March 30, 2016 marked the beginning of positive change in Nebraska for families of Medicaid-eligible children with autism and the applied behavior analysts who treat them.
It was on this date that the Nebraska Department of Health and Human Services announced that the state received federal approval to cover applied behavior analysis (ABA) and other behavioral modification services.
ABA uses positive reinforcement and other techniques to modify behavior, promoting social integration through socially appropriate behavior. According to Calder Lynch, director of the state’s HHS Division of Medicaid and Long-Term Care, ABA is a “great addition to the Nebraska Medicaid program.”
Applied behavior analysis (ABA) continues to make major contributions to improving the lives of those with autism, largely thanks to insurance reform at the state level that is expanding access to ABA services for the children and adults eligible to receive them.
As ABA emerges as one of the most effective and widely recognized therapies for autism spectrum disorder, a large number of states have either started licensing applied behavior analysts or are in the process of writing or implementing legislation aimed at creating a licensing process that would be administered through an independent licensing body or through the existing state board of psychology.
The idea behind creating a licensing process is to establish universally recognized practice standards and uniform education and experience requirements for practitioners as a way to ensure the safety of the public. Though as of 2016, Nebraska has not yet established state laws requiring licensure for applied behavior analysts, the state has begun to take steps toward establishing requirements for practice.
Under the state’s insurance reform law, behavioral health treatment eligible to be covered by insurance must be provided or supervised by either a licensed psychologist or behavior analyst that holds nationally-recognized board certification.
The Behavior Analyst Certification Board (BACB) offers the credential that meet this requirement for both master’s and doctoral-prepared practitioners of applied behavior analysis:
- Board-Certified Behavior Analyst (BCBA®)
- Board-Certified Behavior Analyst-Doctorate (BCBA®-D) (considered the same credential and does not indicate a higher level of practice authority; requires first earning the BCBA®)
The BACB also offers a bachelor’s level credential for assistant applied behavior analysts, and an entry-level credential for non-degree support staff commonly referred to as behavior technicians:
- Board Certified Assistant Behavior Analyst (BCaBA®)
- Registered Behavior Technician (RBT®)
As it stands, applied behavior analysts working for the state are legally required to be board certified. Even outside of the public sector, earning a master’s degree and the BCBA® certification have become a standard requirement of most employers since only services provided by board-certified ABAs are billable to insurance.
Earning a Master’s Degree and Board Certified Behavior Analyst Certification
Earning the BCBA® through the Behavior Analyst Certification Board (BACB) involves meeting specific graduate education, experience, and national examination requirements.
A master’s or higher degree, either in behavior analysis or in psychology or education with a specialization/focus or minor in behavior analysis, is widely recognized as the minimum educational requirement to practice applied behavior analysis without oversight. It is also the minimum educational requirement to earn BCBA® certification.
Many institutions with ABA and other qualifying programs offer distance-based programs, which allow students to complete some or all the required coursework through interactive, online courses. Accredited online programs are ideal for busy professionals and students not residing near a campus with an ABA program.
Eligibility for the BCBA® designation requires candidates to complete a significant amount of qualifying coursework in applied behavior analysis at the graduate level. To meet BACB curriculum requirements, the graduate program must meet one or more of the following criteria:
- Accreditation through the Association for Behavior Analysis International’s (ABAI) Behavior Analysis Accreditation Board (BAAB)
- Include a BACB-Approved Course Sequence (ACS) (The BACB approved course sequence is also available through some schools as a non-degree option for those who already hold a graduate degree but need the required ABA courses to qualify for BCBA® certification.)
- Meets course content allocation requirements (requires a syllabus evaluation by the BACB at the time of application)
As part of your graduate program, you will likely complete a practicum that meets BACB Experience Standards. If the program you completed offers a practicum, it will be structured in one of two ways:
- Practicum: 1,000 hours (with at least one week of supervision)
- Intensive practicum: 750 hours (with at least one week of supervision)
If you completed a program that didn’t include a practicum, you must complete an independent field experience of at least 1,500 hours, with at least two weeks of supervision.
Some of the ABA providers in Nebraska where you may be able to complete your practicum/independent field experience include:
- Behavioral Health Solutions, PC, Nebraska City
- Lovaas Institute for Early Intervention, Lincoln
- STE Consultants, Omaha
Passing the BCBA® national examination is the final requirement for becoming a BCBA®. You must first apply with the BACB to receive authorization to take the exam.
In Nebraska, you can take the exam at one of the following Pearson VUE test center locations:
- North Platte
How Insurance Reform in Nebraska Ensures All Children Have Access to ABA Therapy
Nebraska’s Medicaid-eligible families with autistic children gained access to ABA services thanks to a class action suit declaring that the exclusion of these services violated federal law.
The Nebraska Appleseed Center filed the lawsuit on behalf of two boys, one diagnosed with disruptive behavior disorders, autism spectrum disorder, and ADHD and the other with Pica and stereotypic movement disorder. Though the youngsters were recommended for ABA services, based on HHS policy at the time, both boys were denied treatment.
Appleseed legal director Sarah Helvey said that the ruling is “an important victory” for children who have been denied access to doctor-recommended behavioral health treatments.
The Medicaid victory came shortly after the state’s autism insurance reform, which was enacted in April 2014. The legislation requires certain insurers to cover the diagnosis and treatment of autism up to the age of 20 and requires coverage for speech, occupational and physical therapy, including up to 25 hours a week of behavioral health treatment, such as ABA.
Nebraska Organizations Working to Advance Autism Awareness and Access to Services
Thanks to a variety of state organizations committed to bolstering autism awareness, education, and access to services, families are more knowledgeable of treatment options for autism spectrum disorder than ever before, leading to better professional opportunities for ABA therapy providers:
- Autism Society of Nebraska: For 35 years, the Autism Society of Nebraska helped families and individuals living with autism spectrum disorders by publishing a parents’ resource book, supporting local legislation, and overseeing the statewide autism conference.
- Autism Family Network: The Autism Family Network is a nonprofit, volunteer-based organization located in Lincoln and founded in 2006. The mission of the Autism Family Network is to provide a safe place for families to connect with other families so they know that they are not alone.
- Autism Action Partnership: The Autism Action Partnership (also known as the GWR Sunshine Foundation) in Omaha advocates for education and awareness of autism spectrum disorder; providing diagnosis and treatment options, educational opportunities, and community resources.
Opportunities for Applied Behavioral Analysts in Nebraska
Applied behavioral analysts are found working in Nebraska’s schools, nonprofit organizations, hospitals, pediatric practices, mental health facilities, and for private ABA therapy providers. Some of the ABA providers in Nebraska include:
Childhood Autism Services Inc., Papillion
Childhood Autism Services, using ABA therapy, provides individualized educational programs and comprehensive behavioral interventions. Treatment interventions are based on the principles of ABA, such as:
- Discrete-trial teaching
- Systematic prompting and fading
- Errorless learning
- Differential reinforcement
- Pairing procedures
- Task analysis
- Verbal behavior
- Natural environment teaching
Autism Care for Toddlers, Omaha
The Autism Care for Toddlers (ACT) Clinic is a community-based program, located in the Autism Center of Nebraska, which provides ABA services for children with autism spectrum disorder from 18 months to 4 years of age.
Treatment plans are tailored and individualized to each child’s strengths and areas of need. Teaching strategies incorporate highly structured learning opportunities through naturalistic instruction and discrete-trial teaching.