Right to Practice: Current Issues in the Licensure of Behavior Analysts. Stephen R. Anderson, Ph.D., BCBA - D

Transcription

1 Right to Practice: Current Issues in the Licensure of Behavior Analysts Stephen R. Anderson, Ph.D., BCBA - D

2 Practice of Psychology (Article 153) 2 The practice of psychology is the observation, description, evaluation, interpretation, and modification of behavior for the purpose of preventing or eliminating symptomatic, maladaptive or undesired behavior; enhancing interpersonal relationships, personal, group or organizational effectiveness and work and/or life adjustment; and improving behavioral health and/or mental health.

3 2002 Requirements for Licensure 3 Regulations for the practice of social work and psychology were approved in 2002 Registered nurses, certified social workers, mental health counselors, marriage and family therapists, creative arts therapists, or psychoanalysts were exempted from social work and psychology practice laws State agencies and local governments units exempted to continue services utilizing unlicensed staff; exemption expires July 1, 2013

4 You May be Practicing Without A License 4 If you are engaging in activities defined by Article 153 (the practice of psychology) and: You are a Behavior Analyst who has no other qualifying credential (e.g., psychologist, teacher, speech pathologist) You are not practicing within an exempted group or organization You may face disciplinary and even criminal charges

5 If you are: Right to Practice Independently Certified Teacher with 10 yrs experience and BCBA Privately organized as a LLC Providing individual consultation to families to address behavior concerns and feeding disorders Your work may: 5 Violate the psychology practice law (153) for your family work Subject you to a complaint by other professions (e.g., speech, OT) for efforts to address feeding disorder Not Legal Advice

6 If you are: Right to Practice Independently An individual with a master s degree in psychology (uncertified/unlicensed) from accredited institution and obtained BCBA Working for an approved DOH/EI agency providing early intensive behavioral services You will not be able to: Supervise behavioral aides providing EIBI Provide direct behavioral services (Behavioral Aide) unless supervised by a qualified professional (psychology, speech, special education) 6 Not Legal Advice

7 If you are: Right to Practice Independently An individual with a master s degree in school psychology (certified) from an accredited institution and are a BCBA Working for an approved OPWDD agency to conduct FBAs and develop behavioral plans Your work: Is exempted from the psychology practice act at this time Will not be exempt after July 1, 2013; 7 Not Legal Advice

8 If you are: Right to Practice Independently 8 An individual with master s degree in behavior analysis from accredited institution and are a BCBA Providing individual consultation to families to address behavior concerns and feeding disorders You may be: Violating psychology practice law (Article 153) for family based work Subject to a compliant by other professions (e.g., speech, OT) for efforts to address feeding disorder Not Legal Advice

9 Penalty for Practicing Without A License 9 On the Office of Professions website: The persons listed below signed agreements, on the date indicated, to cease any actions that may have violated Section 6512 or 6513 of the Education Law relating to the unauthorized practice or unauthorized use of professional title in the profession indicated. A violation of the agreement may result in a referral to the Office of the Attorney General for criminal prosecution.

10 Key NYS and National Players 10 SED - Office of Professions NYS psychology license board Other interested professions (e.g., OT, social work, speech) American Psychological Association NYS Psychological Association Office for Persons with Developmental Disabilities NYS Department of Health, Early Intervention NYS State Education US Health and Human Services, HCA

11 Threats: Right to Practice Independently 11 APA Practice Directorate Contacting groups in various states questioning the independent practice of ABA Particularly as it pertains to insurance reimbursement Actions pose threat to individual providers and agencies regarding the implementation of insurance laws

12 Threats: Right to Practice Independently 12 State psychology licensing boards/associations actions West Virginia rule requiring BAs to be supervised by psychologists Massachusetts legislation to have clinical psychologists control licensure South Carolina cease-and-desist orders to BAs Association of State and Provincial Psychology Boards (ASPPB) Formally indicated that ABA practice constitutes practice of psychology Must be supervised by psychology

13 Should Not Be Licensed or Supervised by Other Professions 13 Talking Points: Green & Carr Distinct profession separate from psychology or other disciplines Originated in experimental, not clinical psychology but developed own concepts, principles, research methods and literature Some BA programs reside in psychology departments, few psychology programs provide training in BA Recent practice analysis by ASPPB, did not include behavior analysis, ABA, or behavioral psychology among major areas of training or practice

14 BACB 14 The Council of Specialties in Professional Psychology state explicitly that the BACB certifies behavior analysts and is not psychological practice

15 What Does the Field Have to Do? 15 Act quickly, decisively and with clarity Allies and partners BACB, APBA, ABAI, state affiliates of ABAI, Autism Speaks In NY, we may have only 8 12 mos to make a difference

16 What Does the Field Have to Do? 16 Agree to definitions, key terms and phrases Clearly define ABA and the range of practice Articulate that ABA a distinct and different discipline not part of psychology Begin using language likely to enhance the ability to participate in insurance reimbursement - ABA a behavioral health practice Accept and be able to defend that the BCBA is a legitimate credential and use consistent arguments to defend it Accept the BCBA training and experience requirements at the standard for licensure Unfortunately, we don t have a lot time to debate

17 Common Language: ABA In Practice 17 An approach comprising many evidence-based techniques Stresses positive reinforcement and scientific evaluation Highly individualized Intervention is adjusted continuously based on data Delivered in a range of settings Effective for improving functioning and reducing problematic behaviors in people of all ages, with and without disabilities, when implemented by professionals with legitimate training and experience in the discipline of behavior analysis (G. Green) Copyright 2011 Gina Green

18 Identifying Qualified Providers 18 The practice of applied behavior analysis (ABA) is a distinct profession Not the same as clinical or developmental psychology, behavior therapy, school psychology, counseling, social work, special education, etc. Like other professions, practicing ABA requires specialized training Many behavior analytic methods are powerful, can easily be misused and abused by those who lack proper training G. Green Copyright 2011 Gina Green

19 BACB Established in 1998 to credential practitioners of ABA Two levels BCBA and BCaBA Requires MA degree Completion of coursework and supervised experience Must pass a psychometrically valid and reliable test to determine knowledge of subject matter BACB conducted thorough job analyses to identify knowledge, skills and abilities required subject matter experts and 1000s of surveys BACB task list is foundation for eligibility requirements Comparison of BACB task list with practice analysis for licensed psychologies reveal almost no overlap 20

20 BACB Certification Program 21 Accredited by National Council for Certifying Agencies of the Institute for Credentialing Excellence Rigorous standards and systematic procedures for determining eligibility requirements, developing and administering exam, establishing and enforcing disciplinary standards Provides valuable protections for practitioners, consumers, governments: Content and requirements controlled by the profession, with external contingencies on credentialing body s actions Requirements cannot be changed by small group of people or on basis of transient political/social pressures Solid foundation in case law on professional credentialing Well-respected; NCCA-accredited credentials are accepted by many public and private funding sources G. Green Copyright 2011 Gina Green

21 BACB Certification Program Legally tested BACB functions much like a licensing board Application reviews/eligibility determinations Guidelines for Responsible Conduct (voluntary) and Disciplinary Standards (enforced) Continuing education BACB credentials are currently recognized in laws and regulations in many states and accepted by many public and private health plans (e.g., TRICARE, Aetna, Magellan, United, Fedilis) around the country G. Green 22 Copyright 2011 Gina Green

22 BACB Certification Program 23 Currently ~ 10,000 certificants around the world; over 150 universities with course sequences approved by the BACB as meeting coursework requirements for certification eligibility; 350 testing sites worldwide Professional organization -- the Association of Professional Behavior Analysts supports BACBcertified practitioners G. Green Copyright 2011 Gina Green

23 Endorsed by: BACB Credential Association of Professional Behavior Analysts (APBA) Association for Behavior Analysis International (ABAI) Division 25 of the American Psychological Association European Association of Behaviour Analysis Recognized in: Laws and regulations 24 Private and public health insurance plans Specifically, in many venues are qualified professionals who can practice independently without supervision from another profession

24 Criticism About the BCBA 25 Requirements for direct contact supervision (can be completely online) BACB standards indicate how much can be done remotely BCBA task list does not include proactive and positive strategies Guidelines for responsible Conduct state explicitly a preference for positive approaches Allegation that BCBA routinely practice outside scope of expertise The BACB guidelines for responsible conduct explicitly states that the BCBA works within his/her scope of training

25 Criticism About the BCBA 26 Claim that there is no professional oversight for BCBAs The BACB has a Professional and Disciplinary Standards and may issue sanctions, including denial of initial license and revocation of license Claim that the BCBA may have a bachelor s degree in an unrelated field Must have a degree from an accredited university, that was conferred in behavior analysis or other natural science, education, human services, engineering, medicine or a field related to behavior analysis and approved by the BACB

26 ABA: Evidence-based Treatment for ASD Hundreds of published studies document the effectiveness of many specific, focused ABA techniques for building a wide range of important skills and reducing problem behaviors in people with ASD of all ages, in a variety of settings. 27 G. Green Copyright 2011 Gina Green

27 ABA: Evidence-based Treatment for ASD (G. Green) At least 11 controlled between-groups studies show that multiple ABA techniques combined into early comprehensive, intensive treatment programs can produce large improvements in symptoms and skill deficits in many young children with ASD when treatment is directed by qualified professional behavior analysts. o Careful meta-analyses showed that early intensive ABA produced larger, more reliable improvements than eclectic (mixed-method) treatment or standard services 28 Copyright 2011 Gina Green

28 ABA: Medically Necessary Treatment Medically necessary treatments ameliorate or manage symptoms, improve functioning, and/or prevent deterioration. ASDs are Neurodevelopmental conditions that manifest in behavioral symptoms, i.e., behavioral abnormalities in three core domains: social interaction, communication, and interests and activities. ABA treatment has proved effective for ameliorating those core symptoms as well as building other skills that enhance functioning and health in people with ASD, such as o Hygiene and self-care skills o Personal safety skills o Eating a healthy diet o Sleeping o Cooperating with medical and dental procedures G. Green 29 Copyright 2011 Gina Green

29 ABA: Medically Necessary Treatment ABA interventions have also proved effective for decreasing behaviors that directly jeopardize the health and welfare of people with ASD, such as o Self-injurious behaviors o Property destruction o Pica (ingesting inedible items) o Aggression o Elopement o Obsessive behaviors o Hyperactivity o Fearful behaviors 30 G. Green Copyright 2011 Gina Green

30 ABA Springing Up Everywhere 31 Health Care Affordability Act NYS Insurance Reform Act Early Intervention Part 200 Regulations of the NYS SED OPWDD s Report on the use of unlicensed staff

31 ABA Springing Up Everywhere 32 DOH regulations Autism Insurance Reform OPWDD Exempted unlicensed professionals Consumer need Self-insured companies and related health insurance companies (e.g., Fedelis, United Behavioral Health) Tricare for military personnel

32 Essential Health Benefits 33 Affordable Care Act (ACA) Mandated broad package of essential health benefits equivalent to a typical employer plan Purchased by average premium of small businesses Employees of small businesses (fewer than 100) with low-to-moderate incomes eligible for subsidized coverage through insurance exchanges or expansion of Medicaid

33 Essential Health Benefits broad benefits categories of Service: 1. Ambulatory patient 2. Emergency 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance abuse disorder, including behavioral health treatment 6. Prescriptive drugs 7. Rehabilitative and habilitative 8. Laboratory 9. Preventative and wellness and chronic disease management 10. Pediatric

34 Autism Insurance Reform 35 Every policy which provides physician services, medical, major medical or similar comprehensivetype coverage shall provide coverage for the screening, diagnosis and treatment of autism spectrum disorder in accordance with this paragraph and shall not exclude coverage for the screening, diagnosis or treatment of medical conditions otherwise covered by the policy because the individual is diagnosed with autism spectrum disorder.

35 NYS Autism Insurance Reform Law 36 The Law Defines Applied Behavior Analysis and behavioral treatment and refers to certified behavior analysts and the Behavior Analyst Certification Board. Applied behavior analysis: Means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.

36 Autism Insurance Reform Law 37 Behavioral health treatment: Means counseling and treatment programs, when provided by a licensed provider, and applied behavior analysis, when provided or supervised by a behavior analyst certified pursuant to the behavior analyst certification board, that are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual. Individuals that provide behavioral health treatment under the supervision of a certified behavior analyst pursuant to this paragraph shall be subject to standards of professionalism, supervision and relevant experience pursuant to regulations promulgated by the superintendent in consultation with the commissioners of health and education. [emphasis added]

37 Part 200 Regulations 38 Human Rights Committee Each school that uses aversive interventions with students with disabilities shall establish a Human Rights Committee to monitor the school s behavioral intervention program.. The Human Rights Committee shall be comprised of individuals not employed by the school or agency, which shall include at least: one licensed psychologist with appropriate credentials in applied behavior analysis

38 Department of Health 39 Adds ABA to the list of Early Intervention services Definition of ABA closes follows definitions in insurance Sets forth minimum requirements for qualifications of supervisors of ABA [license, certification, psychiatry, psychology, social work special education, speech who are board certified behavior analysts] Defines ABA Aides includes BCBA and BCaBA credentialed by the BACB

39 OPWDD Recommended Solutions Use of Unlicensed Staff: 40 Expand current exemption from Licensure Article 153, psychology, to the employee of federal, state, county or municipal agency or other subdivision or elementary or secondary school or degree granting institution to include OPWDD voluntary not-for-profit agencies Amend Education Law to include license for Behavioral Health Practitioners

40 Billing Healthcare Companies 41 Current Procedural Terminology (CPT) required codes for billing third party and Medicaid Individuals/Agencies currently use patchwork of codes Group working to develop codes specific to ABA for assessment and intervention

41 Current Capacity in NYS 42 Does NYS have sufficient capacity to justify license and to meet anticipated need? 600 board certified behavior analysts in NYS and nearly 10,000 internationally 12 colleges and universities in NYS have established course sequence leading to certification

42 Capacity in NYS 43 Certified Individuals in NYS: BCBA D 91 BCBA 457 BCaBA 46 (Jennica Nill)

43 Capacity in NYS 44 Areas of Certification 281 Certified in Office of Teaching Initiatives (OTI), most are teachers but also includes school psychologists, speech, administration, social work, counselors 43 Licensed by Office of Professions (Mental health counselor, MSW, SLP, psychologists) (Jennica Nill)

44 NYSABA Activities 45 NYSABA Board of Directors and Legislative Committee Established a set of goals Community grass routes structure consumer groups/individuals General communications written materials, talking points NYSABA membership efforts to increase Regulatory influence autism insurance, OPWDD, Early Intervention, License / Certification Board of Regents Universities/Colleges with ABA course sequences

45 APBA Activities 46 Developed a resource of materials on ABA, licensure / certification Testified on behalf of individual behavior analysts and state association s seeking licensure Worked closely with Autism Speaks on Autism Insurance Bills Helped draft licensure bills and supporting materials Responded to mischaracterizations of ABA and behavior analysts

46 Summary 47 The right for Behavior Analysts to practice independently is being threatened In fighting has resulted in the lost of valuable time and inconsistent communications The field must act quickly and decisively Accept and defend the BCBA Licensure / certification will lead to greater protection of consumers and higher professional standards Need to establishing ABA separate discipline