direct staff can vary, and a high-quality company will have a rigorous training and onboarding process for direct staff before they can work with clients (a poor quality company will not). If you want Masters degree level clinicians working with your child, that can be hard to find at a company. 

  • Rural/International/Low Supply Area - I have worked privately with families as a Consultant for many years. The main reason why these families chose to hire me instead of going to a company/agency, is because in this was not an option for their area. Some of these families lived in very rural areas with no ABA providers for miles. Others lived outside of the US, where knowledge of ABA can be minimal or absent. For others, there were TONS of ABA companies in their area. The problem with that though, is that high demand can = insane wait lists. I'm talking sitting on a wait list for 1-3 years. In these situations, it makes far more sense to work with a solo BCBA via Telehealth/technology. I do not recommend sitting on a wait list for any significant length of time without also pursuing other options.

  • No Diagnosis/Non-ASD Diagnosis - In most states that have Autism mandates for insurance coverage, a diagnosis of Autism is required to receive ABA treatment. If your child is not diagnosed, you're stuck on a wait list just to get a diagnosis (which can happen), or your child has a non-Autism diagnosis, then you may not be able to receive services from an ABA company. Not all companies accept private pay clients, especially the very large ones. In this situation, it would make more sense work with a solo BCBA.

  • Funding Issues/Insurance Issues - Similar to the above point, there can be challenges with accessing ABA therapy through your insurance. For some, a high annual deductible must be met before insurance will kick in. Or, per session co-pays might be very high (keep in mind there will be multiple sessions per week). Sometimes the insurance may cover an amount of ABA that is very minimal, or does not allow for quality supervision of treatment. I have worked with families  where due to their specific insurance plan, I could only see them once a month. That is not enough for high-quality services. 

  • Language Barriers - If you live in an area where that predominate language is not your first language, you may experience a barrier to accessing treatment. For example, many families in Atlanta speak Chinese or Spanish as their first language. But not all ABA companies in Atlanta have Chinese or Spanish speaking staff, or translators available. So what does this mean? It means it can be challenging to initiate services, participate in assessment, and understand what is going on in therapy. If this is your situation, you may want to find a solo BCBA who speaks your first language for ease of understanding and communication. Another bonus is this BCBA would be able to provide translated documents and paperwork to you, in your dominant language.

  • Professional seeking Consultation - Lastly, what if you are not a parent seeking services for your child, but rather a related professional who wants to collaborate with a BCBA? Maybe you are a teacher, SLP, Psychologist, or PT, and you have a particular client/student with challenging behaviors and need some help. This is not a scenario that would be appropriate for calling up an ABA company. It would be far more feasible (and faster) to locate a BCBA and ask about individual consultation. Keep in mind that ethically, the caregivers of the specific client must consent to this consultation as well.



There will be exceptions to all of the points above, depending on the area where you reside, the funding sources available, the quality of local providers, and your specific behavioral needs. 
For example, it is often more difficult for parents of older children or adults to access services. Also, not all agencies accept all insurances. Or maybe your current ABA provider seems to have a revolving door of staff, and just when you acclimate to the team members: they change. These are all scenarios where you may want to consider private consultation.

Just keep in mind that if services in your area are lacking, full of impossible waitlists, or if you have funding challenges, you do have other options available to receive ABA intervention for your child.



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