Inside Behavior Analysis
Volume 3 | 2011 | Number 2 | Online ISSN: 2151-4704
Practitioner Issues in Behavior Analysis
By Joseph Cautilli
The Practitioner Issues in Behavior Analysis (PIBA) SIG is the leading special interest group with a focus on behavior analytic practitioners. Within the first year as a group, we developed the first model licensing act for behavior analysts. We developed this act after then-chair of the SIG, Joseph Cautilli, had communication with several psychology boards from around the country. Several issues emerged from these meetings, the primary one being that it is unethical for a licensed psychologist to refer a patient to an unlicensed professional. The reasoning was that unlicensed professionals should not practice. Thus, SIG members recognized early that the choice for behavior analysts was either to continue illegal and unethical practice or reform their ways and start the process of licensing. Other licensing documents, such as the BACB's model act, drew heavily from our act and are in many ways less stringent than the requirements we set forth. While the SIG has taken down its original model act, it is important to recognize two things:
- Entry costs into a profession play into insurance reimbursement (the low entry costs—just a master's degree and a few courses, for example—currently have rated behavior analysts at two-thirds the insurance reimbursement of counselors)
- Low access to reimbursement coupled with limited populations negatively affects future student draw
These are issues over which the PIBA SIG will continue active communication with the Practice Board. After the creation of the model act and the survey of our personnel on the Behavior Analysis and Public Policy Yahoo listserv, the PIBA SIG immediately took to the road and started promoting the act (Cautilli & Dziewolska, 2008) among nonmembers (Hassert, Kelly, Pritchard, & Cautilli, 2008). At this point, PIBA members have testified and offered guidance to a number of states, including Pennsylvania, Connecticut, Vermont, and Delaware on the need for behavior analytic licensure.
PIBA has not limited itself to the adoption of licensure. In 2009 and 2010, we undertook our boldest initiative: trying to seek a place for licensed behavior analysts in the Health Care Reform Bill. The enactment of health care reform legislation was a crowning achievement for the Obama administration. The legislation was, in many ways, frightening to the American public and lent itself to the same level of mischaracterization as the adoption of the Social Security Act in 1935 and Medicare legislation in 1965. Our goal was to attempt to get licensed behavior analysts included into the bill for both Medicare reimbursement and professional training and development (things like loan forgiveness, etc.). These were all factors that other professions, like psychologists and professional counselors, were pursuing for their practitioners. The SIG started late into the cycle with several nonmembers questioning why we should pursue such a goal. We formally started our push while the House was passing its version of the bill. The SIG members actively met with a number of present and former staffers for representatives and senators. Given the millions of dollars of reimbursement at stake for behavior analysts, as well as the potentially game-changing nature for our profession to develop, SIG members privately paid for lobbying help in the matter. The SIG—at the suggestion of members Corrine Donley, Regina Frey, and Joseph Cautilli—started a petition for inclusion of behavior analysts online. Unfortunately, when the first House bill passed, we were just starting the process of an active pursuit. The Senate bill took a very different tone than the House bill and in the end, all was not enough on Thursday, March 18, when the House passed the Senate version of the reform bill and unveiled a package of changes. Due to the need to reduce the budget deficit with each change (a requirement for a reconciliation bill), behavior analysis was not included. Many provisions by other professional groups and wanted by health care advocates were also no included or were jettisoned from the legislation. The field of counseling immediately began to pursue other options, asking members to create a new bill—HR 1693 and S. 671. As a group, PIBA SIG members decided to take time to regroup and discuss the upcoming legislative agenda at the ABAI annual convention.
Also in 2010, we created our own Yahoo Group. The SIG currently supports 34 active members who are interested in both local and national legislation. PIBA is in the process of soliciting SIG members interested in developing a white paper on behavior analysis in education for the upcoming changes to the No Child Left Behind Act. Since education is largely a supervised endeavor from the school system with no independent practice endorsement, simple certification should be sufficient for those regulations. PIBA held elections at the ABAI annual convention in Denver; only SIG members were welcome to attend our meeting. Finally, the SIG plans to release a newsletter this year.
This past year, we tracked a bill that would allow counselors to bill Medicare, but we wanted to see how far licensing behavior analysts would go before pursuing any action. We currently have 46 members who contributed to 383 posts pertaining to such subjects as clinical trials, training, ethical issues, evidence based practices, and public policy. Finally, the SIG also posts job positions for members seeking employment or a career change. This group is important to our members and others as it provides a source for individuals to explore the various types of issues that can have an impact on providing services to those in need.
References
Cautilli, J. D. and Dziewolska, H. (2008). Editorial on analytic licensure: General historical issues of why people oppose licensing and the common replies. International Journal of Behavioral Consultation and Therapy, 4(1), 1–13.
Hassert, D. L., Kelly, A. N., Pritchard, J. K., Cautilli, J. D., Behavior Analysis and Therapy Partners, and Cynwd, B. (2008). The licensing of behavior analysts: protecting the profession and the public. Journal of Early and Intensive Behavior Intervention, 5(2), 8–19.