Association for Behavior Analysis International

Many individuals diagnosed with autism spectrum disorder will require continuous health care and social services to address their individual changing needs, which is estimated to cost up to 2.4 M over the lifetime (Buescher, et al., 2014). While many treatment modalities exist, ABA is the only evidence-based practice in the treatment of ASD. Despite this, there is no standardization of outcome measures to determine the efficacy of treatments. Additionally, there continues to be significant disparities in access and variability in care. For this project, ICHOM brought together 21 clinical experts, researchers, and leaders from all over the world to develop the ASD Standard Set, with the aim of a comprehensive yet parsimonious set of outcomes and case-mix variables. This session will discuss the process used to develop the standard set, current barriers, and preliminary recommendations for implementation. Value-based healthcare and the importance of alignment between provider, payer, and patient will also be presented.

The quality of services in the applied behavior analysis (ABA) industry is under threat by a rapidly expanding workforce and demand for services in the absence of an empirical approach to promoting ABA service delivery quality (ASDQ). Other industries have responded to similar situations with innovations in quality tools and international standards, and we think our industry is primed and well positioned to do the same. In this paper, we provide a high-level overview of a novel ASDQ framework practitioners can use to develop systems for systematically supporting high service quality in ABA organizations. This talk includes a brief summary of growth in the industry, the need for more systematic discussions about quality, a definition of quality at the organizational level, introduction to the evidence-based practice of ABA at the organizational level, and some suggestions for using culturo-behavioral science concepts with a 6-step action plan organizations can implement now to pursue high ASDQ. Attendees will participate in activities that will help them think in new ways about quality in the ABA service delivery industry.

The Apprentice: An innovative approach to meet the Behavior Analysis Certification Board’s supervision standards (Hartley, 2016) was published 6 years ago. Now, enhancements have been made based on lessons learned through the implementation of this model across dozens of BCBAs and their Apprentices. Supervision of those pursuing board certification within an applied setting requires shared value to the Apprentice, the BCBA, and the organization within which they both work. The benefit for the Apprentice consists of optimal training, including competency assessments, ensuring preparation to become a successful BCBA. The benefit for the BCBA is mentorship to the next generation of BCBAs, as well as support and assistance with an assigned caseload of patients. The benefit to the organization is exceptionally trained Apprentices who will transition into future BCBA positions, at a time when BCBA positions are extremely difficult to fill. For these advantages to be experienced by all three parties, a robust and comprehensive training of Apprentices must include several components: overlap between the BCBA and Apprentice when overseeing patient treatment, identification of a maximum amount of restricted hours accumulated by the Apprentice with patients, targeted objectives for Apprentice competency, and standardization of bi-directional feedback between the Apprentice and their supervising BCBA. The objective is continuous quality improvement of the Apprentice Model with shared value to all parties involved in order to continue seeing successful outcomes throughout the field with endeavors to grow the next generation of highly skilled BCBAs from within.

Over the last decade, the landscape of ABA documentation and billing has drastically changed. National headlines have been made in several instances of ABA companies being found guilty for fraudulently billing for services that were never provided or inaccurately billing at higher rates, amounting to hundreds of thousands to millions of dollars. These instances have rightfully alarmed payor sources and led to more frequent and intense documentation auditing by funding sources. Accurate, comprehensive documentation requires an increased response effort and training to ensure basic requirements are met. An internal audit of session notes was completed at a large ABA company and scores were found to be insufficient. Therefore, a plan was set forth to develop a comprehensive approach to train and monitor the documentation of ABA services and the Session-Note Writing Auditing Team (SWAT) was created. This presentation will discuss issues identified within session note documentation, how SWAT was successfully implemented across a large, nationwide company, and how audit scores significantly improved to meet and exceed payor standards and best practice. These findings are socially significant as developing an effective auditing system for documentation is essential in sustaining ongoing treatment delivery for persons in need of medically necessary ABA services.

Board certified behavior analysts; licensed psychologists; graduate students.