Ensuring Patient Access to Psychology THE ROLE OF SPTAS IN THE LICENSING OF BEHAVIOR ANALYSTS

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1 Ensuring Patient Access to Psychology THE ROLE OF SPTAS IN THE LICENSING OF BEHAVIOR ANALYSTS

2 Today s Panel Chair Cathy McDaniels-Wilson, PhD, ABPP President, Division 31 Connie Galietti, JD Director, Legal & Professional Affairs, APAPO Michael Ranney, MPA Executive Director, Ohio Psychological Association Carolyn Stimel, PhD, ABPP Director of Professional Affairs, Florida Psychological Association Dianne Fitzgerald-Verbonitz, MS, RN, CAE Executive Director, Arizona Psychological Association

3 Overview of the Presentation Background of ABA State Insurance Laws APAPO Efforts Licensing Trends Challenges Moving Forward Experiences at the State Level Question / Answer Period Credit for photo goes to King Street Cats in Alexandria, VA. Support your local shelter.

4 Background of Behavior Analyst Profession Florida created board certification within the state system in the 1980 s Grew into the Behavior Analyst Certification Board in 1998 In the 2000 s, Autism Speaks advocated for insurance coverage for autism treatment, especially ABA services provided by BCBAs. First licensure law enacted in Arizona in 2007 under Psychology Board

5 Why Psychology Took Note Applied Behavior Analysis has been firmly established as part of the practice of psychology since early 1900 s John B. Watson B.F. Skinner APA Divisions are supported by psychologists who practice in this area: APA Division 25, Behavior Analysis (est. 1962) APA Division 33, Intellectual and Developmental Disabilities (est. 1973) State psychology licensure laws include behavior analysis in their scopes of practice ABPP recognizes ABA as part of the Specialty of Cognitive and Behavioral Psychology

6 State Autism Insurance Mandates Approximately 36 states require some form of coverage to treat children diagnosed with autism.* Coverage includes psychological services. Of those 36 states, 8 cover ABA services only if provided by a BCBA. Diagnosis by a psychologist is accepted in most states. *As of last year. HI, MS and WA have bills pending in 2015 legislative session.

7 However while these insurance mandates required coverage of ABA services provided by Board Certified Behavior Analysts, some excluded coverage of these services provided by psychologists.

8 APAPO Advocacy Efforts Created APA workgroup to include the divisions and ASPPB Reached out to stakeholder groups Autism Speaks Behavior Analyst Certification Board Association of Professional Behavior Analysts Assisted states with advocacy efforts APAPO Board of Directors adopted a statement

9 APAPO Statement on Behavior Analysis and Behavior Analysts Psychologists have a long history of developing and implementing effective services, including behavior analysis, for individuals with autism spectrum disorders and their families. Licensed psychologists with competence in behavior analysis are qualified to independently provide and to supervise the provision of behavior analytic services. Therefore, qualified licensed psychologists should be allowed to provide behavior analysis and to call the services they provide "behavior analysis" or "applied behavior analysis without obtaining additional credentials or licensure. Other professionals who provide behavior analysis should be required by law or regulation to demonstrate education, training and supervision appropriate to a defined scope of practice and to the needs of the jurisdiction.

10 Statement, cont d The APAPO Board supports advocacy to ensure that any legislation or regulations regarding behavior analysts or the practice of behavior analysis contain provisions to protect consumers by ensuring that they receive services by appropriately qualified professionals. Further, the APAPO Board recommends that, to the extent that behavior analysts are regulated separately by state law, the benefits of regulation under the state board of psychology should be considered.

11 Statement, cont d The APAPO Board position is supported by two APA policy documents, the APA Model Act for State Licensure (PDF, 111KB) and the APA Ethical Principles of Psychologists and Code of Conduct. Specifically, section B.3 of the Model Act includes "behavior analysis and therapy" within the definition of the practice of psychology; and Ethics Code Standard 2 requires that "psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence. Approved February 2012

12 Model Act for State Licensure of Psychologists B. Definitions. 3. Practice of Psychology The practice of psychology includes, but is not limited to, (a) psychological testing and the evaluation or assessment of personal characteristics, such as intelligence; personality; cognitive, physical, and/or emotional abilities; skills; interests; aptitudes; and neuropsychological functioning; (b) counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; (emphasis added) The full guidelines can be found at -

13 APA Ethical Principals of Psychologists and Code of Conduct Standard 2 Competence 2.01 Boundaries of Competence (a) Psychologists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience.

14 Behavior Analysts as a Separate Profession Model legislation on BACB.org As of 2014, 18 states have some form of licensure in place Behavior analyst licensing board 6 states Board of psychology 7 states Other state agency 5 states Five other states recognize BCBA certification in regulation In 2015, additional states have seen bills filed: Florida, Hawaii, Mississippi, Texas, Utah, Washington

15 APAPO Priorities Protect the ability of psychologists to provide and supervise behavior analysis services. Promote consumer access to qualified providers. Consumer protection. Promote respectful and collaborative dialogue among stakeholders.

16 Trends to Watch Proper exemption for psychologists to provide and supervise behavioral analysis services without additional qualifications. Makeup of regulatory board. Definition of applied behavior analysis Scope of practice

17 Challenges Insurance companies and legislatures are not swayed by APA s ethics standards and respective state laws/regulations that require psychologists to practice within their areas of expertise. Lack of communication / collaboration by stakeholders at the state level. The underlying emotion makes it hard to advocate for good law.

18 CERTIFICATION OF APPLIED BEHAVIOR ANALYSTS IN OHIO: HOW WE GOT IT DONE Michael Ranney Executive Director Ohio Psychological Association APA State Leadership Conference Sunday, March 15, 2015

19 TIMELINE September 21, 2011-Ohio Board of Psychology forms workgroup to examine certification of people working as applied behavior analysts February, 2012-July 2012 Workgroup meets 4 times September 6, 2012-Workgroup issues White Paper And Board approves(included in Board minutes at 12%20APPROVED% pdf

20 TIMELINE: October 3, 2012-Attorney General issues an opinion that a person who uses applied behavior analysis in treatment is engaged in the practice of psychology January, 2013-Governor Kasich issues an Executive Order requiring coverage of autism treatment in Exchange plans and for state employees January-July,2013-Stakeholders work on legislation to regulate ABA and mandate general insurance coverage of Autism treatment

21 Work Group Participants Angela Denney, Autism Society of Central Ohio Jim Carr, Behavior Analyst Certification Board (BACB) Mike Wasmer, Autism Speaks Jacqui Wynn, Psychologist, Nationwide Children s Hospital Sandi Regula, Parent/advocate Morten Haugland, President, OH-ABA Marla Root, Autism Society of Ohio Ann Brennan, Ohio School Psychologists Association Jody Fisher, Ohio Department of Developmental Disabilities Wendy Stoica, Ohio Department of Education (ODE) Carolyn Knight, Ohio Developmental Disabilities Counsel Kevin Aldridge, Ohio Center for Autism and Low Incidence (OCALI) Luc LeCavalier, Psychologist, Ohio State Nisonger Center Melissa Bacon, Office of the Governor Michael Ranney, Ohio Psychological Association Yolanda Tally-Cudney, Ohio Department of Jobs and Family Services Jessica Foster, Ohio Department of Health Lori Peacock, Parent/Advocate Margaret Burley, Ohio Coalition for the Education of Children with Disabilities A representative from the Ohio Department of Mental Health was on the invitation list but did not participate in the process.

22 Highlights of the White Paper 1. ABA is the practice of psychology 2. ABA in Ohio should be regulated by the Board of Psychology 3. Those who design and monitor ABA Programs should be certified through the Board of Psychology to protect Ohio Consumers 4. Those who are certified by BACB should be grandfathered in (does not include hands on technicians)

23 Highlights of the White Paper 5. Providers employed by the County Boards of Developmental Disabilities should be exempted 6. Regulatory legislation should not disrupt existing services or create barriers to access.

24 Ohio law and rules The Ohio law and rules regulating applied behavior analysts are posted on the Ohio Board of Psychology website at Analyst-Laws-and-Rules

25 HIGHLIGHTS OF THE LAW An Ohio Certificate is required to practice applied behavior analysis Exemptions include: Psychologists, counselors, social workers working within the scope of their competency Family members School employees regulated by the Department of Education Employees of the Department of Developmental Disabilities

26 HIGHLIGHTS OF THE LAW Registration every two years Biennial Registration fee = $ hours of CE mandated every two years including at least 4 hours of ethics, professional conduct and cultural competency Psychology Board can refuse to issue a certificate, reprimand, suspend or revoke a certificate

27 RULES Initial application must include verification that applicant holds a current, valid BACB Certificate, school transcripts, 3 letters of reference from supervisor For the initial certification those certified by the BACB are grandfathered in. Initial fee $125 Biennial registration fee $150 Documentation of fulfillment of CE requirement submitted for biennial renewal

28 BEHAVIOR ANALYST (BA) LEGISLATION IN FLORIDA APA STATE LEADERSHIP CONFERENCE 2015 Carolyn Stimel, Ph.D., ABPP Director of Professional Affairs Florida Psychological Association

29 Timeline Florida Legislature meets annually for 60 days starting the first week of March The week before session, a bill was filed for independent licensure of BA in the Senate and the House

30 Multiple problems Some vague language in the psychologist exemption FL licensing statutes for psychologists already include behavioral analysis as part of scope of practice Full interstate reciprocity with vague criteria Reliance on BACB to evaluate training and experience 2 tier licensure

31 Senate Health Policy 6-3 Regulated Industries 9-1 Appropriations 14-2 Senate Floor 31-4 Died in Messages House Health Quality Subcommittee 11-0 Health Care Appropriations 12-0 Died in Health and Human Services Subcommittee

32 We started with opposing licensure in general; morphed into wanting some language changes and placing them under the Board of Psychology.

33 What We Did Next 1. Met with the state regulatory agency to express our position and gather their input. 2. Continued our dialogue with the state Board of Psychology. 3. Met with representatives of the behavior analysts. 4. Applied for and received a CAPP grant. 5. Hired new lobbyists to work the issue.

34 2015 Session Lobbyists have been meeting with health care committee members in both chambers to explain their new relationship with us and to address our problems with the bill. We had our chapter legislative chairs make inperson contacts with key legislators in their district offices during our Virtual Legislative Day.

35 New bills have also been filed this year to license art therapists and music therapists.

36

37 BEHAVIOR ANALYST LEGISLATION IN ARIZONA APA STATE LEADERSHIP CONFERENCE March, 2015 Dianne Fitzgerald-Verbonitz MA, RN, CAE Executive Director Arizona Psychological Association

38 In the beginning BA s filed Sunrise Application for licensure 2008 BA s quietly file licensing bill Reviewed by our lobbyist and Legislative committee, passed, went to Governor for signature as separate board under the chiropractic board. Governor would not sign unless they were under a mental health board.

39 We find out after the fact that in 11 th hour deal, BA s were put under BoPE. Now What??? Funding Licensing Rules

40 Just the Facts.. Licensure for BA s became effective January 1, 2011 License valid for 2 years; Fee for application: $350 Renewal fee: $500 ARS Must meet graduate level education and supervised experience requirements (a minimum of 1500 hours) and pass a national examination. ARS Can be granted reciprocity if meets all requirements prescribed by the board rule.

41 What s ahead BA s are looking at changing makeup of the BoPE to include a Behavior Analyst member Supervision Expansion of reimbursement

42 BEHAVIOR ANALYST LEGISLATION IN ARIZONA APA STATE LEADERSHIP CONFERENCE March, 2015 Dianne Fitzgerald-Verbonitz MA, RN, CAE Executive Director Arizona Psychological Association

43 Questions

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