SENATE COMMITTEE ON BUSINESS PROFESSIONS AND ECONOMIC DEVELOPMENT REGULATORY REQUEST QUESTIONNAIRE

Transcription

1 SENATE COMMITTEE ON BUSINESS PROFESSIONS AND ECONOMIC DEVELOPMENT REGULATORY REQUEST QUESTIONNAIRE Instructions for completing this questionnaire Responses to this questionnaire should be typed and dated. Each question should be answered within a single main document, which is limited to 50 pages. Supporting evidence for your responses may be included as an Appendix, but all essential information should be included within the main document. Each question from the questionnaire should be stated in upper case (capital) letters. The response should follow in lower case letters. Each part of every question must be addressed. If there is no information available to answer the question, state this as your response and describe what you did to attempt to find information that would answer the question. If you think the question is not applicable, state this and explain your response. When supporting documentation is appropriate, include it as an Appendix. Appendices would be labeled as follows: Each document appended should be lettered in alphabetical order. Pages within each appendix should be numbered sequentially. For example, the third page of the first appendix will be labeled A3, and the fifth page of the second appendix will be labeled B5. References within the main document to information contained in Appendices should use these page labels. Please read the entire questionnaire before answering any questions so that you will understand what information is being requested and how questions relate to each other. Section A: Applicant Group Identification This section of the questionnaire is designed to help identify the group seeking regulation and to determine if the applicant group adequately represents the occupation. 1. WHAT OCCUPATIONAL GROUP IS SEEKING REGULATION? IDENTIFY BY NAME, ADDRESS AND ASSOCIATIONAL AFFILIATION THE INDIVIDUALS WHO SHOULD BE CONTACTED WHEN COMMUNICATING WITH THIS GROUP REGARDING THIS APPLICATION. The California Association for Behavior Analysis (CalABA) is applying on behalf of nationally certified California practitioners of applied behavior analysis (ABA). Contact Information:

2 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 2 Matt McAlear, MA, BCBA Board Consultant, California Association for Behavior Analysis 630 Quintana Rd., #118 Morro Bay, CA Cell: Phone (toll-free): (877) Fax (toll-free): (888) [email protected] 2. LIST ALL TITLES CURRENTLY USED BY CALIFORNIA PRACTITIONERS OF THIS OCCUPATION. ESTIMATE THE TOTAL NUMBER OF PRACTITIONERS NOW IN CALIFORNIA AND THE NUMBER USING EACH TITLE. As of March 18, 2014 there were 2,198 practitioners in California certified by the Behavior Analyst Certification Board, Inc. (BACB ) at the following levels: Board Certified Behavior Analyst (BCBA ): 1779 Board Certified Behavior Analyst-Doctoral (BCBA-D ): 269 Board Certified Assistant Behavior Analyst : (BCaBA ): IDENTIFY EACH OCCUPATIONAL ASSOCIATION OR SIMILAR ORGANIZATION REPRESENTING CURRENT PRACTITIONERS IN CALIFORNIA, AND ESTIMATE ITS MEMBERSHIP. FOR EACH, LIST THE NAME OF ANY ASSOCIATED NATIONAL GROUP. Many BACB certificants practicing in California are also members of the following organizations: State California Association for Behavior Analysis (CalABA) - ~1600 members Southern California Consortium for Behavior Analysis (SCCBA) 32 members (organizational memberships only) National/international Association for Behavior Analysis International (ABAI) ~520 CA resident members Association of Professional Behavior Analysts (APBA) - ~400 CA resident members CalABA is a state affiliated chapter of the Association for Behavior Analysis International (ABAI) and an Affiliate of the Association of Professional Behavior Analysts (APBA). 4. ESTIMATE THE PERCENTAGE OF PRACTITIONERS WHO SUPPORT THIS REQUEST FOR REGULATION. DOCUMENT THE SOURCE OF THIS ESTIMATE.

3 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 3 According to a survey conducted by CalABA in March/April 2014, about 90% of respondents were either extremely supportive or somewhat supportive of state regulation in the form of licensure (see figure 1 below). 5. NAME THE APPLICANT GROUP REPRESENTING THE PRACTITIONERS IN THIS EFFORT TO SEEK REGULATION. HOW WAS THIS GROUP SELECTED TO REPRESENT PRACTITIONERS? CalABA is the applicant group representing practitioners in the effort to seek occupational regulation. CalABA was selected due to the association s status as the oldest and largest professional organization for behavior analysts in California. It is a nonprofit membership organization whose bylaws ensure that its governing board is elected by and represents its members. Furthermore, its membership is represented across all other similar organizations listed in question ARE ALL PRACTITIONER GROUPS LISTED IN RESPONSE TO QUESTION 2 REPRESENTED IN THE ORGANIZATION SEEKING REGULATION? IF NOT, WHY NOT? Yes. Section B: Consumer Group Identification This section of the questionnaire is designed to identify consumers who typically seek practitioner services and to identify nonapplicant groups with an interest in the proposed regulation.

4 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 4 7. DO PRACTITIONERS TYPICALLY DEAL WITH A SPECIFIC COMSUMER POPULATION? ARE CLIENTS GENERALLY INDIVIDUALS OR ORGANIZATIONS? DOCUMENT. Behavior analysts work with many different consumer populations to change socially important behaviors by altering aspects of the environment. Representative clients include individuals with autism and other developmental and intellectual disabilities, learning and communication difficulties, behavior disorders, brain injuries, physical disabilities, difficulties associated with aging, and typically developing individuals. Some behavior analysts who specialize in Organizational Behavior Management (OBM) work with organizations on the behavior of people in the workplace. Specific data on consumer populations collected through the March/April 2014 CalABA member survey are shown below. Do you or your group work with a specific consumer population? Choose all that apply % 80.0% 60.0% 40.0% 20.0% 0.0% Elderly Adults Children with Autism Spectrum Children with Intellectual Disabilities Children with Brain Injuries Adults with Autism Spectrum Adults with Intellectual Disabilities Adults with Brain Injuries Typically developing adults Typically developing children Other 8. IDENTIFY ANY ADVOCACY GROUPS REPRESENTING CALIFORNIA CONSUMER OF THIS SERVICE. LIST ALSO THE NAME OF APPLICABLE NATIONAL ADVOCACY GROUPS. California Advocacy Groups Disability Rights California Autism Health Insurance Project Talk About Curing Autism

5 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 5 Autism Deserves Equal Coverage Families for Effective Autism Treatment Consumer Watchdog National Advocacy Groups Autism Speaks Autism Society of America 9. IDENTIFY ANY CONSUMER POPULATIONS NOT NOW USING PRACTITIONER SERVICES LIKELY TO DO SO IF REGULATION IS APPROVED. If regulation is approved the consumer populations listed below would likely access services from professional practitioners of applied behavior analysis more than they do currently: Individuals experiencing behavioral difficulties associated with aging Individuals with traumatic brain injuries Individuals with a wide range of intellectual, physical and developmental disabilities Individuals with mental health disorders Typically developing individuals 10. DOES THE APPLICANT GROUP INCLUDE CONSUMER REPRESENTATION? IF SO, DOCUMENT. IF NOT, WHY NOT? Leaders of advocacy groups including, but not limited to, Autism Speaks and the Autism Health Insurance Project are active in projects facilitated by CalABA. CalABA has also worked extensively with Consumer Watchdog on a lawsuit (Consumer Watchdog et. al. v. Department of Managed Health Care et. al.; 2d Civ. No. B232338) that was one of the catalysts for SB 946, a law requiring certain private health plans to cover ABA services for California consumers with autism. Additionally, CalABA hosts a parent conference in conjunction with its own professional conference annually. Consumer advocates are included in both the content development and participant recruitment for this event. 11. NAME ANY NON-APPLICANT GROUPS OPPOSED TO OR WITH AN INTEREST IN THE PROPOSED REGULATION. IF NONE, INDICATE EFFORTS TO IDENTIFY THEM. Non-applicant groups that may have an interest in the proposed regulation include: Advocacy groups identified in Question 8 Association of Professional Behavior Analysts Association for Behavior Analysis International

6 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 6 Association of State and Provincial Psychology Boards Behavior Analyst Certification Board, Inc. California Association for Licensed Professional Clinical Counselors California Association of Marriage and Family Therapists California Department of Developmental Services and Regional Centers California Department of Education California Department of Insurance California Department of Managed Health Care California Psychological Association Health plans serving individuals in California Higher education institutions listed in Question 46 National Association of Social Workers California Chapter Southern California Consortium of Behavior Analysts Section C: Sunrise Criteria This part of the questionnaire is intended to provide a uniform method for obtaining information regarding the merits of a request for governmental regulation of an occupation. The information you provide will be used to rate arguments in favor of imposing new regulations (such as educational standards, experience requirements, or examinations) to assure occupational competence. Part C1 Sunrise Criteria and Questions The following questions have been designed to allow presentation of data in support of application for regulation. Provide concise and accurate information in the form indicated in the Instructions portion of this questionnaire. I. UNREGULATED PRACTICE OF THIS OCCUPATION WILL HARM OR ENDANGER THE PUBLIC HEALTH SAFETY AND WELFARE 12. IS THERE OR HAS THERE BEEN SIGNIFICANT PUBLIC DEMAND FOR A REGULATORY STANDARD? DOCUMENT. IF NOT, WHAT IS THE BASIS FOR THIS APPLICATION? On July 1, 2012, SB 946 went into effect in California. That law mandates coverage of applied behavior analysis (ABA) services to individuals with autism spectrum disorders (ASD) by certain private health plans. Adoption of SB 946 substantially increased the already high demand for ABA services and the need for the state to adopt uniform, objective, verifiable standards and procedures for protecting consumers from risk of harms caused by individuals who make unsubstantiated claims that they are qualified to practice ABA. The Behavior Analyst Certification Board (BACB) was established in 1998 to develop such standards and procedures. The BACB is an independent, nonprofit organization that is accredited by the National Commission for Certifying Agencies (NCCA) of the

7 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 7 Institute for Credentialing Excellence to certify professional practitioners of ABA. The NCCA s rigorous standards are grounded in case law and best practices regarding professional credentialing. Over the past 15 years, the BACB has developed competences to practice ABA and standards for certifying practitioners based on extensive job analysis studies involving thousands of professional behavior analysts. The standards include degrees, coursework, supervised experiential training, and passage of a professionally designed and managed examination in behavior analysis (see The BACB is required to repeat the job analysis periodically and to use the results to upgrade the certification requirements so that they reflect new developments in research and in the professional practice of behavior analysis. The BACB s standards and requirements as well as the procedures from which those are derived parallel many, if not most, legitimate professional licensing standards and procedures. The BACB has also developed Guidelines for Responsible Conduct for Behavior Analysts and Professional Disciplinary and Ethical Standards (See Appendix A and also available at which are designed to protect consumers as well as BACB-certified practitioners. All BACB certificants must comply with BACB standards as well as continuing education requirements in order to maintain their certifications. The BACB does not enforce its Guidelines for Responsible Conduct, but it does enforce the Professional Disciplinary and Ethical Standards (See Appendix B) and imposes sanctions on violators (see Ethics and Discipline at for the standards, complaint and review procedures, and public information about disciplinary actions to date). It is important to note, however, that the BACB does not have the same authority to oversee practice as a governmental entity, such as a state regulatory board. For instance, the BACB can do little about the practice of individuals who claim to be qualified to practice ABA but are not certified by the BACB. The BACB certifications have long been recognized as qualifications for practicing ABA in the California Department of Developmental Services regulations (California Code of Regulations Title 17, Division 2, Chapter 3, SubChapter 2, Article 3, (a) (8) and (11)) and in the state special education law (California Education Code, Part 30, Chapter 5.5, 56525). Board Certified Behavior Analysts (BCBAs) are also designated as qualified providers of ABA services in the aforementioned autism insurance law (SB 946/SB 126). At present, however, there are no laws clearly requiring that individuals document and demonstrate training and competence in ABA in order to practice in this state, and no entity within California that has legal authority to directly regulate the practice of ABA. The need for state regulation was also noted by an Autism Advisory Task Force convened by the Department of Managed Health Care, which stated in a February 2013 report to the Governor and Legislature The Task Force concluded that all top level providers should be licensed by the state The applicant therefore proposes establishment of state licensure of professional practitioners of ABA with BACB certification the principal requirement for obtaining and maintaining licenses. Benefits would include:

8 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 8 Assuring the State and consumers that license holders meet standards for practicing ABA that are set by the profession. That includes passing a valid national professional examination in the subject matter a common requirement for obtaining most legitimate professional licenses. Establishing a state licensing board comprising professional behavior analysts to regulate the practice of licensees, and to coordinate with the BACB on disciplinary matters. That would provide California consumers of ABA services a double layer of protection, as the practice of licensees would be overseen by both the state licensing board and the BACB. A cost-effective means of providing the protections just described, because those who apply to the state licensing board will have had their degree(s), coursework, and supervised experiential training in behavior analysis verified by the BACB and will have passed a psychometrically and legally validated national professional examination in behavior analysis. 13. WHAT IS THE NATURE AND SEVERITY OF THE HARM? DOCUMENT THE PHYSICAL, SOCIAL, INTELLECTUAL, FINANCIAL OR OTHER CONSEQUNCES TO THE CONSUMER RESULTING FROM INCOMPETENT PRACTICE. Many people with autism and related disorders, intellectual disabilities, and traumatic brain injuries exhibit behaviors that directly jeopardize their health and safety, such as self-injury, elopement, pica (ingesting inedible items), feeding problems, and aggression. Such behaviors often result in costly and largely ineffective use of psychotropic medications, emergency room services, hospitalizations, and residential services as well as tremendous emotional and financial burdens for families (e.g., Mandell, 2007; Montes & Halterman, 2008; Tsakanikos, Costello, Holt, Sturmey, & Bouras, 2006). Substantial research shows that competently designed and delivered ABA interventions are effective for reducing problem behaviors (Campbell, 2003; Hagopian, Rooker, & Rolider, 2011; Hassiotis, Canagasabe, Robotham, Martston, & Romeo, 2010) Heyvaert, Maes, Van den Noortgate, Kuppens, & Onghena, 2012;.Lang et al., 2009). Conversely, research has shown that interventionists who lack sufficient training in ABA can actually increase the occurrence of such behaviors in people with autism and other disorders (e.g., Lovaas, Freitag, Gold, & Kassorla, 1965; Lovaas & Simmons, 1969; Mason & Iwata, 1990; also see Hanley, Iwata, & McCord, 2003). Abundant research also shows that early, intensive ABA treatment can produce moderate to large improvements in the overall functioning of many young children with autism when that treatment is designed and supervised by qualified professional behavior analysts (e.g., see Eldevik et al., 2009, 2010; Green, 2011; Rogers & Vismara, 2008). The resulting decreased need for specialized services yields large cost savings for the systems that are responsible for education, healthcare, and other services for people with autism (Chasson, Harris, & Neely, 2007; Jacobson, Mulick, & Green, 1998; Motiwala, Gupta, & Lilly, 2006). In contrast, studies have shown that early behavioral intervention overseen by individuals who made unsupported claims to be qualified as ABA consultants produced no improvements in

9 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 9 young children with autism (Bibby et al., 2002; Mudford et al., 2001). Thus the fees paid to those consultants as well as the very precious time of the children they served were lost. 14. HOW LIKELY IS IT THAT HARM WILL OCCUR? CITE CASES OR INSTANCES OF CONSUMER INJURY. IF NONE, HOW IS HARM CURRENTLY AVOIDED? The availability of additional funding for ABA services through SB 946, together with increasing numbers of people receiving diagnoses of ASD and other conditions for which ABA services have proved effective, will further increase consumer demand for those services going forward. Without a statute and regulations formalizing minimum standards for practicing ABA competently and establishing a body within the state to oversee that practice, consumers will be at increasing risk of harm from individuals making false claims to be qualified to provide ABA services. The studies cited above show that such harm is likely and costly. Additional evidence is provided by a case in which an individual who fabricated training in ABA and BACB certification was found to have harmed children with autism whose behavioral services she was hired to oversee by school districts in Connecticut (see Appendix C and also available at WHAT PROVIDIONS OF THE PROPOSED REGULATION WOULD PRECLUDE CONSUMER INJURY? As described previously, establishment of licensure for ABA practitioners with BACB certification as the principal requirement would assure consumers that licensees have completed the formal and experiential training that the profession has determined is necessary to practice ABA, and have demonstrated competence by passing a valid national professional examination in the subject matter. Additionally, it would provide a licensing board within the state comprising professional behavior analysts to whom consumers could file complaints about individuals who are practicing behavior analysis but have not met the national and state standards, and about alleged unethical or incompetent practice by licensees. The licensing board s statutory authority to investigate such complaints and sanction violators, on top of the BACB s oversight, would provide strong protections against consumer injury as well as recourse for consumers who suffer harms. II. EXISTING PROTECTIONS AVAILABLE TO THE CONSUMER ARE INSUFFICIENT 16. TO WHAT EXTENT DO CONSUMERS CURRENTLY CONTROL THEIR EXPOSURE TO RISK? HOW DO CLIENTS LOCATE AND SELECT PRACTITIONERS? Many direct recipients of ABA services have limited communication, personal safety, and other self-care skills in addition to challenging behaviors, which makes them vulnerable to a variety of risks. It is typically their family members or other caregivers who seek services for them. Those consumers are also subject to risks, due in part to the difficulties inherent in

10 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 10 caring for family members with extensive needs. At present there are no legal restrictions on who can practice behavior analysis in this state. Consequently, many people who are not BACB certified and therefore have not met the standards for practicing ABA that have been established by the profession purport to provide ABA services to vulnerable consumers. Many of those consumers lack the knowledge required to discriminate such individuals from practitioners who have documented, bona fide qualifications in the practice of ABA. At present the state provides consumers with no safeguards from unqualified practitioners and no recourse if those practitioners harm them. Consumers locate practitioners through (a) marketing tools such as websites, promotions, and community events, (b) word-of-mouth referrals from friends, acquaintances, and parent advocacy groups, (c) referrals from medical doctors and other healthcare providers, (d) third-party funding sources such as the state s developmental services (Regional Center) system, health plans lists of in-network providers, or local school districts, and/or (e) special education attorneys and advocates. Consumers select practitioners based on factors such as (a) the practitioner s responsiveness and availability, (b) the speed with which the practitioner can commence provision of services, (c) marketing materials, (d) geographic convenience, (e) recommendations of the referral source, (f) the practitioner s fees and the availability of funding to cover them, and/or (f) the practitioner s education and qualifications. If the consumer is familiar with the BACB certifications and website, s/he may read the requirements for certification, the ethical and disciplinary guidelines and standards (including descriptions of disciplinary actions taken by the BACB), and other information about the practice of ABA at S/he may also search the registry of certificants on the BACB website certified practitioners in his/her area. BACB Certificants may be ed directly via that registry. 17. ARE CLIENTS FREQUENTLY REFERRED TO PRACTITIONERS FOR SERVICE? GIVE EXAMPLES OF REFERRAL PATTERNS. Clients are referred to ABA practitioners on an ongoing basis. Information about monthly referral patterns for California ABA provider organizations was collected as part of a survey conducted by CalABA in July Results are shown below in Figure 3.

11 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 11 A large percentage of clients referred to ABA practitioners are children or adults with autism or other developmental disabilities. They are typically referred due to deficits in communication, social, self-help, vocational, and other skills) and/or the presence of problem behaviors (e.g., self-injury, aggression, tantrums, elopement, non-compliance, food refusal). 18. ARE CLIENTS FREQUENTLY REFERRED ELSEWHERE BY PRACTITIONERS? GIVE EXAMPLES OF REFFERAL PATTERNS. California practitioners of ABA who are credentialed by the BACB are obligated to comply with the BACB Guidelines for Responsible Conduct, which include requirements to refer clients to other appropriately qualified providers if the client needs services (ABA services as well as non-behavior analytic services) that are outside of the boundaries of the practitioner s training and competence. In some cases the practitioner may continue to provide services to a client (e.g., one who is receiving medical services in addition to ABA treatment), but in others s/he may not (e.g., when a client no longer needs ABA services, or their parent/guardian opts to pursue non-aba treatment exclusively). BACB certificants are also obligated to make referrals when other conditions exist that might compromise the certificant s ability to serve the client ethically and effectively. Examples of such conditions include but are not limited to: Limited client availability (e.g., only after school hours) Practitioner is not contracted with client s funding source Client is found clinically ineligible for ABA services Resources required to deliver effective ABA services are not available Practitioner is unable to serve the client appropriately due to personal circumstances

12 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 12 At present, however, there are many individuals in California who purport to provide ABA services but are not regulated by either the BACB or the state, so they are bound by no code of ethics or conduct regarding referrals or any other aspect of their practice. 19. WHAT SOURCES EXIST TO INFORM CONSUMERS OF THE RISK INHERENT IN INCOMPTENT PRACTICE AND WHAT PRACTITIONER BEHAVIORS CONSTITUTE COMPETENT PERFORMANCE? As noted earlier, the BACB has conducted several job analysis studies to identify the competencies required to practice ABA. Consumers who are familiar with the BACB may find those competencies in the 4 th Edition Task List (See Appendix D and also available at The BACB Guidelines for Responsible Conduct, also available on the BACB website, describe the ethical practice of ABA. Additionally, in 2012 the BACB published Health Plan Coverage of Applied Behavior Analysis Treatment for Autism Spectrum Disorder (see Appendix E), which includes information about practitioner qualifications and responsibilities. However, none of those sources explicitly describe the risks inherent in incompetent practice of ABA. The Autism Special Interest Group of the Association for Behavior Analysis International (ABAI) has developed guidelines for consumers that describe some behaviors that constitute competent performance of ABA in the treatment of autism and incorporate the BACB s standards, including the Task List and conduct guidelines, by reference. However, they do not inform consumers of the risks inherent in incompetent practice. Additionally, consumers cannot readily access those guidelines, as they are being updated and are not currently accessible through the ABAI website. Autism Speaks, a well-known non-profit organization dedicated to science and advocacy for individuals with autism, provides some information regarding practitioner qualifications, but does not describe specific practitioner behaviors that constitute competent practice, nor the risks of incompetent practice. Further, Autism Speaks warns clients and caregivers to check the credentials of those who claim to be qualified in behavior analysis, since there is currently no restriction on who can identify him/herself as an applied behavior analyst or practice ABA in many states. The following websites contain information about ABA that may be useful to consumers: o Association for Behavior Analysis International o Association of Professional Behavior Analysts o Association for Science in Autism Treatment o ABAI Autism Special Interest Group o ABAI Parent Professional Partnership Special Interest Group o Behavior Analyst Certification Board, Inc. o Cambridge Center for Behavioral Studies

13 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page WHAT ADMINISTRATIVE OR LEGAL REMEDIES ARE CURRENTLY AVAILABLE TO REDRESS CONSUMER INJURY OR ABUSE IN THIS FIELD? A consumer who believes that a practitioner certified by the BACB has violated one or more of the BACB s nine Professional Ethical and Disciplinary Standards and has the required documentation can file a complaint with the BACB. After initial review of the complaint, the BACB establishes a Review Committee (if warranted) to determine if the alleged violations occurred and if so, what sanctions (if any) will be imposed on the certificant. The standards can be found as Appendix B, and the complaint form and description of documentation that must accompany it are included as Appendix F. The BACB Guidelines for Responsible Conduct include the following provisions: 8.0 The Behavior Analyst s Responsibility to Colleagues Behavior analysts have an obligation to bring attention to and resolve ethical violations by colleagues Ethical Violations by Behavioral and Non-behavioral Colleagues When behavior analysts believe that there may have been an ethical violation by another behavior analyst or non-behavioral colleague, they attempt to resolve the issue by bringing it to the attention of that individual if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. If resolution is not obtained, and the behavior analyst believes a client s rights are being violated, the behavior analyst may take additional steps as necessary for the protection of the client. Thus BACB certificants may exert informal social pressure on colleagues who behave in ways that harm clients or otherwise violate the conduct guidelines, but those guidelines are not enforced by the BACB, do not carry the authority of law, and generally do not apply to practitioners who are not certified by the BACB. In a July 2013 CalABA survey, respondents who employ providers of ABA services were asked what percentage of their high-level clinicians were BACB certified. Results showed that many practitioners who are given responsibility for designing and overseeing ABA treatment in California are, in fact, not BACB certified (see Figure 4), so the BACB cannot review or act on disciplinary complaints about them unless they misrepresent that they are BACB certified or eligible for involve an applicant or misuse of a BACB certification, use the BACB exams, certificates, or logo without authorization, engage in any irregularity vis a vis a BACB examination, or make false, misleading, or fraudulent statements in an effort to obtain BACB certification for themselves or someone else.

14 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 14 What percentage of your Clinical Supervisors in California are BCBAs or BCBA-Ds? More than 90% Approximately 75% Approximately 50% Approximately 25% None of the Clinical Supervisors is a BCBA or BCBA-D If a practitioner is not certified by the BACB, consumers can submit complaints to the practitioner s employer or to an entity that funds the practitioner s services, such as a health plan, Regional Center, or school district. All professionals who provide services funded by the California Department of Developmental Services or Department of Education are considered mandated reporters pursuant to Welfare & Institutions Code Section or Penal Code Sections through , and must take action to ensure the health and safety of a consumer who may be the victim of abuse. Practitioners who are vendorized by Department of Developmental Services must post a link to the Appeals, Comments, and Complaints section of the DDS website on the public section of their website. Consumers may also report practitioners to local law enforcement agencies or to the district attorney s office. There is, however, no central body within the state at present that can redress injuries to consumers of ABA services caused by either BACB-certified practitioners or those who are not certified by the BACB. 21. ARE THE CURRENTLY AVAILABLE REMEDIES EFFICIENT OR INEFFICIENT? IF SO, EXPLAIN WHY. The remedies currently available are insufficient to protect consumers. As noted previously, there is no central body within California that is authorized by law to protect consumers by regulating the practice of ABA. Consumers who believe that a BACB-certified practitioner has violated one or more of the BACB s Professional Ethical and Disciplinary Standards can file a complaint with the BACB. The ability of the BACB to protect the public is inherently limited, however, because it is an international credentialing body rather than a governmental entity, and the state where has not delegated legal authority to regulate the practice of ABA to the BACB.

15 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 15 There are stringent requirements for complaints to the BACB. At a minimum, the complainant must provide the BACB with a description of the complaint, written correspondence with the certificant in question in which the complainant specifies the nature of the complaint and a suggested remedy, and written correspondence regarding the complaint with the agency that employs or provides funding for the practitioner. Typically the BACB will only review complaints within very specific parameters and only after the complaint has already been acted upon by an employer or governing state or health care agency. (Behavior Analyst Certification Board, 2008.). The BACB generally requires complaints of incompetence or malpractice include official determinations (such as, court orders, jury findings, or treatment professional findings of incompetence or malpractice). If a practitioner is found to have violated one of the BACB s Professional Disciplinary and Ethical Standards, there is no legal penalty. The strongest sanction available to the BACB is revocation of BACB certification. In contrast, governmental entities like licensing boards typically have authority to enforce laws and regulations and impose strong sanctions. For example, a Marriage and Family Therapist who is regulated by the California Board of Behavioral Sciences found to have violated any provisions of that profession s licensing laws and regulations, is guilty of a misdemeanor punishable by imprisonment in the county jail not exceeding six months, by a fine not exceeding $2500, or both (Board of Behavioral Sciences, 2014). Generally speaking, the BACB can enforce its Professional Ethical and Disciplinary Standards only with practitioners who hold BACB certifications. California consumers currently have no recourse if a practitioner who is not certified by the BACB engages in unethical or incompetent behavior, except perhaps through the practitioner s employer or funding source. III. NO ALTERNATIVES TO REGULATION WILL ADEQUATELY PROTECT THE PUBLIC 22. EXPLAIN WHY MARKETPLACE FACTORS WILL NOT BE AS EFFECTIVE AS GOVERNMENTAL REGULATION IN ENSURING PUBLIC WELFARE. DOCUMENT SPECIFIC INSTANCES IN WHICH MARKET CONTROLS HAVE BROKEN DOWN OR PROVEN INEFFECTIVE IN ASSURING CONSUMER PROTECTION. Implementation of SB 946 has exacerbated the demand for ABA services for people with autism, which was already high. One result is that individuals who are not certified by the BACB and therefore have not met the standards established by the profession are asserting that they are qualified to be reimbursed by health plans for providing ABA services. Behavior analysis is younger than many other professions, and coverage of ABA services is very new to many health plans and other funding sources. For those and other reasons, relatively few funders and

16 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 16 consumers are familiar with the specialized training required to practice ABA competently and ethically, or with indicators of genuine, high-quality ABA services. That is, large segments of the marketplace lack the knowledge required to protect consumers of ABA services. Additionally, economic and other pressures may influence funders to adopt lower standards for identifying providers than those that are typically set by professions (i.e., specific degrees, coursework, supervised experiential training, and passage of a professional examination in the subject matter). That will result in consumers being subjected to subpar services against which they will have little protection unless the state adopts laws and regulations requiring ABA practitioners to meet the national standards of the profession and to be accountable to a state regulatory board comprising qualified professional behavior analysts. As one example of the failure of the marketplace to protect consumers of ABA services, a large California agency that purported to provide ABA services was forced to abruptly shut its doors in March 2012 following an audit by the Department of Developmental Services that found that the agency employed individuals who were not certified by the BACB and did not have adequate training and competence in ABA. The findings of the audit can be found in Appendix G and here: That closure -- a direct result of the marketplace s inability to ensure public welfare -- left thousands of children and adults with developmental disabilities without services. The 2010 Connecticut case highlighted in the response to question 14 provides further evidence that the marketplace is ineffective in protecting consumers of ABA services from individuals who are not appropriately credentialed to practice ABA professionally. 23. ARE THERE OTHER STATES IN WHICH THIS OCCUPATION IS REGULATED? IF SO, IDENTIFY THE STATES AND INDICATE THE MANNER IN WHICH CONSUMER PROTECTION IS ENSURED IN THOSE STATES. PROVIDE, AS AN APPENDIX, COPIES OF THE REGULATORY PROVISIONS FROM THESE STATES. At this writing, 17 states have adopted laws requiring practitioners of ABA to be licensed, certified, or registered by the state. All of the laws and the regulations for implementing them that have been developed to date are based predominantly on the BACB s model act for regulating the practice of ABA, with BACB certification the foundational requirement for obtaining the state-issued credential(s). Although some of the state entities that regulate the practice of ABA also regulate other professions, it is important to note that in all 17 states behavior analysts are licensed, certified, or registered in their own right, not as members of other professions. The table that follows summarizes those laws.

17 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 17 *Regulations to be developed or finalized; no state credentials issued yet BACB = Behavior Analyst Certification Board, Inc. L = license; C = state certification; R = registration; NA = Not applicable BehAn = Behavior Analysis; Psych = Psychology; BSRB = Behavioral Sciences Regulatory Board; AMHHSP = Allied Mental Health & Human Service Professionals; BPCT = Board of Professional Counselors & Therapists 1 = Board Certified Behavior Analyst with 1500 hrs supervised experience 2 = Certified Autism Behavior Interventionist 3 = Direct license issued by Dept. of Safety & Professional Services Figure 5. Laws regulating the practice of ABA (source: Association of Professional Behavior Analysts) To date, 37 states have passed legislation similar to SB 946 requiring private health plans to cover treatments for autism spectrum disorders, including ABA (see Figure 6 below). As mentioned above 17 of those states regulate Behavior Analysts through state licensure, certification or registration. In all of the other states BCBAs (and in some, BCaBAs supervised by BCBAs) are recognized as qualified providers and reimbursed by health plans. The BACB

18 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 18 credentials are also recognized in other types of laws in many states (e.g., Medicaid rules, developmental disabilities services and special education codes). Figure 6 Adapted from Autism Speaks 24. WHAT MEANS OTHER THAN GOVERNMANTAL REGULATION HAVE BEEN EMPLYED IN CALIFORNIA TO ENSURE CONSUMER HEALTH AND SAFETY? SHOW WHY THE FOLLOWING WOULD BE INADEQUATE: As described previously, the BACB s limited regulation has been available to California residents, but only with respect to practitioners certified by that body. Consumers have also had the option to complain to employers and funding sources. a. code of ethics The BACB s Guidelines for Responsible Conduct are inadequate to protect consumers because they apply only to practitioners certified by the BACB, compliance with them is voluntary, they carry no force of law, and there is no body within the state that is authorized to enforce them. b. codes of practice enforced by professional associations see previous description of enforcement of the Professional Ethical and Disciplinary Standards by the BACB, which

19 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 19 is a credentialing body rather than a professional association. At present, no professional association enforces codes of practice with behavior analysts in California. c. dispute-resolution mechanisms such as mediation or arbitration We believe that direct regulation of ABA practitioners would provide more cost-effective protections for consumers than these mechanisms. d. recourse to current applicable law At present there are no state laws specifically regulating the practice of ABA. e. regulation of those who employ or supervise practitioners For employers who are licensed by the state, consumers could file complaints with the applicable licensing board, but not all employers are licensed, and the existing licensure boards do not regulate behavior analysts. We believe that direct regulation of ABA practitioners would afford better protections for consumers than the indirect route of complaining to boards that license employers of ABA practitioners. f. treatment guidelines As the name implies, guidelines do not have the authority of law, so compliance with them is entirely voluntary on the part of practitioners, and they provide little real protection to consumers. 25. IF A GRANDFATHER CLAUSE (IN WHICH CURRENT PRACTITIONERS ARE EXEMPTED FROM COMPLIANCE WITH PROPOSED ENTRY STANDARDS) HAS BEEN INCLUDED IN THE REGULATION PROPOSED BY THE APPLICANT GROUP, HOW IS THAT CLAUSE JUSTIFIED? WHAT SAFEGUARDS WILL BE PROVIDED CONSUMERS REGARDING THIS GROUP? The proposed regulation does not include a grandfather clause that would allow current practitioners to be fully licensed without meeting eligibility standards. Rather, we propose to grant limited provisional licenses to certain practitioners who will be given two years to meet the licensure eligibility requirements and apply for regular licenses. To protect consumers, applicants for provisional licensure will have to register with the behavior analyst licensing board, be supervised by a licensed behavior analyst and complete criminal background checks. They will also be subject to the same disciplinary standards as all other licensees. IV. REGULATION WILL MITIGATE EXISTING PROBLEMS 26. WHAT SPECIFIC BENEFITS WILL THE PUBLIC REALIZE IF THIS OCCUPATION IS REGULATED? INDICTAE CLEARLY HOW THE PROPOSED REGULATION WILL CORRECT OR PRECLUDE CONSUMER INJURY. DO THESE BENEFITS GO BEYOND FREEDOM FROM HARM? IF SO, IN WHAT WAY?

20 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 20 Adoption of state licensure of professional practitioners of ABA with BACB certification as the principal requirement will ensure that consumers receive ABA services from professionals who have met education, experiential training, and examination requirements derived from job analysis studies involving thousands of professional behavior analysts, in accordance with rigorous standards and best practices in professional credentialing. Practitioners who have verified training and competence in ABA principles and procedures are more likely to use ABA techniques safely and effectively and less likely to harm consumers than are those who lack adequate training. The proposed licensing law will establish a board of professional behavior analysts within the state that is authorized to investigate complaints from consumers and others and to enforce the law and accompanying regulations, including standards of professional conduct, in coordination with the BACB. That will provide consumers with protection from a wellestablished international credentialing entity as well as a state regulatory board. The presence of a licensing law and state regulatory board that can enforce it will provide strong incentives for practitioners to comply with ethical and disciplinary standards and best practices, which will enhance the services they provide to consumers. 27. WHICH CONSUMERS OF PRACTITIONER SERVICES ARE MOST IN NEED OF PROTECTION? WHICH REQUIRE LEAST PROTECTION? WHICH CONSUMERS WILL BENEFIT MOST AND LEAST FROM REGULATION? Vulnerable populations served by behavior analysts (children and adults with a wide range of intellectual, physical, and developmental disabilities, traumatic brain injuries, and mental health disorders) and their families are most in need of protection and most likely to benefit from additional regulation. Because of their skill deficits, such individuals are often at particular risk of abuse and neglect and unable to advocate for themselves. Many also exhibit behaviors that pose a danger to themselves or others. ABA techniques have proven effective for reducing those behaviors, and for building skills and reducing interfering behaviors in typically developing children and adults in schools, homes, community settings, and workplaces. The latter populations of consumers are arguably the least in need of protection; however, they will also benefit from a state law requiring practitioners to have their training in ABA verified independently and objectively, and to demonstrate competence in ABA by passing a national professional examination in behavior analysis. 28. PROVIDE EVIDENCE OF NET BENEFIT WHEN THE FOLLOWING POSSIBLE EFFECTS OF REGULATION ARE CONSIDERED: a. restriction of opportunity to practice We do not foresee any undue restriction of opportunity to practice as a result of the proposed regulation. Laws and regulations governing the California Department of Developmental Services and certain health plans operating in California already recognize BACB certifications as qualifications for practitioners of behavior analysis,

21 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 21 and many knowledgeable employers either require or prefer BACB certification for certain positions. b. restricted supply of practitioners Licensure will likely increase the supply of qualified professional behavior analysts in California over time as the demand for ABA services continues to grow and there is a clear path for obtaining state-issued credentials to practice and pursue careers in California. We also foresee the development of additional university programs that prepare students for licensure and careers in the practice of behavior analysis. c. increased costs of service to consumer We do not predict increased costs to consumers as a result of the proposed regulation. Reimbursement rates for BACB certificants through the Department of Education, Department of Developmental Services, and private health insurance carriers are already well-established and are not likely to change simply because those practitioners become licensed. d. increased governmental intervention in the marketplace. Increased governmental intervention as a result of the proposed regulation will provide a net benefit by assuring protections for consumers and funders who are in the market for qualified ABA service providers. V. PRACTITIONERS OPERATE INDEPENDENTLY, MAKING DECISIONS OF CONSEQUENCE 29. TO WHAT EXTENT DO INDIVIDUAL PRACTITIONERS MAKE PROFESSIONAL JUDGEMENTS OF CONSEQUENCE? WHAT ARE THESE JUDGEMENTS? HOW FREQUENTLY DO THEY OCCUR? WHAT ARE THE CONSEQUNCES? DOCUMENT. The range of professional judgments of consequence that individual practitioners make on a regular basis is relatively broad. Judgments can range from day-to-day treatment and staffing decisions such as: making an initial determination and recommendation of dosage or intensity of treatment; decisions around discontinuation of services; decision regarding when and how to adjust a treatment plan to ensure sufficient progress etc. Decisions made on a daily basis by behavior analysts can substantially affect the short- and long-term health, safety, and functioning of clients and people around them. Many decisions made by behavior analysts can directly impact a client s ability to function effectively at home, at school, at work, and in the community. 30. TO WHAT EXTENT DO PRACTITIONERS WORK INDEPENDENTLY (AS OPPOSED TO WORKING UNDER THE AUSPICES OF, AN EMPLOYER OR SUPERVISOR)? The BACB describes the work circumstances of its certificants as follows:

22 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 22 The Board Certified Behavior Analyst (BCBA) is an independent practitioner who also may work as an employee or independent contractor for an organization. The BCBA conducts descriptive and systematic (e.g., analogue) behavioral assessments, including functional analyses, and provides behavior analytic interpretations of the results. The BCBA designs and supervises behavior analytic interventions. The BCBA is able to effectively develop and implement appropriate assessment and intervention methods for use in unfamiliar situations and for a range of cases. The BCBA seeks the consultation of more experienced practitioners when necessary. The BCBA teaches others to carry out ethical and effective behavior analytic interventions based on published research and designs and delivers instruction in behavior analysis. BCBAs supervise the work of Board Certified Assistant Behavior Analysts and others who implement behavior analytic interventions. Certain BCBA certificants with qualifying doctorate degrees may be recognized as BCBA- D level certificants. The Board Certified Assistant Behavior Analyst (BCaBA) conducts descriptive behavioral assessments and is able to interpret the results and design ethical and effective behavior analytic interventions for clients. The BCaBA designs and oversees interventions in familiar cases (e.g., similar to those encountered during their training) that are consistent with the dimensions of applied behavior analysis. The BCaBA obtains technical direction from a BCBA for unfamiliar situations. The BCaBA is able to teach others to carry out interventions once the BCaBA has demonstrated competency with the procedures involved under the direct supervision of a BCBA. The BCaBA may assist a BCBA with the design and delivery of introductory level instruction in behavior analysis. It is mandatory that each BCaBA practice under the supervision of a BCBA. Governmental entities and other third-party funders, such as Medicaid and TRICARE (the U.S. military s health plan), private health plans, and others utilizing BCaBAs must require this supervision. Data collected in the 2014 CalABA survey indicated that about 9% of respondents work as independent contractors, with the remainder working in various capacities under the auspices of an organization, agency, university, or school (see Figure 7 below).

23 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 23 What is the primary nature of your employment related to behavior analysis? 100.0% 75.0% 50.0% 25.0% 0.0% University professor Student (with a paid position related to behavior analysis) Self-employed (working independently) Employee of a private practice with other BCBA s or licensed professionals Owner of a for profit company School system employee Employee - other government agency Employee - other private agency Other (Please Specify) 31. TO WHAT EXTENT DO DECISIONS MADE BY THE PRACTITIONER REQUIRE A HIGH DEGREE OF SKILL OR KNOWLEDGE TO AVOID HARM? The contemporary practice of ABA is complex and intricate. Professional behavior analysts choose from a large, well-established array of scientifically validated assessment and intervention procedures to develop and implement highly individualized plans for producing meaningful change in client behavior. Behavior change can include the development of new skills, the reduction of maladaptive behaviors, and/or the increase of adaptive behaviors. Behavior analysts use a well-researched toolbox of interventions in their work, beginning with functional assessments of behavior-environment interactions. They measure client progress on a continuous basis and use those data to fine-tune interventions at every step of implementation. As noted above, decisions made by ABA practitioners determine whether socially significant client behaviors change in ways that improve the client s functioning in the short as well as the long run. The large repertoire of skills that is required to make appropriate decisions are described in the BACB Task List (see response to question 33).

24 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 24 VI. FUNCTIONS AND TASKS OF THE OCCUPATION ARE CLEARLY DEFINED 32. DOES THE PROPOSED REGULATORY SCHEME DEFINE A SCOPE OF ACTIVITY, WHICH REQUIRES LICENSURE, OR MERELY PREVENT THE USE OF A DESIGNATED JOB TITLE OR OCCUPATIONAL DESCRIPTION WITHOUT A LICENSE? The proposed regulatory scheme includes a defined scope of practice and activity for licensees. It encompasses the knowledge, skills, and abilities in the BACB Task List (see below and also included as Appendix D). Behavior Analyst Certification Board Fourth Edition Task List The BACB Fourth Edition Task List is organized in three major sections. The first section, Basic Behavior-Analytic Skills, covers tasks that a practicing behavior analyst will perform with some, but probably not all, clients. These tasks represent basic, commonly used skills and procedures. The second section, Client-Centered Responsibilities, includes tasks related to working with all clients and they should apply in most applied situations. The third section, Foundational Knowledge, covers concepts that should have been mastered prior to entering practice as a behavior analyst. The topics listed in this section are not tasks that a practitioner would perform; instead, they are basic concepts that must be understood in order to perform the tasks included in the first two sections. This list is provided mainly as a resource for instructors and a study tool for candidates. Candidates for the BCBA and BCaBA credentials should have a thorough understanding of these topics. All of the questions on the BCBA and BCaBA examinations are linked to the tasks listed under Basic Behavior-Analytic Skills and Client-Centered Responsibilities. Each examination form will contain one or two questions evaluating candidate knowledge of every task from these two sections. The topics listed in the Foundational Knowledge section will not be directly assessed with a specific number of questions; however, they may be indirectly assessed through questions about related tasks. For example, a test question about the Client-Centered Responsibility task J- 11 Program for stimulus and response generalization might cover Foundational Knowledge item 36 Define and provide examples of response generalization or item 37 Define and provide examples of stimulus generalization.

25 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 25 Ethics and Professional Conduct are subsumed within each section of the task list. The BACB Professional Disciplinary and Ethical Standards and Guidelines for Responsible Conduct for Behavior Analysts are essential companion documents to the task list. BACB certificants must practice in compliance with the professional disciplinary and ethical standards and should structure their practices in accordance with the conduct guidelines. Candidates are expected to have a complete understanding of these documents, including, but not limited to, the importance of ethical conduct as it relates to professional practice of the tasks identified in the Fourth Edition Task List. As a result, questions addressing ethical issues related to specific tasks will appear on the examination.

26 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 26 BASIC BEHAVIOR-ANALYTIC SKILLS A. Measurement A-01 Measure frequency (i.e., count). A-02 Measure rate (i.e., count per unit time). A-03 Measure duration. A-04 Measure latency. A-05 Measure interresponse time (IRT). A-06 Measure percent of occurrence. A-07 Measure trials to criterion. A-08 Assess and interpret interobserver agreement. A-09 Evaluate the accuracy and reliability of measurement procedures. A-10 Design, plot, and interpret data using equal-interval graphs. A-11 Design, plot, and interpret data using a cumulative record to display data. A-12 Design and implement continuous measurement procedures (e.g., event recording). Design and implement discontinuous measurement procedures (e.g., partial & whole A-13 interval, momentary time sampling). A-14 Design and implement choice measures. B. Experimental Design Use the dimensions of applied behavior analysis (Baer, Wolf, & Risley, 1968) to B-01 evaluate whether interventions are behavior analytic in nature. B-02 Review and interpret articles from the behavior-analytic literature. Systematically arrange independent variables to demonstrate their effects on dependent B-03 variables. B-04 Use withdrawal/reversal designs. B-05 Use alternating treatments (i.e., multielement) designs. B-06 Use changing criterion designs. B-07 Use multiple baseline designs. B-08 Use multiple probe designs. B-09 Use combinations of design elements. Conduct a component analysis to determine the effective components of an intervention B-10 package. Conduct a parametric analysis to determine the effective values of an independent variable.

27 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 27. C. Behavior-Change Considerations C-01 State and plan for the possible unwanted effects of reinforcement. C-02 State and plan for the possible unwanted effects of punishment. C-03 State and plan for the possible unwanted effects of extinction.. D. Fundamental Elements of Behavior Change D-01 Use positive and negative reinforcement. D-02 Use appropriate parameters and schedules of reinforcement. D-03 Use prompts and prompt fading. D-04 Use modeling and imitation training. D-05 Use shaping. D-06 Use chaining. D-07 Conduct task analyses. D-08 Use discrete-trial and free-operant arrangements. D-09 Use the verbal operants as a basis for language assessment. D-10 Use echoic training. D-11 Use mand training. D-12 Use tact training. D-13 Use intraverbal training. D-14 Use listener training. D-15 Identify punishers. D-16 Use positive and negative punishment. D-17 Use appropriate parameters and schedules of punishment. D-18 Use extinction. D-19 Use combinations of reinforcement with punishment and extinction. Use response-independent (time-based) schedules of reinforcement (i.e., noncontingent D-20 reinforcement). D-21 Use differential reinforcement (e.g., DRO, DRA, DRI, DRL, DRH). E. Specific Behavior-Change Procedures Use interventions based on manipulation of antecedents, such as motivating operations E-01 and discriminative stimuli. E-02 Use discrimination training procedures. E-03 Use instructions and rules. E-04 Use contingency contracting (i.e., behavioral contracts). E-05 Use independent, interdependent, and dependent group contingencies. E-06 Use stimulus equivalence procedures. E-07 Plan for behavioral contrast effects. E-08 Use the matching law and recognize factors influencing choice. E-09 Arrange high-probability request sequences. E-10 Use the Premack principle.

28 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 28 E-11 Use pairing procedures to establish new conditioned reinforcers and punishers. E-12 Use errorless learning procedures. E-13 Use matching-to-sample procedures. F. Behavior-Change Systems F-01 Use self-management strategies. F-02 Use token economies and other conditioned reinforcement systems. F-03 Use Direct Instruction. F-04 Use precision teaching. F-05 Use personalized systems of instruction (PSI). F-06 Use incidental teaching. F-07 Use functional communication training. F-08 Use augmentative communication systems. CLIENT-CENTERED RESPONSIBILITIES G. Identification of the Problem G-01 Review records and available data at the outset of the case. G-02 Consider biological/medical variables that may be affecting the client. G-03 Conduct a preliminary assessment of the client in order to identify the referral problem. G-04 Explain behavioral concepts using nontechnical language. Describe and explain behavior, including private events, in behavior-analytic (nonmentalistic) G-05 terms. Provide behavior-analytic services in collaboration with others who support and/or provide G-06 services to one s clients. Practice within one s limits of professional competence in applied behavior analysis, and G-07 obtain consultation, supervision, and training, or make referrals as necessary. G-08 Identify and make environmental changes that reduce the need for behavior analysis services. H. Measurement Select a measurement system to obtain representative data given the dimensions of the H-01 behavior and the logistics of observing and recording. H-02 Select a schedule of observation and recording periods. H-03 Select a data display that effectively communicates relevant quantitative relations. H-04 Evaluate changes in level, trend, and variability. Evaluate temporal relations between observed variables (within & between sessions, time H-05 series). I. Assessment I-01 Define behavior in observable and measurable terms. I-02 Define environmental variables in observable and measurable terms.

29 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 29 I-03 Design and implement individualized behavioral assessment procedures. I-04 Design and implement the full range of functional assessment procedures. I-05 Organize, analyze, and interpret observed data. Make recommendations regarding behaviors that must be established, maintained, increased, or decreased. I-06 I-07 Design and conduct preference assessments to identify putative reinforcers. J. Intervention J-01 State intervention goals in observable and measurable terms. Identify potential interventions based on assessment results and the best available scientific evidence. J-02 J-03 Select intervention strategies based on task analysis. J-04 Select intervention strategies based on client preferences. J-05 Select intervention strategies based on the client s current repertoires. J-06 Select intervention strategies based on supporting environments. J-07 Select intervention strategies based on environmental and resource constraints. J-08 Select intervention strategies based on the social validity of the intervention. J-09 Identify and address practical and ethical considerations when using experimental designs to demonstrate treatment effectiveness. When a behavior is to be decreased, select an acceptable alternative behavior to be established or increased. J-10 J-11 Program for stimulus and response generalization. J-12 Program for maintenance. J-13 Select behavioral cusps as goals for intervention when appropriate. J-14 Arrange instructional procedures to promote generative learning (i.e., derived relations). J-15 Base decision-making on data displayed in various formats. K. Implementation, Management, and Supervision K-01 Provide for ongoing documentation of behavioral services. K-02 Identify the contingencies governing the behavior of those responsible for carrying out behavior-change procedures and design interventions accordingly. Design and use competency-based training for persons who are responsible for carrying out behavioral assessment and behavior-change procedures. K-03 K-04 Design and use effective performance monitoring and reinforcement systems. K-05 Design and use systems for monitoring procedural integrity. K-06 Provide supervision for behavior-change agents. K-07 Evaluate the effectiveness of the behavioral program. Establish support for behavior-analytic services from direct and indirect consumers. K-08 Secure the support of others to maintain the client s behavioral repertoires in their natural K-09 environments. K-10 Arrange for the orderly termination of services when they are no longer required.

30 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 30 FOUNDATIONAL KNOWLEDGE ACCOMPANYING THE BACB FOURTH EDITION TASK LIST Explain and Behave in Accordance with the Philosophical Assumptions of Behavior Analysis FK-01 Lawfulness of behavior FK-02 Selectionism (phylogenic, ontogenic, cultural) FK-03 Determinism FK-04 Empiricism FK-05 Parsimony FK-06 Pragmatism FK-07 Environmental (as opposed to mentalistic) explanations of behavior FK-08 Distinguish between radical and methodological behaviorism. Distinguish between the conceptual analysis of behavior, experimental analysis of behavior, FK-09 applied behavior analysis, and behavioral service delivery. Define and Provide Examples of: FK-10 behavior, response, response class FK-11 environment, stimulus, stimulus class FK-12 stimulus equivalence FK-13 reflexive relations (US-UR) FK-14 respondent conditioning (CS-CR) FK-15 operant conditioning FK-16 respondent-operant interactions FK-17 unconditioned reinforcement FK-18 conditioned reinforcement FK-19 unconditioned punishment FK-20 conditioned punishment FK-21 schedules of reinforcement and punishment FK-22 extinction FK-23 automatic reinforcement and punishment FK-24 stimulus control FK-25 multiple functions of a single stimulus FK-26 unconditioned motivating operations FK-27 conditioned motivating operations FK-28 transitive, reflexive, surrogate motivating operations FK-29 distinguish between the discriminative stimulus and the motivating operation FK-30 distinguish between motivating operation and reinforcement effects FK-31 behavioral contingencies FK-32 contiguity

31 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 31 FK-33 functional relations FK-34 conditional discriminations FK-35 stimulus discrimination FK-36 response generalization FK-37 stimulus generalization FK-38 behavioral contrast FK-39 behavioral momentum FK-40 matching law FK-41 contingency-shaped behavior FK-42 rule-governed behavior Distinguish between the Verbal Operants FK-43 Echoics FK-44 Mands FK-45 Tacts FK-46 Intraverbals Measurement Concepts FK-47 FK-48 Identify the measurable dimensions of behavior (e.g., rate, duration, latency, interresponse time). State the advantages and disadvantages of using continuous measurement procedures and discontinuous measurement procedures (e.g., partial- and whole-interval recording, momentary time sampling). Unauthorized reproduction, copying, or transmission in any medium is strictly prohibited. The trademarks "Behavior Analyst Certification Board, Inc.," "BACB," "Board Certified Behavior Analyst," "BCBA," "Board Certified Assistant Behavior Analyst," and "BCaBA," are owned by the Behavior Analyst Certification Board. Unauthorized use or misrepresentation is strictly prohibited. 33. DESCRIBE THE IMPORTANT FUNCTIONS, TASKS AND DUTIES PERFORMED BY PRACTITIONERS. IDENTIFY THE SERVICES AND/OR PRODUCTS PROVIDED. The functions, tasks, and duties performed by practitioners are identified in the current (4 th edition) BACB Task List, shown above and as Appendix D. 34. IS THERE A CONSENSUS ON WHAT ACTIVITIES CONSTITUTE COMPETENT PRACTICE OF THE OCCUPATION? IF SO, STATE AND DOCUMENT. IF NOT, WHAT IS THE BASIS FOR ASSESSING COMPETENCE? The foregoing BACB Task List was derived from extensive job analysis studies conducted over the past 15 years, and constitutes the empirical consensus of thousands of behavior analysts as to the competencies required to practice ABA professionally. The

32 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 32 Task List provides the content for the BACB certification exams, which have been developed and validated by professional psychometricians for assessing competence in the practice of ABA. To be eligible to take a BACB certification exam, an applicant must provide documentation to the BACB that s/he has completed a degree conferred in behavior analysis or a field related to behavior analysis and approved by the BACB, specified numbers of classroom hours of instruction in behavior analysis, and a specified number of hours of supervised experiential training in behavior analysis. Once certified, individuals must document completion of continuing education in ABA (of which at least 3 CEUs must be in ethics) in order to maintain certification. Certificants must also attest that they comply with the BACB Guidelines for Responsible Conduct and Professional Ethical and Disciplinary Standards. 35. ARE INDICATORS OF COMPETENT PRACTICE LISTED IN RESPOSE TO QUESTION 34 MEASURABLE BY OBJECTIVE STANDARDS SUCH AS PEER REVIEW? GIVE EXAMPLES. The competencies in the BACB Task List are measured via objective professional examinations. Completion of the eligibility requirements to take the exams (degrees, coursework, supervised experiential training) are objectively verified by BACB staff. 36. SPECIFY ACTIVITIES OR PRACTICES THAT WOULD SUGGEST THAT A PRACTITIONER IS INCOMPETENT. TO WHAT EXTENT IS PUBLIC HARM CAUSED BY PERSONAL FACTORS SUCH AS DISHONESTY? DOCUMENT. Some specific activities that would suggest a practitioner is incompetent, is unethical or lacking competence may include: practitioner s using ABA assessment and/or intervention procedures incorrectly; failing regulation; failing to collect and analyze data during treatment to determine client progress or lack thereof; using non-behavior analytic procedures while practicing as a behavior analyst; failing to maintain proper clinical boundaries; breaching confidentiality; or using corporal punishment. Public harm can be caused by personal factors such as dishonesty, as documented in the description of the 2010 Connecticut case in Question 14. In that case an individual falsely represented herself as a Board Certified Behavior Analyst and caused harm to the children receiving her services. VII. THE OCCUPATION IS CLEARLY DISTINGUISHABLE FROM OTHER OCCUPATIONS THAT ARE ALREADY REGULATED 37. WHAT SIMILAR OCCUPATIONS HAVE BEEN REGULATED IN CALIFORNIA? Licensed Psychologists

33 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 33 Licensed Professional Clinical Counselors Licensed Marriage and Family Therapists Licensed Clinical Social Workers Licensed Educational Psychologists 38. DESCRIBE FUNCTIONS PERFORMED BY PRACTITIONERS THAT DIFFER FROM THOSE PERFORMED BY OCCUPATIONS LISTED IN QUESTION 37. The practice of behavior analysis is distinct from the practice of other professions in both content and methodology, and expressly excludes psychological testing, neuropsychology, psychotherapy, cognitive therapy, sex therapy, psychoanalysis, hypnotherapy, and long-term counseling as treatment modalities. The BACB Task List presented previously differs very substantially from the task lists yielded by job analysis studies conducted by and for other professions (e.g., the job analysis study of the practice of licensed psychologists that was conducted by the Association of State and Provincial Psychology Boards in 2010). 39. INDICATE THE RELATIONSHIP AMONG THE GROUPS LISTED IN RESPONSE TO QUESTION 37 AND PRACTITIONERS. CAN PRACTITIONERS BE CONSIDERED A BRANCH OF CURRENTLY REGULATED OCCUPATIONS? Although it could be said that behavior analysis like several of the occupations listed in question has some historic ties to psychology, the practice of behavior analysis actually originated in the experimental analysis of behavior rather than clinical psychology (the area in which most licensed psychologists are trained). Behavior analysis has long been a distinct scientific discipline with distinct concepts, research and clinical methods, professional journals, training programs, textbooks, ethical and practice standards, and scholarly and professional organizations. As the BACB Task List (question 33) shows, practitioners of behavior analysis do not do what members of the other professions listed above do. Further, the training and exam requirements for obtaining and maintaining professional certification in the practice of behavior analysis are very different from requirements for obtaining credentials in other professions. The State of California has recognized that behavior analysis is a distinct profession for more than a decade. For instance, a written opinion issued by legal counsel for the California Department of Consumer Affairs in February 2000 stated clearly that the practice of behavior analysis is distinct from the practice of psychology (see Appendix H). Since that time, the California Code of Regulations governing the Department of Developmental Services has included unique vendor categories for behavior analysts (defined as Board Certified Behavior Analysts) and associate behavior analysts (defined as Board Certified Associate now Assistant Behavior Analysts). The descriptions of those vendor categories state explicitly that behavior analysts do not practice psychology, and reflect the definition of the practice of behavior analysis presented earlier in this application, which also appears in the 17 state laws to license or otherwise regulate practitioners of ABA (see question 23) and most of the 37

34 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 34 state laws requiring private health plans to cover ABA services for people with autism, including the current California autism insurance law (SB 126). 40. WHAT IMPACT WILL THE REQUESTED REGULATION HAVE UPON THE AUTHORITY AND SCOPED OF PRACTICE OF CURRENTLY REGULATED GROUPS? None. 41. ARE THERE UNREGULATED OCCUPATIONS PERFORMING SERVICES SIMILAR TO THOSE OF THE GROUP TO BE REGULATED? IF SO, IDENTIFY. No. However, there are many individuals who call themselves behavior analysts, behaviorists, or behavior specialists and represent that they are qualified to provide ABA services to vulnerable client populations who have not met the standards for practicing ABA that have long been established by the profession, i.e., the BACB certification standards. 42. DESCRIBE THE SIMILARITIES AND DIFFERENCES BETWEEN PRACTITIONERS AND THE GROUPS IDENTIFIED IN QUESTION 41. N/A VIII. THE OCCUPATION REQUIRES POSSESSION OF KNOWLEDGES, SKILLS AND ABILITIES THAT ARE BOTH TEACHABLE AND TESTABLE 43. IS THERE A GENERALLY ACCEPTED CORE SET OF KNOWLEDGES, SKILLS AND ABILITIES WITHOUT WHICH A PRACTITIONER MAY CAUSE PUBLIC HARM? DESCRIBE AND DOCUMENT. Yes. See the BACB Task List in question WHAT METHODS ARE CURRENTLY USED TO DEFINE THE REQUISITE KNOWLEDGES, SKILLS AND ABILITIES? WHO IS RESPONSIBLE FOR DEFINING THESE KNOWLEDGE, SKILLS AND ABILITIES? The BACB is responsible for defining the knowledge, skills and abilities required to practice ABA competently. It relies on subject matter experts who are currently certified as BCBA- Ds, BCBAs, and BCaBAs working under the guidance of the BACB s psychometrician. The BACB uses a job analysis process that begins with convening one or more panels of subject matter experts who, with guidance from the psychometrician, develop a comprehensive list of all of the tasks performed by practicing behavior analysts with accompanying foundational knowledge. The rationale for this approach is that jobs can best be described in terms of the tasks that are performed by successful practitioners.

35 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 35 The draft task list is used to create a validation survey that is distributed to all current BACB certificants. The survey asks practitioners to rate each task based on its importance and frequency and to rate the importance of the foundational knowledge for each task. Results from the survey and test development standards are then used to determine which tasks are of sufficient importance to be covered on the certification examinations. Tasks that are rated as being of low importance or are only performed by a minority of practitioners are excluded from the final examination content outlines. Once the examination content outlines have been finalized, several additional panels of subject matter experts are convened. The first panel is tasked with identifying the knowledge, skills, and abilities required to perform each of the validated tasks. The second panel reviews the bank of examination questions (currently all multiple choice) to determine whether each question accurately reflects current practices and whether it matches the new task list. Any questions that are obsolete or cannot be matched to the new task list are discarded. Subsequent panels are charged with developing examination questions to address any new content that was added to the task list. 45. ARE THESE KNOWLEDGES, SKILLS AND ABILITIES TESTABLE? IS THE WORK OF THE GROUP SUFFICIENTLY DEFINED THAT COMPETENCE COULD BE EVALUATED BY SOME STANDARD (SUCH AS RATINGS OF EDUCATION, EXPEREICNE OR EXAM PERFORMANCE)? Yes, and all applicants must pass a professional examination to obtain BACB certification. The BACB certification programs are accredited by the National Commission for Certifying Agencies, which conducts (NCCA) a third-party review of the BACB s examination development practices to ensure compliance with NCCA s standards for accreditation. The psychometric properties of the BACB examinations are evaluated using classical test theory methods, which include conducting item and test analysis after each examination administration. The results of these analyses are reviewed by the BACB s psychometrician and any poorly performing items are reviewed by subject matter experts. Examination forms are statistically equated to ensure equivalence and fairness. As described earlier, the job analysis serves as the primary source of evidence for the validity of the examinations, as it links the exam content directly to activities and knowledge that practitioners have indicated are important to the practice of behavior analysis. Reliability refers to the consistency with which the exam measures knowledge. After each item analysis, the Kuder-Richardson Formula 20 (KR-20) statistic is calculated to measure internal consistency. Exams are usually considered to have acceptable reliabilities when the KR-20 is over BACB examinations typically have KR-20 indices that exceed The job analysis is updated every 5-10 years to ensure that examinations continue to reflect current research and practices in behavior analysis. The most recent job analysis study was

36 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 36 conducted in It resulted in the 4 th Edition Task List, which will govern the content of the examinations starting in February 2015 (the current examinations are based on the 3 rd Edition Task List, which resulted from the 2001 job analysis). The BACB examinations are currently developed and maintained by the BACB s in-house psychometrician. Along with BACB personnel and a team of subject matter experts, the psychometrician oversees conducting the job analysis survey; developing the Task List (the content foundation for the exam); developing knowledge, skill, and ability statements; identifying examination specifications; overseeing the item-writing process; examination construction; performing post-examination psychometric performance assessments; and analyzing examination results. The examinations are currently administered by Pearson VUE, Inc. of Minneapolis, Minnesota. Pearson VUE offers secure, controlled computer-based testing environments at over 200 sites within the United States and at over 150 sites internationally. 46. LIST INSTITUTIONS AND PROGRAM TITLES OFFERING ACCREDITED AND NON- ACCREDITED PREPATORY PROGRAMS IN CALIFORNIA. ESTIMATE THE ANNUAL NUMBER OF GRADUATES FROM EACH. IF NO SUCH PREPATORY PROGRAMS EXIST WITHIN CALIFORNIA, LIST PROGRAMS FOUND ELSEWHERE. The BACB does not accredit university-training programs, but it does approve on-campus and online course sequences that meet coursework requirements for eligibility to take BACB certification exams. BACB-approved course sequences (on campus only) at accredited California universities are listed below with an estimate of the number of students who complete the course sequence each year. Data not available is listed as N/A BCaBA California State University, Fresno 22 California State University at Monterey Bay N/A California State University, Northridge 2 California State University, Sacramento - 8 California State University, San Diego 2 Palo Alto University N/A BCBA Alliant International University N/A Azusa Pacific University N/A California Polytechnic University N/A California State University, Fresno 7 California State University, Northridge 30 California State University, Sacramento - 6 California State University, Los Angeles N/A California State University, San Diego 25

37 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 37 California State University, San Marcos N/A California State University, Stanislaus 8 Claremont Graduate University 2 Fresno Pacific University N/A National University N/A Palo Alto University N/A The Chicago School of Professional Psychology, Los Angeles - 25 University of California, Santa Barbara N/A University of the Pacific APART FROM THE PROGRAMS LISTED IN QUESTION 46, INDICATE VARIOUS METHODS OF ACQUIRING REQUISITE KNOWLEDGE, SKILL AND ABILITY. EXAMPLES MAY INCLUDE APPRENTISHIPS, INTERNSHIPS, ON-THE-JOB TRAINING, INDIVIDUAL STUDY ETC. Applicants for BACB certification must complete supervised experiential training as well as degree and coursework requirements in order to sit for a BACB examination. There are three options for fulfilling the supervised experiential training requirement: 1. SUPERVISED INDEPENDENT FIELDWORK (1500 hours BCBA, 1000 hours BCaBA) To qualify under this standard at the BCBA level, supervisees must complete 1500 hours of supervised independent fieldwork in behavior analysis. To qualify under this standard at the BCaBA level, supervisees must complete 1000 hours of supervised independent fieldwork in behavior analysis. A supervisory period is two weeks. In order to count experience hours within any given supervisory period, supervisees must be supervised by a BCBA at least once during that period for no less than 5% of the total hours spent in supervised independent fieldwork. For example, 20 hours of experience would include at least 1 supervised hour. 2. PRACTICUM (1000 hours BCBA, 670 hours BCaBA) To qualify under this standard at the BCBA level, supervisees must complete, with a passing grade, 1000 hours of practicum in behavior analysis within a university practicum program approved by the BACB and taken for graduate academic credit. To qualify under this standard at the BCaBA level, supervisees must complete, with a passing grade, 670 hours of practicum in behavior analysis within a university practicum program approved by the BACB and taken for academic credit. A supervisory period is one week. In order to count experience hours within any given supervisory period, supervisees must be supervised at least once during that period for no less than 7.5% of the total hours spent in Practicum. For example, 20 hours of experience would include at least 1.5 supervised hours. 3. INTENSIVE PRACTICUM (750 hours BCBA, 500 hours BCaBA) To qualify under this standard at the BCBA level, supervisees must complete, with a passing grade, 750 hours of intensive practicum in behavior analysis within a university practicum program approved by the BACB and taken for graduate academic credit. To

38 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 38 qualify under this standard at the BCaBA level, supervisees must complete, with a passing grade, 500 hours of intensive practicum in behavior analysis within a university practicum program approved by the BACB and taken for academic credit. A supervisory period is one week. In order to count experience hours within any given supervisory period, supervisees must be supervised at least twice during that period for no less than 10% of the total hours spent in intensive practicum. For example, 20 hours of experience would include at least 2 supervised hours. For all three of the above options, no fewer than 10 hours but no more than 30 hours may be accrued per week. Supervisees may accrue experience in only one category at a time (i.e., supervised independent fieldwork, practicum, or intensive practicum). All supervision must comply with the BACB s supervision standards (see Appendix I). 48. ESTIMATE THE PERCENTAGE OF CURRENT PRACTITIONERS TRIANED BY EACH OF THE ROUTES DECRIBED IN QUESTIONS Specific data is not available regarding the percentage of practitioners trained by each of the routes described above. However, it is important to note that any individual pursuing certification as a Board Certified Behavior Analyst must complete graduate level training through an accredited educational institution in addition to the clinical supervision outlined in question DOES ANY EXAMINATION OR OTHER MEASURE CURRENTLY EXIST TO TEST FOR FUNCTIONAL COMPETENCE? IF SO, INDICATE HOW AND BY WHOM EACH WAS CONSTRUCTED AND BY WHOM IT IS CURRENTLY ADMINISTERED. IF NOT, INDICATE SEARCH EFFORTS TO LOCATE SUCH MEASURES. At present the only standardized, validated examinations of competence in the practice of behavior analysis as those that have been developed by the BACB, described above. 50. DESCRIBE THE FORMAT AND CONTENT OF EACH EXAMINATION LISTED IN QUESTION 49. DESCRIBE THE SECTIONS OF EACH EXAMINATION. WHAT COMPETNCIES IS EACH DESIGNED TO MEASURE? HOW DO THESE RELATE TO THE KNOWLEDGE, SKILLS AND ABILITIES LISTED IN QUESTION 43? The BACB examinations consist of 4-option multiple-choice questions, delivered using a computer-based testing platform. The content of each examination is based on the 4 th Edition Task List, which specifies the number of questions that will be asked about each of the content areas and tasks identified during the job analysis survey. The BCBA examination consists of 150 scored questions while the BCaBA examination consists of 140 scored questions. Both examinations include an additional 10 non-scored pilot questions that are being evaluated for use on future examinations.

39 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 39 The examinations cover the content areas listed in the table below. Number of BACB Examination 4th Edition Content Outlines Questions Basic Behavior Analytic Skills BCBA BCaBA A Measurement B Experimental Design C Behavior Change Considerations 3 3 D Fundamental Elements of Behavior Change E Specific Behavior Change Procedures F Behavior Change Systems 8 8 Client-Centered Responsibilities (will include at least 2 questions addressing ethics per section) G Identification of the Problem 14 9 H Measurement 9 6 I Assessment J Intervention K Implementation, Management and Supervision Total Number of Questions Behavior Analyst Certification Board, Inc., all rights reserved. Reprinted herein with permission. The competencies that the examinations are designed to measure are identified by the tasks listed within each of the content areas noted in the table above and described in the BACB s 4th Edition Task List. Every question on the BACB examinations (BCBA and BCaBA) is directly linked to one of the tasks in the 4 th Edition Task List. Each task is further described in terms of the knowledge, skills and abilities required to perform that task (i.e., the foundational knowledge.) It is important to note that although the examination content outlines are strictly based on the task list, each of the examination forms also covers a representative sample of the knowledge, skills and abilities identified in the foundational knowledge section of the 4 th Edition Task List.

40 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page IF MORE THAN ONE EXAMINATION IS LISTED ABOVE, WHICH STANDARD DO YOU INTEND TO SUPPORT? WHY? IF NONE OF THE ABOVE, WHY NOT, AND WHAT DO YOU PROPOSE AS AN ALTERNATIVE? We support the only validated professional examinations in the practice of behavior analysis, the BACB examinations described above. IX. ECONOMIC IMPACT OF REGULATION IS JUSTIFIED 52. HOW MANY PEOPLE ARE EXPOSED ANNUALLY TO THIS OCCUPATION? WILL REGULATION OF THIS OCCUPATION AFFECT THIS FIGURE? IF SO, IN WHAT WAY? In a report published by the California Health Benefits Review Program (See Appendix J) it is estimated that 12,700 enrollees in DMHC-regulated plans or CDI-regulated policies currently access intensive ABA therapies. Due to the wide scope of practice of behavior analysis previously discussed, in addition to the individuals already being served, we feel there are tens of thousands of individuals who could benefit from the services of a behavior analyst. 53. WHAT IS THE CURRENT COST OF THE SERVICE PROVIDED? ESTIMATE THE AMOUNT OF MONEY SPENT ANNUALLY IN CALIFORNIA FOR THE SERVICES OF THIS GROUP. HOW WILL REGULATION AFFECT THESE COSTS? PROVIDE DOCUMENTATION FOR YOUR ANSWERS. A typical ABA therapy session lasts between hours and the cost is based on a number of variables including funding source, place of service etc. Therapy rates in California can range from ~$20-$75/hour for direct service. In addition to the direct service hours, ABA programs include both direct and indirect supervision by a Board Certified Behavior Analyst (BCBA). The cost for these supervision services range from $75-150/hour. As mentioned above in question 52, in a report published by the California Health Benefits Review Program (See Appendix J-10) it is estimated that 12,700 enrollees in DMHCregulated plans or CDI-regulated policies currently access intensive ABA therapies. Current annual expenditures for intensive behavioral intervention therapies among these enrollees are estimated to be $686 million. Coverage for ABA services is currently required under both the existing behavioral health treatment mandate (SB 946/126), through the Department of Developmental Services Regional Center system and the current California mental health parity law. As a result, we do not expect additional governmental regulation to have a measurable cost impact. 54. OUTLINE THE MAJOR GOVERNMENTAL ACTIVITIES YOU BELIEVE WILL BE NECESSARY TO APPROPRIATELY REGULATE PRACTITIONERS. EXAMPLES

41 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 41 MAY INCLUDE SUCH PROGRAM ELEMENTS AS: QUALIFICATIONS EVALUATIONS, EXAMINATION DEVELOPMENT OR ADMINISTRATION, ENFORCEMENT, SCHOOL ACCREDIDATION, ETC. A licensing board comprising professional behavior analysts will be required to (a) coordinate with the BACB to verify that applicants for licensure have met the degree, coursework, supervised experiential training, and examination requirements established by the profession; (b) verify that applicants have met any other state requirements, such as successful completion of a criminal background check; (c) review and investigate alleged violations of the licensure law or standards of conduct in coordination with other state entities and the BACB; and (d) impose sanctions when violations are found to have occurred. No development or administration of examinations or accreditation of training programs will be required. 55. PROVIDE A COST ANALYSIS SUPPORTING REGULATORY SERVICES TO THIS OCCUPATION. INCLUDE COSTS TO PROVIDE ADEQUATE REGULATORY FUNCTIONS DURING THE FIRST THREE YEARS FOLLOWING IMPLEMENTATION OF THIS REGULATION. ASSURE THAT AT LEAST THE FOLLOWING HAVE BEEN INCLUDED: a. costs of program administration, including staffing see below b. costs of developing and/or administering examinations None. This task is already in place through the Behavior Analyst Certification Board. c. costs of effective enforcement programs see below

42 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page HOW MANY PRACTITIONERS ARE LIKELY TO APPLY EACH YEAR FOR CERTIFICATION IF THIS REGULATION IS ADOPTED? IF SMALL NUMBERS WILL APPLY, HOW ARE COSTS JUSTIFIED? Year applicants Year applicants Year applicants 57. DOES ADOPTION OF THE REQUESTED REGULATION REPRESENT THE MOST COST EFFECTIVE FORM OF REGULATION? INDICATE ALTERNATIVES CONSIDERED AND COSTS ASSOCIATED WITH EACH. Making BACB certification the principal requirement for obtaining and maintaining a California license to practice behavior analysis will be a very cost-effective way for the state to regulate this practice. The state licensing board or staff will not have to check each applicant s degrees, coursework transcripts, or evidence of supervised experiential training to see that s/he meets national standards for practicing behavior analysis; the board will merely need to confirm that the BACB has verified that the applicant has met those requirements. Nor will the state board have to develop or administer examinations, because applicants will have already passed the national professional examination in order to obtain BACB certification. Passage of a professionally designed and administered, psychometrically valid and reliable examination in the subject matter is required to obtain a valid credential to practice most legitimate professions. At present the only professional examinations in the practice of behavior analysis that comport with accepted psychometric and legal standards are the BACB s. The BACB only gives its examinations to individuals that the BACB has vetted for compliance with its eligibility requirements. It does not contract with state regulatory boards to give its examinations to applicants that those boards deem eligible. We are not aware of

43 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 43 any other appropriately accredited entity that is developing a professional examination in the practice of behavior analysis that will meet accepted standards, or is likely to do so in the near future. Therefore, the only alternative we considered was to have the California behavior analyst licensing board develop an examination. We estimate that would take many thousands of hours of work on the part of that board, many other behavior analysts, expert psychometricians, and attorneys and would cost hundreds of thousands of dollars. We do not consider that alternative viable, and it is unnecessary because the BACB has already done the work and borne the costs of developing high-quality examinations that it is fully prepared to continue administering and updating.

44 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 44 Part C2 Rating on Sunrise Criteria Assign each Criterion a numeric rating of 0 5 in the space provided. The rating should be supported by the answers provided to the questions in Part C1. Scale descriptions are intended to give examples of characteristics indicative of ratings (Little Need for Regulation) LOW HIGH (Great Need for Regulation) I. UNREGULATED PRACTICE OF THIS OCCUPATION WILL HARM OR ENDANGER THE PUBLIC HEALTH SAFETY AND WELFARE 5 low: Regulation sought only by practitioners. Evidence of harm lacking or remote. Most effects secondary or tertiary. Little evidence that regulation would correct inequities. high: Significant public demand. Patterns of repeated and severe harm, caused directly by incompetent practice. Suggested regulatory pattern deals effectively with inequity. Elements of protection from fraudulent activity and deceptive practice are included. II. EXISTING PROTECTIONS AVAILABLE TO THE CONSUMER ARE INSUFFICIENT 4 low: Other regulated groups control access to practitioners. Existing remedies are in place and effective. Clients are generally groups or organizations with adequate resources to seek protection. high: Individual clients access practitioners directly. Current remedies are ineffective or nonexistent. III. NO ALTERNATIVES TO REGULATION WILL ADEQUATELY PROTECT THE PUBLIC 4 low: No alternatives considered. Practice unregulated in most other states. Current system for handling abuses adequate. high: Exhaustive search of alternatives finds them lacking. Practice regulated elsewhere. Current system ineffective or nonexistent.

45 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 45 IV. REGULATION WILL MITIGATE EXISTING PROBLEMS 5 low: Little or no evidence of public benefit from regulation. Case not demonstrated that regulation precludes harm. Net benefit does not indicate need for regulation. high: Little or no doubt that regulation will ensure consumer protection. Greatest protection provided to those who are least able to protect themselves. Regulation likely to eliminate currently existing problems. V. PRACTITIONERS OPERATE INDEPENDENTLY, MAKING DECISIONS OF CONSEQUENCE 5 low: Practitioners operate under the supervision of another regulated profession or under the auspices of an organization which may be held responsible for services provided. Decisions made by practitioners are of little consequence. high: Practitioners have little or no supervision. Decisions made by practitioners are of consequence, directly affecting important consumer concerns. VI. FUNCTIONS AND TASKS OF THE OCCUPATION ARE CLEARLY DEFINED 5 low: Definition of competent practice unclear or very subjective. Consensus does not exist regarding appropriate functions and measures of competence. high: Important occupational functions are clearly defined, with quantifiable measures of successful practice. High degree of agreement regarding appropriate functions and measures of competence. VII. THE OCCUPATION IS CLEARLY DISTINGUISHABLE FROM OTHER OCCUPATIONS THAT ARE ALREADY REGULATED 5 low: High degree of overlap with currently regulated occupations. Little information given regarding the relationships among similar occupations. high: Important occupational functions clearly different from those of currently regulated occupations. Similar non-regulated groups do not perform critical functions included in this occupation s practice. VIII. THE OCCUPATION REQUIRES POSSESSION OF KNOWLEDGES, SKILLS AND ABILITIES THAT ARE BOTH TEACHABLE AND TESTABLE 5

46 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 46 low: Required knowledge undefined. Preparatory programs limited in scope and availability. Low degree of required knowledge or training. Current standard sufficient to measure competence without regulation. Required skill subjectively determined; not teachable and/or not testable. high: Required knowledges clearly defined. Measures of competence both objective and testable. Incompetent practice defined by lack of knowledge, skill or ability. No current standard effectively used to protect public interest. IX. ECONOMIC IMPACT OF REGULATION IS JUSTIFIED 4 low: Economic impact not fully considered. Dollar and staffing cost estimates inaccurate or poorly done. high: Full analysis of all costs indicate net benefit of regulation is in the public interest.

47 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 47 REFERENCES Bibby, P. Eikeseth, S., Martin, N., Mudford, O.C., & Reeves, D. (2002). Progress and outcomes for children with autism receiving parent-managed intensive interventions. Research in Developmental Disabilities, 23, Campbell, J.M. (2003). Efficacy of behavioral interventions for reducing problem behavior in persons with autism: A quantitative synthesis of single-subject research. Research in Developmental Disabilities, 24, Chasson, G.S., Harris, G. E., & Neely, W. J. (2007). Cost comparison of early intensive behavioral intervention and special education for children with autism. Journal of Child and Family Studies, 16, Eldevik, S., Hastings, R.P., Hughes, J.C., Jahr, E., Eikeseth, S., & Cross, S. (2009). Metaanalysis of early intensive behavioral intervention for children with autism. Journal of Clinical Child and Adolescent Psychology. Eldevik, S., Hastings, R.P., Hughes, J.C., Jahr, E., Eikeseth, S., & Cross, S. (2010). Using participant data to extend the evidence for intensive behavioral intervention for children with autism. American Journal on Intellectual and Developmental Disabilities, 115, Green, G. (2011). Early intensive behavior analytic intervention for autism spectrum disorders. In E. Mayville & J. Mulick (Eds.), Behavioral foundations of effective autism treatment (pp ). Sloan Publishing. Hagopian, L.P., Rooker, G.W., & Rolider, N.U. (2011). Identifying empirically supported treatments for pica in individuals with intellectual disabilities. Research in Developmental Disabilities, 32, Hanley, G.P., Iwata, B.A., & McCord, B.E. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36, Hassiotis, A, Canagasabey, A., Robotham, D., Marston, L., Romeo, R., & King, M. (2010). Applied behaviour analysis and standard treatment in intellectual disability: 2-year outcomes. British Journal of Psychiatry. Published online Dec. 15, 2010; downloaded from bjp.rcpsych.org on March 23, Heyvaert, M., Maes, B., Van den Noortgate, W., Kuppens, S., & Onghena, P. (2012) A multilevel meta-analysis of single-case and small-n research on interventions for reducing challenging behavior in persons with intellectual disabilities. Research in Developmental Disabilities, 33,

48 Senate Committee On Business, Regulatory Request Questionnaire Professions & Economic Development Page 48 Jacobson, J.W., Mulick, J.A., & Green, G. (1998). Cost-benefit estimates for early intensive behavioral intervention for young children with autism: General model and single state case. Behavioral Interventions, 13, Lang, R., Rispoli, M., Machalicek, W., White, P.J., Kang, So, Pierce, N., Mulloy, A., Fragale, T., O Reilly, M., Sigafoos, J., & Lancioni, G. (2009). Treatment of elopement in individuals with developmental disabilities: A systematic review. Research in Developmental Disabiliites, 30, Lovaas, O.I., Freitag, G., Gold, V.J., & Kassorla, I.C. (1965) Experimental studies in childhood schizophrenia: Analysis of self-destructive behavior. Journal of Experimental Child Psychology, 2, Lovaas, O.I. & Simmons, J.Q. (1969). Manipulation of self-destruction in three retarded children. Journal of Applied Behavior Analysis, 2, Mandell, D.S. (2007). Psychiatric hospitalization among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, available at Mason, S.A., & Iwata, B.A. (1990). Artifactual effects of sensory-integrative therapy on selfinjurious behavior. Journal of Applied Behavior Analysis, 23, Montes, G. & Halterman, J.S. (2008). Association of childhood autism spectrum disorders and loss of family income. Pediatrics, 121, e821-e826. Motiwala, S.S., Gupta, S., & Lilly, M.D. (2006). The cost-effectiveness of expanding intensive behavioural intervention to all autistic children in Ontario. Healthcare Policy, 1, Mudford, O.C., Martin, N.T., Eikeseth, S., & Bibby, P. (2001). Parent-managed behavioral treatment for preschool children with autism: Some characteristics of UK programs. Research in Developmental Disabilities, 22, Rogers, S. J. & Vismara, L. A. (2008) Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology, 37, Tsakanikos, E., Costello, H., Holt, G., Sturmey, P., & Bouras, N. (2007). Behaviour management problems as predictors of psychotropic medication and use of psychiatric services in adults with autism. Journal of Autism and Developmental Disorders, 37,

49 BEHAVIOR AN,\ I.YS r.. C( Rp flcation aoa RU' Guidelines for Responsible Conduct for Behavior Analysts Rev/lOlll/ly 1010 in accol'tiance wilh lhe 411, Edition TtlsJ.: List for bellav/or t111ll/ysls '" :: Introduction "- I'oo'tlom of the BACB artificallon CXIIminations relating to elhlal.nd profei.slonal pnoc!ka ~ ~ on the IOUawing Gulddlna. The Guidd...,. oddrao ethical and po'" sima! conarns putleulu to IlACB CJeftiliQ.n1f,,, wdi.. CODCtrn$ tt>.t In! ~ 10 tbr InloOrKIlono ~ behlvior onalysis. the people lhey _ and sodcty, In ~ The Guiddhlelatf: pr<wi<ini for gfmnoi rererena to prac!lliontrs,...,pi~.. and consume.. of appl~ behavior analyl.ij oervicea. F<>r (GnU,n'.boull~fi' Pr;I(liaI: by a BACS Cfttlficonl, pluk refe, to the BACS Professional DiscIplinary and Ethical St.ndords, 1"," GUiMinet... y be ttfettnctd In <;omplalnl. alleging v\oiatjoo ofsktlon 6 of tho BACB's DiKipiinary and Ethical Stando.ntt; these Gulddines, ~r, are not Hpar;lrdy enfun::td by the BACR. (ur_1m",iddlm II rdenn\ 10 Rqiotn'<d 1I<ha... Tedlnid...' Responsible Conduct of a Behavior Analyst. The bdlavlor... 1)"1 malnlalns 1M hish standards of profwional beha.v\or 01 tho pmlwional <>rpaiulion Rfllance on Scifnlific Knowlfdge. oat Bdtavlor onaiysts rely on scientifically and profcssioooally ckriwd knowitdge w","n malting scietltll\c 0, profeulona!!udgmenl$ In hum... oervice pm"bkln. 0' when engaging In Kholarly or profeuional """ Compelf nce... (0) BchIVI«analysts pn:m<k ~ leach, and condl>cl rconrcb only with in the bow>darief of their compctmce. based on IMIr i!dua.lit)n, tninlng. 1IJperv\Kd opmo:ncz. or appropri>.l00 profwional op<1ima. (b) Sduvlor analysts pmvide oervlca, leach, 0' conduct ruurch in ntw &tt&i or lnvolving new Itchniques only firt! undortaldng.ppropri&~ Itud}r. lr;lini... IIJP'I'rvblon, and/... conswlation from penont who an comptlent In t'-... IMlniques. \II

50 1.03 Professional Development. lit &havlor In.lysll who enp~ In USffiment,!M",Pr. 1ucbln" rne.!'ch, OfSInlu!loml consulllng. or oth... procnsionalletmd., mlln!lln I rnsonlbl.lovd of awarm<:ss of eurr~nt Iclentlfic: Ind p<ofeuicnj Inl'onnalion In tbrir f\dd$ of activity. and \l""'~ Ctn&Oins dfortl to mairil1in com~ in!he oitills thqr USC br radi"ll the approprillc liunlture,.ttend,... ronf=nca and convmdona. panicipotins In worbhops. and/or obulnlnc Bcbo.;o,- Analyol Certification Board """"'''''' Integrity. "IT (I) Bcblv\or analym. ilk tnlthful and hontst. The beha.;o,- analyst IOlIowt throu&h on ob/iptloos and profcosional commiunmu with high qualitywork and refnoinl from rnalwis profesoional commltmmts thatlwj$ho: cannot kttp. (b) The behavior anilj'*i. beha>'lor conf"orm.lo tho: Iqal and mot'lli cocks of tho: tociai and professional community of wiildi the beh.;o,- analyst If. membtr. (e) The ACtivity of. behlvior anll)'lt falls unlkr these Guldtlin.. only If the ICtlYity II part ofhij Of" Mr work ",laud functions or tho: activity Is bduov\or onllytic in natu~ (d) IfbduoY\or analysts' ethical resp<lftsibilitiei OOItftkt with law. behavior anai)'$u mllce known tho:ir commitment to these GuiddiMt and lake okpt 10 mel", tho conflkt In 1 mponsibit- manntr III accordona with law Professional and Scientific Rela tio nships. lit (I) Behavlor Inolysts provide behlvloral diagllolue, tlu:rapeutlc, teach.l"l- research, JU~rvisory, CONublti"" or o<htr behavior onol)'tlc ~rvi"'" only In the oontu.t of. <kilned. ",m""""'tm po S ' ienal or ocimtific rciauonship or... (b) Whom behav\or analysts pr<>"'idc... _. evallulion. treatment, (CU... I"I-lupo:rvlAon. Itadlin.. consultation. rcscatd!. or other behl'rior lnalytk 5crYkeo 10 onlndmdual, a poup. or on orpnl~.!h.,. usc Ian,... that Is fully Understl...w.le to tho rccipien1 of those ~rvice$. Thty provide IWroprilto lnf"onnilion prior to ~nicc ddl",f)' obout the nalu", of IUch ~nices and Iwroprlate information lat... bout malts ond condlllions. (e) Who.. dlk=nca of IF,.. ""ltr. rau. ethnictty, nallonal origin. ""ipon, oo:nw orientation. dlsabn~ Ianpage. or oocioooonomk IlatuJ... Ificant/y ak«t bchoy\or analysts"...:n. <On«rnI"8 particular 1ndMduab: or 1fOUps. behavior ona.i}'iu obtain tho tninj.ns. e:q>criea<i:. oorualllotion. or suptrvision nrcosoary 10 ~... tho: compmna: ofthcir ~niuo, or they mom Iwroprilto.. f.nab. (d) In th~lr work related actlvl11a, behavior.."alystt do not.ngag. In dlscrimlntlon Iplnst individuals or li1""ps burd on IF. Fnder. 111«. etlmldty. DlLUonal orifn. rell&ion. snual or\milollon, di$ability, IOCIoKonomlc ow... or any basis proocribcd br law.

51 (~) Ildllvior analystj do no! knowingly mpp= In bohavlor that Is ~ins or dermanl". to pe... willi whom!hey inl<:ract In thtir work based on (acto<s.sud! M those penons' IF. amdcr, race. ~,nationll oriiin, rdipon, oauai orientation, ciisabili~ language, or.odoo_.qmic _... In t«onian«willi law. (0 Behavior analysts recognize thai thoit pel"$oll&l problem, and o;onflicu my Inl<:mre willi tholr dl"ecti""mfs. BdI.vIor analysts rcfnoin from Pro-MJIII S«Yka when their personal dmlmruonces m.y compromim: ddlvt"l"lng $l.'rvices 10 the best of Ihelr.bilities Dual Relationships and ConflidJ of Interest. UT (I) 'n Imny communities and Ii=tions. It mar not be ta.1bic or ~ (or benvior onalysu to lmid $OCIII or 0IMr non~ conc.:tl willi pmont...m as dimls,ltudenls,... pcrrisccs, or raeardo panlcipants. Btbrrior onalysu mwt always: be IftISitlvt to tho poitntlal harmfull!"ft«u of other contacts on their work and on tiwm perso'" with whom they <Ita!. (b) A behavior analyst refnoi", from enltrin, into 01" promising a personal, kicnllfoc. profeuiofw, financial, 01" GlMr relltlonship with any I"",, penon lfit.ppeanllkcly thlt IUch I relltlonshlp,nsonlbly might Imp.1r the beh.lvior.""iy.t'l obj..:llvlty or otherwise Interfere with 1M behavior analyst's abuity to elfktl""ly perform Ills 01" her tunctto", IS I Mhavior analyst, or might harm or ClIpioit tho otl>e:r puty.. (,) If a beh.ovior analyse finds that. due to unforelffit f1octon, I potmliauy harmful multiple rclatiomhlp has arisen (i.e.,.- in wbich the rcuonabk pmsibililyof oonfilct oflntcreot or undue InBucnce Is p.ae,ii), the behavior onalyst lt1cmpl1 to raci"" It with due rq;ard for tho bcsi Interests o(w a/fc<fftl penoo and muimal O)fIIpll&nc1! with ~ Guideline$ Exploitat ive Relationships. UT (a) Behavior analystj do not exploit pej"50'" ow. whom they hi"" sup"rvbory. C"YIl... tl... or oth.,. outbority.sud> IS ltuden1$. supetvistt$, emplo)ut. raeardo participant$, and dltnt... (b) Bthavior analystl do not... gogoo in snual relllionlbips with dim... 1IVdm1$. 01" supcrvbca In tnlnlnf: O'VU whom the beharior analyst has...ajuative or direct IUthari~ because such relationships easily impair JoadgmnII or b«ome upi<oiiatlw. (,) Behnior analystj... o::aut~ apins! bulctin, with dienu; b..:..... It Is often ( I) dlnlqjly OO<ilnoindial<:d, iuid (2) pro formllion of an uploltsu... relationship.

52 2.0 The Behavior Analyst's Responsibility to Clients Ddinition ofclient. UT The term cllen! u uk<! here Is broadly Ipplkf.ble to who"",,,,,, tho bth.a 1or af\.ij}'it provides sertk«whelm, an Irwllvldutl ~r'$on (servk.t recipient). parent or guardian of I...-vIa: recipi<nt, an Institutional representltm, a public or privato I~ncy,. firm or corporation Acccpling Clients. The behmor analyst acccpli u clients only!hoot individuals or mtilit$ (~ firmt. etc.) whou behavior pmbinnl or reqlxsltd servict IOU oonuno"",l1ii. with 1M beh>vior analys(sf<hntlon, training. and ap<:... ~ In lieu oc thtw oonditlons.1m bth.avior anoly>t mull Nnctioco un.der 1M Jupt'ntision of Or In consultation with. beiumor InlJ}'It whose credentitl.s permit worklna with sud! Mhavior probl.m. or services Responsibility. UT 1M behavior analyst~ rnponsibiiity is to all partin: atrmcd br bchaviotai servlct$ Consultallon. (I) Behavior.natysc. ar... for IPPmpri.o~ _Itatlons and rdm'ab \>uf<i principally on the best Internu of thei, dlen1$, with approprilte consent, arwl su,*"" to oilier relevant COIIsl&.r>tions, induding Ippllable law and contnctuol obligations. (b) When Indlcaud and profnsjonauy Ippropriatr. be:havlor anolysts coop<r>t. with oilier ~ In ordr. 10 servo their d iorntt..trkllvdy and opproprialdy. lkhavior analysts 1'\'roBIIW: thai 0Ihtr ~ ha~ ethiqj codta thai ""'y dijf... in their sp«lfic: requirtrrlttu from thtw Guldclu Thlrd Party Rcq"~l$ for Scrvl(ts. (I) When I behavior 1lJ\a1yt1 ogrfti to provide.. rvi«f to. PfflOO or ",lily It 1M requw. ell third puly, 1M behavior Inalysl cbrilles to!he ~nt feuibk, I t 1M OUlsct ofthc.. rvi«,!he nat= of 1M relationship with.ach plrty.this clarification IndO>dcs the roi. of!h. behavior I noly't (such.. therapist, organluliocool consultant. oro~rt wit...), 1M prubablc I1SeS of the.. rvica provided or the in!onmtioco obtaimd. and tho bet that theft may be: limit< to conadmtj.ojlty. (b) If!hen: Is I r.. Cke bio risk octhe beh>vior Inal}'It brijig <ailed upon to perionn (OftRktLnc roia bcca... ei the InYOlftm(1l! oc I third party, the bthayior onaiyst darifa the l>i!rm II>d ditktion -.

53 ofhit or her rupon.libiiititt, keeps au p;ortles Ipprvpriatdy informed.. mamfll devdop. and taaives the >ilultion in oc:cortiaria with th<k Gukldlna. 2.(16 Rights Ind Pn:rogathti ofclient$. UT (I) The bch.avlor anal)"llupports individual rlshu unckr th~ law. (b) Th( ditn\ muit ~ provldt<l on rtquq\.n.""... If, cu~nt sel of th. behavior analyiu credentl.l.. (c) Permlssion for ckctronk: recording ofldtemwllnd service ddj""ry S<S$Ions It I«umi from ditrtu anci ~t stalf of all otmr settings. ConsonllOr dlffel'vll usa m~ be obtaimd spedfially and wp.... tdy. (<I) Oicntl must be Informed ofthelr rights, and about proced... to complain about profcuional practlcq of the bohaviot anajyst. (e) The bch.ayior analyst COOIpUQ with all rtq..umnrnu for (rlminol ~nd d>r<b. 2,07 Maintaining Confidentiality. gl' (a) Bdl.vior Inll)'lu hi"" I primary obligation Ind toke r<... ble preautionj to r<1p«t th~ confident1&lily of Ihote with wbom they work or comwt, ruognlzins that conilckntlallty may be: t$bblw>fd by law. I",tltullonal rult$, or ptoftwonal or tclmtilic rdatlon$hlps. (b) Q;.."u ho"" I ri&ht to ooniidedt1&lity. Unlw It It not teuibie or it <OntrUnd.k:01<<l, the discussion of coniidmtlality ot:curifl the outset of the n:lariomiilp anci therealkr.. _ dr<u1\\jt,ajlas mar ~, (e) td or-drr 10 mlnlm~ InltUlloou on privacy. bch.aylor analysu lndude only Information Ff11WIC 10 the purpok for which the conununiq.tion It made In wrlllfn and or.ol "'1'Orta. f;onlwt.tion.. and the: like. (d) BeIl.vlor Inal)'ltl dlkuii confidenllal informilion obtained In clinical or (OfII~ltlng rdatloru!lips. or evahw,l"" dati conurnlng p;otients, Individual or orpniratio:mal dients, Itudents, rnnrdo partldp;onts, """,rvi$eis. ond employea. only for appropriate sckntllic or po,r... 1onal purposes and only with perloftl dearly C(IrIarnr<i with ludi... llen Maintaining Records. UT Behavior lnalysu maln... in If'I'!OpriItc confidentiality In crn.tin" ltorin" acctf4ing. tra",(emns. and disposing of records under their control, whether "'-~ wrinen, automattd, or In Iny other medium. IIchavior analylts maintain and dispose of I'CCOrW In occordancc wllh.ppllcabic law 0<" regulalioo, and corporate pdq, and in I manner that permits complbnce with the «qul... "",nto of thek Guiddl...

54 2..09 Dis.closures. oat (I) BehaYior InaI}'Itf ~ ronfidentiallnfornwion without!he COIISC1II of!he individual only IS mandolal by law, or... '" pennlmd by low lc>r I YIIid purpok. ouch IS (I) to prurick.-<ltd prof<oulonal Strvla$lO 1M indmdl1ll or orgonlwional dioont, (2) to oblaln I~k profewon&l conrultallons, (l) 10 proicct 1M dknt or OIhen (rom harm, or (4) 10 obialn payment for Strvl~ In which lrutlna disclosun I$ llmlt«lto the minimum thltl$ necessary to achiev< tht P"'l"*. (b) Behavior anllytu Wo may ditdosc ronfkkntiallnformatlon with 1M "l'proprilte (;()IIStnt of the individual or orpnlutional dim! (or of anothu lcpliy authorized penon on behalf of!he dioont), unl<ss pn:>hlbittd by law Treatment Efficacy. (al 1M beiwilor llu\liyst always Iw 1M ~ity 10 n:com.mtnd 1Ckn1!6caily tupop<ll'kd most effective t... tment pro«<jurh. Etrrolve tmlment pro«dures have b«n valld,li..! as hiving both long-.. rm Ind IhO,He,m benefit< to dkntl Ind t<kiety. (b) Cli<'nU ha~ I right 10 df«u... t.tollment (I.t. ba$cd on 1M r=an:h literotu", Ind adopted tu tht Individual dlent). (e) Beha... llu\liysts In: mponlibic lc>r""";"w and oppralsai ofllkdy f"fjktj of au altc:matl... lln1mmtj. lndudlnf: thooo: pro idcd by 0Ihcr disdplinel and no in\e"""tlon. (d) In \host instanm wi\m: _ than <1M odmtlilcauy IUpop<II'kd ueounent has b«n HIIbIid>ed. additional faeton may be COIlIidem;l1n I1d«tIng Inttrwntlons, indudl"" but not Umltcd to, etfickncy and COIt-el'f"ccti... risb and IkIc~1f«u ofth.. inl<'rvl'ntionl, dlent p,d.",iic<'. and pnctitioncr "1"',1e1lC<' and training Documenting Professional and Scientific Work. lit (I) &biylor anal"... appropriately document their profeuiorw and scimti!ic work In orkr to bciliwr pta'ii$ion of KrvIca lata by thom or by oihc. professionals, to msun _ntability, lrid 10 _ oth<'r ~Immnts ofinslitutions or!he law. (b) When behavior II>IIym ho... rtuon to bdltw: that ruords ofthclr prnfo.tionaltcrvla$ will be uocd in Icpl proceedjnp IlMlIving rfdpknu of or putjcipanu in tbrir worit, they hove I mponsibuity 10 emo.. Ind maintain documentilion In th<' Jdnd of <k\.:;iu and quallty thai would be coruisknt with n:15oii&bl. scruuny In an adjudicative forum. (e) Beh. vior Inalytt. obtlln and document: (n Instltutlonal Revkw Board (lrb). and/o.locai Humon Raarch Commi~ approvol; Indlor (2) confi,matlon of compllana: with Institutional ""lul:"hmnu wlvn dati pthemi durill3 thci.r pro{a$ionaitclvicos will be JUbm~tcd to prokaional conl'm::nca and peer... io d joumak. '\.

55 2.12 Rcwrds iuld Data. lit Beha>ior ana/ysti Clate, maintain. dwcmjnat.. lion, retain, and dispose of!'kldf'dl and data rdaling to thtit resn.rch, pnctlu. and othtr...,.. in aa:ordance with appiiabi<: II"" or rtpimjons and COl poi.t. policy and In I mann... tlat permits «mpu.. neo with tht roqui~ments ofthtst Guiddinel F«S, Financial Arrangements and T~rm s ofconsullalion. (.) M.. rly u is f sibl. In I professional or.. ~ntlfi<: relationship. tho bdll vior Inal)'lt l nd the d~nt or ot/w:r appropriate I'Kipltnt oftwhavlor analytic KrVicn rnch an ljfh1"... t opocifying cornpo:ntation anci biiung ;uran~ntj. (b) Bcha>ior analyses'... pnctias are CONisItnt with low and behavior analy>tj do "'" mbroprekm thtlr tfts.lfumiwloas to.. nica can lit anlldpalcd bta.uso ofumitationt In 6nanci... this is discui:sed with tht polltnt. dimt. or otht-r approptillt rraplml of ~ 1$ nriy 1$ 1$ f... ibie. (~ ) Priur to the Impkmenlltion of senicos the behavior anal)'jt will pruvidc: in wrillnl 1M Imno of consultatlon with ~rd to ~fic: roqui~m.nll for pl'o lding.. rvias Ind tho reoponsibilitics of all!»-nics (a cont"..;! or D«Iaration of Professional Strvkes) Accuracy in Reports 10 Those Who Pay for Services. In their reports to thoh who pay for.ervlus or IWrca of mnr<h. prottct, or procram funcllng. behavior anal)'lts ac:cuntdy ItolC the... tu~ «tho rfttud! or stni<:e prorided. 1M t<>a or charp. and w~ appi;abi<, 1M Idc:ntityofIM p".. ldc:r, tho 6ndlnp. and other roqulml dekriptiyo dw Referral5 and Fees. Whtn 0 bdloyior anal)'lt!»-)'s. rcctlves!»-ym.nt from, or divides fees ""ith anot""r professional other tiw, in an ernplo)'t'l'omplo)'h rntionshlp. tho ~f.rral shall "" disdokd to tho c1~nt 2.16 Interrupllng or Terminating ServicQ. (a) ~ analysts make ~ djons to plan lor r.. mwing can: In 1M e>'mi that behavior analytic.eryiat art l ~rnlpif:d by &.cton$oldl.. 1M behavior analyst~ W- Impmding death, Wlavail.abUlty. or mnatlon or by tho dient'. reioqtion or fi~ Umiwlon.. (b) Whtn mitring Into employm.nt or conl~uaj m.lionship$. behimor analyitl proyid.o: for orderly and appropriate mol"uon of rnponsibuily for d~n t CI~ In 1M event thll the employment or contrac:lu;>l rd;t\iqnship ~n<b. with paramount ooruddtrat!on gl... n In the...tfa~ ofth.dlmt. (c) Bdtavlor analym do not abandon dients. BcNvior analym Imninate prnfwlonaj rdatlonshlp when It becoma ~ dear tlat 1M dknt no longer needs IM..mc., II not """"fitine. or II bti"ll harmed by rontlnued servia:. (;,

56 Cd) Prior 10 II!nnlnatlon lor wh>.tno:r reason. e.-pi w~ pm:iuded by tiv diem~ conduct. tiv bdioyior anal)'ll ditn>siej tiv dlent, views and nom.. pt... idt:s "W'''I'' iole!w.termlnltion oerrica, sussau oitcmati.., KI"Iia: pto'o'ldo" as "I'f'tOI"'iI.1I!, and I1b:s othtr I'fNONbk *ps 10 fadliuu tranokr of,"poruibility 10 ar10thn ptti"idcr lrtlv dient needs one lmmediltdy. 3.0 Assessing Behavior. BdI.v\oran.o.l)'$IJ who '* behlvionj usnsn'l<'nltoedtnlques do $0!Or pu~ Jh11 Ue Ippropriall! ;" li!voi of raeum. IkhIorior onalym m:ommmd seekins I medial coruulwion If then: ia any reuonabic poosibilil}' that. rri:rr<l behlvlor III rauh oil mediation sick.&ct or -... ~ a~ (a) Bmavlor anaj)'iif' _nil, "'C01llmo:ndationt, ~ and ~uatm Itllemmlf ~ based "" informalion Ind Itdlniques su/lidcm 'D pr> idc Ippropriale subuantiatkon for their ~ndinp. (h) Behavior Inalyall ref.. ln from mis... of asseumenl techniques, interventions,,"ult.. Ind Int.rpret.atlons and take n:a$onable li<polo p",vent otl>c:.. from misusing the Information these te<:hniquu pi'ov\i:k. (e) Behavior onoi)'$ij n:aosnlu limits 10 tiv ccm.lnty with which judgments or predlclions can be maox aboijllndmdua1s. Cd) IId>Mor arw)'$ij do... pmmoit the '* ofbehavloral assasmtnl techniques by unqualifitd pa-.. u..1llomc who ""' ~ by o:~ ~ and lui... ft(ii dmoorutriied..jidand rdlablo.-nt skilb Behavioral A s~ss menl Approval. The behavior afulyst muit obwn the client's or dlelll-lun'os,mi'pproval in wrillnl ohm hehlvior...",.nt prooedu," befun: Impl.menTln8 them. AI uocd Mn:. client-surrogate n:f... to 00"",,,,," IrpUy ""~ t" maito oxdslons for the pt'rson(l) """* bduovior the I'"IS'"'" is Intended to cha""", o:amplel of d..iiint """"C"lt$ indu(\( pmnu 01 rninon, pardi&ns, and ItpIIy drsiplated np... nlalivej 3.02 FunctiolUoi Assessment. (0) The hehavior anal)"1 COndoctl' functional _... nt. as do6ntd below. to provide the necessary data to dcwlop In effective bdl.vior change p... m. (h) FunctionalllSQl... nt Includes. varlcty of.pl.mltlc Inform.otion l!"therlng KlMI'" regarding f.octon innumdl\8lhe OCCUrft"nCl! oil hehavlor (LoS-. antoadcnu. consequences, ominscwnu. or m<>\mling opnatlon$) 1nd.wlin8 inlol"iiii", dire(t obfervatlon.. and Upt'rim<ntoI anaiyo.is..

57 3.03 &plaining Asscument Resu lts. UnlO$S the RaW", Illthe... tiomhip is dearly upi&intd 10 the pttsor brinb ~ In ~ and precludes provision III on apbnuion III IQuIu (~ q In son>< O<pnizllion1l tonsullalion,... ICI"CeIIinp. and fotmlic n'llilwkhu), boehavioor onal)'itj miu",!lw on aplanatlon of the results Is providfd usjn8longmo~ Ihal Is rnoonably un.kmandablc to the p"f"sofi ~ (W to anoth" legally authorlud p"roon on bdlalf of th< d\en\. R(prdl... of whdher the Inlerprdal!on Is done by the behavior analyst. by qslltants, or others. bot-h.vior.""l)'itj t.oke reasomble SI<pI 10 ensu", WI appropriate upb""tlona of rhults.", gi Consent Client Records. Tho bchayior analyr obiain the wrinm corumt of 1M dlml or dlmt.$1i1"l"opii: bod;,n! obtawng... djoc\ooj"l dlont ~ fn>m or 10 od>tt _.-.lnducfi"l dinial supervisor Describing Program Objectives. The bdlavior analyst dn<:tlb«, in writing. 1M obj«u_ of the behavior duo"", program 10 lhe dlml or dic:nt-jurrogalt (1ft!>dow) bdo", alltmpllng to Imple... nl the prosram. And to the atenl possible. I risk benefit onal",1s shoujd be conducted on the proacill"'" to be Impkmented to reach tho: objectiw. 4.0 The Behavior Analyst and The Individual Behavior Change Program. The bot-havior Inllysl (I) dffigns program. lhal.'" bahd On beh.vior ' '''''ytic prlnclplt$. Induding... mcnts of efl«u of other inlervmtion methods, (b) invol_ the dlml or the dient... rroplc in the piannlns of such ~ Ie) obtalnj the COfIS"nt of the di... t, and Id) mpecu the right of the dionlto U:nnInale... rv\ca II any lime Describing Conditions for Program SUcce5$. The bdia>'lor analyst <ietcril>n to the ditnt or d\ent'$1irrog>te the... "iroru".ntal condition. that... nec... ry for the program 10 bot- dfect~ 4.02 Environmental Conditions that Pl"('cl ude Implementation. If environ... ntal conditions preclude implemenllllon Ill. behayior analytic program. the behavio< analyst recommends thai ocher pt of ' "Ia! asslllana: (i.e., assessment.. consultatlon or thomopeulk InlC... tlon by othrr probsionab)'" JOIIIht. 1'1

58 4.03 Environmcntal Conditions that Hamper Implcmentatlon. If ~nyironjnmtal condklons hamper UnfV_tlon aim., bobrrior ona/ylii; ~ 1M behavior onoiystiftb IOdlmlnale the~ta1 OOIUIJlintI, or Idt-ntifiQ in wrilinb theobltldn IOdoiDg so Approving Interventions. 1M bthavior InalY't mlut Wain tm di~nt'l or cllenl'lurl'ople~ approval In wllllni of the behavior Intervention pro<:odures before imple"",nllnl them, 4.05 ReinforcementIPunishment. Tho bobavlor analyst ruommcnds mnfooumtnl mho. than punishmmt ~ p<w'ino If punishmrnt proudu,," an noussary. the bd>avior ana/y$t always lncludq lfinlotumoru proudura fur altemat;'" bdllyior In tht- prog~ 4.06 Avoiding Harmful Reinforcers..IT The bthavlo.... Il'" mlnlml... the use ofl~ml u potential... inforco.. th.t maybe ha, mful lo th~ lonl term health 01 the clltnl or participant (~'I-' dprdkt. sup or ht 1aden food), or that may n:q~ undtsirably rrwud deprioation prooodu... U moiioatins opcnliont On-Going Data CoUmion... The behayior analyst colkcts dm. or...!he dlen!, dlenl su...ogm, or dooign&ttd O!hfrlto col""'" data ncc.kd to... 1""'\VesI within the prosram Program Modifications. 1M bthavlor anllyst modifies the program on the bub of dala Progfllm Modifications Consent. Tho bd>rrior analyst upialns prlii'&i1i modification ond the n:awns for the modifications to the ditnt or din\t'surrople ond obtolns consent 10 Implement the modifications Least Restrlc1lve Procedures. The bthovio. In.ll'" f<'views ar.d app... isa the restrlctl""n... of alternatl"" Intervenlionnnd always n:commends the Ieu\ restrictive prooodures likdy \0 bt./i'mi"" In Malin. with a behavior problem Te-rmination Criteria.

59 Tho bd>ovlor analyst aubliwt un&~ and objtctn.o (Lf., measu~~) (ritfn for!lit tennination <li!llt procram and desaiba tmmlo lilt dienl or dienl-sum>ptc TaminatingOimts. Tho behavior anai)"t lennlnal.. the rdalionshlp with the dlml when the CSlaI>IWI<d crittrla for ttrmination ~ ouoinm. Il$ In whtn a stries of plann«! or revismlnttrylontion pll nol bhn completed The Behavior Analyst As Teacher And/Or Supervisor. Ikhavlor anaipu cidtpit 10 thrir.",~ suptl"t\tftt. and rnurd> lsfbwru onjr thok raponsibuities!1m IUCb pmom can n:asonably lit ap«ttd 10 ptrfurm rompetmtl)\ 5.01 Designing Competent Training I'rograms and Supervised Work Experience$. Ikhavlor analysts who are responsible for muation and tjolning prog~m' and wpt... ll<)l'y Kli.itils sttk 10.noun thai the p...-ms and suptrvisory octlvltla: ~ compmntlydcsigncd _ p!'o"'i& tht pnlpcre1j"";"iicu and m«t tiw nqulrtmto" fur lia"",re, ~ttllialion, orothtr go&b fur which claims an: made by tiw pnlsnjil or wp<ryilor Limitations on Training. ~havlor In&lpts do not lcado the uoc oftcchn;quu or prcudures that n'qull't IPfdallzed IrlInlng, liaonsw<, or expertife In OIhcr dlsdplln.. 10 Individlllis who lad< the prerequisite tjolnl"" kpl "'O!'" of prktiu. or f_ptrtltt, P«p\1l$ thtm; I«flniq... may Ix uxd in bchrtiorai... h.atlon <li tilt ~ of various trewnmu, In_ions, Ihtnp;a. or td_ionai methods. 5.0] Providing Course or Supervision Objecli\'eti. Tho bth.ovlor anai)"t provides. dear description <lithe objtctlva of. COlI... or IUpnvision. prekrably in writing," the bq;innlng of 1M COlI... or suptrvi<ory rtlilionship Desaibing Course Requirement!. Tho bd>ivior anai)"t pro'rida a dear description <lilllt &m&nds 01 tbt """,rvisory... Iionship or courw (... ~ oums, proj<cts. rcpom. In",rwntlon plans. g~ dlspi.,.. and faa: 10 faa:

60 5.05 Oaaibing Evaluation Requin:ments. The bebavior analysi prowidei ~ dear description of tho: requirements for the t\oiluatjon of INdenti oupervisn: performance ai tho: beginning of the..,pnvbory rd.allomhip or rouf'k Providing Feedback to Students/Supervlsees. Tho bdlavkjr lljialyst ptoyidtt r-ibad< rtganling the p«form.~ of. studtnt or IUptn'iI«III Imt once per two Wttb or COMisknt with SACB requlmnonu Feedback 10 Sludcnt/Supervi5«$. Tho b<havlor analysi JIfO'I'Idcs feedbock to the studtntl..,pervljec In I way that lnclnsq 1M probobuity that the stl>d(ntllupervl$ee will ~I\tfi t from tho: ~ 5.08 Reinforcing Student/Supervisee ljehavior. The behanor lnalyst lilts poiiu"" rri:lfor«mcnt u frequently OS the behavior of tho: IIU<\tnti IUptn'iI«and tho: environmcntll conditions ollow. 5,09 Utilizing Behavior Analysis PTindplu in Tnching. Tho bdlavlor analyst uluizcs.. many principia: ofbchavlor analysis in tachinz. rourw u tho: maltrill. con.ditlo... Ind acackmlc poilcin ouow Requi rements ofsupervistes. Tho bdiavlot lljiol)'$!" beh.vioral requinmmts of.,upervisn m... t be In tho behay\or.ll repertoire ofth. Illpervls«. I(tho: behlvlor require<l II noi lo tho: ",pen1sof:~ repertoire. tho: beii.vior.nal)'$! IItmlpts to provide tho: conditions for the acquisition of tho: requi~ behavior. and... krl tho $ti~ for mnediai $kill dcvdopmmt Krria:s. or pnmda!hem wilh ouch KrriaI, permitting thrm to mttt at lout mlnlmal b<haviorai perforrnaioa requi... merus Tralnlng, Supervision, and Safet y. Ikhavior anolysu provide proper training. supcrvblon. Ind oafety precautions 10 Ih.ir tmpl"j'ff' Or IU~ and lak... _.. tol. '!<pii" see thll such perwn. perform KrtlceI ~pon s ibly. competently, and dhlcally. lf imtlllltjonol poilclq, proadures, or practlas """,,nl fulfiu<mnt of this obiiptlnn. ~hay\or ano/ysla Itttmpl to modify IhtIr'" or to COfl'1'Ct tiw liluatlon to the attnl fns;bi

61 6.0 The Behavior Analyst and the Workplace. The bchivior anajyot admrts 10 job commilmtlll$, ~ ~mplo7,w intmdlom ~ In_ion. wori<s within h~ r ~ oltraining. deodops Intuvtnllonlwl benefit emplorett. and ~ conflicts within!hek GuKltlin Job Commitments. lilt The bc:havlor lji.ily$t admrn 10 job commi!mcnts made 10 tho <mployin8 orpniu.llon AMenlng Employee Interactions.. The bchivior anajyot auosscs tho bchiviot~ronmonlln~ 01 tbt ~ bd'o~ dqign!n, bohrtioj analytk prosranu.. 6.0] Preparing for Consultation. The behav;o, analyst Implements or co",ullo on behavior ma""gomenl PfOIIlnoml for which the: bftiavior analysl has b«n aokqualdy ~ 6.04 Emplo)m Interventions. The bchovior arwysllk dops IrIltn'U\liolu WI bftit/illhc: m>pk>yft$ as wdl.. ~L 6.05 Emplo)'ff Heallh and Wdl Being. The bchovlot analyst dcw-lol" InttIWnlkMu thatenhan", the health and wdl ""1n8 oflhe employees Confl icts wit h Organizations. lilt If tho demands of on orpnizallon with wilich bchovlor analysts.,.. aiiilla~ conflict with d... Guiddinet, behavior ualysijdarifj' the:.w..... of dw conlllct. mab known their ogmmkmcntlo!hek GuldcIinet, and 10 the ~nt r.a.;bk. ted< 10 """"'" tbt o:onliict In a woy WI pnmjts Ihc: fullest odhcm>ee 10 thch GuKltlincs.

62 7.0 The Behavior Analyst's Ethical Responsibility to the Field of Behavior Analysis. The behavior analyst hal. moponsibuity 10 luppon 1M oftbt 6dd. to ~lnile ~ 10!he: public. 10 IK famuiar with these gulmlliu$, and 10 dikour.lg<' murq>ratnllllon by non certlmd IndlvlduilJ Affi rming Principles. UT 1M behavior... 1ysI upholds and advanas lho vajuq, &Ia. princi:pl<s, and mlmlon of lho 6dd ofbmavior onaiyiis. Panldpallon In both nail! and nallon&l or inl<'nwional behavior lftaly$is orpniulions Ia Jll'OI\str ~ 1.02 Disseminating Behavior Am.l ysis. on The b<h>.vior In.-lyse ""I,,, lhc: profmion In mlkjnllkhlvlor... ;>IysU methodology lvajlable\o the gcnenl public ~ing Familiar with These Guidelines. UT um.vior anaijsli"'~ an obiiplion 10 be: f... Uiar wiih d>eoc: Guideli... olhcr owi\qbk fthia cocks, and Ihdr appilc:atlon \0 behavior analysts'...n.. LacIr: of lwumcss or mlsuncltmanding of a rondllct Sl2n<bn:l" oiooiludf a &r.ru. to I ma,.. of uncthlaj rondlxt Di$Cour.oglng Ml5Upl'e$entation by Non-Certified Individuals. Uf Behavior analysu dikou,,"g<' non,enifi«l p,,",ulloilt... from ml.$rqlf'uentins lhallhoy at< cortifi...t 8.0 The Behavior Analyst's Responsibility to Colleagues Ethical Violations by Behavioral and Non. behavioral Colleagues... T When behavior anal)'lll brjiew thai there may hl~ b«n an ethical viol_ii"" by IrlQlhcr behavior analyse. or non bdlavloral colleague. they altemptlo t<joj.., the issue by bringinslt 10 the IU<ntion of that indiyldu.oj If on Informal resolution a~a","ppropriate and the: Inte...,nlion doh not violate any con!idmuallty ri8hu Wt may be: invoi~ If resolution Ia not oi>taimd, and 1M bc:bavior analyr believes. dlmt~ fi&bta arc brins violaii!d. the bc:hayior on&iysc may w.. addition&llltpl..... ry lor the protcctlon ofthc diml R "

63 9.0 The Behavior Analyst's Ethical Responsibility to Society. The ben..;." analyst p<omoici w senmai wdfa.., ol JOdety 1h""'Kh tiw appiimlon olw principles olheha>ior PromoUon in Society. I n The behavior Inalrlt Ihould pmmote the application ofbdlavlor prlnciplq in IOdety by praoonting I ben-.rionj oltemiitm: 10 othtr procedures or mett\o(b Scientific Inquiry. The bch:awior lnalyst ohouid promotelbc lnalysis olbchawior as alegitimate fidel ol lcientilic inquiry PublkStatement.s. (I) Behavior onal)'lto «Imply with those GukltllnQ In public stotements..,jltlng to their pmfesslonal services, product.. or pub/!cauons or to the ficid ofbflu.vlor analyais. (b) Public JUttIMntJ include but are not limited to paid or unpaid ad",nislng. brochure$, printed Statnnenls brothers. ur mlun. dinctoty Lbtlngs.. personal raumesor currkulum Y\toc, interviews or com... nu for lise in media, $tii mtiiu in Irpl pmchdings.. l«iures and public... pratntatlons. Ind published (I) Bdu.vior lnalysu who engoge othen 10 "",ate or place public liotemmu thlt promote their pmfnsiollol practl«, produd$, or activltl.. retain pmft$llonal rtsponsibulty for.um li,temenu. (b) Behavlor lnalylt. make... sonabk cil"orti to p"""nt owor1 whom thfy do n.ot rontro! (,uch as em~... pubiism... oponsors. orpnlzatlonol diont.. and reprekntolivh of the prlnl or ~ mcdla) from making dtuptiw IIltcmmu conorming behavior ana/yiu' praaioel or pea( olcmal or KknUfiI; 1Odi'Iitir:$. (e) lfbcha..;." onaiystilcam of ~ ItatClTlC1lU about W:lr ~ madt byothttj" behavior analysts mw reasonabie.1'foru 10 COf"n:CI ouch IUlm"IC1ll$. (d) A paid acmr1bttntnl mating to the behavior onaiysi'llctlvilics m"" he kicnillicd as JUch, unleu II is alrndy app.rent from the ronfu;( Avoiding False or D«cpliw Statement5. "'" Behavior anol)'lll do not muc public stote"",nu thai.., false. d<uptive. milladl... or (",udu""t, either bca... of """'I they ltate, convq'o or IUgat or bca whal they omit. OIIIIDOmin& W:lr

64 raean:b. pndiu, or other work Ktlvities or mo..: of penon$ or orpniuuons with which Ilwy On' aiiiliaud. B<hMor anaipu claim u ot<kntiab for thrir bd>monl work. only dtjreei thot wen: primarily or adush'dy bthovlor analytic: in conlrnt Medi.. Presentations and Emerging Medii-Based Service$. (a) Whm bdllvlor IW)'lU provide advice or romm~nt by me'nl of public Iecturu, demoflst"'tionl, ",dlo Or tde>'!slon ptogtanu. prtrecorded tlpa. prlnlt<!."ideo. m.llt<! maltrla!. or oth.,. medi., tmy take n'uonabi. Pf"aouliotu 10> ensu... thlt (I) the IUtement, I... bakd <Ill oppropri.atc behavior onol)'tlc Utc",turc one! practlu. (2) tho _... n1l ore otherwi$<: wnsbtenl with thnoo Guiddlna. and (3) tho rrciplon1l of tho information... not oncounop 10 Inhr that a rdllllcnuhip has bhn $IbI1$hed with them pmomliy. (b) Wht>I bd>...sor onaly$1i doeij>otr 1UYices,!nCb or conduct reeard! usi"llaisti"ll or emtfging medi.a (e.g. Inlernet, ~ ln.mlng. interxli~ multl media), Ilwy consider ony mlcal challenges praml..! by medil'hued delivery (e.g. prlncy. CQnfidontiality. evidoncc booed IntcrwnliCl!ls, Mgoing dati collection ond program mo<!i"""uom) and moko tvtry.fron posslbl. to> adhtre \() tho miool fl.ndardt dtkrlbod h..,in Teslimonials. UT Behavior anaijili do _ JOlicit tcotim<>nilb f!'llm CIIfTml ciients«patients «other pmons who b<caust of thrir panicubr draunsw>cn....w... rabit 10 ~ 1nlIumce In-Penon Solicita tion. 01 Behavior onol)'lll do not tnpi', dirktly or through "FntJ. In unlnvit"" In-person wilclu1ion of business from.ctull or potential ule", of Ie.vktt who. beaoust of their p""lcular clrcumst."""" a... vulnc:nabic: to und~ InAum«, ""up! thai Ofpnlwional behavior mona80ment or,,"norman«managemc:nl onvtca may IK maruted 10 corponlo entities rcganlless ofthd. proj«i..! fi... ndai position The Behavior Analyst and Research. Ik/llvior anol)'iu dollgn, oonduct. ond "'J'O'1 ","arch!n acamianco with m:ognlud 'IIndlnls of Klentific rompttcnu Ind.thlool rnurtl!. Ikh... or analysts oondu<l ","arch with human and "",,-human IaGKh participants.,;cording 10 tho propopi.~ by. local Human Ittsearch Commm... oneiior [IIIIllUlional ~ 80mL (a) Bd>a.vIor onai)'iu plan their researd:!... U 10 minim!.., IIIe poco:oib~ijy that raulii will II<' m~ng. A "

65 (b) Behavior In&Iym conduct raeuch comp<untly ud with due CODCern for w dlplry ud wdfar. ofw ~ RanrcIwrs ud 0Mistan1J... permitlftllo pnform only!hom: Wb for whldt tmy;m~traintdand ~ Ct) Behavior anal)'slllrt mpoll.iblc for w cthk:al condoo of raarch condllclcd by thm! or by othe.. unckr Ihrir fupervislon or COfIlroL Cd) Bmavior anllystl <OI\dllClin8 appii<ed ret<'um conjointly with provuion of cllnkf.1 or human services obtain required U1~rnal reviews of proposed clinical research and obser"" requirements for both Intervention and,""arch Invol"""""1 by dlc,nt_pntlcipanl$. Ce) [n planning resnrch. brhavio<,..,alyn.:oru.kicr IIJ tthieal..:«ptabuity uoo..r thut Guideli~ [fan ethiallmuc II ul\d... bchavm>r.naiy>ij thk 10 MOI",,!he issue tiuoujh consululion with """"'... institutional rcvkw boards. animal art ud... commlnccs. pttr consuiti\ion$. or othn proper Scholarsh ip and Rcsnrcll. (a) The behavior Inllytl tngaged in study and rtsearch Is guldnl by!he ">n",,,,(ion' of Ihuden«ofbehavtor Ind...!lng the emphaili on the analysis of Individual behavior and IU;"". \0 modd OW«:>p<bolc awlkallons III proftsslotuj 1If.._ (b) BehavM>r onaiyiij f.lkc _oblr $Iq>t 10 noid harmln, tlwit ditnts, raarch portlclpants, students, and othm with whom thqr woft.lnd 10 minlmlu harm w~ it IlIOraHabIr and -- unavoidable Harm II ddincd h= u roepl;'" ditcu or side dfcru ofbehavtor analr* thai. outwrigb positivi: dkcts III the particular lniiaru, and thai... bchrriorai or physlocal and din:ojy (e) Ilea"", behavior I naj)'iti sdcnlifi< and profwlonol Jll<llIMnlJ and 0CI1onI &/feet the II... of others. they In:.Iert 10 Ind JUlIn! against person.l. finlndal od.~ orpniutio>lll, or poilti<al factors that ml&ht I.. d \0 misuse of wi. Influence. (d) Behavior analy'" do no! putlcipatc In actmtin III which II apptan Hkdy that their sitiill or dall will be mllusrd byolhtrs. unlt$$ -m-c -.:hanlsm$,,,,s-- ptft" or Ukrnal prolcsalonal or indcpcndcnl ~ "'"~ (e) Behaolor analpu do no! aagcraic dajms ror.trod;"'_ of putiwll. prooodiim or ofbohmor anal)"$illn ~ (0 Ifbelwrior analpu Icun of mimsc or mll'"l""w'llllon of tholr individual ""'"' pn><\1lcii, they take reuonable.nd feu.ib/c i1q>5 10 corrtd Or mlnlmite W misuse or mlsreprtsentatlon Using Confidelltial Illfo rnlalio" for Didaclicor In s tructive Purposes. C.) Behavior lnalysu do I>OC disdose in their wriunp,ltcluru, or othn pubtk 0Mdla, confi<kntial, pttsonaliy Idclllif1ablc Inl"ormation cona-rlll", Ihrir Indivtdual or orpniulional di.. lis, students, raarch portldponts. or ocher 'Kipiocnll of thrir IIn"VI«f;!hat they ob\2.intd dun", w course

66 of thru wofk.,,""" the pt"l$oi'i or orpniutlon hal consmted in writinj or urua. the.. Is otmr nhiaj or Icpllulhorizalion for doi"'... (h) Ordinarily, In ouch ~1l6c and pro&$sionl prowntoliools, behavior anaiysu dispite confidtnliallnfor_1on <>:>nenni"l JUCh pmon or orpniulions 00 thai they... IlOl individually j<!tnufiabk \0 omen and 00 thai dlscu.. ions do IlOl cau.. harm \0 _nlltiabl. p;lrticip;lnu Conform ing with Laws and Regulations. BehaYior anal)"tl plan and cond..a raearch In I man... conii!.unt wltb olllpplicablo laws and rcpb.1lom, 1$ -U It proklsionai Sbndards JO"mII"I dw: rood..a 0( roseam.. and pntkularty thooc standards JO"mlm. raearch willi human pnticip&nll and animal suto;ocu. Behavior anaiysu.!so comply with IIIhcr appiabit laws and rcpb.llons rdatlnc \0 mandated ~l"l roqulmntnu Informed Consent. <") Uling llilli'"(!\' thalli ftl$onlbly un~rilanrboblt 10 p;lrti(:ipanl$, behlvlor Inllym Inform p;lrticipanll oflh. noluft ofth~... rch; Ihey inform p;lrti(:ip;lnts th.llhcy I.. flft 10 participak' or to decline to pntlcipau or to withdraw from tho... rch; they explain tho fornftoblc: COfIK<jU<na:S 01 dcdlnlng or withdrawinj; they Inform participants oil1snlficanl acton thai may b< exp«ud \0 Inll_ tbrit wiiiinpa.i \0 J'IfUdpott (sudt 1$ ri$b, dikomfort. od trso dfocts, or limilalionl on ton1idmtiallty, =<pi 1$ prorided in Standani ID.OS below): and they upi.o.in otbt. upkli about which tho poospectlve p&rtldpanu Inquire. (h) For f"1"o"' who... Lrplly lnap;lbk of gmnj Informed consont, bd>avior lnalyw... rtbcicss (I) provxlt In appropriate expwt.atlon, (2) disc:ontlnue.-...arch if the pnson 11_ dra. IIg"" of unwiliingnhi 10 conunu. participation, Ind (J) obtlln Ipproprlak' per mission from Iltgolly lulhori...j pt"rton. If sudt substitute t:oiii<'nl II pt"nnllted by law D«eptlon In Research. (I) Behavior anal)osu do not cond..a I Jt\Idy In"tOM,,, dkq>tion unim they)w,o,o dturmlned th.oi tbo use 01 deooptm: t«bniquells justified by tho 1Iudy'1 prooptoctlve odenli6c, ed_ionol. or oppiied value and that ~liilly.1fect1 e alt<mallve proadui'tl thai do 1>01... ckuplion... IlOl ftuibie. (b) IkhoYio< anal)'ill _r dkriw raearch partlclpanu aboul s1&"fficaoi 1Ip«U thai would Iff~ their willlngrw:u lo p.rlicip.~, ouch II phyaial nib, dikomforl, Or unplomnl fmolionl <:<peritncet. (,) Any other dt«ptlon thll is IIIlnl.gra\ MIll", of the design Ind conduct of In exp<rlmtnl must ~ npl.ained 10 par\icipiiiu AI ftrly II Is!ftllbI<. prtf.rably II the conclusion oithru participalion, but no later than II tho condullon of tho!'tifttch. A "

67 10.06 lncorming oc Future Use. Behavior anal)'ltllnform raardl panlcipanls ollbd. aruicipau<i $I>arin& or furthtt Wf' 01 p"rsorw/y Idmtifiable A!$<'I1dt dab. and 01 tho pouibmt)' 01 u... tlcipoted fut= Minimi:dng lnterferen«. In oondu<1lng research, behavior anal)'lls Int~.fe",.. Ith th~ participants or ~nvironment from.. hich dati are coll«te<i only In I manner th.t it wornnt\"d by an appropriate res.an:h d<sl&n and thot it con&went with bdliovior antlysi$' roles II odentific Invtstlpton Commitments to Re:scarch Partidpants. Behavior analysts:.1ajonobic meosura 10 honor all commitments they hi......x 10 raard! participants Ensuring Partici pant Anonymity. In presentln8 r'qhrrh. the bdllvior anol)'ll ~"",ra plrtlcipant anonymity uill", IpKl6cally... lved by tho participant or '''nosat~ Infonnlng ofwlthdn.... :al The: ~ analyst lnfonns tho: partkipant that wtthdnwal (TOnI tho: ranldl..., O«U' II..".limr without penalty nap! II _ipulatcd in advana:, II In ftti oontin&eru llpon oompicil"i" projtct Debriding. The behavior 1011),lIln(o.ml th~ pmtlclplol thai dcbrlc:fing will occur al tho: conclusion orlhe ""rticipant"s InYd... "",nt In tho raarch Answering Re$earch Qua tions. 1M bdlavloranalyst OJU-..s all qunlion$ 01 tbo putldpant about tho ratudl that an: oonsuimt with brin, able: IOCO<1dud tho ~ Written Consent. Th. bchovio. analylt must obtain the written oon~nt OhM particlpanl o. $II"08"to before beginning ",,,,,,,,,,,. PI "

68 10.14 ExtnCredil. If!he bduoylor onaiysi rkrults partjcipanu from da.- and!he particip&nu..., pto"'idfti additional O'\'dit for partkipiou"i In W n'selrd\, noonputkiptunti Jtudents must be proridtd tj_tmo activities that II""""'~ tompanoble O'\'dit Paying Participants. Th~ behav;o,.lnllyat who IM)'I participants for,unrch jnvol~men t or usa money u. relnfof<~r mllr obtaln imtilutlonal Revkw Board or Human Rl&hts Committee approval of this prxtict: Ind conform 10 any Jp«iIl ~ts thai may be H\.lblis/wd in!he p<ocw of approval Withholding Paymmt. The behavlor... tyst who withholds j:w1 ofw rnonqr nrncd br!he part\cipent until the panicipant has O)mpl~ th lr l'qt'arch involvtmtnt must Inform the pankipanl of this wndltlon prior 10 beginning Ihc tj;perlmen~ Grant Reviews. The... behavior analyst who RrwI on ""'" ~ paj>dt.voida COIlductins any rtrardi dhaibcd III """I»I'OfO'Ib that Ihc bduovior analyst rem-d. aupl u rcpiiations fully atdilins the prior ~ Animal R~arch. s..ha>'ior anal)'ll$ who wnd..a ",..,arch invol>'inglnlmtj. ""al them h.. mondy and... In mmplilljla' with appl!able Inlmal welf... laws In ""'Ir counlry AccuracyofDala. 8eha-rior analysts do not ~ <Iota or fabify ft$ultsin th Ir p"nlootlons. Ifbrhavlor onaiysts discawn... Uic:ant mon in th Ir pllnisbod <Iota. they tw: rnsonabk stq>f 10 ~ oudi emn in corn:ction. n:traction,..."ium, or othc1-.ppoopow~ publicolion rnn.n Authol'$hip and Findings. B<havior analysts do nol p... nl portioru or ~l~m~nl' of lnothd, work Or dots. u Ih~lr own. c... n if "'" <>thor work or <Iota _ra: is dted occa.<ilonally, nor do Ihcy omit findings thai ml&hl all.r <>1M... Inl~rpn:talions oflhclr worit or bd>a"o'lor anaiysli In.. ncral

69 10.21 A cknowl~ dging Contributions. In ~nllng m.eatd>. \lv: tnnvior on;ilyst ~ \lv: conuibutionl of otbtl1lo wrondua ofthc raearo. by lndudint; them as _ow-. or I'ootnocl"" their contlibullonl Principal Aulhorship and Other Publicalion Credits. Principal ouihonhlp Ind OIMr publication emlll ccu.. ~ly rtikct \lv: m.ll... K~ndfu: o. professional connibutloru of the lndivlduab InvoI~ rcgordim of IMi. m.ti... fl.tu$. M... J>O$S<$$ion of an InslllUtional position, ouch as OepIrtmc:nt OW., does 1>01: juslify authorship credit. Minor conuibutlono to!he raeon::h or 10!he...ttln. for publications... wopriatdy adrnowlcdgcd. ouch as In loot.-or In &lilntmductoo-y _ f\lrth.n', Ihc$t- Guiddi_ rfcoiillu and $Upport the dhic:al req..urenwnts for IUthonhip and publication poactlcq contointd In tiw tthkal «>& of the American I'JyI:boIoJIcaI Auodalion Publishing Data. ~h o vio nalpls do not publish, as original dota, dltl that h.... been pmiously publlshtd. This does no! preclude rq>ubi!j.hln. data ",hen they I.. Iccompanied by proper actnowlcd.mc:nt Withholding Data. Aller...n::t. mulls... publlohrd. bdwrior amiyou do """ withhold tt.. dats on whldi their condusiono... bued frum other compmnl prvfessionali wbo... to"";fy!he IUbstantr.o. daimj through... nalyob and who Intend to u.. ouch dats only for thai purpox. pr<mded thaltm conllmndality of the participants an be proiecled Ind unlnsltgal right. conccmlns proprielary data pududc thoi, TCI ~... ~.loljlor"_"""cco ( _... ~..., _.. ~ t t t Of"',. 1 """'... _.. _... _ "" -.-,.....,..-y..... _...,.. t... _,.., _ 'Cof!o\IIII IOU lor" _...,. Coo... f-...cr), ""_..., ;:a.. (P 1= A "

70 BIiI IAVIOR ANAlYSTCIiRTIFICATION BOARD Disciplinary and Ethical Standards & Disciplinary Procedures I. BACS Professional Disciplinary and Ethical Standards 1M BACS may!ssw AIICtioou, indudi... t _ limlled to, denials ofinillll anir.e.tior\, m>ew1l or rktrtfficatlon. I"tYOCOtlon., AlIpmsiorI or &II)' othor limiution of catificatjon 01 combination of sanctions. Groundf for II.I.uIn, JaJ>CtioN lndudr: I. lnclislbliity fol certification. rqardlcss of wh~n the Ineligibility Is discovered; 1_ Any violation of_ BACB rult or pr'ocfllu,*. II may be rev:i... from tlmc 10 tlm~. and ""Y fa!lu,* 10 PfO"I<k Inwrmalion '*'I_ted by!lacb, or 10 updall' (within thlrty days) information prn;ousiy provided 10 BACB. indudinllo... 1 not limited to, any &'UUl1' 10 IImdy rtpo<t 10 BACB on K1Ion. ccmplalnl. 01 dwj! Ihat rtbtcs 10 rwes 6-a ofm-pounds for diodplinary Klion; 1. Unauthorized p""!cs'1on of, usc of. distribution of. or access to I. BACB ennu. Ii. Certificatet, Ui lo&o of M Ca.!Y. 1"tackmarb and abbtniations rdatina; therelo, indljdinc, but not limited to, mlj~ of tdr. prokssionai proctlcc or BACB cnt1iicotlon IhIIU, prior 10 or ~nb the gran! of anlfietuon by BACa. if ""y. bodmduais nul ccrrified by 1M M CB AfC ap<tssjy ptdltibitdfr- "'isrtpr/:>uiii~ 111m. tmy"'" BACB certified 41,;Ihtr" BCBA IN BC..aA. <If" "';'rtpmmlingdigibilit]"" IICB..t or BCrBA (trllji(t>i/on. ;",hodi..g ",1"'pJ'I!Slnlallo... of rim;"', d.. igmtti<mj dtsignn 10 imply BACB urlijitl1l;on or tligibiulylloluj, Till. ",,'c will be.nforu d "galnll 'njmj..,,1s who h"". p J.. a/d from " Ctr/ifi' ''U"...,,/i"g d",,,'lon,,1 prt>gr"m, who " '" ",,1m/mat kl rtpram/ BA CB etrrijit"i1/>1<.."ii/.,.dr Ii... III Ihoy "'" etrli}iej /1y 1M /lacs. App&alll. Jar ar~..".,...,...,...,...". mij7rprt:stllld BACB

71 utlificdridn", tligibilil)'.iilius ""'1 "" wbj«11il djj;lionij fi- dnd Pf"""ia ($Sa) for ttj<h -.., 1/", I"" "'impmtnldlioou prier Ii> ~iofi gflhriturtiji(miofl ~..""tinl Y. Anyother SACB documents ond... ~ vi. Mbch&racteriZitlon ofinactr..o stl\li5, and/or any ot:/w:r ina«unolt <qiiu<ntltion of SACS urtlfi<:;auclo status. 4. Any enml~\lon Irrtguluity. including. but not 1!mlttd to. ropying ansvl'e'" ~nn!nlng on«htt to copy onswen, disrupling me tondlld 0( an uaminl lion. falsifylnl Infonn.1ion or idcnlilicatlc!n. tdl>catiorl or credentials, pmvidlng and/or rtumng linauthclriud.dvic. obool <DrII (Onltnt bri:w. during. 0< following me uamlnatlon. In addition 10 other authclriud sandions. tim: SAC8 may delay. ana:i or refuse 10 mea.. euminltiorl mulu If an eum irrtgularity bas bcm dcmon.stnotcd: 5. Obtaining or anemptlng I<> libtooin «rtifio;tlon or ~rtij\cotion for ()tladf or an<>ih<r by a fll.. or mlsle.dlng Itatem.nt or f~l1u~ \0 make I ""lui~ statement. or (,,00 ord.",'t In any communication 10 8ACD; 6. C""" or ~td nqjipn«. it,,;omp<tm«. mlkondl>cl or malpnctke In po ofu,lonai work. lnciudi,.. but not limited to. L any pb)'slcol or mental condition WI CIIrn-ntly impain compftml profaj:iorial paformanoo or... oubrtanlw risk 10!he: dlentlcoru.uncr of Mhavlor onaiyob.. rvica; b. Profaslonal condl>cl!hat consliluta an mmno ond unjuslilitd dtvialiorl from!he customary rtandanl 01 pnoctla: acapicd In!he appllod Mhavior.naIytk community and th.ll crt"ltu 0 terioul rid< o(horm to or M«p!lon of COf\<umcrs; Co Abandonment of. COn,umer resulting In tht Itnnlnatl()tl ofimmlntntly "«<led. co'" of a COf\<umcr without adequate notice or provili()tl for transition: d Profusional record khpini and/or data coikctjon th.ll constltuta an <:II",,,,. ond unjlutllied devillion from 1M C\>stomary rtandanl 0( practic. for!he fidd, and/or draptivdy altmnl conrumer records or data; eo ~ In blatant fraud. dec.eption. m~ faite promlte 0< pret... or intimidation In the pnciia: of appilod beiuovioranlyob Of in ooiicitlliorl o(_mon; and t n.. unauthorik<l material diodolu", of confidcnlw _mer Infomuo\1on. C""" or rq>ea\ed nqll~ complaints muit Indudt nidena 011 disciplinary review and form..j finding by an employe profusiono! p«r rrricw orpnlzltionlgroup. iovcmini officio!. federal or lialt "iency. or <>ih<r li""... in8 Or «rllfi<a!l()tl board. [f!he «rlifiaonl wu not ovc.-n by In ~mploying agency. governlnl oiiicw ogency. or oth~r Board.!hen the BACO PresidtnL and Ex«uli... Director riwi dtttrmi... by con.....,.. whethn!he """plooinl oboold be lubmltled 1<>. Rrriew CommltL... lncompettnce or malprx1ia: mull be Mdn><ed by <>fficiai dtttnninltlodf; (such N. court ordot", Jury 6nding:r.. or LrntJnmL pro(a.iionai linding:r o(inccmpetcna: Of~);

72 1. Umitltlon, lano:tion, ~ion or suspmlion by 1 hnlth an: orpnlwion, profasloow orpnlwion, or other private or ~... W body. rdating to b<hmor...jy$ prxtiot. public Mllth or Weey Of bdlaviot..uj,.. cnti6at1on; 8. Any conviction of 1 felony or mlsdem.. nor directly relating to bthavlqr lnaly'b practice and! orpubllc~llth Ind..,fny. 9. FaU,"" to Idcquatdy oupcroisc or be oup<1'ybed In ~ with 1M BACB Standards for ""'''''''"'" II. Reporting Requirements Applicanu and unlficintl mult report the following to tht: BACB within thirty (lo) day' 0( the occu,-n,nce of: I. A choni!' In nl~, addras Of other vitllinformation; 2. nw MInt; 0( In)' I;tImlnal Ol cmi chatjtt opini.t the oppiiant Ol ~rtifkant; 3. nw initiation oilny dikipl;rwy cb&rga. IlIYeI1iplioni or findinp'oandior\t by. htalth CUI'...-pnIDtion. fedoral Of III~ "&",ncy. or other professional usoclatlon 19a1nll the applicant or ~ rt ificljlt; and 4. Any oth~r chi".. In Information J>f'O"Idt<I by the applicant or certificlnt to tl>e BACB. All notices to the BACB mllll be Jent via... rinhlo: methods 01 ddmryr. such It, unlfltd nwi mwn-rudpi requoqud. E nw1 notices will IlOl be deemed ollie! unicss 1M oomdcr ruci...sl (non- 11l1Ornili::) (l)ll.tinniuon Nlwlltttn from the BACB. Ill. Limitations on Applying An individual oon~ ofl fdony dit«tly rdotod 10 behavior analysis pnctl~ andlor public hnlth and r.akty...u be ]n(11jlble to apply for BACB ~rtux.tlon or m:~rtificotlon for. period ofthl'ft (3) ran from the WI_lion of "f'i'uit, compldlon of parole Of pmbotlon, or IinoI mnsoe from confinanmt (If In)'), wblthevoer is later.

73 rv. Procedures: The Review Committee 'I1\j' SACB Chair NIIappolnt to rhe ReviewCommlrt«Itleut two BACB oerllf>canlf and 0... current or ronner DI=ror who shall..,~ u Chair ofihc Review CommillCC. 1hc BACB Chlir may at... appolnl addlilonal membe.. lo rhe R",iew Commlrtcc In \he di$cn!llon ot'rhe BACB Chair. For aampte. rhe!:iacs Chalt may oppoint lljlln IUI. oerllfi«nl, or a penon with Ip«IaI expertise to..,~ on ihc Renew Commime. in dcsisnatlng In addilional pcl30n to.. ~ on rhe Re-riew Comml1~ ihc!:lacs ow. shall also kkn1lfy wh<iho. iiw. p<i3on wrria! will be OIl", or """ >01;"11 (od-riaory only). I. Wrillen owe"" (rom deni"" of oppiiaollon$, exlmlnalion <:oddillon$, rtnewal or ~nlficallon dtdtlonj.the appeal must be filt<!ln wirhin rhlrty (30) day. o(\he dale of rhe decblon bcingappnlcd or!he cuminatlon admlnut... tion be-i1l8 contated; and 'I1\j' Rev;ew Commill.. shall only conduct ill m'kw IlIrougll written documrntallon. However, if d«med n«eioa'1' by!he Review Commillcc, the hv\ew Commm.. may ttlcpllonlally or otberwiso contact applicant.. ceni~clm.. wit... and/or BACB 11111"10,"ceive addil\onllinrormilion. AU decisions of the hvit"w eommittcc are final ""'"' appealed to rhe Board of DirectorI within rhiny (30) dayi of the cbtc of ~pt.,( ihc Review CoI!Imittcc dtci$ion. Awnh 01 ajksed \owions<!l!he!:lacs Pror..1onol D!sclplill&r)' Siandonls shall be... n:t by u Appeal. Committee (:OlUoiI1ing of. minimum of rhree BACB c~nt or former Direaon. The BACB Chair sh.1u IppoInl rhe BACB ",,,,,nl or forme. Directors to rhr Appn). Commltt.., and IIUIJ' (In!he 101. discn:tlon of rhe BACa C... irl.ubmil rhe lwel llo be htard by theenti", Boord.,{DllUtors. In penon appcal. will be held II rho nut,",&ul.rly Khedult<lln pcrson Boon:! m..,tlng I( luch bearing Is rtqlw1ft! by the appd.lut. CandidaICS and Ccnificonll ore ~ble for their own <(IOU usociatft! with l\b:ndina rhr appcai i>earln&- CandidaICS and Ccnilianu cntided 10 on appcai htarin, m.aywaiw the in pc... hcartnj,. and "'ill$, ins!nd, thai the hc&rljl8 be held idcphodlcally or In writing.

74 AU Oilier 'ppo;ili must ~ in writing ond..,011 noi ~ enli!lod. 10 an in-person hearing. Candida!.. and C<:rtlficanll Ippnling doclslons regarding Ippllca!loo.. n:newals and reurllfication.!hal do noi lnvqi... alksed violotlons of the Profnslonol DIscIplinary IOIId Ethical Standanb on: not mtitkd 10 on in-pellolllwarlng. In the ax of... y Ippeallhnrin" the dccioion of the Appeab Commil1Ce Is fino! and ""'Y 1>01 be furth.or oppcmd nw BACS ""'y publloh the najm. Jt&ndard(.j found 10 ha... bttn..;.,wed and.. nctlon Issued "pins! lily curn:n! Or former ur1ifinn! thalli unctlor.ed In final RevIew or Appeal Commilice action with I unction thai =Wu in.limlt.uon on practice, such os. ''''P"1Ui0Jl or tn'oci.tion of urtllicatlon. nr 1 ~. IIOU '" "",...,. ~ _' "".("IAcr").....-"-"""'-'1",. """""' d """'''-''-.Ir,...,..c:.. a _-10<.: : _ c:..- _,...,.,... -.aa-.. _c. -~ ~...,... "ICoM :..._"'.._...,..tua 1 _. 'b. bod b... S 1'1 t

75 '" Schools Need To Require Certification Of Bebavior Analysts Aprill.,lDlO B, Pm! 8'*".....,.,..,. Ca.enI Ric:1wd B"--"aI -,. -.pol "'" a.-.j A_11O odos>ilqioioi"" requ;,;., iliac local... '-Os... 1'1 pn:>i'... ccnilkolicoo bttot. hiridti oppi;": _ <po<w aiucation 01 <1.. ilb... j......,... (fit BlumelllhaJ...,;...,.,... New YOft,..,.,.." woo omljllod in Coo...,,,"'.,... COlIn loday rof olleledly usi". fabc ~I", 10 chat&<... pa~ and pvt"" lens of,~ of doll... ('" ".,1...!realmrnl sel"0:e$. Tho openior oisptwm Kids u.c _ d We..-II (ot...,.. joitioi ",_"OIive ofl'"" b)' Nonoalk Pol"', \be U.s. Do:"bh"~ 01 ~""andbi~.of6co. 8~. ofke io _.;,to NorwaD; PoIloo 10 ; _;.;~_;;;;..._ /IIi... ;Il10.,...,... ods 01 dol... for... _01'1, '.... poolib/y... _its... behalf oila>.~)'oti... _,"",;10. B~ Mid ~1I<lion is-=-yoo local.. /I00I bootdo - tod,...;n.1atiy dii~ - -1"""<'<Ud (""" ("lin out I0<oI si>ciuici... boo reqooi opp/iod _"g... you _ boll...,"'" do... 1d...,. thai sikh...,... OS< oenilled b)'... B.<ba...,,11&1,.. C.rti~1ooI 80anI (BACe). 1 "'P&teOl... "'" _I.. of prof... ionali... when 'heir child i,.,... ke - potilcululy when lbtir child... na >peew.i... ean..1 C i

76 81...,..,..,.. _.I,"ThI'IeJi.I~iooo ensura """ _ boord lnpoy... If:'.-of all It:"" cbilcinoo _ full, pr<m0citd r""" dccqio.i.. -.I r... loa..mea.. 1 a:i, bocoone... _ p... ip... "'- is 00_ ceni-.,. Of '" _ """' ibdi idows IMn!d for _..._)'SIs terri<a _..wa- I... 1 """... mom.. I """"""'"... ~ ~1ItaliC:. '"'","0dI _... 0IId _... of5ciaio """ _>iorai portoje: Other... 1M< "11"" 8ACII ceru-'" inch.s. Atbaou. Colif""".~. Florida. III;"";', 1ao:IiaIIa. K... ucky. M.,.,_. M i... """ M",,_. Similar!'os1S: O S...,S... n " «f 2 Responstf tosthooh Nud To Rt,uin Cmjficlltio" Of B_hll.ior "'''lllysii, ~ R oc: ~.,on "prii14. 20'0.. 6:44 pm """,ally, "" IndividllAlo willi o... bi l"... Edocatlon... (IOBA.)_ RqUi~... _ di..n.u '" perl... fuoctioooal 6eIo>vlor... y otnaio.~. WhiIc MI. 81"""- is «IIT<'<I.. lei... cen"'_""'~.. penije bo ~ "'-'1lIcoc "W "',... ho is... in..)'ioa"'--..."-id. OIM bo tecjuftd '"_1lIcoc _..._.h." prin<ipoi Of""'... "'"""P<I '" <di _... Pl'Jdr!oIocJ... OIM qualify... ba.. "'" _ 1O,..,r- "'" "... con..;dy _ ~ II1II. -,. oriu too n_... "'" 1Oilco:. di<ablod ~ will bo ohoti.~ """ f~,...-. will ~ IOlilipfa dliici"s....u.-j -. _... H... "'" joti.so. rilhl.. bo,. willi 0IId '" -,. """ p. Cidton " pri l l , 10:46 pm My bioi i... in_lpciooo "'.his VUJ 1Opic. So..., AD" """"""*_... ""D" Thenpiiu" _1wI.. 1IId 1IOIloi.. but """,p.onloo Ole 9p1oitin,IOtistic cbildr<oft _ "'~_ "'lupo)'otdol~. h i. 0lIl of """"'>I. E..."'" _ ~... "'... ""'''J"of,. I... -'illed.cioock_ y.- _.../INoW MIA po.ida, """ loid our IflheJ' JIrO"icIo _iwe doillmol quill)'...".. no. oacilniiio io... _ ""_... I_lOr"""'... raoiflupo)'ot,- Lea>"e I Reply ''' [I==~ ~.I

77 II F.I IAVIOR ANAL ' ST CF. RTIFICATION 110,1 RD Fourth Edition Task List -. Introduction The BACB Fourth Edition Tali< List io OMpniud In 111_ major _ tion: 1M finll«lion, BuIc Bd>a,.;oc_Analytk Sldlls, «:tym Ia$b rmt a [Q(Ildnl bdtanor arul)'sl will ptrfo... n with some. but probibiy MIl.11, cliont.. These Ia$b ~n t basic. commonly used dc.ilil.nd proced ur... 1b~ _000 _tlon. C II ~ n t - c.,nt~ftd Rc$porulbilit!es, includes tasks... llted to working with all dk'nlt and thq> II>ould apply In _.pplird sltulllon$. The lhlrd I«llo!>, Foundation&! """"' Ird~. ~n """"'"PIS lhat II>ould ha... ~n ma$kmi prior to ~ntcrlng practla:.. I bd>avior onaiyst.. The topoa Listrd In IhlllCClion are MIl tasb W I a practltlomr wouki ptrfotm; I~ad, they are!>uk CIOfICq>U thai must be undcntood In 0f1kr 10 ptjfonn the tub IMludrd In the first two sectlo",. This list is provldtd mainly.. I '"""ret: for I"'trueton and a <ludy tool for candldat... Candkbtes for the BCM.nd BCaJlA e~ntw l ohouid ha... thorough undtntanding oithne topla. AU of the qucsti... Oft the 8CBA and BCoBA cuml""tions are linked to the tub IIlIrd undtt Buic Bchowior-Anal)'llc Skills and aiont-cmkml ResponsibUitia. Ead! cnml""tion fomi will coni.iln OM or two quat""," evillwing canciicim """""Iede< of e...-y!uk from thcic \WI) KCtions.. 1M Iopia Listrd in tht. Foundotional KnowItdI" section will IlOl be dirtctiy usased with opecific number 01 questions; ~, th.,. may be indj~tly ~ through q~1 obout mlled lub. Fo r cumpl ~,.. ICiI question l bout lhe airnt-c.,nitr«l Resporuibilily \.ask H J "Program for.limulus IlI1d,"poolOgen.ralizatlon" might COV<1" r-oundallon.al Knowledl" item J6 "Ottine and prnvidt uampl.. of rtifio'isc ",ncraliution" or ITom 17 "Delin. and provide: cumpla of.stimulus I"ncraliutlon." D

78 Eihla and Pror-iorW Conduec an IUbsumed within taeh lcdion of!he!uk 11ft. Tho BACB ProfHSional DircipHnary and Ethical Standards and Gukklincs for Rcspon.ibit: Conduct for 8cl!ovIor Analysu Ire ~nti al companion document. lo lbelo.j!< US!. BACB un.lfiant. musl p~ice In compllanu with lilt professional dltdplinary and ethiaj II.lrIdards and should WUClUIY Ibtl. practlat In oc:cordana: with!he condua guiddincs. Candidalcs an: apcacd 10 ha..,. compltic understand!", ofu.-cioxujm:nu, indudl"" but not Umlttd lo, lilt imporw>«: of <thicai condua as i!. rdalcs lo professional pnalce oflhe wb idmdfied In tilt Fourth Edition Task lift. Iu... 11, q... stloltj.ddresslng ethlcal l.. ua rdated to specific t.... wiu Ippnr on tho oumination. D

79 < A. :\lea~urcnll'nt : A OI Mcuun fmjumcy (i.e. count). A 02 Mcuurc n.1t (I.~. COIInt pcr unit 11=). A OJ M.uun: duration. A-O<I M... lau.ncy. A-f15 M... Intnraporw! tim. (1m A..Q6 Meuwe pnmlt of ~ A.(J7 Meuun: trials 10 ailerion. A 08 A>oeM and Inltrpret inttrob...rv.or "8fftmcnL A og Emu,u lin: accuracy and m!.obuity of mcuurcnunt pf'<>udurl:l A-IO DctISR, ploi. and Inltrprrt dal.o luln, oqu&l.jnlttwj graphl A II OWln, piol, and Inttrpt"'t d.w. usln, I (Umulall... ~ 10 di$pb.y data. A 12 Design and lmp&m-t <;OnIin_ mw.utffmftl procnu"" (... I!'Wnt recordlng). A I} Design ond Impirmnll <!iko.>tin MUrtnvnt proctdum c... paruilar whole Interval, momtntary link Am~. A I. Design and ImplmKntchoia: mnsu_ B. FXPt'Tlllll'IlI,11 DeSign. 8.01,1968)lOevaJuaIC.,...,... D '

80 B IO Conduct. component analysis to dttotnnl..e t"-' ~~ componmuo( lljilnlnwntion padt". (. Bl'ha\"ior ( hangl' Considl'rations CoOl C-Ol S\.ot~ 0J>d pian for tho! poisible unw.nttd dr«ls of "'inforument. St.alc lljiod plan for the poaiblc Wlwanted dftcu 0( punw>:mnt. D" fund.liih'nt.lllll'lill'nls of Behavior Change 0J>d odudul.. of ",inforcemcnt D.., D D

81 0 2(1 Usc responsc lndeptndtn! (tim.- biosfd) sdltdules of,."infora:m~n! (I.e., noncorulng<1l! reln(oium~n!) Usc dilf~rential reinforcement (eb-. ORO. ORA. OR!. OR!.. ORH). I. Spcllhl Beha, ior ("hang!.' Procedures, I. Ikh,1\ lor Change Sy~tl"nlS : F-Ol Usc scif man.gem~n!.tnl"lliu. F Ol Usc token «:onamia and owr conditioned reinforcement 'Y't~mL F-Ql Usc Direct IllSIrualon. 1'-04 Usc precision tadllnbf.05 u.c ~rwnalized I}IIemJ of Inotrudlon (PSI). F-06 u.c incidmtailekhl,.. F-m Use functional communlc:ltlon uainln&- F-OI u.c IUpncntatM: communiaulon IfIImlI. D

82 (I. Identlh~JtlOn of the Problem i G-OB,. In cod'bontlon with OIbrf'l who... ppon andfor rcd..u the n«d for b<h.vior lnalym H. ;\lcasun:rncnl H-Ot SeI«I. I systm. 10 ow.ln rtpru<1itlllw <1m ~ the dtmmsions of the btmvior IZId the logistics of obllcryi", and ~ H 02 St-lecc uch.-dole of OO"-... \ion and recording J>(rlo<b. H-03 SdeCl dati d"play that elfeccivdy communk:lits ~I quliltit.atl~ motion$. H M H.{IS E..JUlI. c:hanjet in tevd. trend, and oarlabiiily...., EnJUite temporal m.tions botwcm ~ YUiabia (within &; brtw«rl1lcl$lonl, timr I. Assessmcnt [ 01 Define be/l.ay\or [n oinervabie Ind m.qurab!e torm.. [-02 Odi... nvlmnmonta1 vari.bl.. tn obkrvabio and mnsurobl. temu Dftip and Implnnrrll. tho fud... of functional asscssment prooedum. \.{IS Orpnlu,..wyu.and irll.01pm obscrmidata.. D

83 1-06 Mab: ~~ ~I bdui~ Wt mllst M esuoblishcd, malnlo'l\ed, I~OI'~ J. intctn'ntion - K. Implcmcllt,lIlon, l'i-lanagemcnt, and Supcnisio K,OI K-m Provide for onllo'nl documenla11on ofbeha..;.,ralkrvi<:a. IMnilfy the contlnlcncies ~rnlnl the bohavior of those responsible for carrying oul bth.v\ot o;hangt" P~ and. dqlgn lnlflwnlionj accordin&ly. K 03 Dnl&n and. usc competency bun InLini"lllOr ptf$oi>$ who ll1' mponllble lor ClI'I'JIn&... 1 bcba \onl uscumenl and. bcho \onhan.. proctdum. D '

84 K-{)4 Dtoign and UK djrcll~ pcrfonnana monitoring and mnfolcl'mcnt ~m$. K-{lS Design and u.. Iystellll for monitoring procedural integrity. K-06 Provide supcrvwon for bohavior-du.nf... nll K-07 Evahw.1ho otre.;t~n... oflho behavionj provam. K-D9 S«u~ Iho support of othn1; to maiiit>.in tho dltnt"1 boha.-lonl rtpcrtolm: In tbrir natunlenviron~nll K ]O Arrange for the ordorly termination of.. rvlc.. whon they arc no IolIg.r ~uired. D

85 Explam and Ikha\t' in Accordance with the : Philosophll,11 Assumptions of Behavior Analy~is Define and I'rO\ ide (.xamples of: FK-IO FK-Il FK-12 FK-13 FK-14 FX_15 FK 16 FK-17 FK l8 FK l9 FK 20 FK 1I behavior, rupo~. K$PO~ dou ~nvllojlmtn~ $\\muh... ttimuh.. clau ltimulus tquivakncc n6a1w rdaliono (US-UIl) ~I condilloning (CS-CR) "!,,,rani a>ndi!lonl", rapondonn'perantlnterad.iono uncor>d.jtioned reinforcement conditioned reinforcement unco!>dlt\on(d punlsh...,t condit~ punlshm<nt Khtdula of tdnforurnmt lj>d punlllun<:nl 0,

86 FK.)6,. FK ) 1 FK--41 FK--42 ()istlllgul~h brt\\rrn the Vrrhal Operants. FK--4S Tlell FK-46 [nl... ~1 1 D "

87 :\leasurl'lilcnl COlllCptS - FK-48 Identify Iho measurable dlnvnslonf ofbchavlor (e.&-. rate. duratlon.laimcy. Int.~ tl""'j. Stall; 1M advant"8" ond diso.dv.nllga of \l$ln, C(>nlinUOU$ R>ealumntnt procnw'n and dis<:o.ulnuo", m.uu",,,,,,ni proctduru (t.g.. p>.rtiol-.nd whol.-into"",l rkording, momtntary lime.. mphng). ~OlOlllor"_"""'c n.ocrj,...._'. ' IM'+..,... ~; In, ''''''.' b_... c.. ",...' 1o<:1IACr: C--_...,..... "I(:aA -_~...,.....,~-: Iot'.._... c. ( _.P n... _..,. '...,.p'", D "

88 Health Plan Coverage of Applied Behavior Analysis Treatment for Autism Spectrum Disorder ~ \

89 Copyright C 2012 by the Behavior Arlaly51 CertifICatIOn 8o d, Inc. (' BACB '~ VM. 1.1 """"'alport... "'.. bo..-ior..."=... ~ ---- _..-..._IorPf<llil",_".do'wI.-... Iong... ~o;!o1jiir..._... ~_... rlooo;... ~ B ,-...~..." """_.... M _..,... InI_---.

90 TABLE OF CONTENTS PART I: Overview SECTION 1: Executive Summary... 3 SECTION 2: Autism Spectrum Disorder and Applied Behavior Analysis SECTION 3: Considerations S PART II: Unique Features of Applied Behavior Analysis SECTION 1: Training and Credentialing of Behavior Analysts SECTION 2: Applied Behavior Analysis in the Treatment of ASD SE:(TJON 3: Assessment. Formulation of Treatment Goals. and Measurement of Client Progress SECTION 4: Service Authorization and Dosage SECTION 5: Tiered Service Delivery Models and Behavioral Technicians SECTION 6: dinical Management and Case Supervision SECTION 7: Working With Caregivers and Other Professionals SECTION 8: Discharge. Transition Planning. and Continuity of Care PART HI: Appendices APPENDIX A: Eligibility Requirements for BACB Certification APPENDIX 8: Selected Bibliography APPENDIX C: Footnotes

91 SECTION 1: EXECUTIVE SUMMARY T1w purpose of this document is 10 inform decisiori.making fl!9iirding the Wi' of Applied ~ ~ (ABA) 10 trmt medic.jiy neassary COI'lditJc:e 50 as 10 develop. rnaontaw\ or testore, 10 the maxlllll.,m extent poacticablt, the functlol'liog of indmduah with Aubsm Spe(tIum o;sorder (ASO) i'l ways thin are both effocacious and COSt tffectm!.' The document is ~ on the best _liable scientific I!YidencP and@xpmclinicaloponion regarding the use 01 ABA as a behavioraillea~h treatment for IOdiYiduaIs diagnosed with ASO. The QU~ ilre Intended to be a brief and user frifnd!y introduction to the application of behavior analysis for ASO when funded by health care plans. Althoogh the guidejines are wr~ten primarily for 1'ISUref'; and Ilealth plans, they.,.,;a Mo be lmful for consumers and proyiders. ThIs docummt prrmdes ~ guidelines and other nforrniition iibout ABA as a treatment for ASO. ABA has a number of dncai and ~ corr,poo!elm thai make it la'liqiie among eyidenc;~ behihiol. hemh tre.ltmeilts. Thus. it is ~I tiwt those diiiiged with building a pioo'idef network uncietst ld the COI1'Ij)OOenU and deiiwfy of ABA, induding: trari'lg and credeotiaing oilieh.wior Analysts ABA as a treatment for ASO - treatment components - assessment. formulation of trhtment goals, and measurement of client progre$s - clinical procedures - treatment cio:iage and duration - supervision mooei - tierw service dewery - irm::l/iiemem. of uregmors and other proiessicnais - discharge. transition piinning. and contriity of tare ser...:e authorization and benefit ~ ThIs is the fom edmon of thr!. ~ ~ Itld It wii be ~ petiodially to ~ changes on diroc.1i practice and reseatttj fwldi'lgs. Addi\IONI re/ererices and... Iormauon can be found... the apper.dices.

92 SEcnON 2: AUTISM SPECTRUM DISORDER AND APPLIED BEHAVIOR ANALYSIS 1 What is ASD? ASD is ci\iifacteri!ed by varyw'og degoees 01 difflcljty... sociiji irltefiktion and W!baI and ~ communication. and the presero::e of ~Itiw bei'iavior and restricted interests.' This means 1M no two individuals with an ASO ololgoosis are the same with respect to how the disorder manifests, ~. the _ity of!he disorder is a reality for all indmduais with this dilgno$is and their f<jll'lilies. Because of the MtlR of the di5ability, ~ with ASO wii often not acneye the ability to function 'ldepeidei illy 'Mthout appiopii.jte me!icaltj nec;essary trhtment. 2 What is ABA? ABA is the design. implementation. aod evaluation of environmental ftio(jjlicalions 10 prodllce sociauy significant ~t... human behavior. ABA i-.cjudes the lm of clr«!. observation. measurement, and fulctionai ~ of the relations bety.ftn ti'ivi!tii'iiti and behavior. ABA uses chiinges in erm- 1001InI'I,\aI Po'II'fIU, induding antec!dem. stjmui and c;onseilue0a5, to produce practical iii1d 5igoificam d\ange!. in be/lm:ir. These ~ enwortnentai eyeilt5 art' usuatj odenbfoed through a wrie!y of speciarlll'd ~ methodo;. ABA is based on the fact that an ~'s beh.mor IS ~ by past and current envifl:wnental events 11"1 conjunction with organ.:: V<1nab1es wth as the. genetic endowment and ongoing phy5ioiogical Vo1roables. ABA focuses on lleatong behaviooll difficulties by changing the individual's environment rather than Iocu5ing on variables thai are, at least pre5ently. be)aid our direc;t ;JCI;I/SS. The suuessful ~ d ~ deficits of ASD, and the (Ie" :'JP.oeo,t or resloraljon of ~ documented in t.jnmds of peer~ studits po..dshed O erthe past SO)'lNlfS M made ABA the standard of care for the treatment of ASO.

93 SECTION 3: CONSIDERATIONS This doament contains ~ Ill,f«WI'IITII!nd. thai ret\ect estabished IeSeiIICh fon6ngs and best dnkai pi'a(tio:es. ~. ~Iized treiltmeni is a defwwlg feature ~nd ~ai componem of ABA. wiw:t1 i$ one INSOf1 why it h.ls been 50 suocesuu in I1NtlOg th6 he!etogeueous disorder. Some I'IdMduals cmgnosed with AID ~ ~ concfltlorr!i including. but no! limned to ~1«tuaI disabiliti6,!eizurl! di5order$, ps~ disotde<"s. d-romosomaimlnoi'iiollitles. feeding disorders, and a V/Iriety of other conditions that ll'quire additional medical treatrr«lt. These guidelines apply to individuals diagnosed with ASD with these co-o«umng «Inditlons, as nilsearch has established ABA as effective for these client populatlons 8S well. The guidelines pn:mded in this dorumem are pertinent 10 dewioping. ma'nt3l'wlg. Of restorvlg. kl the maju/tluiti extent pliictabie. the funct~ of an incm:iuai WIth ASD and thu5, may no! JlKl5. SMiy n>pfl!5ef11 the optjmai ~ for ptoduci'ig an "appropriate education" in school set~ n-~ sho!.*i not be usecllo dirnroish the avaiiabiity, quality. Of ~ of ~ awr3 hie ABA trntrrlefit services. Cowrage of ABA treatment for AID by a hnith pian does not supplam ~ of ~ or goo.oemmentail'i1trtjes. Specifoc.nioo of ABA in an Individualized Educational Plan Of ~ pmgram does!'lot supplant ABA CCM!rage by a health piiin. o ABA treatment must not be restricted a priori to specific settings but instead!.houid be deliwred in those settings thai maximize treatment 0IJ!(QmeS lor the Wldividual client. Tho$ document prow:ies guidilnce regatdi'lg ABA tre.ltmef1t only; other behayiorai health lrntmeflts In! not addressed. In adiition 10 ASO, ABA as a ~ ~ treatment has a prdotni ~ 01'1 the l/nti'i"iei'it of intwi6jals with ii range of cinoi need!; wr;h as vnoulg cessation. ~ plobiem behaviof (e_g_ self ~ weight loss. attention dtflcil disorder, pegatric ~ di5aden, and rehabilitation of acute medical condibon5, Elements of this report may be ~ to the I1NtI'neIlt of these ome.. woditiom ii5 wei, but this dc:io;mem i5 ~ocaiy dwected towards the use of ABA 1'1 the treatment of ASO.

94 SECTION 1: TRAINING AND CREDENTIALING OF BEHAVIOR ANALYSTS ABA is a specialized bet\aviof,. health treatmeoi.md I'!'mt graduate Of postgrilduale If<lri"og programs in psychology. COlKl5eIng, sooai work. or othef 0/ clinical practki! do not prow;ie n-depth traoning in this discipine. Thus, <Ill undefstancing of the uedentjaiing proress of 8ehiMor ~s b>r' the BehiMor Analy,it Certification ~ (BACr) (an.mist health pi.w ard their subscribers in identifying those proyiden 'Nho meet the basit: ~ 10 practice ABA. The formal training of professionals CMified by the SACS is similar to that of other medical and behavioral health professionals. That is.!/ley a.e initially trained 'Nithin acaderrua and then begin wori<wlg in a ~ dioicai setting with diems. A!. they griiooally demoo ~tr~te the compet~ ne<essiiiy to Il'IaIliIge ~ dinocai p!obiems ac:rms ii wriety of dients and medical ermrorvnents. they btojme ndependem practit.oonen. In surrwnary. BehMJr AlIiIIysts U1ldeogoa tigofous coo.ne 0/ traii'iing and ed.x.ltion and IIa'.'e <Ill "internship" penod WI which they begjl by v.ob'ig LW'Idet' the din!ct ~ of an expeo oeolcied 8ehMor ~ II should be noted that omer bmed ~ may haw' ABA within their partici.il scopt of trolirwlg and ~ In addit.on, a smai Sl.tMI 0/ diniciao'l may be Ii«nsed by another profe5sion and (100 hold a oedentiai from the SACS, thereby proyiding evidence of the natl.if\'.. nd depth of their training in ABA.. While health plan ~ of behavioral health treatments supervised by Behavior AI'IIItysts is relatively recent BeI\aYior Analysts. like other medical MId be!\ao,;orai health proyiders, ~ upon stra~ and pttadures documented in peer~ itefmure. I!S~ tre.nrnent pi\jlljc1as, a.nd decisicw'i trees. They o;li'llftjaiy evaluate the current stale d the dent ivld cuswmi2ii! tj""b''''''\ ~ based on the ~ 01 dftct observation and data ffom range 01 othtr ~ They also soiioi Id li'itegate inbrnadon from the c:ient and! nit """ Ilbeos and ~ c;n ~ 0Iher ~

95 The Behavior Analyst Certif ication Board The SACS is 11 nonptoli! 501(c)(3)corporation e5la~ished 10 meet professional credentiaung needs identified by Behaviaf Ana ;ls. ~ts, and consumers of behavior ar.alysos services. TN! ITII$SIOn of the SACS IS 10 develop, promote, and irnpitrnent iji'l r.!eri'iatiorwi <ertificatioti program for BehaYior Analyst ptactjbonefs, The SACS has established Inform COf1!eOt, standards, Id aneria for the ~ process th.jt are designed 10 meet The a«ejlted starklards for Ooltiooai cenificatlofl programs; and The SCM and SCaM ceflifkiltion programs i1re currently accredited by the Nillional CommissIOn for CemfYlng Agencies (NCCAJ, the accreditation arm of the InslllU\I! for Credentialing Excellence. NCO reviews and OYerset'S all aspects related to ensunng the development and apphcation of appropriate credent,aling processes, The SACS credentials and Il!COgnizes practitioners at three IeYe1s: Profe5sioNIs credentilled at!he SCBA O od SCBA IeIIIi!Is an! defwled as ~ AnalysIS. The SAC8 requires thai BClIBAs work urroer the supervision of 11 SCBA D Of SCBA,

96 Eligibility Requirements A.ppIiunts who meet the degree. ~ and supetvised expel"w:ee!igibity requirl'ments described in the next sectjon lite pemiued to SIt for either the SC8A 01' SCa8A ~ (see figure below). E«h exammtion is pro/essioniiy dheloped to meet ~ed ~tion standards IItld is ~ 01'1 the re5uits 01 a ~ JOb ~M1d 1UWY. In odilioi ~ ai SAC8 ~ are off«eel under secure testi'lg cooditioi'is and are professionaiy illtnrstered and scored bv.ldepeidet.t prof~ entities mat meet industry standards.

97 Continuing Education and Maintaining Certification BACS certiflglnts are requirl!d to attest to their compl'ance with the organizatior1'5 pthical and discipliroary rules (see below) on an amual ba5is and obtain 24 (BCa8A)or 36 (BOlA. BCBA-D) houfsol continuing ~ credits every three,ean. three hours oi...nil;h must relate to~or ~ A.gl'ncies that employ BehaW:lr Ana!r;ts need to 5UppOI1 and proyide this training as needed. BCaBA BCBA BCBA-D Disciplinary Procedures AI certificants must _Itt attest that they \WI1oIow the GuideIiles for Responsible Conduct for ~ Analysts and they are subject 1(1 discipiii y iic\jof1 ~ the SACB if they YI00te ooe or more 01 the nne ~ ~and Ethal Standards twww.sac8.com). The SACB lms iifl online complaint system ~ wnch the organizatijn ii alern!cl to poteniiai di5ciplinary Yioknions. Eadl compiaont is evaluated ~ the BACSIegaI department and if there appea~ to be merit to the complaint ~ is forwarded to a discip6nary Review Convnittee. The comm~tee members are senior BCBAs or BCBA O$ [email protected]'ldependena! (ndudingamemberlrom the certificam s $late}. ~ actions for ~founts irdjde. but are not limited to, mardated mntinuing e<l.igiborl. suspension 01 ceruficauot1, or INXatJOn 0/ cen.ficabon. Re5u1tng diiopiinary actiono; are p!.a;lidy reported orr.e. lice n5ure of 8ehavior Analysts BAeS credentials are currently the basis lor licensure in tho5e states where Behavior Analy$ts are licensed. 6.Jsing iansure on SACS credentials is tost eff~ ar.d ensures that etitoi competencies omth regards to practla1 and rese-ard! are pet iodicaty ~ and updated ~ prac:titioners and reo searchers. 'NtIemer it is tmd as the ba5is lor icensure or as a "free standllg" credenbai. BAeS ~ uais are ~ in those Sta\1!S ~ insur.ince reform laws hiwe been enacted. E\i)

98 SECTION 2: APPLIED BEHAVIOR ANALYSIS IN THE TREATMENT OF ASD The f.elcl of Beh.Mor Analysis e-.dved from!hi! 50entlfk study of tile principles of learning and bt havior. Applied Behavior ArI3Iysls is a weikie\ieioped dikiplioe among the helping professions, witll a matute body of s6entif" kr.ov.4edge, e5~ ~Ulnd.lrds lor 1!'IIdenc;I!-Oased practice, dl'lmct meth om 01 S@NIU, IKOgIIized elipi!iiet..., and ~ requirements for prac\ja, and «fentjfoed 50lAUS of in ~ Pmfession.JIs... ABA engage in the specrfoc and ~ use of pmcipies ollearrwlg, iidoong operant and respoo deo,\ learning. in order 10 address be/laviq(iii needs of widely varying individuals in diverse settings. 1 Identifying ABA Treatment Heafth plans and insurers /TMt be able 10 re<:ogn0! bona fide ABA tlatme'nl and those qualiflf<l \0 provide it ABA trl'attnent has some important char.tctefistia thai 5hou1d be apparent throughco.lt treatment: 1. An objoctne a~ of the diem's WIldfIIOIl by obserw>g I'OY the enwonrnenl affects the diem's beii.wior, as eyioeoced thtough appropfiolte data coiiectoon 2. Impollance gover> to ulldl!fstanding the context 01 the behavior and the behavl()(s v.ll..e 10 the ondmc:lual and the commul"i!ty 3. VtIlizatJon of the p... oples and ~ of behawjr ~ soch that the cieilt's healtfl. fldependence, and quality of life ;we ompro.ed

99 2 Essential Practice Elements of ABA Tlltse charaaerinocs W:JuId be appareot tiwughout ai phases 01 assessment and tre<ltment: 1. Description of specific levels of behavior ilt baseline...tjen establishi"og tre<ltment goals 2. A p!xticai focus on establi$hing sm<lll units of behavior whkh build IOw ds 1afget'. ITIOI1! sillnific.am changes in fu'lctioriing reiatfd 10 mpro.oed health and Itw!Is of.ldepet deo ICe 3. coaection. quantifocation, and analysl!.. 01 dl~ t observational data on beh.moro!l targets during Ue.ltment and foiiow up to maximize and maintain progress towards treatment goal$ 4, An emphasis on undentandlng the current functio n and futule value (0( Importance) of behavior(s) targeted fa' In!atment S. Efforts 10 design. establish, and managi! the treatment environment(s) in 0f0ef to minimize plobieo., beh.1viorwand maxmize rate of improyemem 6. Use of a carefully oonstnk\ed. IndlvidualizM and ~tailed behavior analytk trtol tment plan wnd'1 utues IH,b...,"" It and other behairior analytic prwlcopits as opposed to tilt use 01 methods or ted1noques whoch lack ~ about theo" efiectiveoe.s based on evidence II peerfeyiewed publications 7. An ~ on ongoing and frequent direct assessment, analysis, and adjustments to the treatment plan (by the Behavior Analyst} base<! on client ploijress 8S oowmined by observations,liid objec~ data analysis 8. Use of treatment protocols that are Implemented repeatedly. frequently. and consistently IIO'OSS ermronments ootii!he client can fixiction i idepeldet otiy in rn.o~ $ituatoon$ 9. Direct support and tr3ining of family memben and other involved prof.s,ionals to pm- rnotii! optomailtn:tiorwlg and prori'ocu ~ and rnainter'wrn 01 behimorioi ~ 10.Supervislon and management by a Behavior Analyst WIth ~ and foonailraining in ABA for me 1l1!i1tmef11 01 ASO

100 3 Treatment Models ABA trtatment progriirm!of ASO i M;Drpor,lIe fi~ from h...teds of applied studies focused on u~.",d IreiItlng ASO pui;iii$iled WI peer~ ~ fmi a SO.,ear SjWI. Treaunent ~V y WI II!m"6 of intensity and rmatloll, the<di.lplexityand ~ of tre/itmem ~ and the extern of direct treatment pi'ovided. Many ViIilabits. nctuding the number of bet\aviorii!mgeu. specific aspects of!hme behaviors. and the cllent s CPNn Iespo!1Se to treatment help dtttoimorll! whid1 model is ITIO!iI appropriate. Although ejusling on a rontinuum, the5e differences can be ger'li!faly c.negorized as one of two treatment il"iodeis: Focused ABA or COIT1prehenWe ABA.' Focused ABA Service Description Focused ABA i"m;:wes diect serwe deim!ry to the diem. It is no!: restricted by age. ~ 1twI. or co-oc:curmg a:ond"ltior6. focused ABA refers to treatment ~ dftctiy to the dent lor a limited FoonH ABA if>lione< nul'l"tlef of beh.morai t.jrgm. AIthoogh the prese. ice of problem behaviors ~ more ift>quently trigger a referral for Focused ABA \leatment the absence of appr0- priate behaviors shoold be prior~iled. <IS this is often the precurwr to $efious behavior problems. Therefore. individuals who need to acquire $l:iiis (e.g.. COIMlUnicabOn. toieratw'lg c/laoge in environrnenu cognlfl~ /fwl. or and activities. setf~ social skis) are also approprlilte for Focused ABA. In.o6bon. ". tre/itment plans whict1 t.lrget reduction of daj'9!!ous or undesired behayior must a:oncu~ irotn:d.oce and strengthen more appropriite and ~ ~. EJciIrr1JIes of behayior-<har'oge f gets n a focused ABA treatment pwo ford"tid.i/i. who lad b!y t..octjomi sus ondjde estabiisiw'og ~ with ~ and dental proce<l.ores, sleep 1ftgieo"II!. seif-ca<e sus. safe and I"Idependent Ittsure!d's (e-9-. appoupnate partq:latjon on famiy and corrmurity ~,

101 Exalfllles of treatment targets where the pnmary goal is ttl redua! be!'i.mof problems rrqtt include. bijt are not limited ttl. physical ()( verbal agqfl3wn towards self ()( omen. dyshmctional speech. stereotypic motor behavior. PfOPeI'ty destruction, noocomplianc;e and di~ptiye behavior. ()( dysfunctional social behavior.... v.11en po itizil'9 tilt order.,...nm 10 des ~ IJe.JIlTIent IiWgftS,!he ~ sh:dd be behaviors that may threaten the llnith or safety of themselves or othe<'s (e.g.. aggreswfl, ~ 'n)ury Of ~f mutolatjon, property destructoon); beh~v i or disorders that may be a barrier to their ability to remain in the least restrktlve ~tting. andlor limit their ability to participate In family and community life (e.g.. aggre5000. ~''"JUfY. nonwmpliance~..!»enc:. of ~Opmentally appropriiote adaptive, woal, or func:tional skills (e.g., toiletjng. dfes:w>g, feeoo9, ~...m ~ procedures) that are fundamental to maintain health, sooalloduslon, and oncre.lsed ondepeoden(e. When the focus of treatment il1'l'olyes the reduction of a problem behavior. the Beh.:!vior Ana Iyst will deu!m\ine which ~tuations are most ~keiy to predpftare problem behavior and begin to isolate its fur.ctoon ()( purpo5e. 1M may requ~ conducting a Il.nCtlOfIal IOat,'SiS to err9ricaiy demonstrate the "plifjxm" (i.e., function) of tilt PfOI*m behavior. The results enable the EIeha-r ior Ana~ todeytlop the most eflectwe IfNtmI!nI pro«xol When!hi! fu'iru:on 01 the poobleo behavior is identifred. the BehiMor ~ may design a trntment plan that ijitefs the er-onment to reduc.e the motnation for pooblem behavior andrtjr establivl II new and more appropriate behavror that ~ the same function and thtr'etore "fl'piaces" the prtrbiem behavior. Social k~1s deficits. II WfI! defkil of individuals d~flosed v.ith ASD, art often addressed... focused treatment progriirris. Treatment maybe delivered in either an ~ Of smal-9'ol4l format. When conck.cted... II 5maI group, typico)ty de<cljping peers, ()( others...m sorriiar diag. 0IJ5eS, partocipm"'!hi! 5IMion. Clients pracuce behmorai targelswhie smu~ 1'!lI'da!. ing ~ of!hi! treatment to the othei' rneortler\ of the group. As is!hi! case for,ji treatrnerlu, programming iof ~aliu!jon of kiis outside the 5IMion is anicai.

102 focused treatments ge.lelaty I J9I! fran ton per v.ft4t ci difec:t thejapf IJlks ~ iwld ~ supe!'viiion ~.n:i an! 5OITlI!lme5 part ci a ~ <bm1 01' ~ plan from a COt'iplellellSiIe ABA TIMImI!nt pio!1mtl Comprehensive ABA Treatment Service Descriprion ComprehensNe ABA refers to tteatrnem v.mfe there oji1! ~ targets licjms ill de>. elope, oti.. tal domains that ;t(@aff«ttdbytheirldmdul! saso. The5e programs tend 10 range from hours of direct tre<nme!'lt plus supervision pi!f~. Initially. this typically ifnoives 1:1 staffing and IN)' gradually irldude SINI group formats ii'l is appropriate. Although there are different ~ of OJIiOPe/le.~ treatment. onetml'l1ple is intens/ytnriy treatment ~ the OOfIaodliiog gool i!i 10 dose the gap between the dient's Ie-.eI of functlol'iing and that of typically c!e\;tlc\)ing ~. Targets Me d!awn from muh.ple domalm of fullcfurullq ii'lduding cogn~ive, communicative. social, and emotional. Ta,gets also iodooe ri!dudng tht symp IOiTIS of co-ocrurring behavior dtsorders!ouch as aggression. 5C'~.iojury and 51M!01ypy. Ha.YeYer. ~ bthaw:ni tteatrnem IN)' also be iippiopi i<rte for older ini:iividu.lk tugnosed 'MIh ASO, particularly if ~«ogage in seyer! 01' ~ bthim:nac;n:& l!ilwuotoi!ilu. In some case5. re5idtntoai plnl'lle'''t 01' inpatient hospot~ may be r~ for ii period of Iimt. Treatment I\ours are iooeased or ~ as a function 0/ the ditnt's resp;:rrse 10 treatment as ~ as tht iltensity fiefded 10 reach tre.limi!i'it goals. il some cases. direct treatment I'Oln ~ gaduaiy. are rnairitawied at rnaximjm ilten5ity lor ii perq:i of U'nt.n:I E' then systema\icatj deceased in prep;jrabmlor disdi ge. k1 ou1tr cases. b\'iftr'tlefit /i'iiiy begoro at maxrro.om lela Treatment is intensiye and initially pn;mded in slji.lctlji'ed ther<lp'l' SE'SloIOfIS. MOI'e r.atui'alislic. treat ment approaches are ulililed as soon as the ciien1 demonstrates the ab~ity to benefitlrom these treatments. A5 the ditnt progresses and meets est.joblished criteria for partiopation in larger 01' different ~ treatment in those setlings ojnd ii'i the larger CU'IVl1Ui'lity 5houId be pn:mded. Training aod partiopation bycaregm!rsarealso _ ISan ~ (OIiipOloetil.

103 Program Components cogrlflm> functlofung prl!-acaoemk skiis ropng and tolerance skis adaptm! iind ~-help skits social skiii5 play and ~Ie s\:, 1s language and comm",ilicatlol1 attending and social referemu\9 reduction ofljlterleting 0( inappropnate behaviors Intensity of Comprehensive ABA Trutment 'o'.'hen!he goiii is to ch.lngt dt<ot'lpj,e,tallfaji!ctones to matdl!hat of!)'poly de\pl,-rg ~ -m, ndudi1g _oji tr'iew~ show!nt hoors p«weet. (6-7 hoors daily, S-6 ~ of ~ ABA IIt'atmtOt IS needed. Hours gen I3Iy dkrn5e as the diem progress es in indepeo det~ and generalizes ~ ci"i.:iriges to omer critical ~ ChildIerI v.oo iijl! \nier 3 )@ SoIiilgewilt!iiI\ASD diagr"ro'm ~ better OU!<:OrT'ie v.t.eo they receiye houmyeek, a'id ~ is not urw:onvnon lor ctw:iren n this iiige group to rectiyi! 30 JIours of treat ment or rtiofe as they approach 3 ~ of iiige. ChildIerI w\'"() ~ chafiicie\'isu:s of ASD at iiige 36 mooth:o; wi conti"j.je to reqo.ire Oi 9Oi' rg trntment. Recor'M"IenOed hours and ~ ~ an! b.hed on the indmduai's ch.lrilcterisllcs. ~ and -aabity lor ther.!py (e.g., Mdurance. attention span, need lor ~ Although tilt ~ Ed ruttrer of hoors of th@rapjmay5eejtlarduousto'5clltlep.nnts0i)qung drikll", ~ it $hwd be J"IO(ecf!hat time 5pft11 ~ from ~iiipy may ~ children ~ farthef ~ ITom d sftd normal deyeiopmentai tra~ies. s...d1 delays willbly result n increased costs and greater dependera on JT"IOIl! in~ ~ iio"l:m their ife 'ipiwi.

104 4 Variations Within These Models TreallnE'nt plq9(anls within any of these models vary aiof\g SIMlral programmatic dirnerosions, inciud ng the degree 10 whidi they are prmarily proyider. Ot dieot-dreaed (someilmi!5 di&ribed as "struc tured vs. naturabtw:-). Other Y iinions inciuir the extent to whidi ph15 Ot parents ~ as behavior change olcji!i'ils. rnaty. some differ in tem"5 of the ~ to YhdI they are "br.mded" and ",..a He commercially. Decisiorrs.tbout how these Yanous dimi'ruions iii'~ implemented WIth'" indmduai treatment plans must reflea many variables, including the research base, the age of the doent, speofoc aspects of the IiIrget~, the <lieonown rate 01 progress. detrolstration of prereq1.15rte sirjis. and resou~ ~ to support irnpiernentatio of the treatment piaol across setti1gs. DespIte ~ dii~ if a gnen treatment meets the E5senbaI Pro)(tU EIernerTu of ABA de5aiied in this lktion (p.tl), a treatnimi program $h;o.jid be ~ an ABA tre;itmeni.. 5 ABA Procedures Employed In These Models A large numbpr of ABA procedures ill'@lqutineiyemployedwittoo the models previously described. They ciffer frcm one another in ~ 1Xlf11PIe:uty. speoficity. and the extent to YhdI they \Yef"e M- 5igned pri'n iy for usewrth indmdualsdiilgnosed WIth ASO. AI e bas«! on the pl... of ABA and are l'fllliored with ~ determined ~ the ~ specific ItNtment plan and response 10 treatrnenl If one ABA procedure OJ comboriatoon of ABA procedures is not pnxiucng the r:iesftd response. a different one may be systematical,>, implemer1ted and evaluated for its effectiveness. These pr!xi!(iures include different types of re;nforcemeot and schedules of ft'ln/oru!ment, difft'l't'i1tial reinforcement of othtr behavior. differential revl/of,~ of <I~~ behawlr, shaping, chijirliog. behm::wa1 momtntum.. pioti1pti"og and fading. behm:lr,.!kits ttaroing. functional communitation traiw"og. (jsoete \rial \NCtWlg. wocicselrtal teaciwig, se/f-mafl<lgemenl plefeot'llo!! oruesments, adivity schediaes. ~ and maintenance procedo.wps. among many~. ana is IS conslilnltt de-oelopil '9 and evalualin9 applied behavior change procedures. The field of benvior

105 6 locations Where Treatment is Delivered The standard of care provides for treatment to be deliwred in mu!tiple settings in a(cordance with clinical judgment to promote generalilation and ~ of therapeutic benefits. No ABA model i5 ~oc to a panio.iiar Iotation and al rri#f be dewerfd.. a variety of settwlgs. ~ residential treatment fdbts. ctncs. homes. sdo:lis, and pbces 11'1 the 00ImII.II'Iity. TINtn'IenI proiided.. muftipie settii'igs...m ~ adults anci-tlr siliings UI'O!r the proper cm.nstmas. will Sl.WJrI general. ization and INll'lten.1I'OCe of treatment ghls. In some cases. the wrnistef1t applicauon of ABA.JO'OSS,. settings of the penon's life may be the most 1XIS1-effec.1M! mt'aos of liniment. 'Nhere possible. most children under 3 years of age should receive ill least some treatment in their horne. Howeo.-er. treatment should no! be...,thhtld. nor should fal1liy rnembtrs be expkied to forego ~ etc., in order to tkene such treatment. linder O!ftain CifturTl5ta1"aS, clinic based services are most appopllilte. LOCATION SCKOOL & CUNIO KOSPITALI HOME COMMUNITY OIITPATIENT RESIOENTIAL INPATIENT FOCUSED V' COMPREHENSIVE V'

106 7 ClientAge 5ervices Vlould be prt:mded as soon as possible aftef diagrlo56, and in wme' cases SefVices arf warranted prior 10 diagtic:i5is. Evidence suggoests that the Nrier trntmem begins.. the!lintel' the IibIh:lod of positne long-term ouii:oi'ih. CompIehet&W" ABA trntmemc l result in recb:ed need for SI!fVIa5 as the chid glc'ns oidef. HoweIIer. reseil!di.150 demonstrates that ABA IS elfectm! aooss tilt ~ fe span. Older individuals may need intensm! and oompiehensiye tlntmenl espedally if they present with dangefol.ls behaviors. Research has not establ~hed an age Evidmce suggestj SI,eate'!he n~lil>ood of PQSirive long r~(m Iim~ beyond...tlich ABA is not effect~. 8 Combining ABA With Other Fonns Of Treatment F'1'Idings from seveviti studies show that an edec;tm: model,...t\e(e ABA is combined with othef form5 of treatment, is less eflectiw" than ABA alone. Thefefore. treatment ptans which ~ a milclure of methods. ~1Iy those wivch lao:: ~ ef~, should be considered with CAUtion and. if iipj)i'o>«i. should be rrloi'liiorftj ~uiy. If there are tlntmtnt protocols that are not aligned WIth the ABA tre.atment iip\lfoodi, these 6f~ ffmt be rescmd in order 10 dewer ~ted benefits 10 the cient.

107 SECTION 3: ASSESSMENT, FORMULATION OF TREATMENT GOALS, AND MEASUREMENT OF CLIENT PROGRESS 1 The Assessment Process A deyiolopmenlally appropnate ABA assessment plan must identify strengths and weable5ses acr05$ domains, The cia!.) from such it plan should be tile bas;'; for developing the indmdualized treatment plan, Ao ABA asse:i5m1!!l1 typically utilizes data obtained from multiple methods and muftiple infoimants, such.u: Direct observation and measurement of behavior Di"ect observatoon. ~ and,...viii!! of benvior isa clelii_1ii ~ of ABA "" data sene as the prirromy b.lsis for identifying pre-tri!atment ~ disdla~ ~. and evakjatjon of response to an ABA treatment program. They al$o 4I'l~1 the Beh<Mor Analyst in ~ and adapting tre.ltmefll proloo)fs on an ongoing basi5. Direo:t obsoervation of behavior shoold happen dljling MuraUy occurring opportunities, as well 015, $tructured interactions. File review and administration of a variety of behavior scales or other assessments as ilppropriate The type5 01 ii'i~ should A'1Iect the goal of treatment and should be respoo 150M! to ongo.'ig dalj as they are collected and analyzed, Interviews with the client. caregivers, and other professionals Caregivers and other stakeholders are nciuded...t.en seleai"og trwtmenl goals. ptotocols. and evah.iamg PfO!1eU as 0IPPQP'0lte caregm!t i Ill!! oiews. f~ sc:ales. and soci,)i validity measures should be...sed to assess the ~~.e"$ peoceptiools 0/ thew chid's ski deiio:m and ~ioiai excesses. and the exitfli to ~ these deficits and eusses Impede the ~ d the II'Idivdu.JI Id the~. The client should.lisa paftocipate in the5e processes as apjllopriate.

108 2 Selection and Measurement of Goals ~ of.j t«get beflaviof defimoon. method and frequl'llc)l of me.1sufement appo-oiich.jnd dilt.j ~tatjqn must be indmdl.lillized to each Ylu;ltJOn,~, and available f~m!s. BeMYioriII targets should be prioritized based on!her ri5ir: to diem safety, irldeptnde!a, IOd ~ for the diem's health 1d wei~, Both baseline performance and treatment goals should be ~ for each uitlcal domain and specified in te<ms tllat are ob5efvable and measurable so tim there is &gfhmi!!'lt regatd ing the presence, absma!, ()( ~H of behavior change reiatm! to trntmtnt goals and di5charge criteria. Treatment plans 5ho:U:l specify oote<lni! and ftln5ufabie treatment protocols. It sholad i"dude tht service ~ and PRI 01 ~ for the dient Data coiiectia. and ~ shooad 0CDs ftequemlyenough so as to pemut changes to the WiMlI!nt plan at a fate whocto nw;irroim progress. Data VlouId be '~E5II'oted in ~ Of graphit.ji form. 3 Data From Standardized Assessments These dilti1 may ~ inform issues related to selection and prioritizafun 01 trntment goals and deter rnirwig the fe5poll5l' to treatment. Starodarlized tests that.mess ~ in CD9f\IINe. ~ soci.li, ~. beh.jviofai domains may be appopliate to e<1ab1i<h pre-treatment IiMIs 01 perfontlanao and inform deci5ion-mablg during treatment pianrwig. SOOres on such asses.smtnts. ~, shooad not be used to exljde indmdoais from reaiw'og ABA tre.jtment. for example. ~ we functioning is not an aa:urate Of appiopiiate detemwoer 01 an ~I'$ ~ to ABA treatment. Cd\

109 -- Assessment batteries must be "'dividualiled SO that they If!' appioptoate for each dient. For example, I1OrM!I'baI ~s may ptoyioe I men! ac.curate prof>le for I dieot WIlt! limited Formal st~ ~ may also be ~e in some ales for IJW on ;In ;JnnUaI b;m as!)art of ~ progress 11'1 COmprehensiye ABA IINtITlent Pf09<IITI whm the 90'1 is to c:iow perforniance 9iIPS WIth t."xaiiy de\elcpl9 peers. HQweo.oer. scores on sud\ omessmenu :ihotad not be used as the sole b.nis to terminate ABA treatment lor n.:tmduai dieflts_ 4 Problem Behavior Assessment PrOOetTl bthimor ~ may also be reqt.wed when co--ouurring behmor disorderl (e.g., aggrl5- sion, se/f~, property dl5tr\1ctj01'1, stereot~ are preen!, to identjfy the IibIy ~ potbleon ~ OCCU" and the skills and Stril!egies ~ to iimeiiorate!hem. Thos ~tes.functional ~...tmdl may or may not i'iioone, function.ji anaiy5is (i.e~ ~ of erman Complexity of Assessment mental eyi!ots and record of chiwlges in strerlgttl 01 target ben.a) to deb!o mo ~ the f1.oncbon of the In most cases. the ABA assewnent can be compjeted in hou~ ranck.oding report writing). However, up to 40 hours may be required if the Behavior Analyst needs to conduct I /unc;1iqnai ~ to OeterrrMne the Iuncbon of the pooble.n bei\ao.oior. OJ.

110 SECTION 4: SERVICE AUTHORIZATION AND DOSAGE 1 Services Authorized Authofiution periock Vlould not be for less than 6 fi'ioilttis and may inyoiw! SO!TM! Of all of the followtog -W::es. If there is a qufstloo IS 10 the approprialeoess ()( effe(tjyene$$ of ABA lor a particular d;ent, a review of treatment diita may be conducted morl! freqventty (e.g., alter 3 months of treatment).,. ~! 2. Treatment P!3o ~I 3. DIrect TrNtment 4.!it.ope!Wion (direct and indirei:t) S. Parent /rod Comrnur'llty ~ Training 6. ConslIt.lOOn to ErI$ur@ Continurtyol ~ 7. Discharge PI.Jming 2 Treatment Dosage Treatment dosage, which is oflel\ ~ io1 the treatment ~ture ii5 -i'lttfisi1y,- wii V3lyw'th Nd1 ~ and should reflea the 9Ool1s of IfNtmtnt. specific dent needs, and respc!i'i5t 10 treatment TfNtmfOI dosage should be consodertd in tyoodsti'ict utegorie: ittensityill'ld durauon. Intensity IntenIrtY is!ypicaiv ~ in terms 01 f'iui'i'ber Ii hoo.n per ~ of dwoct tremrnent. Intensrty chen refie<:ts whether the \IWJTIeIlt is ~ CKross ~ ~ or fomed (hied no..omber of behaw:lrai targets).

111 If the goal of treatment is to bring the dient's f\lndioning to levels typical for that dilonological age 0( maximiu independente in multipa. areas ie.g., cogrutm. social. ~. COI'lpIeheo~ A.QA. fe(pjires i"rtensiye treatmeot. defired as hous per week 01 direct treatment with adjustments based on individual diem need!; and rtsjx)i'ise to tre.llmet"1t. - Treatment flours are mc:05t commonly in the range of I"Iours per week for childrtrl under 3 )'Nrs of age end I"Iours per week for children c;r.er 3 years 01 ii\j@. - Treatment houn do IlOl indude tome spent 'Mth other ~Of lariy "m.~mmbel"', spedficaiv ts<wled \(I extend and ~ the benefits 01 treatment. When the goal is 10 address " limited number of "reas sud> as deuehing dangerous behavior or Improving socl, 1 skills O.e., Focused ABA)... Direct treatment I"Iours wi be related \(I the dient's indiyoduai needs id Ieamrog history. the need \(I train direa-qre staff, ='""_ ~ lime, arld data _lysis.. In addition \(I intensity being measured in terms of treatment hours per week. "'tensity rn.ly be further defined in terms 01 the numb«0/ diem. behimors or ~ per hour as arranged by the treatment protocol. These are SOfIII!times referred to as trials. Higher ~ of trials. ptogfammed with COf"ISI5tent impiemeo otation, aa! often importmlt to obtaining lldequate prtl!,ftss. Thus. "'tensity 0/ treatment must f1!flkt. 0Iher a5pkls in adcillol, to the numbei' 01 treatment houn per 00r. week. 0( mooch. Duration Treatment dojration i e/feai~ managed by evaluating the diem's re5pof"ise to treatment This evaluation can be (l)i1(!ucted prior to the concio.gion 01 an authorizaton period. Some indmduiis wi corotin..or \(I demohstsate ~ ~ and ~ trntmeni Jar a ~ duration ie.g.. c;r.er a penod 01 ~ ForUilmplt. the bene/its 0/ Cornprehensiwo ABA ~ treatmem to be dd.eoecl OYer rt'ij~ years.

112 SECTION S: TIERED SERVICE DELIVERY MODElS AND BEHAVIORAL TECHNICIANS Man ABA treatmeol protjrams ~ a ~ senice ~ mcxlei where the 8et\avior Analyst designs al'ld supeo,;ses a ~I program tld.eled by ~a l T~. 1 Rationales for a Tiered Service Delivery Model raed ~ deliyery ITIOdeIs which rely upon the use of Behavioral TtchnOili'lS I1ave been the primary rnec;haro6m for act»evng many of the sigoificant improyements in cognitiye, 1aoguiIge. social, behaviofal. ;n;i ~ dornins tnt hm been dorurnmted in the peet'-rwiewed lit@ratl,l'\!..' The use of ~ trained and wei'si.ip'i 01Sed lieh<morai Tedu~ is a oommon poactice... ABA IlNtmenl. u The use of Ilehavior1II Te<hniciarlS enables health plans aoel insurl!l's MSiJIl! that they mafntain adequate prcmder networks and demf rntdically roeamary IJNt~1 in a w~ that ~ =U. The use 01 8ehiMoraI TMvwlans produces I\'lOI'e oost-effectm! MIl oi5ei'via! kit the rura- 60n of treatment because it alows the ~ Analyst to!tioji'iq rnrn ~ of direct v"""'"' The use of the tiefed service dei~ model permits sufficient expertise to be dei~ to each c.hi! at the ~ needed to reach treatment goaii.. This is cri6cai as lhe Ievej of supe!vision requftd may need to shift rapidly WI rt'si)otise to rapid cierll progress Of de< '1OIlSbated need. Toered servo ~ modeb can helpe't5ure 1hoJt!leiltlnrnt isdl!iooel1!d 10 famie in hard to aooess rur"..-.d I b<in areas as IM!I as fmniies who him! WfIIjlia fiftds.

113 The BCBA iiild BCSA-CYs dri:al SIJI)efYISOfy. MId c.t5e I'!IiIOiIgemI!n actm\je5 olri! oiten 5UppOfU!d boj othef staff suct11s BCaSAs woru'>g 'Nithin the scope 01 their traliling. pr~. ~nd ~ ICe. Below is one eumple of this ~fic tiered service delivefy model. an apploach considered COSIeffective at delivering desired treatment outcomes. BOARD CERTI FIED ASSISTANT BEHAVIOR ANALYST --- Such models assume the foiowing: BEHAVIORAL TKHNIOAN A BEHAVIORAL TEOiNIOAN """""' ~-...t poioaii 1. The BCBA Of BCSA D is responsi)ie for ai 'sp«ts of cheal directoon. supervision. and c.t5e management. WlcIudilg activities of the supporl staff (e.g.. a BCaBAj and BehiMoraI Technicians. 2. The 8CBA Of BCBA-D mu5i haw! ImcwIedge of e<idl pefsoo's ability 10 tffectnely carry out iictmties before assigiing them. 3. The 9CSA iiild 8CSA D pn:mdes c.t5e supervision..mich rlijst nch.m:ie ~ f~lo-f.ace supervisiofi oti a con5isient basis. rtg diess of ~ Of not there is clinical soppori proyided by a BCIlSA.

114 2 Selection, Tra ining. and Supervision of Behavioral Te(hnicians 8ehaYIoriII Tedncians 5houId ttifet specific 0'IIeria before prowling I1NImMt (re/ef 10 Sowrde Background IIeqw'ements on p. 27). C_ assigovnem ~Id match the needs of the Qent with the skloieyei and ~ of the BetIaYio!a! Tedncian. Before 'oyoi1mg WIth a dient the BehiMoroJl Ttd'tlidoln must be sufficiently prepa~ to ~ the treatment protocols. lbs r.dudes a re-.-itw by the Bthavior Analyst of the client's history. current tteatment progoams. behaviot reductiorl protocols. data ooileaioo procedures, etc. CaseIoOOs lor the Behavioral T~ all! ~ermined by the: - complexity 01 the uses -aperience IIOd skis of the 8elVlaaI Technician - nurrber of hol.n per week fttlpioyed -~!emity of tu.n of tmrapy the dent is recermg Q\.0fty of impiememallon (trntment integrity ~ should be rnonrtored on <HI OIlgOItg ~ TNs should be rt'icn ~I lor new SLJff, when a new dieni is as:signed. Of -MIen a client ha5 chaueoging behaviors or tompiex treatment protocols are ~. Behavioral Te<:hnicians should receivt direction on the introduction and revision of treatment protocols on a weekly to moothly basis. INs activity may be in dient briefings with other memberi of the treatment team foch month. inc:iooog the 5UpeMsing BeNvtor Arla/ysl or individually, and with or without the dierrt prese<'1l The frequency and forrm should be dictated by an ana~ of the treii!mefit needs 01 the dienllo make optimal progreso Whie hinng quaification5 and IMIaI traiiwlg an! ~ then> mun be OItgOIIlg ob5erw. bon, traming. and supemyofl to maontain and ~ the Behao.1oraI TedncioJn-S stili whie inpiemenmg A8A~ ~

115 sample Tra ining and Job Requirements for Behavioral Technicians: Background Requirements Q High sdlooig<aduate (minimum) Q AA degree (preferred) o Pas~ criminal Mck9l'ound check o Pass TB test Initial Tratntng 0'" Q HIPAA o mandated reporting, problem solving and ooof);ct management related to empklyrnent o ooofidentiality and em;cs Q ASD Q d_lopmental milestones Q data collection Q bask ABA p(()cedures such as reinforcement, shaping, prompting, etc. Initial Competency Demonstration Q correctly re5poi1d to written and oral scenario!; Q demonstrate abdity to corrktly respond to tjmtmerlt protocol:> ii!; evidenced by dirkt observation and written eva luation Sample Duties o implement treatment protocols Q collect and summarize data Q implement feedback delivered during live supervision and from wril1en evaluations Q satisfactorily pass treatment imt'9'i!y checks and ongoing evaluations Q al1end client stallings and trainings SuperVISion o frequem diffici observation and feedback during in~ia l employment period..men being a:>signed a fli!'w client, and...hen w:)rlcing with Sl!Yere p(oblem behavior Q ongoing supervision and training

116 0- SECTION 6: CLINICAL MANAGEMENT AND CASE SUPERVISION ABA treatmerru; an! ~ described., temls 0/ tilt no..mbef of din!ct ~ Inn pi!f v.eet.. Sometines ab5ent from sud1 discussions IS.efeeoa to!he requftd Iewt! of dinicai rnanagi!itleol and case ~ by the BehiMof A.oaIyst. Super.;sion begin!; with ~t and contjnije5 through dischilrge. ABA treatment requm o:>rnparat~ high Ieo.oeI5 01 supemsion because of the indivdjalize<i nature of treatment, its reliance on frequent coi~ and analyses of 6eo1 data, and need lor freql.letlt adjustments to the trntment platt TN!; se<tion wi describe the Clinical MaMgemen1 and Cas.!! SupeMsion <I(tiVities that are individuajired for the die<n and medically ri@c~ to achiew! trntment goals. Roubne ICY actmtifs thai would no! be ditectiy biljbie are no!: inck.ded hefe. 1 Clinical Supervision and case Management Activities Clinical manageml'ut and case ~ actmues can be described IS!hose that ~ oontac1 'Nilh the diem or ca~iyers (direct,) and those ti'0t do not (indirect). some octmties are ~riy clinical in nature, while others are more related to case mar.agemem. On il'rragot. dia!c1 s.upervision activities comprise SO'*' or more of supetvision; both direct and iodilea supemsion activities are criti <ai to producwlg good treatment outcomes.

117 Conducl ilssewneo1s ~ treatment 9(l<11s. po-oiocciis. im1d data coiecbon systems 5ummar~ and aoil~ data' DIrectly obsene treatment Meet: im1d eyaluate performaoxe of BehiMorai Technician staff fv.jiuate ~ pnl9'es1 towards treatment goai5 ~ irnplerrlefltaool'l of uwtmenl Adjusl llhlmenl po-otocoi5 based on data Monitor lie.l1ment integnty Traon im1d cor!$uit WIth c.anogm'f'l im1d other professionals Evaluaw: flyc management im1d CI'M man.agement Enwrl! WbSfactory ~tion of treatment po-oiocois RPpOrt progress towards treatrnent9(l<11!. Respond 10 changes on dent health or Sltuatoon Develop im1d 0'0'I'I'SH tral'lsltlclllo'di plan

118 1 Modality Some dini(al management and case supervi~ activities occur fac:e to fac:e; others can occur remotely (e.g. through telemedidne). H~. whenever possible. telemedkone should be combined with some "face 10 face" 'lupervrsion. In additooll. depending on tm s.ituation. some tralnlll9 of CiI"'9M!fS and treatment updates may occur in srniigroups rather than in an individuallomlat_ Finally, some indirect case ~t iktmbei are ITIOA! ~feclm!fy carried out in YenUl!S other than those used during the KtUoli treiltment ~. 2 Dosage AittJov!tI the amount of supervision b each case roost be respous;1'i! 10 indmduai client needs, 1-2 hoi.n for --r 10 hours of ~ treatmef\t is the general standard a/ car... When <in!ct treatment is 10 hours per v.o!ek or less. a mnnurn a/ 2 hou~ per WI'eIc of dinic.ji management and case ~ IS genet'aiy ~_ Clinical ~ and (a e supervision may need 10 be temporarily irlo'nsed to meet lhe needs of individual clients at spedlk time period5 in treatment {e.g., intake. assessment. significant change in r~ to treiltment}.1 Thio; ratio of ~ management and case supervision hours 10 dr<1\r!i1tment hours refleru the Cl)I.opIexitycl ASO and the 1eSj)OfiSive. individualized. data-bilsed deci5ion-makii' which ~ ABA treatment. A nunijer cllaaors ro- or deonse cheal ~ and ~ ~ needs on a shorter- or longer-term basis. These M.de:: treatment dosageiinte<tslty diem behavior prooierrrs (f3pkially il dangercous or dewuctivel the ~tkauon or wmpieaay of trntment pro!owb; the ecology a/ the fanwy or communoty I!f'MrOmIent lad of progress or 0'ICrea5ed "'Ie of progtes dianges on treatment protocols trarmloi'is With impiic;jtoom lor aln\lnuriy of care

119 3 Caseload Size Caseload ~ for the 8ehaYior AniJ1y!;t is typically determined by these same IacIOfS and reflects, number of hoojrs of treatmeot Ndl doent ~ recerving kx;ation and modality of supen.i5ion expertise and il'l/allability of support /(l( the 8ehaw:w An.l1y!;t (e.g., 11 8C1IBA) The _age aseload for 0I'lt (t) 8eh.Jvior Analyst supeooising ~Me IINUnent ~ support bya 8GJ8A ~ The ilyl!lagi! caseioad for one (1) Behavior AniJ1y!;t supervising com~ treatment... /h SUfJPOft by one (I) SCaBA is 12 - t6. Additional BCaSAs permit modest ~ in caseio.lds. The _age caseioad /(l( 0I'lt (1) Behavior Ana1y!;t superyi5ing focused tr@(itment "";!hour support of a ~isto I~. The ~ as'!kw for 0I'lt (I) Be/l,)yior Analyst supenising Iocused tr@(itment..,,;dtsuppooalg'le (I) BCa8A is As stated earlier, IMn ~ there is a BCaBA;migned to a cas/!, the Behavior An.l1y!;t is ultimately re5poi1sib~ /(l( 1I11l1$peCU of cas/! mar.agement Id dirocal direction. In addition. it is expectf'd that the Behavior ~ will pro.;de arect supemsioi1 2-4 ~ per month.

120 BEHAVIOR ANALYST Qualifications Q BCBA-MCBA or License f1 related IitId Q Competence in ~ and de\e'l'p'19 ARA tjeatment programs for dmt1.wh ASD" Responsibilities Q Surnm.Jl'i2e and analyze data Q Evaluate diem progress towards lfeatment goals a SupeMse implemenltltion of tmtment a Adjust tmtment proiowis basfd 01'1 data a Morvtor trmtnent integrity a T~ and COI"ISIJI Wth caoegi..ers and other professionals a Evaluate risk. ~ arw;i om mallilgel'!'lmt a Ensure sat;,;lactory impiementa60n of tmtment protocols a Report PlOQless towallk tmtmenl goats 1:1 DewIop and ~ trallsitia'lldisdwge plan ASSISTANT BEHAVIOR ANALYST Qualifications a BCaBA (preferred) Responsibilities a ASzts BeI'Ia>mr Ana/y5t f1 Yilfious rdes ard ~itin th determined appropriate b'j' 8ehaYior ANIyst and delegated to BCaBA

121 SECTION 7: WORKING WITH CAREGIVERS AND OTHER PROFESSIONALS 1 Family Members/Others as Important Contributors to Outcomes Famitt mernben. ini:b:iing ~ sllii'lgs. and other COI'JV'I'IUI'Wt GJregn.oetS shouki be ~ WI various capacities and at diffe<er1t points diri'ig both foclmd and CO!'npreheftsiy ABA treatment programs. In addition 10 proiiding important hinol'lcal and CDnt&lual infon'nation, tml!9iyen must receive trainil'lg and wnsulultion IhlOO9hout liniment, discharge, and follow-up. Treatment targets. proiocois. and deterrrwlatioi' of ou\c()roes should rtilkt the i'ld'rvidual dieo1 as ~ specific ojsp!ds of famitr He. The sogrlflcilllt dtficn and excess btil&yiors that usuaiy ~ a ~ of ASO Inp.)ct the family's fulctioo,;"g and the health of ai of its members. 1Il~, the dient's progress rn.jy be el~ by the e>(\eilt!o which ca~ support lleatmenl goals outside treatment hours. Their abil~ y 10 do this will be parlilllly dete<mtned by how well matched tile treatment protocols all! to the fm'lily's own YilIues, nhds, prlorities, iiod reources. The r'oftd for family ~ trai'wig and suppori reflects the 1oIowing: t:aregiwn frequently haw 5pI!CioJized information about the dimn functiooog, Jnf«tnces. and behimoral MIOfy. Qrtgivers IlliIY be ~ forllf(lyisiorl of ate,~. and deaii'lg with chaler9l9 ~ dlmg ai wad\g hour.; owide at school or a diiy tlhtmem program. SOme pe!wiitq d inciyiduati w.m ASO pre5ent v.i1t1 Jt)1)icaI sleepi: 'Y p;rnems. Therefore, some ~ may be mpomtie forenwmg the wfetyof their ettie, iiildior ipie.'i'iei.tilog pnxedures at nighl iiild may. ~ be al risk for probitrns olssociated with sietp ~ C.,mg for an fldmduai with AS!) ~ many challenges to caregivm; and f" milies. Studies haw documented the lac! thai parmts fa chiid~ and ac1j1t'l with ASD e~ hoghet!ellell; of Stte5S than thole of parents with typitaiy dew:lllpi '9 diti",, or ewn piiil!f1ts of chiido"" e."')1..\ WIth other knds of special neec5.

122 The beh.j>ioial excesses commonly encounten!d...,th pmoos 00gn0sed 'Mth ASO (e.g., I!! ~,nonfuoctionailleh.lviot wch as I'OCal or motof ~tereotyp)') and behavioral challenges (e.g.. tantrums or aggreswn) seoondary to the social and language delkits associated with ASO, often preseflt partiwlar challenges for ca~ as they attempt to manage their behavior problems. TI1)icaI panonti1g SUategoes OIl!! often i'lsuffocient to..vble ca~ to ~ or manage theoi child's beh.lvior, whodi can impede the dms pmgres5 tonil!ds ~ IeYeIs of functioning and irldependence, NOte that while family triiining is ~ of the 0>'ffiII treatment plan, it IS not a rep1acement!of p!ofeuionally dif@cted and,~ted Ileatmeo1. 2 Parent and Community caregiver Training Training is poiit 0( both focused and C~ ABA treatment models. Although parent and caregiyef trh!ing is sotnetor!'ots delivered as a stand.llone" tteatmeo1, there are ~ few cienls for \'ooom this would be recommended as the sole or primary form of lleatl"ntfll, This is dlje' to the severity and complexi\yof behavioral excesses and clefocits that can accom pany a diagn()$is within the autism $ptciri..m. Trainrog of par«iis nt other caregivm usuaiy iiwot.oes standard, but iromualized. CI.mCUk.m regarding the basiao/ ABA. TrairwIg ~ skib denl ';Ai... n and 5UppOI"I ~ thai ~ becai",~'1 in implementing treatment poottxols iiu05s 0"I'licII enyiolmei lis. Training usually invi::o/iie an indiyidualized behimoral assewnem, a Col5I! formulation, and then customized didactic: presentatiorls. modeling and lil'nloilwations of the s>:ii, and prilclice with in viyo~ for ~ ~ic skit. Ongoong activioe5 ~ ~ and COiIdWlg do..omg ~ pooblem- ClJrr/culum rv:garding rm ba.i" of ABA. solving as issues iirij.e. and $I4IJlOI11of.,opIeo'IeI'tabori of strategies in new~ 10 en5ur' opti'nai gains and POOl'iOIe general"aation and ~ of thefapevtic ~ PIe.lse note thai wch training is not aoo;mpiished by 5imptf having the caregiyef or gwroian pmef1t during treatment. t., {"

123 3 Sample Behavioral Targets The following are common behavioral targets for whii;h ca~ often seek assistance. Note that caregiller training lor t~ targets is typiaty in COIiunction with a Focused or ~ ABA treatment P!O!1Im for these same behimoroli targe!$. GeneraiuUon d sidi!; ao:p..ond in ~ settings into home and commurwty 5etting5 TrNtmI1flt d co-occurring behavior disorders that risk the hnith and safety of the chid or others on the home or community setu:'lgs, including reduction of seif-injunous or aggressive behaviors ij9airrst siblings, caregiwfs, or others; establishment of replaument be!layioo which are more tff«the, ;)daptive, and appropriate ~ sidi!; IriIirWlg 5UCh as functoonal ~ PiJrbOpatlOI'1 in ~ wiich help mantaln good hnlth It-9, p.ytq:iabon in dental and I'rleIIcaI t>cm'is. feeding. sieepj newflg tatgtt StttW'195 where it is orticai thit thty 0WJr (0Iltingtnc)' managemtnt to redllct 5teo'tOtyP1C. ritualistic. or ~tne bthaviors and fvnctiorlil repiactmtnt behaviors as previou9y described 4 Program Components TI'is should be a ~ approach that indudts didactic instructjon lor ~ and farrily ~, including wtien M<esxny e~ /amiy ~, modeling 01 pmcedures by Behavioral Tec:hnician staff and ~pemsors, and hands-on training with "'regiven [Including wrbal expta... tion, modeling, roll! play, in yjyo practice, and feedback,l. SupervISion should include jn-yiyo ob5ervation andklr review of 'o'ideotaped ses5iorrs and ~

124 5 Coordination with Other Professionals Consultation with other profes5ionijls helps ensure diem proqre5s throoslh efforts to coordinate care and ensure COI'lSIStency 0ldudI0g diiring uanwon period!; and di5dlarge. Treatment goals are most ~ to be~ when there is a Wred und@ntandingandcoordination ii<tlcii'l9 at healthcare ~ and proiewonais. WmpIes indm:ie coiabor.itoon betv,e~,!he presoilrig ~ and the BehavIor Analyst to dewtrr.1e' the effl!ru of mediatoon on treatment targeu. Another ~ inyoiyes a c:onsrsteni approadl aoos.s professionals from different oisopii1es in how behaviors are managed acmss environments and settings. ProfesSlONl collaboration that leads to rornisten<y "";11 produ(e the best outcomes for the ctient and their familles. Differences... Ihforeucal orientations or profes.sionai $tyies may ~ make this di/foa.ft. In adcftjon.. reviews of _n:h on purported ~ fof ASDs '-deo'loilstriited that there are a number of u~ l"ie'f~tne and sorneti"iles dangerous treatments for ASOs. ~ $UdI treatments are presoijed I1f some Pfofessionals in combination "";!h ABA. Some research suggests such Pfactices may result in Ie1s effectm> outcomes th 1 rroghl otherv.-ise be achieyed. Consutt.tion to resom! sic}nificanl differeocts that ur'ldernwle the benefits of ABA treatment or any ~b.jsed treatment ~ be piioritiad. The BACB Guiii4te- lot" Re$pOtIsi:l/e COr"IlUr lot" ~ ~ts ( Behavior Analyst to,econvnend the most eflectiye s6entificaltj supported UNtment lor each dient. The Behavior Analyst muo;! also review and ev~uilte the likely effects of ahernative treatmf'nt5, induding those p.'o>'ided by other disdpiines as well as no treatment. In ~, Behavior Analysts refef out to profewonals from other ~ when there are diem cond"ltions hi are beyond the IfiIirwlg and competence of!hi! IIehaYIor Analyst, or where wordn.ltoon of care..wto suc:h professionals is appiopiiate. &.lmpie5 ~ ino:.de. but are no( i'nmd to. ii suspected medical CDnditIon or psyo:hoiog.c.ai concems reiojted to an aruuety or mood ~.

125 SECTION 8: DISCHARGE. TRANSITION PLANNING. AND CONTINUITY OF CARE Transition and discha.'ge plar1llirog from it II'NtmI1nI program 5houId R:IucIe ~ wntten plan that spec;.. f.es details d monitoring and IoIow-up as G ~ lor the ildmcl.0l and the famiy. Parents. corrmunity aregiwn. and ocher ~ ~ should be ~ iri tilt pia!ywjg process 3 6 ITICIflths prior 10 the flfst dlange iri service. A de5cription of roles and respon5ibilitje of al po'(mders. effectne dates for beh.jviotal targets that must be achieved prior to the next phase, siloold be specified and coordij'\aled with all provider~ the dient, and family members. Discharge and tr.if'isiudi'i planning from allintmi!ni. programs should generaay irm;jmo it gradual nep dcrnrl in semces. ~ge from it ~ A8A tteatment program oftt!n requr5 6/11Ontta ~,,-. Discharge The cient no longer meets the diagnosbc cnteri.j for ASO (.Is measured by appropriate stan dardited pi'(l(ocois} ThE' dieol does nol demonstr~ progress tcmtards goals for ~ authorizatloo periods. ~ mere.. ~ about the ilpplflpriarmess Of effacy of l«\iices,!he procedt es 5ho4Jd berel!eo...ro by", ~ pntejoi8ehi'nia ~andodu ~ ~ ther'e_ issves aboor the ~~trni!ss Of effigjcy d senoices., In ~ =e. inwding ~f 10 ~ metnai Ofe>'l&T1.lllllJPH/lMing to~befle6ts. fhe~ body ~m.oe~r8y f 3<l quatfied IJoiNd Qrtifi«1 BehaMor Arr.l 1S.

126 APPENDIX A: ELIGIBILITY REQUIREMENTS FOR BACB CERTIFICATION BCBA Eligibility Requirements A. Degree Requirement Possession of a minimum of.. bao:tieior"s and a master's degree that was confl!fred in behawjr arwlysis 01' other natural yjence, education, human semces. engineering. medicine 01 a field relatl!d to behav ior analysis aj'ld approved by the BACB from an accredited ilstilutioo of higher I!ducation. B. Training and Experience Requirements Option I: Coursework 1. Coursewotk: The appiic Tt must complete 225 cl1sstoom I'Iourl of gr~ level instruction c- AmopCabIe CoulSe'>'o01c beiow\., Iht foioy..;r-q wntent areas and for the ~ 01 holm-5 spedlied: a. EtI'icaI coorsideoatioos 15 holn b. DeflMion & characteristics and ~Pno~_" '" proc:!mi5 & concepts - 45 I'Iourl c. Behavioral ~t and Sf4«ting intervention outcomes & strategies - 35 hours d, E~ ta l eyilluation of int~tiom 20 hours e. Measurement of behayior and DISPlaying & interpfeting behavioral data 20 hours f. BehiIvior.II change pro<l'dures and Sys~ ~pport 45 hours g. D&n!tionary. 45 hours 2. Experienc:e: In~ "" """" Practla.rm...,... '-...

127 Option 2: College Teaching 1. College Teaching: The applicant must COITflIeIe a one ao::ademo:--ye. IIA-bme flkulty awoa,bl ipo,t at a college Of u!'iivemy IoJs de5cr'bed.. section A aboiie) dun'ig which the applicant - T~ classes 011 basic pnn6pies of behavior. single subject research methods. ~ of basic principles of behavior in a~ied l!ttings. am ethical issues; and - conduru and publishes research" behavior analysis. 2. bperience: same as the Cou~ option (1) Option 3: DoctoratelBCBA Review 1. Ooctor.Ite Degree: The appic;ant OTlUStilao.oe a doctooal degee. conferled at least ten (10) years prior to applying. The foeld of study must be be/lavoor analysis. ~y. td.ocallofl Of another related field (doc::1qfa! (!egret's " related fields are sui:l!oo 10 BACB approvai). 2. BCBA Review: The a~icam OTlUStilao.oe 10 years post-doctoral experience in behavior analysis. E~ must be...erified independently by three Board Certified Beha-.ior Analysts (BeBA!;) and supported by information J)(OVided 011 the a~icaot'scufricuh.om VItae. BCBA-O Eligibility Requirements The 8CSA-O is a de5iijriation!hit recogtiizi!s doctofai-ievei BellAs who: 1. Are indmduais who are ~ certofied as a BClIA; ANO 2. Are individuals who haw! Nrned a doaorate deqree in applied behavior analysis, other human services, education, scieoc:e, medicine Of other field approved by the &ACB and strongly related 10 applied behavior analysis, that was conferled by an accredited unnefsoly; ANO 3. Are indiyidual'i who: a. Used gaduath!w/ urwemy colfil!yoork. (U1::en for gack>ate academic. aedit) 10 quaify inotiaiylorthebcba;of b. 1ia>Ie taught 000JrWS " behavior IIIysis on a uov-.ersity program with a BACB ~ a::ourse sequence fui..\ji'm for 1\ INs! \WO years; Of 40

128 BCaBA Eligibility Requirements A. Degree Requirement I'o<w5sirv! of " ITIIIIIITIUfTI 01 a bocheior's degree mal was conferred in ~ al'\alysis Of otili!i' natural science. fducatiott. human -. tngll'm!eo.g, ltoecit:ii '" Of I field related 10 behojwiof analysis and apptoo'ed by the BAC8 from an acoedited instrtuljon 01 hoghef education. B. Coursework and Experience Requirements 1. Caurstwork: The appiicam mu5t complete 135 d.mroom hours of rntruction (see Oefinitiofl of Terms below) in the IoIowing content areas and for the number of holn ~oed : a. Ethocal c:onsideratjons - 10 holn b. Defillltion & dwacteristics and PI ir lciples, processes & COl r:epis - 40 hours c. Behavior~ assessment and Selec:ting in~ OU\altTle'; & strategies - 25 hours d. Experimentaj evallliltion of inter.oemicw, & Measurement of beha".ior and Displaying & intef ~ behavioroll datil - 20 hours 2. ExperielKll: 1000 hours Supervised Independent _ Fieldwork.. (non-..-srty bi6ed): 1 boweeidy~~,- 67<1 hours Practlwm... (~y bo<t\ed); SOot,O"" Intensive Practkum (..-srty based~ 11~~ """" f 4\

129 APPENDIX B: SELECTED BIBLIOGRAPHY Cohtn. >I, AtnerirIf oo.ns, M, A StrW>. T. (2006). Emi In~ _ In. 00<MIIJIlIty "Iling. a..'... _IUI ~ 27. $145 $1$5. a-.r.. So QOO9I. 00II00mI '.. _... Do."",.. IUI"""!.~ &.. IfHtlNnl: ~ 01 tile l.icla mocioj... ~ i,,.,... _os 1or)lOU'lt chiidom """ _!Itst<Itdo EiUst1h. S. SnwI\. T, Ww. L. A ~ S. ( ~ _ M tdood lor'" '" 1_"'*1 cioiohn..o.h.. ~ A l_","""",-,,,,,,tdod otudy._~ 1' EIo:IeYiI; S, HMtW>gs, R. P. 1Iu!II'>n. J. C. Ho/W, E. E~ S. A Crou. S. (2010).lJsiIIg... tidpml data 10.._ ~ ~ for inim!nf btnwior.. ~oon fur chijdrtft with fvii>m, AmerUo JtNrr4lCtl ~ II'Od ~...-oioiwbiiiles. 11~ 381..tOS. l-*. s..1iooiongs.1l P...,... J. C. liiw. L.!iI<eo1h. S. 6 er... s. QOO9I. ~ 01 NtIr 0'IIffWM ~.1tII<.. _,b JtNrr4lcl~QWtJ >dad<jo... '~ 3S..~50. rou. R. M. ClOCla.~ _~ """, Tho.wool... or\. 0tItJ ~ ChUclNMhAmfrQ &l4. GtHn. G. IWMan. L C. A f... D. (2002). I"~~" ~_, fur. 1Odd1fr.. t.gio risk!or ooutiitn. UvMot ~K69 102, Hdty. G. P A. '" MCCord. Eo QOO~ Fo.nt11orwoI...,..oI ~ w--: A~. /<NI".JcI AppIifd _~J6; 141 1U ~ S. ~ C. R. Cohen. H. G. Gt-.. G. '" SUnosIow. H. (2005). A ~ 01"_ bokivioo- Irti<... odkti< tih""'-os lot ~ diildo'" with 0UlIIM. _... ~ '1""".. olm~ 26; 159 l81. l... _ 0. L (1987). ~.. _""."U and... _... and ~ fuolctloo.'iiin ~ OiIli<bC <ti<h<i./l:j<.lrrylclc-.«i'i9_~~ S ~ ~ L Ber_i<Ib:. D. A. ~ L S. ~ T. ' Iigkl C. (1996). w-..1rnin'ioni "'... 1ir; ponons: A_oI oeonjdilrom 1980"'... prestfil.-.tt... OrL I,,.UlOju/OJ!>os 11, McEodwI. J. J. ~ T. '" """- D. I. (1993). Lang... out:omi lot.. wn who oe<ened NtIr... _...""... AonftirMt./l:J<.lrryl "" J71. SoIIows. G. 0. '" Gt_. T. D ). In_ ~" lmlmotll lot chijdrtft with MlIOSm: ~ 0</II:6"ne tnd poedicloo!. ~ JQ<.n>oI CtI"""'" ~ 11~ ~L(201~AI>P'td~ONIyloc...,..., ~Ind dol. '_ WJ/ltId"'...--.QoIoa/1'rfdooIof11-...r.)Q b""" In Ntlrd"'_~_ tile

130 APPENDIX C: FOOTNOTES I Tlvoughout 1hk documt<o! IhI... AutiItn ~ DiIorder (4SO) is IlIOd \0 rmr 10. O<OIIP of rompio!c ~ <isof<ier!, m.t... -""",..,., os AuIisIic DGordo<.,... Do!' olc;>_,tii DisotdtI' Not 0chtrIMse ~ Aspe<go<'s s,.o... /tigi'i "" ,. AuIi5m....,... '1ht Diogo_...:I Sgt,s.\QI MonuoI ~ _ 0iI0fd0rJ ([JSMI 0I1hI-'"...,..., A.ssoc:iooon ;. ~ lng -- rmion,... IhII)SM.V _ lot po.tiioijon ~ 20.). Aca:rding.."'" pubk...-by IN _'ond~. ~ ~ ~!he term.~ s.,.an.n ~ wii be U5O'd 10 dnoije 1hI... "... u:.li>wd "-. Tho prtoftii gudftnft... irmndfd for ~ ~ "'"" DSM-V -.. b.t.so Of """" _... _. I foruied... C~ AlIA nisi on. _... wi'itio rtfit<... """*'"' of \IIlIfI bei\iyion and... of cline! Thnt >\ COhiptlt"IIO..n-w< ItUt"*"... ond... oilen ~ lei by.1iirieiy of _ ~ ~ tht<jpist _ ~ ~ MCW, OIdftclhltlf1. 1htv...-.g..t~dW-.1ICh""'''_'i'''i _'' dislntdr~ from _of-'_po<bm~ ",""bono. _ ~. _or... l~... oi~ ~ ID Ndl coot in _10 P"'f"OIe IJO"O"... rod IUS- UIintd 1JHIJI'ItfI, btntfjls lot "'" dit<lt TM... ~ ~ I...,.. in trnllm<ll.iio<.n _10,WI InN. ~ -aobil)l. ond _. t1(. I"~. ccmp_";" _.mont _... ""'I' '-' 5...,." Tfd'Ino<iIn<""9'fd 10 I <ingr. cas.. Eoch... T_ ""'I' IIIowart wkh _.. cmnu ICIOU tho_. ' '" on "'" "ff(ij of rn. i'icimdjoi doon\,...,... T~ ""'I' tbo ~ II'JII'IOI'I9 In (CO l......,... ris&: ~ ptog'_ b ~...,".g. CPIOI. CIccIsionoIjo. ~ Tedww;iono,.,.,. _.. bekjo8aob... _oi.-...g_... ~_... 'Giftn tho fiift'do\y oilt-._..."-'_ 01 It. dill.-.d tho \IeItmot1\ pion... JIHded. Tho IItNooicJf AAI/rSI ~_..,teyitw~da!.oat... I-'<I\'. '. _ that dn(! _!IMI11 ord dtiicoi...,...;sion ore f_l~ <ItlW<ed "" \he...,. <loy of...,;,;" oro... bo\i1 tmi "'!e<yql1or Nt dirjo, Y3

131 Development of the Guidelines The SAO Board of Directoo iiu~ the deveiopmerl\ of priktkt guidelines fof ABA trtatrntnt of ASD<O>'tI'td by health plans. A~was IppOinted v.tjo then ONted ii r~ o.oer. sightwmmmee that deqitd the IMfiIII dp.r' 'I~I\ ~ and COI'IItIII outline. The IM!f5I9ht rommiuee then soiicittd ilddita\:1l conteni-area leaders and writers Ifom ii national pool of ~ that inc;luoed researdlrr$ and pri!( l ~oontrs 10 product a firsl draft of the gu~ints. The roordinator, O\!efsighl tommit\[email protected] SACS staff then gtnerated a serond draft that was A!Yil:wed by ~ of additional reviewers. wtw;h n ijddition to beilg oompnsed 01 experts... ABA. also WIduded (OIlSUfTIers and fxperts'" public policy, ThosS«Oi'ld ~att _<lisosenllo alsacs <ioectoos for iidditjonal "'put. The ptqect ooordi"oatdi' and SACS staff then used this IeeIb1ck to pro6.xe the final docurntril, which was approwd by the SACS Board of Olft!Cttn. The proftwonllls...me serwd as Cl)()t. dir:iilor, owrsighl mmmittel! members, con!l'ill arta Ieoadefs, conll'lll woilef$, and reviewers W!!i't ji~ ~ mall"," expms in ABA as evidenced by po.obiic.a\lol'l reams, subs\lll1tia1 Dpl'Iieo ICE' proyiciirog ABA strw:es. and IeiIderYop positions ~ the dlscipiio It.

132 - JI Behavior Analyst Cen.iflcation Board 1929 Buford IIou\eYaO'd T~.fl t: 8~-76S 0905 F: 8s.o flfoobacb.cofn

133 COMPLAINT FORM CONSENT ANO RELEASE This form n.i5t be completed 'AfleneYef Iha BACB i'iyesiigates ~ COITl'Iain! 1haI involves Iha ixoyision 01 services 10 an adutt, 1eg~1 min«and/or Incapacilated individual (collectively referred 10 in!his loon as Client). In accordance with HIPAA Privacy NoIice requirem&nts. Iha SACB may be Iimiled i'i its conduct oillvestigalxlns Wr.o/WIg Iha provision 01 ser.ices 10 a Client. By signing below, you agree 10 the BACB's investigation of the Certificant named in the complaint. If a pwenl (I( legal gllmlicwl, you agree 10 assist!he BACB by provi:ii'ig )'OUr CORSenIIO lreatmenl raciities and professionals 10 release to the BACB any and a,! i'llormation relating 10 the provision 01 services by the CertiIii:a1t named in the complaint. If \his form is noi bei1g Ned by a pareni or lap guatdicwl, I*ase pio\'ide a oopy 10 the parent Of legal guardian for lheir completion and submission 10 the BACB. At anytfme during or following an investigation by the BACB, the BACB may, In its solo discretion, comply with any state or IederaI agency request for release 01 Iha facts of the investigation and det&rminaliln(s) by the BACB. By)'OUr signature below you consent to and wami any dalms br liability against the BACB for the conduci 01 this i'lvestigalion, the final delan'nilation, ard the release (disc:los!e in any manner) of information in'dmg the ixovision 01 services to Client. You expressly understand!hat the SACB may disclose your idef1tity, the identity 01 Client and Certilicant. and the outcome of the maltef, if such information is required or requested by any state orgoyenvneotofficial or agency. Name and address 01 till BACB ceniflcanl tiiat provided services to the client ("Certificarui : Level 01 certification of the Ceftiflcallt - circle one: Board certified Behavior Analyst ("BCBA1 or Board Certified Asslstan! Behavior Analyst ("BCaBAi Of Unknown. Date(s) sefvices provided: Date(s) lila! islare the subject of the complairu:

134 Name and address of employer of the Certilicant QrlCtude contact names and numbers. if known): HilS I complaint been filed with a stale agency, govenvnent official professional organization, andlor!he Certificanl's employe(? If yes, indicate below the parties complained to and the outcome (attach any official docl.mentation, including a copy oilhe complaint, findings of fact and final determinauon): Yes No If ~ Yes. " describe who filed and received!he complaint and the outcome thereof: Name of Client [If you are an adult): If Client rs a minor or incapacitated individual, provide Client's initials with the name of the parent Of legal!jiardian next to initials of Client: Address and contact information for Client: SACS Disciplinary and Ethical Standard alleged to have been violated by Certificant (check ar that apply below): o 1. Ineligibility for certification, regcw'd1ess of v.tlen the Ileigibiity is discovered; o 2. Any 'o'\oiatk)o 01 a SACS rule or piocf!durii, as may be re'tised from lime 10 lime, arw:i any fal.ire 10 prowse inklrmalion requested by BACS, Of to update (\YittIin thirty days) inlormatioo previously provided 10 SACS, n:ludi1g, but not limited 10, any fawre 10 tmeiy rii90rt to BACS an action, complaint, or charge that relates to any of these Disciplinary 5taodcwdS; (rrbjr edt (0 reiiet:i diatges h<rjimg III SI8ndarrJs) o 3. UnauthOfiled possession of, use 01, distribution 01, or access to a, SACS exams,

135 b. Certificates, c. logo of SACS, d.trademarts and abbreviations relating thereto, nduding, but not Uniled to, misrepreseotaoon of self, proiessioria ptadice or eaca certffication status, prilr \0 or following the grant of certification by SACS, if any. fndmduais not reniied by the BACS we exjnjssiy ptohljied mrn mistepresettng that /hey we BACS cetti1ied IS eithet 8 BCBA orscam Of misn!presentingeligibilityforbcba f 8CABA cettiicaiitxt h:jxing ~ d s6niw desitpiiions desifp!d to;,py BACS cenificdfion Of eiigibifity S/8tus. This rui8 will be enforced '98insl individuals who have v«jualed from II certhicate IIWafding «IucMionaI pmsnm. who an not entitled to rt!pfe5eflt BACS cerriric.jtion until such time.js they life certified by the BACS. AppIcafts for ct!tt icatbn..no have prev;wsiy liislepesented BACB certiflc8lfon Of eifgibiiity S/11/US may be subject (0 8ddiIioniN fines.jnd penaiies (S5IXJ for e.jch fxai1"eik:i!) for /he ~ pfia (0 axrsider8tion d {/Ie; certification oppiicalian: 8fId e. Any other SACS dcx;uments and materials. f. ",scharacterization of inactive status, and/il( any other ilaecurate representaton 01 SACS ceriifk:aiioo status. o 4. AAy examinatiln iregu\a'ily, i"dudi"lg, but not imted to, oopying answefs, pennining another to copy IWlSwers, disrupting the condud of an examination, ratsif)w"g iliormatioo or identibtion, education or aadenlials, pro'oiding a'ldior raceiying unauthorized edvice eboot exam rontent before, durilg, Il( foioiwig the examnaliorl In addition to other auihoriz9d sanctions, the SACS may delay, cancel or refuse to release examination results if M e)(8m irregularity has been demonstrated; o 5. Obtainrog or attempting \0 obtain certification or recertification for onesew or aooihef by a _ Il( misleading statement or faivre to make a tequired statement, or fraud or deceilin anycommljllicaoon 10 SACS; o 6. Gross or repeated~, iicompetence, miscooductor malpractice in professional work, including, but not ~m~ed to, a. Ally physical or mental condition that curreniiy irnpafs competent professional perfcwmarce or poses a subsiatrtiai risit to the c!ien!loonsumer of behavior analysis services; b. Professional condud that constitutes an extreme and ~ de'o1ation from the Mtorr\a'Y stniad 01 ptadice 8CICe!lted in the appi"led behaybr analytic community and that creates a serious risk of harm to or deception of COOSIITo8fS; c. Abandonment of 8 COIISUmef resullilg in the temwlalion of immineotfy needed care of a consumef withoul adequate notice or proyisioo!of transition; d. Professiooat record keeping aodior data coiiectiori \IIat COI"I5IituIes an exnme and unjustified deviation from the customary standard of praclice for the field, and/il( cleceptively ajteting COI'lSlJI'I18( records or data; 8. Engaging In biaiani fi"aud, deception, misrepresen t alion.l~ promise or pretense or intimidation In the practice of applied

136 !lehavior analysis or in solicitation of oonsumers: OW'ICI f. The l.i\authorized material diswsure of oonlidenlial consumer i'iiormation. Gtoss (X" repeated r.eflitjt:nc<,,~a.""" '''' rrvst kr:axie evidence 018 disciplinary review lnid fomilj/ finding by an employer, fxoiessional peer re~ ~ govenwig offidsi. federal (X" SIaIe agency, (X" oihet ia:lism9 or cettiicsrion boatd. K /he rett1it:stt was not rm!i'si!t!fi by an f!ffj1ioyd;j agency, governing aifdai agency, or other BowrJ, /hen /he SACS President and ExecWve Director shah determine. by consensus. whetiier /he complaint should be submitted to II Review CotmIiItee. Jnconpetence or mapactice ftjj5i be MJenced by offid6i defetrrrlafions (sucii ~ cout cmnpy wmgs. or tremmeiw ptufessicnaj Ii""''''..,., d incompeience or ma/pnictice), o 7. Umitatioo, sanction, revocation or suspension by a health care organization, professional OIgarization, 01" o1hef private 01" governmental body, reiatilg to bei\aw:lr analysis p!actice, po.bik: health 01" safety or behavior analysis c:ertift;ation: o 8. Any oonvdion of a felony or IMderneanor ~ relating to bet\avk)r aoaiysis p!actice and/or pubic health and saiety, idjdilg. 1M noilimi!ed to: exploitation 01" abuses of a oonsurner, assault and/or battery of a ronsulti8f, or violent or negl;genl beha'llor creating risk of harm to consumer. o 9. Failufa to adequately supervise or be supervised ti acc:ort!ance I'oi!h the SACS Standards for Supervision. FACTS (Each Discip/llary and Ethical Sl<rdard Checked aboye should be factuady supported. ProW:Io additional pages H necessary, uwig 8112 by 11 paper) F ~

137 Names and contact Information lor individuals who are able to verify the lacts stated above, jf any: Us! 01 additional doc:tnents anached to and incorporated into this complaioc: OECLARAnON AND AUTHORIZATION: I hereby declare thai: (1) I am of legal age 10 sign!his cornpiaioi; (2) 11Wn!he Client or!he parent or legal guardi! of Client or II\aYe c\n!ct kric.i'medge of the matter, (3) I agree 10 the lerms and conditions stipulaled In this form ; (4) I waive all daims or lability against the BACS lor the conduct 01 this kl'o'estigation andjof the release 01 information relating 10 this investigation; and (5) the in/ofmaoon provided In this complainl is Irue 8tId aocurale 10!he bestof my knowoedge. By signing, I agree 10 indemnity the SACS lor ati'f iabiityor damages arising out of the BACS's Investigation of this complainl, if false, ioaccuraie or misleading inlormalion is provkied in this complaint Agreed by Client or Parent or legal Guardian of Cliert OR Eyewitness of Services:.~ ' ifflled Name:

138 DEPARTMENT OF DEVELOPMENTAL. SERVICES AUDIT OF WELLSPRJNG HEAL THCARE SERVICES, I 'C. Programs: Ikhavior Management Assistance - P1.081S and PL0921 Behavior Analys! - PL0814 Individual or FamiJyTn.ining - PL0894 (Audit Period: July I, 2009 through June 30, 2010) Audit Branch Audito.. : Michael Mum, ChiefofVcndor AuditS Ahon KiIIY. Audit Supervisor Trt:isa Muhammad, Lead Auditor Mubashshir Ahmad, Audilor Soi Ly. Auditor WillRdo Golcx, Auditor Agnieukl M0zd2en, Auditor

139 WELLSPRING HEAL THCARE SERVICES, INC. TABLE OF CONTENTS Page{s) Executive Summary Background Objective, Scope, and Methodology... 2 J Conclusion..._... 4 Views of Responsible Offieials..._... 4 Rcstrictotl UIC... 4 Findings and Recommendations Attachment A- Summary ofuttsupported Bil1ings and f ailure to Bin "

140 EXECUTIVE SUMMARY The Departmenl of Developmental Services (ODS) has audited Wellspring Hcallhca.re Services, loc. (WHS). The audit was performed upon WHS' Behavior Managemenl AssiSlance, Behavior AnalYSI and Individual or Family Training Serviees for!he period of July I, 2009, tluougb JUIlC 30, The lasl day offiddworlr; was March 9, The results of lhe ludil disclosed Ihe following issues of IIOn-eompliance: Finding I : Bchavl\lr Managemenl Asslslallee Illd B~hav l o r Analn t - Unsupported Billing. and FaUure 10 B U The review ofwhs Behavior Management Assisumcc and Bellavior Analyst. programs, Vendor Numben PL081S, PL0921 and PU)814, revealed!hat WHS had both lin$iippofied billings as _ll as appropriate support for services thai il failed 10 bill 10 Nonh Angeles County Regional CentCl" (NLACRC). It was found that WHS had. 10lal ofs in unsupported billings and a IOla1 ofsl,44s.97 for which it failed to bill 10 NLACRC. Finding 2: Overpayment due to Unlicen. ed SlafT Perrorming Rchul(\[ Analyse DUlles The WHS llafflbat performed the dulies Ind responsibilities ofa Behavior Analyst for Vendor Number PL081 4, lacked the Board Certified Behavior Analyst (BC8A) certifications as required per Califomla Code of Regulations, Tille 17 (CCR, tille 17). The services billed under service code 612 should have been billed under service code 620. The 53, unount identified in this finding is the resull of the rale differential between SClVice rode 612 and service code 620. The lotal WISupported and unlicensed billin8 discrepancies identified io Ihis audit amounts ,630.17, which is due back 10 DOS. A delailed discussion oflhcse findings is rontained in lhe findings and Rt:«)mmendalions section of!hij report.

141 BACKGROUND The DDS is responsible, under the Lanterman Developmental Disabilitiel Services Act., for ensuring til/ii persons with developmental disabilities =ive the service$ and supports they need to lead!il()r: independent, productive, and IIOTTIIIIllives, DDS conlraeul with 21 private, nonprofit ~gional centcrs that provide filled poinl$ ofc:on~t in the rommunity for serving eligible individuals with developmental disabilities and their families in CalifomiL In order for regional centers to fulfill their objectives, they se<:urc lcl'vicc:s and suppon from qualified service provroas andlor contractors. Pursuant to tbc Welf~ and lnstinnio", (W&l) Code, Section , DDS has the authority to audit those service providers and/or contractors that provide services and $Uppor1 to persons with developmental disabilities. OBJECTIVE, SCOPE, AND METHODOLOGY The audit was conducted to dctenninc whether WHS' Bdlavior Managemeot AQistance, Bchlvior Analyst, and Individual or family Traininll were compli.ant with the W&I Code, CCR. tide 11, and NLACRC conljlcu with WHS for the period of July I, 2009, through June WHS was vmdoriud by Nl.ACRC and provides services to Frank D. u.ntctm.ln (FDLRC). Tri Counties (TCRC). Orange County (RCOC). Eastern Los: Angeles (ELARC), Westside (WRC). and San GabrieU Pomona (SGPRC) Regional Centers. Our audit reviewed the services provided to NLACRC COMUIIlC"n. The initial ~iew ofwhs' pro8j2m5 consisted ofa two-month sample period sel«1ed from tbc audit period of July through June: 30, Within the two months that were selected (Mardi and April 2010). the audit sample revealed a large JICfCCI1tage of unsupported billings.. As. result., the audit period was ex~ to include November and Doocmber The audit was conducted in accordance with tile Gcncndly Accepted Government Audi ting Standards (GAGAS) issued by the Comptroller General of the United States. The auditors did not review thc financial statements of WHS, nor was thil audit intended to express an opinion on the financial statements. The auditors limited the ~iew ofwhs' internal controls to gain an understandinll of the transaction now and invoice preparation process as ne«$wy to develop Ippropriate auditing procedures.. The audit scope WIll limited to planninglnd perfonning ludit procedures necessaj)' to obtain reasonable ISSIII"IIlCe that WHS complied with CCR. title 17. Complaints that DDS' Audit 8nmch WIll lware of WCf"C addressed durin. the course of the audit. I'rograms: During the audit period, WHS operated five programs. The audit included the review oftllm: programs. The propms audited are listed below: Behavior MlIllgement Assistance. Vendor Number PLOSI5 and P10921, Service Code 615 Bchlvior Analyst. Vendor Number PLOSI4. Service Code 612 Individual Of FamilyTraining Service, Vendor Number PLOS94, ~rvioe Code 102

142 The procedures performed It NLACRC, the vendoring regional center, Ind WHS included, but were not limited to, the following: Review ofnlacrc's vendor files for eonlraets, rate lett=, progntm Iksigns, pun::hasc of service authoriutions, and eorrespondence pertincnt to the review. Interview ofnlacrc's $tifffor vendor biockground infomtalion and 10 oblain prior vendor ludil reports. Interview of WHS staff and managemc11110 gain an undcrstandina of its lccounling procedures and processes for billings. Review ofwhs' servieelal1cndance records 10 determine ifwhs had $ufficic111 and appropriate evidence to support the direct care services billed 10 the reaiooal cc11ters. Performed... analysis ofwhs' payroll and anendancelservice rocords to detenninc ifwhs provided the level of slifting required.

143 CONCLUSION Based upon items identified in the Finding! and Reeommendati()flS section, WHS did not comply with the requirements orccr, title 17. VIEWS OF RESPONSIBLE OFFICIALS The DDS issued. draft report on October 11,2012. No response was rc<:eived, due to the sudden elosure of WHS. The draft report was forwarded tn WI\S' anomey of record, only to be returned with the explanation tbat that anomey no longer represented WHS. RESTRlCTED USE This report is solely for the inronnahon and use of the DDS, Department ofllealth Care Services, NLACRC, FDLRC, TCRC, RCOC, ELARC, WRC, and SGPRC. This restriction is not intended to limit distribution of this report, which is mattct of piiblic m:ord.

144 FINDINGS AND RECOMl\fENDA TlONS flndlng I: Brhavior Management An l$lante Ind Bthninr Anah'.! - llot!lpportrd BjilingJ and,,'ailure 10 om The review of WHS' Behavior Management Assisl= and Behavior Analyst programs, Vendor Numbers PI..08IS, PLOnl, and PL0814 for Marth to Apri12()IO and November 10 Oc<:ember 2009 revealed thai WHS had both unsupponed billings, as well as appropriale support for services thai it failed 10 bill to NLACRC. Unsupported billings occurred due 10 alack ofappmpriatc documentatioo to support the Wlits of service billed to NLACRC. The failure to bill occurred when WHS had.ppropriate supportin&<iocumentatioll, but did not bill NLACRC fouefvice:s ptovided. vendor Number PL08IS «i IS) WHS was not able 10 provide appropri.te supponing documentation for 12, units of services billed urwkr Ven.dor Number PL08IS. The l.ek of documentation resulted in unsupponed billings to NLACRC in the amount ofssis,924.s I. In addition, WHS provided approprillc supporting documcntlltion for units of service under Vendor Number I'LOSIS which was nol billed to NLACRC. This ll'suhed in an unbilled.mount of SS)().29. Vendor Number P!.092! «lis) WHS was not.ble 10 provide appropriate supponing documentation for 2, units of services billed under Vendor Number PL0921. The lack of docwncntalioq resulted in unsupported billings 10 NLACRC in the lillount of$40,92s.80. In addition, WHS provided 'pproprille supporting docwncntalion for 29.SO units of lcn'ice under Vendor Number PL0921 wbich was not billed to NLACRC. This resulted in an unbil1ed amount ofs9is.68. Vendor Number PL081 4 (612) WHS was not able 10 provide appropriate supporting documentation for 4,431.()7 units ofscrviccs billed under Vendor Number PL0814. The lack of documentation resulted in unsupported billing5 to NLACRC in the amount ofs322, The nel lotai of the billi", discrepancies resulted in $877, 76S.02 of unsupported billings due back to DDS. (Sa: Attachmenl A.) CCR. title 17, $lection S4326(') (3) and (10) WIleS: ~AlI vendonlhall:

145 (3) Maintain recon:ts of serviee provided to consumers in sufficient detail to verify delivery ofille units of service billed.. (10) Bnt only for services which ilrc actually provided 10 consumct"li and which have been autborized hy the referring regional center ~ Also, CCR, lille 17, sections W604(d) and (e) states: ''(d) All service providers shall maintain complete service rc:cords 10 support all billing/invoicing for each regional cenler consumer in the program. (e) All service providers' reeords shall be supported by soun:e documentation." Recommend ation: WHS must reimburse DDS S877, for unsupported billings. In addition, WHS shollld develop and implement polities and protedures to ensure thai proper do<:umentalion is maintained 10 suppor1 the amowtts biued 10 NLACRC. Flnding 2: O, erplymenl due 10 UnlictnH4 Sla lt Performing Bt havior An. h sl nulits The WHS statr lhal performed lbe dulies arki responsibilities ofa Behavior Analyst for Vendor Number PL0814, lacked the Board Certified Behavior Analyst (BCBA) certifications.s required per CCR, title 17. Pursuant 10 DOS Program Advisory for Group J>nictice, HAil pt'fsoils providina services as defmed in Title 17, CCR. Section 54142, must hold the appropriate lii:cnsufe orcemficatioo 10 be vendo=ilo provide rhose specific services. Aides, nincd staff, lls!iiisl<ulls, and others within a group prkiice who ilrc allowed to provide servi~ under licensed or oertified irkiividual within I &foup practice musi be authorized utjdc:r. sc:pantc servioe code 10 be determined between the regional center arki the vendot." The audit revealed that 6 OUI 004 $tbit providing the Behavioral Analyst Services were licel1!led BCBAs. Therefore, Ihe servi0c3 billed undcr service code 612 for the 28 unlicensed S1.ffshould have been billed under service code 620. The S3, identified in this finding is the ~ult oftlle rate differential between SCfVioe code 6 12 and service code 620. CCR, title 17. Section (axil) Slales: "(II) Bellavior Anal~t. ~ce Code 612. Behavior Analyst means an individual who assesses the function of a bellavior o f a consumer and designs, implements, and evalualcs instructional and tnvironmc1l1al modificalions to produce socially si&nificant improvements in the consumer's behavior throug:h skill acquisition and the reduclion of behavior. Behavior Ar\jt]ysts engage in functioni assessments or fimctional analyses to identify environmental factors of which behavior is a fimctioo. A 8ellavior Anal~1 shall nol practioe psychology, 1$ defined in Business and Professions Code

146 section A ~gional center shall classify. vcndoru. Behavior Analyst if.id individual il rc<:ognized by Ihe national Behavior ANI)'Sl CeniflCltion Board IS. Board Certified Behavior Anal)'Sl." Recommendation: WHS must reimburse DDS for the rale diffe~n1ial ofs3,86s. IS for services that were performed by 28 unlicensed staff but we~ billed under service code 6 12 for licensed RCRAs. In addition, WHS should ensure thai staff performing the duties and responsibilities or. Behavior Analyst under service code 612 have the approp.ute license or certification. ;

147 , <.. I,, = - ~~lg,.- --.<, " ~~~ 'r ;., -0 ~ i~ ~~~ I' ~ " r -- "., " i 0: 0: 0 I - -.~: :-':5 l ~ ~ ~ iii,, ~, ; ~. 11 i~.~ ~ < ~ ",. I~I 0 - ~ ~ 1 5 :l14!!;; ;:("; ~~ ~.. :<i ::::~ <,!! ~-" " - ~. ~~. i~i 'r '1 ~~ ~ ~I 6 ;7. --., ,, !.< H to. "r - ~r -!!!i!~~ ~ ~ ". ~ ~I ~;; ~ t j = ~ "..; '"~ ; i' II II II n ~~i ~ I~ ~~ -, :;; ~ - - H " :l ""::;: '"- - > ~I;!...,"!. ~ "' ~~! -- ". <» > > > >» ilil l= --.' n n :'1 >< ' i H j~ - - U --.1 I ] - j - <, I. } < f H j )., I I h -~ j!...-~.- - 0; ~ ~~I " ~- ~ ~. ~ ~ GID ~ = &

148 < i,li I ', ~ <, ~l j :: ; 0 < I, 3, 0 < ~ 'I ~ 'I ~ i... I I, :2 "~'# " 1 1~ 1 i ~, i, 3..; :: j..... l ~... ::,.- ' ' ( it. ~ ~,~ i - ill., Ii :; to I i i> < r i.! 0 s e I 1 i s;s; ~ ;:::;::; I H H, t!, ~ ~ 0 ~ ~ ~, I, ~ ~ ~ 2 I I ~ i,,, ~ " l ~ ~ ~ " " e e " I G \

149 o...1d L Shook PhD BCBA.,..QJ / QS{U 19 ; 11 EM III 1~ 4 U, ~. lups! ltl Of/OU -..,... "" """"""_... _ c~... ~ """.... LeGA L """AIRS... A S1'Nn....,..._, SAC... "" ""'"'"1)0 Febnu?, CPt. THY 6ARANKlN Sacramento Advocacy 2:2.20 Cap~oI Mvo~ S8Cf!III1t1f11o. CA 9$811; Roo: a.h!yigrol Analyst, DNrMs.~ TI>I. Is In rcspcnselo)'our "'quest met I m""",rial_ in.wiling, ;.,...;_tion and '-gal OI)ioIoII rel&ta'lg to bcnmoi$i _Iysl$ lita"l I ofi'eo-w at. "oee1k>9 at the OooparUnsni or Educatlon In JanlJ:UY 01 1 ~7. In thlll prehrtatl(ln I corducitod!/!.at bthavior.jl a nalysts. ~.. described, are not r.<!ulr..t k11>e Ii1::eond as p.oyd>oiog"ts Ot marriage. f2m,iy and diild «U1se1or11 (naw "',,"ibge _ familytl>empiel5). lavonr,o ~~ who 18"'" as legal CCII.WIuJ 10!he i!aard of BehavIon;II Sdenees, and who. Iw llltend~ thlll ml!eting. CCr.anad In!he "PirOon. I ap<>ioalze \hat me press of business II' 011" Dff\c e precluded my Qf!!l1ng It1I!; 10 you ~tner. I The foik>wing rnemoiieiihs ti1 Q presenla~dii, Whld. Induded hlslcfy oilile Dap.a ~rne n: of eonll.nler M~rn. (DCA) Irwo!loement In the ","Mr. DCA', IrMllveme'" began In the 1;01\111" pilot at 1990f wi"", Ih10 d_r1mt!'~ was >lsked 10 _pond Ig $Bt\es!11 "",,,"lions relating to I".,.".,,!aGo, of sa 989 (11196) by!he Department Ed lj... tian. At thai Ii... Greg Hudson wtji. S~ Prq>e\ Conollllantwltl1lh. DepaJ1mentof EdllClltlon and was m.;panslble fer tormuiating 1~,"""Ierllenling regulations. Mr. Hudson... wor1<ing withe g""", of Inte<ested _jcs. c:jled the sa 'las WOf1\ Grow. on the regulations. ~\

150 Geroold L Shook PhD 9CBA 03/111/03 ll!,h...w.'.l1 U' 3nS uar~ a.... ca1hy "";'I4-l Febru:iry 1" 2000 "SO' IcsUH. In early DltCeIllber 199/1, a second meetllili was 11>", hliid with Mr. Hudson 10 discul. \he... Signlf"",'" """ valuable i-iput was prcvided I»'e ",.,.bfir of ;",.,.,st." ~~ and IN! Leg. Offlce alirmey. I"8I4wed!he Irtormetlon. TlIc IIIN,I of I ~" lnforjllll!ll;ln and.-gumont was IIlal beh~ analysts weill no! pradlcing In)'chOIogy Sloes. li1ate1rre. Wflf() 1101 reo...-re<l to be lic... d. In mld-january. on DeIIaj' of!he beh&rior.ii analysis. )IOU ll.!qoosled II meeting "Ilh \he L<lgal (:)fii.,. atiflmey5. On J.-...y 'Z1.1he..-.ier.signed end LaVonn" P-*l '"'" with)"cu. Greg WWJnt:I". " licensed ~ist end ~ aroa/ys1 WM I«; lor Ihe [)epanment of OeWIo~maI :5erYic:es, and Ma!1< LeYine. a beh.-.ioial.nalytil and ~ of the Dehaviorel Ccunse1ll1g and Resurch Center. Or. W8gNH" I!IIIde 1\ do'3r lit! was 81 the mee!trq solely In hill private capacity and nat. H",..presentBlMl of DOS. n... was flriheredbnsiyb djsc.. sim of \he lichid preclloe3 01 behavlorul.~ Al... ftioiluru, you InClcllod lh01loglslalion would be Inrroduced"lO stmlltlfly l1g>gnlzll b-ehay\onil _"" ts. On January 3(1,,91'1, tt. und.rs1g... d and t...\fonj)g Powell allendeel ii meeting oft/'e $iii 989 WQI\I Group. We ~tnenled h ab~ted ~'91ca11'is1ary of DCA'f In~""""in "'" Mgulatory procefs... d Oll'iegal.wn>adllO 3!\&1yzlR!1 the I""",",sing Inue!hal had iirtwo, The foltowng!"forrnaaon and _lysis chlnged 01. r preliminary <:mdusion. 1. 8ehaviurai"""illySlll do 1>01 ~ in dl~1r19 """,,-, d~ Ollrf>.d"!l... ral alscraers. tli.l! locus III ejrtemai environmenlal r:aclcn lila. Innu~ tiehavior. 2. When In<tM.!uaI Ed"""Uon Plant (IEPs)... de "'lopo<iiol c:nicir1on ""Odit'Ifi opooigl ed~1lon letvices. K.I$...,.,..., fa" "'bnled meroliu he.~ul,pror..so.idruo '1g b<o <Ji1... 1MI1u3~1On ream. prowj~ tkos8. UlNlces requiring IClllSUre..

151 .... 0:1/ 0$103 I O'U EM II!I!l u JUI OAPSI... Cathy B.,nldn Fellrtla.y 11, 2000 ' 3. While bo~.nlllysts are,n;aglild In beh.<'iior modi!k:atlon. H.In, contald.,nd liiiiiltjoduk>g)1 o;iif,,.,nt Ih... tho!t at" psyc:hoiogist ard _"';'''90. family and diid cooosekm. 4. Th8 \enn "dl~ Is not ""ing used ", Its a:~ undors1ood medlml or clinical nl1s1j. A ltiofe ICQ.n\Ie hin"n In Ihis con_ '- firoc!ior1al!lnl!lysl:i. 5. Most ~n!ly. whirl Ih'... is viewed Irmn astrid: legal porspective, ~ ~ appear emerneiy dlllcult 10 prco.dc;uie.. b!lhllvidnli _!)lit for engaglng In IhCI...,1Ioe1lSOd pnldice at P!lIc/Io:IloQy cr man1age. talfluv"nc1 dlild ooun.jeifog. Unlt:ensell pr.jc!lce II I crm.. ThIs m-. It\at bncin!ll ~ _~.,. r.qu1red 10 pnove bevond..,.,_bie doubt 1I1a1 the POI"$(I(I engaged In.mlceJl$1!Id p!1iciic8. Give" hi li1e D-opartmenl of Educ:.alicn has,.1 leul trnplk:!tiy. l"&cog11imd.. lid luthori2ed 1M pr.jctke or beh8"/ioniii_~.ts. and ~ h8$ bmn practl.,.d for _ 31><- joe......,.,05fulprol-.;ulion for ~ practlce.seems dch,blfojl. I trust \he kir1!going Is nespon,"'" Ie )00/ leqlie:st. If)'tlu him! any quii5uom. Of need to further di_ the kkegoin!;l. pleua,... '1M 10 contact 1111 QI your eiotmo~cg. Sine.reIy, OONCHANG Sup.""""", Co",,"1,f;~~ Ely D. WIEl8UNTJER s,.nier Staff Courosal cc: T_ O'Connor. EO. ~rd ofps)'d"lclogy Sherry MehI. EO. 80itrd of BohIYloral Sciences ~V_ PI:r Il. Stall' Camel (

152 BEHAVIOR ANALYST CERTIFICATION BOARD - Experience Standards - INSTRUCTIONS This document OOT1lltiM ~Il of tile standards aoo forms for experience used to qualify for BACB certification. All experience used toward the requiremenl5 for BACB certification ml151 meet the$e standards. The BACB require!! the $ u~rvijo r and,upt.n'l$ee ~~ tb;, t n ti~ d Of:ument togetber I nd discuss any conerrnl btfou the n perien«beglnl. In addition to the experience-5iandards definitions, this document contbins two fonns for documenting cxpericncc used toward BACB cerlification. They arc: I. The Experience Supervision FOOD: This form. or equivalent, must be eompleted at least ooce durin&: each supervision period, throughouttbe duration of your experience. This form must be duplicated with a copy n:laincd by boib the supnvilor lnd supervisee. "'" 2. The Expericnce verification Form: This fonn should be oompleted Itthc conclusion of your experience. 1 f you have multiple experiences, you will need to complete multiple forms; one for each expcrience/5upervijor. The original. unaltcml form must be submined. Forms with white-out or other altctlltions will not be accepted. Forms must bear the supervisor', original signature. Photocopies will not be accepted.. All appliclloll for certification mllsl submit documentation oflbcir experience: using the current venion of the Expcriencc: Verification Form. Previous venions of the form will no longer be ae«pted. lnitial exam applications should include Experience Verification Fonns only. Do not $ubmit the Experience Supervision Forms completed during uch l uptf\'itory period unlcn spedfiu Uy requested by the BACH. I'I&< 1.f7

153 EXPERIENCE CATEGORJES SUPERVISED INl)EPENDENT FIELDWORK (1500 " ~ u rs RCBA, 10M hours BCDBA): To qua lify under this standard at tbe BCBA level, supervisees must complete 1500 hours ofsupetvised Independent Fieldwork in behavior anal~is. To qu.lify unda" this standard It the BC.SA level, supervisces must complete 1000 boors of SUpeTVised In.doe-penooknl Fic:ldwoO; in behavior analysis. A supervisory period ill two WRks. In order to counl experience hours within any given supervisory period, supervisees must be supervised n le:u t onn during that period for no less than 5% of tbc lotal hours spenl in Supervi5ed looependent Fieldwork. For e:u.mp1e, 20 houn of experience woold include alleast I IUpc1Vised hour. PIUCTJCUM (JOOO hours HCBA, 670 hollrs DCIISA): To qual ify under this standard It the SCBA level, supervisees must complete, with a passing grade, 1000 hours ofprsetieum in behavior amlysis wilhin a university practieum prngjam appro, w by Ihe BACB and wen for graduate -.;adcmic: credit. To qualify under tlli! standard II the BCaBA level, supervisees musi complete, with a passing gnidc, 670 hours ofptactieum in behavior analysis within a university practieum prognm approvfd by the BACB and wen for aclldemic: emii!. A supervi!lory period is one " Rk. In order 10 count experience boon within any liven IUpervisory pcriod., supervisees must be supervised at least ~ n c e during thai period for no less than 7,5% of the houn spent in f'racticwn. ForeJ:amplc, 20 hours of ej:perience would include alleast I.S supervised hours. IN TENSIVE PIUCTICUM (750 hours DCDA, 500 holl's DCaBA): To qualify under this standard at the SCBA levd, supervls«s must complete, wi th a passing grade, 7S0 houn of lnlcosive Practicum in behavior analysis within a university p.-.c:tieum progmn appnl"cd by the BACB 100 taken for graduate academic: credit. To qualify under this standard at the BCaBA level, IUpervisecs must complete, with I passinggnde. SOO hours of Intensive Practieum in behavior analysis within a university pnoeticum program appnl"rd by th ~ BACB and taken for ltc8dcmi~ eredil A SUpc1Visory period is one " R It. In order to COWlt experience hours within any Jiven supervisory period, supervisees must be iupervised at lust t"'lce during that period for no less than 10% orme total h(lljts spenl in Intensive PrIIcticum. For example, 20 hours of e ~ perien<:c would incl ude alleast 2 supervised houn. For all three of lbe above options, no fewer than 10 hours but no more than 30 hours, including supervision, may be &<:erne<! per wecl<. Supervisccs ma.y accrue ej:perience in only one ca tegory per slipen'isory pe riod (i.e., Supervised Independent Fieldwork, PTacticum, or Intensive J>racticum). COMBINA TION O /O' /:,'XPERIENCE CA TEGORlES: Supervisees may elect to accrue hours in a single category or may combine any 2 or 3 of the categories above (Supervised Independent Fieldwork, PrlI c t i~um, Intensive Practicum) to mccttlic experience requ ireltlc1lt, with Praeticum havi ng l 'h times the tempotal value of Supervised Independent Fieldwork, and Intensive PrllClicum having 2 limes the temporlll value ofsupc1vised Independenl Fieldwork. I'>&< 1 of '

154 -. ~Q,&,"'_'t '. _... llili201. STANDARDS ONSET OF EXPERJI;'NCe : Supervisecs may not stan accumulating Supervised Independent Fieldwork., Praclicwn, or intensive Pr&cticum!lours until they have SUl!1cd allcooing c~s required to meet the BACa COUrKwork requirements. APPROPRiATE ACTIVITIES, The $Upenoiscc's primary focus should be kquiring new Ixhavior-anal Ylic Ikills ~Iated to the BACe Third Edition Task List (IT the BACa Fowth Edition Task List as appropriate. Activities must be consistent with the dimensions ofapplied behavior analysis identified by BaCT, Wolf, and Risley (1%8) in \he article ~Some Current Dimensions of Applied Behavior Analytis~ published in thcjournol of Applied Behavior Analysis. The supervisor determin e If u perlence activities qualify bu ed on Illese sou rcell. Supervisees are $lrongly c!ic(iilnlged to have mulliple experiences (e.g.,,ites, populations) with multiple supenoison and from each of lhe activity areas below. Conducting usessmenl$ notated to the need for bd\.lvionil inl~tion (e.g.. $timulll$ preference awessnlfnl, functional assessment, staff performance _ment); DesigninS, implementing, and systematiclilly monitoring skill-acquisition aoo behaviorreduction programs; Overseeing tile implementation of behavior-analytic programs by othcrs; Training, designing behaviorn.1 systems, and performance management; Other activities normally performed by a behavior analyst tlla! are directly rdatcd to behavior analysis such as alleooing planning meetings regarding th.c behavior analytic progmn. researehi", the HteraiuK related 10 the program. and talltini to individuals about the p~. Eumplcs of activities tha! will DOt count as upcrienee include: anendini mectinas wi!h Hille or no behavior-analytic COIllent; providing interventions!hat are DOt based in behavior analysis; perfonning non behavioral administrative activities; and completing nonbehavinl1ll assessments (e.s., diagnostic asscnment!i, intellectual assessments). paperwork, documentation, billing, Or any other activities lhat are not directly related to beru.vior analysis. No more than SO% of the total accrued expcric:rk:c hours o;an be in the direct implementation of behavioral progmni. A PPROPRIATE CLIENTS: Clients may be any persons f(ll" whom behavior..analytic services arc appropriate. However, the supervisee may not be related to the client or the client'li primary caretalter Or be the client', primary caretaker. Supervisces must work with multiple clients during the experience period. (Also. SC(: the following relevant sections of tile SACS Guidelines/or Responsible ConducrJor Behavior Anoly.m: 1.06, 1.07, 2.0, 3.01, 3.03, ~, 4.0, and ~m.) SUPERVISOR QUA LIFICA TIONS: During the upcricnce period,!he liupervi$or must be a Board Cmified Behavior Analyst or Boud CcrtirLCd Behavior Analyst Doctoral in good standing. The supervisor may not be related to, subordinate to. OT cmplo~ by the supervis«during!be ejl!xrimce period. Employment does DOl include compensation received by!be supervisor from!be 13

155 BACBu,e.-S ' di UlJI2GI' supervisee for supervision services. (Also, see tile following relevanl se<:lions ofthc BACB Guidelinesfor Responsible Conduct/or Behavior AnalY$ts: 1.0~, 1.06, l.07, and ~.O,) NATURE OF SUPI:,'NVISION, The purpose of supervision is 10 improve and mainlain!be behavior-analytic, professional, aoo e!bical repcl10ires of!be supervisee and flldlitale the delivery of high-quality seryiccs 10 hislher c~ts. Effective behavior-analytic supcnoision includes: Developmenl of performance expectations Obsavlotion, behavioral skills training, and delivery of performance f«dback Modeling teehniul. professional,.nd ethic.l behavior Guiding behavioral case conceptualization, problem-solving. and decision-making repertoircs Review ofwrinen materials (e.g., behavior programs, data sheets, reports) OvCl1light and evaluation of the effects of behavioral service delivery Ongoing evaluation of the effects of supervision The supervisor IJI\J$I observe and provide feedback to the supervisee on hi$lherbehavior-analytic.ctivitics wi!b. client in the naturll environment during each required supervisory period. Lnperson, on_site obsery.tion is pn:fern:d, II0wevCT,!bis may be <.:onducted via web-cameru, vidcotape, vidooconferencing. or similar mcan$ in lieu of tbe superyisor being physically present; synchronous (real-time) observation is strongly encow"agod. Supervision may be: conducted in small groups for no more than half of!he IOtal supc:rvised hours in each supervi$ory period. Small groups are interactive mce1ings in which 2.] 0 supc:ryisccs who!hare similar experiences partidpalc in the supervision.ctivilics described above_ If lioi1-supervisccs an: presenl during the mce1ing. their participation should be limited SO as to idcteisc the interaction opportunities of supcrvisees. The remainder of tbe IOta] supervision hours in each JUpCl'YOOry period must consi$! of individual supervision. SUPERVISION CONTIlACT, The supervisee and supervisor must execule. wrillen contract prior to the onset of the experience. The purpose of the contract is to protl:l:t al! involved panies and align experience activities with the purpose of supel'lilion described under Nature of Supervision (below). The contract should: State the rt'5pott!libilitics of the lupo:rvisor and supo:rvisee; and Include. dcscri]xion of tile approprialc!.ctivities and 1ns\nlctional objectives; and Include tke objective and measurable cilwillslancc$ under which the IUpo:rvisor will sign the supervisee'. Experience Verification Fonn wilen!be experience has ended; and Delineate!be consequcnces should the panics DOt adhere to their ~sponsibilitics (inc]uding proper tenninatioo of the relationship): and Include a statement requiring the superyisee to obtain wrillen penniuion from the supervisee's on-silc employct or manager when applicable; and Include.n.nestation thai bo!b parties willadhcre to the DACD Guideline$for RQpo1Uib/e Conductfor Bdal'ior Ana/y$U and the BACB Ol$c/pli.raryand Etllical S/andanb

156 8AC8~ _. llll1lgl. The supervisee and supervisor are responsible for retaining and providing 10 lhe BACB. if requested, B copy of lhe oon~tual agreement. DOCU'4 EIVT A TlON OF ONGOING SUPER VISION: The supervisee Ind supervisor m: responsible for collecting documentalion for each $UjXlVision period on!be Experience Supervision Form during each supervisory period. One form should be completed at the end of each supervisory period. The SACS re5ervesthe right to request this documentation at any time following an individual's application to take the ccrtification CllBrn. This documc:ntation should NOT be submincd with an exam application unless specifically requested by the BACB. Supervisors may develop their own version of!be: Experience Supervision Form. These alternlive forms molt include all of!be: following elements: Datc of each supervisory m«1ing Duration of each supervisory meeting Format of ellth supervisory meeting (Le., individual or 5JTUI1I group) An e\ibluation ofsupervisee performance: The IOIaI experience hours obtained during the supervisory period The IOIaI individual and small-group supervision houn obtained dumg the supervisory pori'" Date lines fot supervisor and supervise<: indic.ling when!be form was completed &. signed Signa~ lines for supervisor and supervisee The supervisee and supervi5ol' are fl'sponsible for retaining and providing 10 the SACS, if requested. ropies of supervision documentation. Supervision documentation should be retained fot II least 7 yem. The SACS EJcperieocc Standards and Forms were updated in September Please be sure to usc the current version, available in the Downloads scc.:tion ofwww.ba<.:b.eom. All Bpplicanu for certification must submit documentation of lhei. experience using lhe current vcnion of the Experience Verification FOffiL Previous versions of the form will no longct be ac«picd. CONTESTED EXPERI f\'ce: If I... pervisee is w:uoble 10 obtlinthe si&nature ofa supervisor on the Experieocc Verification Form or disagr=! wi!b the IOUI number orboun rewrdcd on!he fonn, the supervisee may supplement hi. Of" her application with proof of the following: a. A copy of the supervillol)' oon1l"&t b. Copies oflhe signed ~perience Supervision Forms completed durina the experience c. Letters or olher documentation from third parties who observed the IlUpervisory relationship Supcrvisees allo must provide the 5llpervisor with copies of the doc\imenlation they 8Je subrnining to the BACS and must include proofofprovision of this information to the supervisor (e.g., ccnified mail receipt along with.1<:ttct from the supervisee to the supervisor). The BACB may ancmpl to contact lhe supervisor to conftrm receipt orthis information and to provide him or her with an opportunity to address this maner in writing. Supervisors will be asked to provide documentation of dissatisfaction/concerns regarding lhe cxperience previously provided to supcrvi5ccs claiming a contested supervision. If the application is denied based on the lack of proof of supervision. supcrvisecs will hiove right to app:lllhis denial. 1 t;" '.lor1

157 SACS Experience Supervision Form "'is form (Ot' "I,,'w>Mnl) must ~ romplettd m INSt rmu during ~ado su;xrvisl)l'}l pniod. Supcrvisce: Supcrvisor: Supervisory Meeting Dalc(s) &. Duralion(s), Supervisory Meeting Fonnat (check all thai apply): individual --",,"p Thil documenl coven!he: IUpcrvisory period from ~ _,_ to,,_ Elptn~"" ~ HoPI'S A«um ul.led DunnE This Suptn'bory P~nod (tomplht. 11 fo" r lina) A) Number of indc:pendc:nl expcrieooe boun aceumulltcd (excluding lime apenl witll JUpervisor); Of the bow'j lilted above. swe the number lpcili in dil'llct implemenllllion ofbehlviol"li prognmo: B) Number of indi,.idwil JUpcrvision how'll accumulated, _ C) Number Df small-goup lupci'yisi"" IK>ur$ Io«:lUIlull lcd: 0) Total experience I><>ul'f ocwmulatcd (Md lines A tlu'ougll C): ChUUlt n. lkj of Suptn'blon CondU( ltci Durin, TIIII Supen1sory Pt riod (c heck pply) BACB T.k LlsI wlls eo~(iist Tuk numbers): Specific clim.l) discussed aiml priy8c)' proiccicd Ob$t;rvatiorl of... pcrvikc (video) Ob$t;I'Yllion of... pci'yisee (in-penon) SUPCI'Y;sory disc".. ion,. feedback (in_perwn) SUPCI'Y;$Ory disc,,";o",. feedback (mnote) Readin,,! vailial ion O.'wIII evalualion ofsupervistt: pcrfomutlltc dun", this period (cin:le one): S Nt u Supervi$ee signatun:, Dale: SUpeMsorsignatun:: Dale: SUPERVISOR WITH TIlE EXAM APPLICATION FORM FOR AT LEAST 7 YEARS... 60/7

158 BACD Experience Verification Form Uw one form prr upfrit ntt. Applleanb may accrut only one Iypc of upcritnct al lime. Applicant's Name: _ Elpericnce!lours Aceu mullted {«Implelt all lh ru line. ): A) Number or indcpendenl experience hours accumulated: Of 1M hours listed obove, ItIIC tho nwllber spenl in direct implenlell\j.tion ofbdllvioill proararro; B) Nwnber of $UpervisiO;n houjs loc:umulatcd: C) Total experience boors accwnujated {add JillCl A and B): EJ pfritnee Type Obtained (ch«k only ont): o Supervised Independent f ield work D BACB Approved University Practicum{lranICriplmustlhow pw... "..,.liiw """"..,...,.) D BACB Approved University Inlensi~ Pntcticum (-nptmustlhowpwioll"",,"diipjhg.ai-.-) Elperience TJme-Fnme: Starting dale (MM/OM YYY)_' _ 1 Ending date (MMlDDNYYY) _ 1 _, (Muse NOT be prior 10 April I. lot)j) {lndkllc lpcciflc dole; do not writ. "l>f<sent1 Supervisor's Name: Slipervi'lOr's Tille: Ttltpbllnt :' Elpcrienct Stillng: _ CUy: SlalelClluntry: )\I u" be complcttd by supervisor By signing below, f he,eby attnt tllat: lbc applicant completed 1M e~pcrience as specified in Ibis policy document under my supet"l'i$i(ni and in compliance wilb all of the Silted requirements. I am the responsi ble supervisor designated in the,upervision contract with this superviscc. During the applicant's experience J was a Board Certified Behavior Analyst 11 _ Supervisor: By signing below, ),ou alltst tllal ALL o/the in/o,matiol! contained on this Expe,iellce Ve,ificatio/l Fo,m is t,ue alld correct to the best o/)'ou, knowledge. Printed Name IIfSuperviSllr: Signature: Da te:' 11Iis timummi ",wi /INI' 1M origind si6/tlj1ufy of 1M s~. PholocopiQ.j<ud. or t_iln ecpia of litis dt;jc,._nl... ill l1l)i be 11 <>«qjitd OrWlnDI ~IS tnu ~ '-" DlfnN (wiii1~1. sfriu.fiororct tic.) wilt _ N tjjc«pim. l~t~~1s will_ /ltijcctpltd. '... 7of7

159 California Health Benefits Review Program ExeCUlive Summary Analysis of Senate Bill 126: Health Care Coverage: Pervasive Developmental Disorder or Autism A Report to 1M WL C.Jifomia Legi!llature Mareh :s \

160 A Report to the Californ ia Slate Legislature Analysis or Senate Bill 126 Health Care Coverage: Pervasive Developmental Disorder or Autism March 24, 2013 Ca l iro ~ n i a Hulill Bendlll Rtview Program Franklin Sirttl, 11" Floor Oakland, CA \14607 Tel: Fu: 511) www,chbro,odl. Additional free copie$ or this and otbcr CHBRP bill analyses and piibliealions may be oblained by visiting!he C HBRP wtbsite at Sugge$loo Citllion: Californill l ltllhh Benefits Review Program (CHBRP). (20lJ). Ana/yslso/&na/e Bm /16; Health Cart! Coverage: Pervasiw Deo.-e/opmel1la/ DiJrmJer or Aullsm. Repel" to California State Legislature. Oakland, CA: CHBRP.

161 EXECUTIVE SUMMARY California Health Bend its Review Program Analysis of Seliale Bill 126 The California Senale Comminee on Health requested on January 23, 20]3, that the California Health Benefits Review Program (CH BRP) conduct an evidence-based assessment of the medical, financial, and public health impacts of Senate Sil! (S6) 126. [n response 10 Ihis request, CHaRP undel100k this analysis pursuant 10 the provisions of the program's authorizing $tatulc.' In 20 14, CHaR? estimates thai approximately 25.9 million Cali fornians (67%) will have health insurance thai may be subject!o a health benefit mandate law passed at the stale level.' Oflhe rest of the stale's population, a portion will be uninsured (and so has no health insurance subject 10 any benefit mandate), and another portion will have health insurance subject to olher stale laws or only 10 federal laws. Uniquely, California has a bifurcated system of regulation for health insurance subjoc1to state benefit mandates. The California Oepanment of Managed Health Care (OMHql regulates health care service plans, which offcrbenefit coverage 10 their enrollees through heallh plan contrncts. The California Dc:pattment oflnsujlmce (CDI) regulates health insurers" which offer benefit coverage to their enrollees through heallh insurance policies. OMHC-regulated plans and COl-regulated policies would be subjec!!o S However. S6 126 exempts Medi-Cal Managed Care Plans and the California Public Employees' Rctircmem System (CaIPERS). Therefore, Lhe mandate would affect the health insurance ofapproximatcly 18.5 million enrollees (48% of all Californians). Developing ESlimales for and t he Effed. "ft he Affordahle Care Ad The Affordable Care Act (ACAj! is expected to dramatically affect health insurance and its regulatory environment in California, with many changes becoming effective in It is important to note Lhat CHBRP's analysis ofproposcd benefit mandate bills typically address the marginal effe<:ts oflhe p roposed bil!s-specifically, how the proposed mandate would affect benefit coverage, utilization, costs, and public health, holding all other facto!] constant. CHBRP's estimates of Lhese marginal effe<:1s are presented in this repon. Because expanded enrollment will not occur until January 201 4, C HBRP relies on projections from Lhe California offer fbnr4 of, c atlfl<i2g '1,

162 Simulation of Insuran<:e MarkelS (CaISIM) model' 10 help set baseline enrollment fof 20 14, From this projccted basc=line, CHBRP estimates the marginal impaet of benefit mandates proposed thai could be in effcct aftcr January B' li-spedfic t\ n.ly ~11 of S S8 126 would extend the $W1$CI date of an existing stale benefit mandate IMt requires coverage for behavioral health IJUtmcm fof peryb$ive developmental disordcror autili1\ (PDDlA).'Tbe existing Slate benefit mandate, bueaftcr referred 10 as the bebavlonl health trealment mandalt. sunsets on July I, 2014, SB 126 would extend tile sunset date until July I, 20 19,' but othelwise contains the SlIme language as the existing mandate (enacted in 2011) th8t requires coverage for behavioral health treatmcnt for PDD/A. The existing behavioralllealth treatment mandate defines behavioral health ~almenl as including but not limited 10.pplied behayior analysis (ABA).' Sp«ifiully, il defines behavionj heallh IJUtmcnt as ''professional scrvi«s and treatment propms, ineludilll.pplied behavior analysis and evidenec-based behavior intervention programs, that develop or ~tore, to the maximum extent pn.cticable, the functionina: of an individual wilh pervasive developmental disorder or.utism.. ~ In lhi5 report. intcrventions based on ABA and other th.eories of behavior are referred 10 as intensive behaviot1ll intcfvcnlion thc11lpies. This report focwcs on intensive behavioral inicrvenlion therapies based on ABA bceausc the behayorial health treatment mandale sp«ific.l1y mentions ABA. The existing behavionl health treatment rnarw;bte requires that treatment be J'I'l'$Cribed by a licensed physician and surgc(lll ordeveloped by.iicenxd psychologist. The mandale requires that the treatment be Mprovided W1der. treatment plan prescribed by I qualified aulism K"l"vif;C providcr,~ and administered by I Mq... lified IUlism scrvic:c: provider" (QAS provider), I ~qualified IUlism IICfYlee professional" (QAS professional), Or a -qualified auti$1ll service parapmfessiona!~ (QAS paraprofessional) who can be an '"unlieedscd and unecttified" pclwll. Oftbose persons who can administer intensive behayiot1ll inlervention IhcNlpics to enrollees wilh PDDlA under the behivio/1l.i health ~3tmCn t mandate, QAS profcs$ionab and paraprofessionals musi be employed and.uperviscd by a QAS provider. The mandaic requires lhal DMHCregulaled plans and CDi-regulaled policies maintain an adequate network ofqas providen to supervise and employ QAS professionals and paraprofessionals.. The existing behavioral health trcalmcnl mandale additionally requitc$ that the mandated benefits be provided in the M~ mantm"and shall be sub~ to the same requirements as C.tStM was iiovelopodjoi,,"ty and i. openl«l by ItIc Uftiversily ofcalifomia. Loll ",..,.1.. ec..... r... Hcotlh Poticy Resean:h and the lhilvenity ofcalifomil. Berkeley Cenler r... lobor Restan:h and EducoliOil. The modet OSIimales,he impact of provisiofto in ItIc ACA on O""4'k>y<r ded,iofto 10 offer, and Ir.:Iilfiduil deciok>nl 10 obtain. health inrunn«:., H4SC S«:tioo ] ODd tc Sections 101"'4.$1 II1II tol"'4.$2. *' cno.t<od by S8!M6 (2Ot 1). I HASC Sedioao I37UlODd IC Stctiom 101"'4.$1 0IIId 101"'4.$2 (a... «1 by S8 ~ 20t I) become inopeni,ve "" July ond rcpajed 01\ J...ary I S te1 be imperative.. July I or.:! rq>e*ied "" J...,. I, lo2o. ()ooo ItIc -. ill... e io "" Ion... req..uw. -' """.tooelllil-"';' r... on!be do..!be tel beaiiiie inopeni... 1I4SC Section ond IC Stctiom ond 101"".$2. a emcied by S8 ~ (2011). C-.. oljll.olxlij...,

163 provided in" current mental health parity!.w in California, which mandlltcs parity with other benefits in tenns of lifetime mu:imum$, copayments, arid deductiblcs. In!eGClion With Otller California Rcauirrrrn;nts As $late!!, extends the sunset date of!he existi", bekayionl health treatment mandate thai ~ires covcrqe for behavionl health treatment for PODIA.' In addition, eul'm1l California mental health parity law" mjum ~rage for!he diagnosis arid medically neccssa!)' treatmenl ofscvere menta] illnesses, including for PODIA, for persons of any asc. The curmll California mental health parity ].1'1' applies to most DMHC-regu]ated plans and COl-regulated policies; it exempts Melli-Cal Managed Care Plans.'1 Coverage for Intensive behuloral In tel"\"en tlon thera plcs for those with PDDIA Is required under the current C Mllfor nia mental health p. rlty l.w.'j Anaj'l!je Approach.ad Ksy Assumptjons The existins bekavionl health treatment mandate requires coverage for mtc1\sive bekavioral intervention tbtrapies for persons wilb PODIA. u does!he C\IITCIIt Califomi. mental health parity taw." Th e rdo ~, as con ragc for Intens;' c bebavio ral inlt n-cnlion Ihenples fo r PODIA is cu r~ntl )' n(julnd under both tbe u b llng behavioral hu lth tru tmenl mandate and the current C alifornia mental health parity 1.1'1', SB 126 would not r equke new coverage,. nd C IIBRP d OCll noi ex peci 5 B bave a measurable COSI o r pu blic health impact. Pervruiw dewlopmental aijl'w"tkr CH" tnlfijm Curm!tlaw does IlOl definc PODIA, but regulations so~g OMHC_rcgulated plans u definc PODIA as inclusive: of Asptrger's Disorder, Autistic Disorder, Childhood Dlsintc:gntive Disorder, Pervuive Developmental Disorder Nat Olherwisc Specified (including atypical autism) (POO-NOS), and Ren's Disorder, in ~ with the Diagnl>fficand Statistical Mantlalfar Mental Disorders, Fourth Edition (DSM-IV}-Texl Revision (Junc 2000). COl also includes these five disorders within PODIA." This repon uses the term "POD/A" in an effort to makc clear Ihat!n:alln<:nt is re<juircd for all five dis(lrders. Payers Other Than Health Plans and Insums P1Iyment for intensive bekavionl inlervenlion tbtrapies for PODIA for pe~ enrolled in OMHC-n:gulated plans or COl-reguLated policies 11\.1)' come from OIhcr soun:_ situalion IhIt may be more common than is the case for persons wilh other disordcn.. PatienlS (or!heir families) ma), pay directly for care, arid ekaritics may.iso become involved. Moreover. for '. H&SC Setri"" I 374.7' and Ie Sections ond '2... onacred by S (20 II). " H&:SC Sectiooo I )R71 and Ie Setlion "TIM: <urm1t c.!ifornia mrn!ai health parity... diao;uued """' "'''''"OpII Mtdi-Cal ManapI C-(H&SC s...rion and Ie Sect ), 0$ -.!be cisrinc bdoa..ml hcallll 1>_"",,1,,.', and S " ~ _iati... S.1..owefts!rin. DMlle..wI J. r-... COl, fcbruory 201]_.. ra-l... iaori... S. Lo.<_io~ OMHe.""" J COl, Fcbruory u Ca!ifomia Code ofr...,~""'. (v... JI), rlllt 11, M...,..t IItaIIh Cate.. S«:rioII UOO.74.72«},. ~ """""""ic:ooriod, I..-.".,..".. COl. Much loll c..-.oljrnnoi!... 'n

164 POO/A related behavionl health treatment, regional centers contracting with the California Department ofdevelopmcntal Services (OOS) may pay," and public schools in California arc mandated by state and federal law to provide related SCl'Vices to students thai alll found eligible by an individualittd edueation program team to n:«i~ special education. 11 DOS does not colleet infdml8tion about!be soun:cs of health illsuflllll:e that would allow clients 10 be identified IlS having health in$uranoc subject 10!be existing behavio11ll health treatment mandate," and rqional centers may sejve persons wilbout health insurance. Similarly, California Department ofeducatioo (COE}-affiliated schools may serve persons without health insurance, but does not collect information on the health insurance status of public school students.l:o In addition, some enrollees with health insu~ce subject 10 the behavioral health treatment mandate may not $Uk assistance from a Illgional center or school, may pay directly for care, or may nol meet severity threshold criteria 10 qualify for services per program eligibility rules. l1ierefolll, the o~rlap betwttll those with PODIA who are served by ODS and/or CDE and tbose who are enrollees with beallb insurance IlUbject 10 the behavioral health treatmo:nt mandate, and thus SB 126, is not clear. Requirements in Other SylrS AI least 32 stale$ and the District of Columbia have passed health insurance benefit mandates related to autism. Some Statel identify treatments for which coverage is specifically required. Over halfofthe states with health ins~ benefit mandates related to autism specifically require coverage for ABA. Rlc\;ground On P frvad~e Develo pmentlll)lsordu or Auti.m PODIA includes n.eurodevdopmental disorders that typicallybccomc symptomatic in children aged yean, but may not be diagnosed until age j orolder. PODIA is I chroniccondition characterized by impainncnls in social int~tions, communication. sc:nsory processing, sttrc<)typic (repetiti~) behaviors or interest, and sometimes cognitive function. Symptoms of PDD/A range from mild to sevcre. The cause of PODIA is unknown. and there is no cure. PDD/A is associated with other comorbidities such as epilepsy and cognitive impairment. Medical EfTectlvfU"' Manychildrcn with PODIA an: treated with intensive (e.g., 2S or ~ hours per wed,) interventions based (HI ASA, hereafter referred lolls intensive behavioral intervention iherapics. that are aimed at improving behavior and reduqna deficils in cognitive function, llnguage, and social skills. The medical effectiveness review focuses on intensive behavioral intervention therapies based on AaA because sa 126 specifically mentions AaA. II PcnonaI OOInmW'IiariOll. E. Oclbcr ond P. ChooIC. Cll;fom" Department Qf Dcvclopmrnlll Services (DDS). FebnI&Iy 20U... SeMoe.s "", icied by public: tchoob... JdaIcd.. I'an 8 <>flhoo ICdcBI lndivillial. wi'" Oisobi~,"" Edlx:alion Ace ~! a! """""""ialion. E. Oclba' ODd. a-. DDS. FebnI&Iy 2O11. re.-i toiiioiuiiation. A. SmidI, Calirornia D p.b... 10( fdi... March 201).,_ "..... >

165 CHBRP TmniDoJOIIY foroming Evidence o(medjul Effectiveness CH BRP uses the following terms to charac!eritc the Strength of the evidence it identifies regarding lhe medical effectiveness ofa treatment for which a bill would mandate coverage; Clear and convincing evidence; Prcpoodcrance of evidcooe; Ambigo..ousleonniding evidence; and insui'rk:ient evi~nce. A grade of clear and CQn_lrn;ing evidence indicates that there ~ multiple studies ofa treatment and that the large maiorjiy of studies are of high quality and consislenlly find that the treatment is either effective Of oot effective. A gra~ of preponrhn"'u oj mdtnce indicalc$ that the majority of the $tudies included in!be medical effectiveness review are consistent in their findings thai treatment is either effective or not err.:ctive. This can be fumber subdivided into prcpondcn.nce of evidence &om bjgb;gua!jty!tooier' and prq»n<ierance of evidence from Iow:QUJljlY studies. A grade of omblguolislconj1icring e_idence indicates that althougb some studies included in the medical effectiveness review find that a treatment is effective, a similar number of studies of equal quality suggcst the treatment is not effective. A grade of ituliftu::lenl evidence indicales thai there is not enough evidence Ivailable 10 know whether Of nol I trcitmci1l is effective, either because there an:!on few studies of the treatment or because the IVlilable studies an: IlOI ofbigh quali!),. It does not indicate thai treatmelll is not effective. Metbodolo2jCJl CgnsjderalioDs The literature on intcd$ive behavioral intervention Iberapics based on ABA hal several important limilations. Most s!\>dies do II()\ randomize participants to intervention and comparison groups. In ll9iu"illdomizc studies, it is possible Ihal difftmiccs between JfOUPS Ire due 19 differcnccl in the cbaraacrisl:ics of persons ill the two groupl nuber than differe"ces in the intervention. $!Ud.ied.. In addition., lome ltimiies lssign ehildren 10 intervention and comparison groups billed on parent preferences. wbich miiiy introduce bias. " lhp-quahty studi", ~,ludi",,""t:(t) ""vo oampt.,~ that on:,uffic;.,.,tly latje 10 detect ltatilticauy lipif"""" difli:_ \lerwun the intervention ond t:oi1ipii"iion I'<"'P' (100 Of... bjcc..); (2) "">Ie low ""riricln...""(las _ 20%); (3) "">Ie intctvention ond """"P"ri- _.p that.",...u.kaity cquivoknl poi«10 the iftlervenlion, witlt rapccc 10 boseli... _ of the -... Odd impononl r...,..... Ja1 willi lite _;(.).._tn>llod \ler"", _ dkr oksi collect doli "" bach the... ~ IJIOUpI prior to lito...,. dkr the in\u CllliOll);..(S).;... noodotnty puuo... to inletvulbou _ -.n-""""" Of... ~..ariabi<s. pmponoity -. Of... oopititticucd IIIrisrical motitocis to oddreot odcciion thai Odd a.g..t f<x conamldtn. c-.. ol.ljw2(ll ) 'Sl

166 Many studies have small ample sizes, wbicb limit tbeir ability 10 detect 51atistically significant differences between intervention and comparison groups. Most studies of imensive behavioral intervention tbenpies only assess OUtcomes immediately after tjutrm:nt is complete. Ikcause only a limited number of studies collect data on OUtcorm:s posttreatment, there is insufficicm evidence to dctermine whether use of intcmive behavioral intervention therapies has benefits that pcrsistthroughout childhood and into adulthood. Findings from sndies of intensive behavioftj intervention therapies based on ABA are difficult to synthesi:«: because: The duration and inten$ity oftju1menls studied vary widely as do the settings in whicb trellml:nt is provided. The eharactcristic:s of comparison groups,iso vary. Sorm: studies compm: more intensive to less intensive ABA-based interventions. Otbers IXImparc intensive ABA. based interventions 10 treatment as usual, which typically consi$1s of an eclectic mix of interventions. The outcomes assessed also vary. Only four outcomes arc measured by. plurality of studies: adaptive behavior, intelligence quotient (IQ), language, and academic placement. Study findjnss Charac/erij/ia of populo/iam jruditd Nine recent meta analyses and syj\crmotic reviews and eight individulol studies piiblishcd after!be litenllr searches that informed the meta-analyses and JyStcmatie rcvicw$ were completed assessed the effectiveness of intensive bc:bavioral intervention t.ltcrapies based on ABA. Only two randomized controlled trials (RCTs) 011 intcnsive behlvionj intervention therapies based on ABA have been piiblished. e.ch ofthcse ReTs enrolled fcwer than 30 panicipanls. In addition, their findings are inconsistent in part due to differences between the comparison groups in the two studici. In light OftM small size oftbcsc ReTs and their inconsistent findings, CHBRP assessed a broader body of literature consisting of all studies of intensive behavioral intervention therapies based on ABA thatllad a eompanson group. The intensive behavioral intervrntion therapies $!udicd were provided by a wide range of personnel including cenified applied behavioral therapists, child care WOTkers, nurses, ClCCupalional therapists, psychologists, spec<:11 and langu<lge tberapists, students, 1Ckhcrs, teachers' aides, and parents, Penons who did not have graduate degrees in behavior analysis or related field were typically supervised by ptf!ontlcl with graduate degrees, Most cllildm! enrolled in these Jludies ~!Jelted for yelll"1. C\oo"toO.. of )110110'), on

167 Studies of intensive behavioral intervention therapies enrolled children who ranged in age from 18 monlhs 10 9 years. Most of the ellildren enrolled IIad Autistic Disorder or POD NOS and had IQs within the nmges for Mild or Moderate Mental Retardation. CHBRP identified no studies regarding effe<:tiveness of intensive bellavioral intervention ~pics in cllildrcn younger!han 18 months and per$oiis older tiw! 9 years. nor is Ibm: dim:t evidence,bout tile effcccivcness nf these tmotments for peqom diqoosed with Asperger's Disorder, Reu's Disorder. or Childhood Disintegntive Disorder. Theabs~ of cvidena 1$ not evidenq! of II(} effect. Intensive: behavioral intervention then.pies may be applop>iate for some persons with PODIA who fall outside the POPlilltion$ that have be<:n studied. Outcomes for individual cllildren enrolled in studies of intensive bellaviofl'] intervention therapics vary widely. Findings from "lidies lhat llave a\tempted 10 identify!he ebaracteristies of cllildren who an: Il\O$t likely to benefit from these interventions suggest \hat ellildml who an: younger and who have: higher IQs and ~ater adaptive behavior skills (e.g.,..ommwlication, daily living, motor, and social skills) II initi.rion of treatment derive greater benefit from IrealmenL St,,,Jy outcomes Adaptive behavior: The preponderance of evidence. wllich comes from low-q..ality studies, suggcsts that intensive behavioral intervention therapics based nn ABA are more effective: tlutn u.su~l treatmenl and that motc-intensive ABA-based tllentpies are mon: effcccive: than less intensive ABA-based thenr.pics in improving adaptive beliavi«{e... commwlication, daily living, motor, and social skills). One mcta-aoilysis of studies., which In: primarily nflow quality, fou.nd that!he intensive behavioral intervention therapies ofjonger dllration have greater impact on adaptive bellavior. Intelligence quotient: The prepondeflllce of evidence, wlliell comes from low-quality studies, suggests that inlensive: bellavionl intc:rvcntion therapies based on ABA an: more effec:tive: in inereasing [Q than \lsuallreatmmt and that more inlensive ABA_ba$ed thenr.pies an: more effe<:dve than less intensive ABA-based therapies. Mosl Sllldies flll",d thll/ /lre cllllnges in inlnlig~nce is n()l sllffid~nllj' large to enable III ~ majority of d,ildl"tul.. itlr PDDlA rll aelrlcv 1cv ls of inl~flectll fll flnd edllcfltillniji funclionirlj; s/milflr til petrs wi/i'iim PDDlA. Language: Findings Ire Imbiguous as to the effects that intensive behavioral intervention tllcnpics based on ABA have on both expressive languaif: (i.e., ability 10 verbally exprss ooc's oeeds and wishes) and rcccpfive langluge (i.e., ability to respond to requests from othets) CWJeoI.. oiliwlolj...,1mp",

168 relative to U$ua l treatment. Evidence regarding the relative elte<:tivencss of more intensive versu, leu intensive A8A-lnIscd therapies is also ambigiou" Academic placement: Findings Ire Imbiauous as to the died that intensive behavior.! intervention therapies based on ABA have on acadcm.ie placement reillive 10 usuallreltmml. Evidcocc regardina the relative eff«tivencss of more intcnsivt: versus less idtensivt: ABA-bised therapies i. also ambigious, Benefi t Co.'erate, Utili11tlon, and Cost [mpatts SB 126 extends the.unset date of California', existi", behavioral heal th treatment mandate that requires COVCT1lgt: for intensive behavioral intervention therapies for PODIA. Current California mental health parii)' ),own also requires roveragc of intensive bellavion,] intervention therapies for persons with PODlA u for most OMHC-reguJlted plans and COI.regulated policies,:n Thercforc, II co\'era,e for Inlcnsive bchavlonllntcl'\'cn tion tbcraples for PDI>IA i. currently req ulred under both th c ulstln, behavioral healt h lrel tmen t mandate and the current California mt nlll htltth parity law, SO 126 would nol req uire ncw coverage, I nd CHORP doc, not ex pect SB 126 to hne a nlea$urable COSI impacl, CHBRP estimates that 100% of OHMC-regulated plan, and COI regulated policies subject to these two state benefit mandates thai require coverage for intensive behavioral intervention therapies IS a tn:atment for PODIA provide this covenge. CH BRP estimates that 100% of OHMC_regulatcd plans and COl-regulated policics subjed to the exisring behlvioral health treatment mandate maintain an adequate DCtWork that includes QAS providen who supervise and employ QAS professionals or palllprofessionals who provide and administer behavioral health tn:atment, CHGRP estimatcs that 127,000 enro!1ecs are diagnosed witb PODIA in OMHC regu lalcd plans {)I' COl-regu lated policies subject to , ofwhicb 12,700 are estimalcd 10 currently use intensive bebavioral intcrvention therapics, Current annual expendirun:s for intensive bebavionl intervention therapies.mong these enrollccll is estimated to be 5686 mi llion, Cowu e [mdic!s No measulllble change in covelllgc for these services i$ expc:<:tcd IS CHB RP CSlimates that 100% ofohmc-rcgulated plam Ind COl-regulated policies subject to currently provide coverage for intensivc behavioral intervention tbel1lpies IS required by two existing California state benefit DUlndates, " H4SCSa:tioD 1374,72: tc Sect... IO t4.6.5,... CDI, FcbNIry 2Ot ~,.. The ti>ituii CalirOl1lilo..-.. _ puiiy ta... (H4SC ~ 1 ~ IfId IC s.c.;. tot...5) CIIm!pOJ Medi Cal M...,.t c..", doe! "'" e<iorid& bdiovioral hatdlllu\melll...(h4sc Sect... 1 ~74,n _ IC 'J<>ttWn _ tot".52, a enoctcdby S8lN6[20tt J ~ li J>enonal ~ioa. S. t.owe..m.. OMIIe... J, f' _ cw-.. ot JI1.<IN tl...,

169 Utiljzatjon Impacts As no measurable change in benefit coverage is expec!ed, no mcasunoble change in uti liultion is proje<:tcd. COS! ImDIIC\s As no measurable cbange in bencfit coverage is expected, no measunoble changes in total premiu~ and total health eare ex!k'ndilureli Il!'C e ~ pected. Pu blic liulth Impacls CHBRP expects the coverage and utiliultion ocintensive behavioral intervention therapies 10 remain Ull(:hangcd u coverage Cor this thenpy for PODIA is CUITCIltly required under both the existing behavioral health tfutment nuondale and!be CUITCIlI California menial health parity bw. Therefore. CH BRP does not expect SB produce a public health impact on persons with PODIA. Additionally. CHBRP estimates SB 126 would have no impact on possible gender and I1IciaVethnic disparities in hcallh ouicomes or a:onomic lou, and no measurable impllct on longterm health outcomes. Inler.clion Wllh the Ftderal AffordQ1>le Can ACI Below is an analysis ofllow this proposed benefil mandate may inlcrac! with the ACA's requirement for «1tlI;n beahh insunonec 10 cover "essentisl health benefits" (EBBs). U S B 126 and Esymial Health Benefits SB 126 stiles thai!be benefit mand.:ltc WOIIld "not require any benefits 10 be provided lhal exceed!be essential health benefits." extends!be sunset dale of!be existing behavioral health treatment mandate requiring COVCl1lge of intensive behavionol intcfy<:ntion tbenpies for enrollees with PODlA.l<i lbe existing IlalC benefit mandate was enacted before December 31, 201 L. and is therefore included in California's EIiBs for 2014 and 201S.f! The StlllC would not be required to defray any costs IS l"csult of in and c-.. ofjll4l201l 'P... "

170 ACKNOWLEGMENTS This report provides an... lysis orlbe lixdical. financial, and public health impacts DrSenale Sill 126. In response to a request from the California &nate Commiucc on Holm on January 23, WIJ, the California Health Benefits Review PJo&ram (CHBRP) IlAdertoolc this analysis J!W$U<UII to the progmn" authorizing statute. Janel Coffinan, MfP, PhD, Gina Evans-YOWl&. and Margaret Fix, MPH, all of tile University of California, San Franeitc(l, prepared the medic.l cffcclivaless analysis. Penny Coppernoll Blach, MLlS, aftlle University of California, San Diego, conducted the lilcnllure search. Diana Cassady, DrPH, and Dominique Ritiey. MPH, orllle Univ~ity of Cal ifomi a, Davis, prepared the public health impact analysis. Todd Gilmer, PhD, of tile University of Cali fomi a, San Diego, prepared the «lsi impllci IlIJIlys;s. Robert Cosway, F5A, MAAA. and Scott McEachem of Milliman, provided actuarial analysis. Content «pert NaUicha Akshoomoff, PhD, orlbe University ofcalifomil, San Diego, provided technical assistance with the literature review and expert input on the _lytic approach. Lain Grossmann. MPH, ofchbrp staffprepaml Ole Introduction and J)'1Ilhesited Ole iddivid... lllef;tions inlo. single report. A w1x.ommincc of CHBRP's National Advisory Council {see fmal pages or this report} reviewed Ole _lysis for its acwnw::y, completeness, clarity, and responsiveness to the ~gisl.ture's 1llQU0C5t. CHBRP gratefully acknowledges all of these contributions but assumes full responsibility for all of the repon and its contents. Please direct any questions concerning this repon 10: Califoroil Health Bendi" Review Prog... m F... nklin SlrH I, II'" Floor OaklJind, CA 946(11 Tel: 511) Fax: 511).16l-42S3 All CHBRP bill analyses and other publicatio!lll are available on the CHBRP website. OooftoI.. ofjllolf.!ol, w:n!mq", "

171 California li ea lth 8onellt. R.vlc:w Pr",ram Commltt_.nd St.rr A IfOUp of r.eulty and It1ff WIdmak.. 1lIOII of w.alysis thou inf"""" repoiu by tile Califo:wnil! Health Beoolill Review JITotram (OIBRP~ Tho CHBRP r... lcy Tall:.'OI'U <:<lnip'ites rowint represenlltivel fium ~ Uni... ity ofcalifomii (UC) ~ In Iddirion 10 these tepocsciitlti-. tbck ,..,... oontributof1l to CHBRP from UC. "Thif I.arJer poup provi... advice 10 the OIBRP ""ff on tile ""... n adminillrltion of the program and tonducts much.. fim... Iysis. Tho c uoo r.t.rr oooniina,es th<: dfom of the Tosk Fot<:<:, woru with of the,nalysil, ond coordinate.,n I The le~1 of invol"""'""t of mtn>berl oflm,,., ill The Nallon>1 II.d.. lsory Council provid«oxpert revi~ of droll IlII.lyses and orren,eneral guida""" on the program to CUBRP stiff and 1M FICuhy Tu k FOI"OO. CHIl RP i. ""tefu! for 1M voluable assistance oro;! thouptl'ul critiq\les provided by the ",."obooi orlm NatiorWol Acbi!o<y C_ll. However, 1M Counoil don not ~y 1IIlP'O'" 01" ~ of 01" ~ \hit report. OIBRP -... filii responsibility for tho: report ond the occwxy or ill 0DIIIm1L Todd Gilmer, r ho, VI<:.! Clwir for COSI, Univef'1ity ofcolifomil, Son Dieao Joy Meln lko", MD, MPII, Vic. Clwlr for Publk Hwlth. Unl","ity ofcolifomla, Davis Ed Yolin. PhD, Vic. Clwir for AkdietJI EJ!«IiwMn, UoiV<"llity orc.lifomi.. s..n r... is<:o S ~ su 1.. EIIMr, PhD, Uoivenity olc.uforn'" Loo An&cl l "fhho.n! Gul.tl, MD, University ofcalifcmia, San Diet<> Sbo:Idoa G_.IltId, MD, Univnty olcalibnil, IrMo S)'I, I. G... d.. m.... PhD, LCSW, Uni... ityolcalifom... Bcrl<eiey Ta.k r orc. Contribute" Wi de Au bry, MD, University of California. San F... ijto Diul C'Hady, DrPIi. UnivcrsltyolCalifornia, Davis Janet Corrm.., MPP, PhD. UniYUSity o(california, San F...,ito:n Gin E... y OII"" Ulliwnity.. f C.hlOmia, San Frucilco M... ortl.1x. MPIl, Univnty..( Californ'" s..n F... ito:o BrtDI r.ltu, PhD, Uliivtnity of Califomla, Berkeley Jeanlfe. Kemp... MS, UnivenityofCalifomi.. San Oic:ao Shan L... I. PbD, MPP. Uni",,,ity ofcalifomil, Los Angeles S tepb~n ~ I.C u rdy, MD, MPII, Univenity.. fcalifomi.. Da.i, S.". McMeulOlD. PhD. UniversityolCalifomi.. San Die... Ninu Po,,", PbO, Univtnity ofcalir...u... Loo klp:1ei DolGin]" " Killey. MPII. University.. fcalifonria, Davis Mq:hu S.uhby, MPIl, Uaivcnity..(California, Davis Chris TUMr, MPII. Univctl;ty ofcalifomia. San FIWIci_ B)"unl-K... I{BIq V... 1'010, MS, PbD. UaiVUJity ofcauforni., Davi. o ofjtwjoii "

172 1,lureD Lt.Roy. PhD, Fmr. Prelliden! and CEO. OrtnlmlOke.. In lie.lth. Wuhinaton, DC. Chair StUr! H, "UrnJlD. PhD. ProresaorofNatiooal Health Pol..,.. B... UaiYCniI)', W.hlIln!. M" ~bonh CItoIItf. Ph D, Scruor fellow. MaIbon:lO!ica Polity Researdl, W~ DC J OHp h P. Di!rf Eoq, EJ<eaJI''''' Director. Consumer! lor "Iftwdoble H... thc.rc. A... ME "Un D. FftlOr. Fmr. DepuIy SccreIary fo< Htalth Savices. Nonh Carolinl De... n! ofllealth tnd liumad Savices.IWcicJt. NC Chlr'" "Cblp~ Kahn, MPII. President tnd CEO. Foderslionof American Hospilllia. Wuhington, DC Jdr~ Ltrne., PhD. Pmickm and CEO. ECRlln,!ihl!e Hetdquart... Plymoulh Meelin" PA Trudy U.bermu. Director. n... llh and Medici.., Reponing Program. O...s..!e School afjoilmlli.m, City Uni"".. il)' afnew York. New York Cil)'. NY Donald E. Mot.. EJ<roll;'. Edi!o<. H.. lth Mf,in, Botbesdt, Maryland Mao1lyn Moon, PhD, Vice PmideDl tnd 0"",,101', H... 1th ~ Americoa IlllIilUICS fo< R...,h, S;lver~MD Ca. olyn Parr, CEO, Buyers H... tit Can: ""lion Group, 8~ MN Mkhel PoUont. JD, M PII, Sen... f.llow, Inttihl'" for Health PoIi<:y Sohd_ WNhin&oon. DC C~rblop b e. Qt.enoDl, Pn!:slc\eD1 tnd CEO, Wil«lnsin CoUabonli"" fur licalthclre Quality, Mldiscn, WI Rkhnl Robe".. MD, JD. Prof... affamily Medici... Univen.ityofW~in-Mld iscn, Modiscn, WI "r... k SIDlUH, LLB. Fonner Sci<:nce tnd Technolol)' Advitor. Go emor'. Ofl"ooe. Sill'" ofdltio. Colwnbus, OH ' a.. ld, S mith. Prui<knl tnd CEO. AllioneeofCommunily Heallh Plans, Wuhington. DC Pronl l.. T lylor, MI>. ReJionaI Center Medicol D"""tor, Advoeale H"llk Cental, Ad.oc.. e H... lth c.",. 0.;""10. IL J. Ru T.. "... Vice Pmidon~ Oidicoll'Iac!iw tnd Thenpeulic:$.Medoo H... ltit SoI..tiont, Inc, Brookfi.1d. cr AI... Wti~ JD, MPP. Exeaui"" Din:cIOr, NItionaI AcacIemy furs..!. H... Pol..,., Wahiftclcn, DC CIIBRP SIIIf Caron Corbell. MS, Director J oho Lt... I.. MP", Auoci.le Director Loura Croosm.nn. i\ipti, Pri""ipol Policy Analyrl IIloh Kim Q u..,b, Prindpai Poliey Analyst II1lmll Ruparrl, Ol1lduloee IIQltIt I'o~,y Inlml KaN Wood, Proanm SpcciIliIt Cilirornil H ~l l t b 8 ~ n ~Il ' $ R... Ie... Program Unlvu.lly of California om orlb. P ~ i d. nl Fraakl1n SI. HI, I lih Floor Oal.:lllD<I, CA!J4601 Tel: 5UI.. I81 317' f a> : 51o.16J..<11S3 c"bmlllr... t~brp. 1"J...,c~brp.on: The Colifom;' Healtlt iknefiu Review Proanm ;'ldminblercd by... Divi iool ofhcal1h Sciences tnd Services.ll'" Un;venil)' of Cal i(omi a, Dffice afl'" ~sidenl. The Division b Ird by Jolm D. Slob<>. MD. Senior Vice President.... c--.. oivw>o', ".., "