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| Foundations and Innovations: Evidence-Based Service Delivery and Quality Monitoring Within a Multi-Site Provider Organization |
| Sunday, May 26, 2024 |
| 3:00 PM–3:50 PM |
| Convention Center, 100 Level, 103 C |
| Area: AUT; Domain: Service Delivery |
| Chair: Rachael Schneider (Autism Learning Partners) |
| CE Instructor: Rachael Schneider, Ph.D. |
| Abstract: Models for provision of ABA-based autism services should be rooted in evidence-based practices. While some best practices have been well researched in the context of service delivery (e.g., implementation of behavioral skills training in the mentorship of behavior technicians), there is a paucity of research to guide certain practices that are critical to supervisor competence and optimal client progress. These lesser explored areas include: decision support for recommendations of medical necessity, best practices in structuring a supervision session, and scalable systems for embedding clinical quality monitoring into behavior analysts’ workflows. This symposium will include presentations that address successful, scalable interventions to ensure evidence-based recommendations for medical necessity, effective structuring of supervision sessions, consistent use of best practices in clinical direction and protocol modification, and quality assessment and measurement. The presenters will provide job aides for training and data collection, behavior analytic approaches to shaping organizational behavior, and related outcomes data reflecting supervisor fluency and client progress. |
| Instruction Level: Intermediate |
| Keyword(s): ABA recommendations, Clinical direction, outcomes measurement |
| Target Audience: Intermediate |
| Learning Objectives: After this presentation, attendees will be able to: 1. summarize levels of care represented in behavior analytic literature; 2. describe behavioral repertoires of clinical direction and protocol modification; 3. identify and measure effective supervision strategies. |
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Aligning Recommendations for Medical Necessity With the Research |
| Anna Castonguay (Autism Learning Partners) |
| Abstract: Insurance-funded, ABA-based autism services require behavior analysts to provide a recommendation for “medical necessity” as part of their functional behavior assessment to initiate services. This recommendation requires the weekly hours of ABA needed to obtain the goals outlined in the client’s program. Data related to the recommendation practices of various organizations is not publicly available, but given that this is not on the Behavior Analyst Certification Board ® (BACB®, 2017) Task List (5th ed.) nor is this commonly addressed by verified course sequence graduate programs, it is a skill that many new behavior analysts may require explicit instruction to master. The research base does not explicitly identify best practices in making recommendations for medical necessity; however, multiple research articles evaluating treatment effects of ABA-based services include information regarding the total weekly hours of care to achieve outcomes. The present paper offers a decision support model, based on the available literature, for synthesizing individualized, clinical presentation of clients in the FBA process. The author will present a demonstration of a decision support model, paired with the clinical expertise of the individual behavior analyst, across a multi-site provider organization. Data will focus on movement toward evidence-based levels of care across clients. |
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| Scaling and Measuring Direct and Indirect Quality Monitoring Systems |
| CARA GIBNEY (Autism Learning Partners), Kristine Rodriguez (Autism Learning Partners
Endicott College) |
| Abstract: Behavior analytic literature offers gold standard practices in case conceptualization and clinical oversight in the provision of behavior analytic autism services (e.g., Parsons et al., 2012; Ferraioli et al., 2005). These best practices contribute to quality service delivery and lead to optimal client outcomes. While there is research demonstrating how to implement these individual best practices, there is a paucity of research identifying behavior analytic approaches to implementing and scaling quality auditing practices across a provider organization. This paper will focus on development and measurement of quality assessment procedures across a multi-site organization. First, director-level behavior analysts received training in a conceptual model of timely problem-solving (Ferraioli et al., 2005); next, directors were provided with client outcomes data in order to identify clients in need of advanced review to trouble-shoot stalled progress. Directors implemented a monthly quality mentorship process with behavior analyst case supervisors, in order to improve supervisor skills in programming and to ultimately improve client progress. Finally, directors were provided with measurement systems for monitoring use of behavioral skills training (Parsons et al, 2012) during client-facing supervision sessions. This presentation will include job aides for assessing supervisor skills, as well as an analysis of associated client outcomes. |
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| Creating an Operational Definition for Clinical Direction |
| JAMIE M. SEVERTSON (Autism Learning Partners), Kristine Rodriguez (Autism Learning Partners
Endicott College) |
| Abstract: In 2019, the field of applied behavior analysis attained a new milestone of professionalization with the inclusion of behavior analytic services under medical CPT codes. One of these codes, 97155, is designated for use by behavior analysts to provide case oversight. Notably, the term “Supervision” is not included in the definition of this code, but rather this code is to be used for “Clinical direction and protocol modification”. In response, the ABA Coding Coalition has provided substantial guidance to the field in interpretation of these billing codes and corresponding clinical activities. However, these terms have not yet been defined in the peer-reviewed literature, and client outcomes data related to the defined activities is not established. This presentation offers a working definition for the practical application of clinical direction and protocol modification in the context of case oversight by a behavior analyst. The presenter will share a framework for structuring supervision sessions, and will provide an overview of an initiative to scale this framework across a provider organization. |
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