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Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

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42nd Annual Convention; Downtown Chicago, IL; 2016

Event Details

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Paper Session #314
Practical and Ethical Issues in Service Delivery to Individuals With Autism Spectrum Disorders: Credentialing, Insurance Funding, and Polypharmacy
Monday, May 30, 2016
4:00 PM–5:50 PM
Grand Ballroom EF, Hyatt Regency, Gold East
Area: AUT
Chair: Anita Li (Western Michigan University)
The QABA Credentialing Board Report
Domain: Service Delivery
THOMAS MCCOOL (QABA Credentialing Board)
Abstract: Summary: The QABA Credentialing Board Process In 2008 The QABA Credentialing Board initiated the ABAT™ (Applied Behavior Analysis Technician) job analysis to identify and confirm the competency areas of the paraprofessional delivering Applied Behavior Analysis treatment and support to those individuals diagnosed with Autism and related disorders. In January 2012, formal surveys of candidates and subject matter experts were conducted and continue to June 2015. The process began with a comprehensive literature review to initially identify and validate the core competencies of the Applied Behavior Analysis Technician™ (ABAT™). The initial competencies that were identified then were subject to a pilot survey and a large-scale validation survey, in order to assess the appropriateness of the various core and domain competencies and tasks to the ABAT™. Validation studies were conducted to further confirm and increase confidence that the identified Performance Domains are representative of those used in actual practice. The survey was conducted using an online survey tool and was sent to 2634 ABAT's to further validate the committee of SMEs recommendations. The QABA job analysis identified and verified the competency areas of the paraprofessional delivering Applied Behavior Analysis treatment and support to those individuals diagnosed with Autism and related disorders.
 
Navigating the 10th Circle of Hell: Medical Necessity versus the VB-MAPP
Domain: Service Delivery
VINCENT LAMARCA (Little Star Center), Breanne K. Hartley (Little Star Center ), William Tim Courtney (Little Star Center)
Abstract: Receiving reimbursement for ABA therapy from insurance funding can be a hellish experience, both for ABA providers as well as insurance companies. Health insurance continues to gain prominence as the major source of funding for ABA therapy in the United States. There are currently forty three states that mandate insurance companies fund autism treatment. One hot topic behavior analysts would do well to understand is medical necessity and its impact on both the assessment and treatment of autism. For instance, the VB-MAPP is a common assessment tool used by behavior analysts. However, its categorization of skill acquisition as well as its suggestions for IEP curriculum development can lead to tension between what is medically necessary and what is educational. Such tension may ultimately result in a denial of coverage, on the basis that the service should be provided by the Department of Education. This paper will focus not only on differences in language used by medical and behavioral professionals, but also on how these differences impact treatment objectives. Finally, this paper will identify a potential resolution that allows proper funding of ABA therapy upon which both behavior analysts and health insurance providers can agree.
 
Navigating the 10th Circle of Hell: Trends in Adverse Determination of Insurance Funding
Domain: Service Delivery
BREANNE K. HARTLEY (Little Star Center ), Vincent LaMarca (Little Star Center), William Tim Courtney (Little Star Center)
Abstract: It is crucial to understand the rationale for adverse determinations through health insurance funding when attempting to solidify services for Applied Behavior Analysis therapy for individuals on the autism spectrum. Through understanding the rationale for these decisions, providers are better equipped to appeal the adverse determination and increase the likelihood of solidifying funding for the medically necessary services. This paper will analyze trends in adverse determinations of insurance funding within a non-profit Applied Behavior Analysis organization providing services to individuals on the autism spectrum. Trends over the past five years will be specifically highlighted, outlining the rationale for which insurance funders did not approve the entirety of services that were requested through submission of a comprehensive treatment plan. Responses to the denials will also be reviewed, in light of evidence-based research and other support for the medical necessity of the requested treatment. Lastly this paper will review data regarding the monetary totals and the number of service hours that have been recouped through appealing adverse determinations made by health insurance providers.
 
Ethical Considerations for Practitioners and Current Status of Evaluations in Polypharmacy in Autism Spectrum Disorder
Domain: Service Delivery
ANITA LI (Western Michigan University), Brian MacNeill (Western Michigan University), Alan D. Poling (Western Michigan University)
Abstract: Polypharmacy is defined as the concurrent use of multiple medications by a consumer and has been increasing for individuals diagnosed with Autism Spectrum Disorder. Polypharmacy has been predicted for individuals by a variety of factors such as psychiatric support, group home residence, and history of aggressive behavior. Unfortunately, there has been little research conducted examining combined drug effects on metabolic or behavioral factors in individuals diagnosed with Autism Spectrum Disorder. This has serious implications because it is assumed that each drug will impact the consumer individually while in actuality, there may be summative effects that may impact influence behavioral interventions. This paper will present an overview of current studies that have examined combined drug effects, predictors for polypharmacy, and potential effects of summative drug administration from a behavior analytic perspective. In addition, the paper will also discuss ethical considerations for consulting practitioners in relation to responsibility and the conflict of evidence-based treatment recommendation between behavioral and medical interventions.
 
 

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