What to Expect from ABA Therapy

ABA programs are highly individualized to best suit the needs of the learner. The skills and behaviors targeted in any given ABA program will depend on many factors such as the age and diagnosis of the learner, specific challenging behaviors, skill strengths and deficits, and location of services (e.g. school or home). While no two ABA programs will look the same, there are some general components that families and learners can expect from ABA therapy.

After the assessment is complete, and your funding source has provided authorization for ABA services, your provider will assign a team for your child. This team will include a Supervisor (typically a BCBA) and one or several Behavior Technicians. Expect to receive a schedule of services before the beginning of each month. Additionally, expect your ABA provider to reach out to you to receive your availability for services and to create a schedule that best fits your loved one’s needs.

Particularly in the early stages of the program, rapport building is essential. The staff assigned to work on your child’s team should strive to build a positive relationship with your loved one. Not only is this rapport building important at the beginning of services, it should be maintained throughout the duration of the program. Therefore, families can expect the first couple weeks of ABA therapy to include a lot of play and conversation with their child. Simply put, your child should feel comfortable and have fun with the Behavior Technicians. This helps ensure that your child associates positive experiences with the Behavior Technicians. This also helps with learning rates and ultimately produces more desirable outcomes.

Expect collaboration and communication from your ABA team. The Supervisor on your team should communicate with you to make sure your questions and goal preferences are addressed. Additionally, with your permission, the Supervisor may ask to get in contact with your child’s other service providers (speech therapists, school teachers, etc.) so that coordination of care can be established and that everyone is working collectively toward the same goals.

Depending on the approach used by a particular ABA provider and on the location of where services are provided, you can typically expect Behavior Technicians to work one-on-one with your child. The length of these sessions may vary based on your availability and schedule, but it is typical for in-home or in-clinic sessions to last about 2-3 hours (sometimes more or less depending on individual factors). This session time is where skill acquisition goals are targeted and the Behavior Intervention Plan (BIP) is implemented. The skill acquisition goals will be identified during the assessment process, before ABA therapy begins. These goals may include skills in the socialization, play, communication, academic, and other domains. Similarly, the BIP which was also designed during the assessment process, will be implemented by the team to reduce your child’s challenging behaviors and replace them with socially appropriate, desirable alternative behaviors. Both, skill acquisition goals and the BIP should constantly be evaluated and modified by the Supervisor or BCBA who manages your child’s case to ensure they are clinically relevant and up-to-date.

Parents and caregivers should also expect overlaps and team meetings. These are designated times throughout the month where the Supervisor observes one or all members of your child’s ABA team to ensure the treatment is being executed correctly and to address any concerns or questions that may arise. These overlaps and team meetings are imperative as they help ensure treatment consistency, progress, relevancy, and communication between all members of your child’s ABA team.

How Much Does ABA Therapy Cost?

ABA therapy can be quite expensive. This is because the administration of ABA therapy is intensive, highly individualized, and requires staff who has received specialized education and training. Additionally, ABA therapy requires rapidly changing materials and supplies. The good news is that most people won’t have to end up paying out-of-pocket for the full cost of ABA services. When there is a medical necessity, most health insurance plans will cover at least a portion of the cost. Therefore, it is best for families or individuals to reach out to their health insurance providers for more information on the cost of ABA services.

With more legislation being passed statewide and nationally, mandatory coverage of ABA services is expanding. This is the case with private insurance and includes Medicaid, Medi-Cal, and Medicare entities. It is becoming easier for families and individuals to get access to ABA benefits. Flexible Saving Accounts and Health Spending Accounts can also be utilized to pay for or defer some of the cost of ABA services.

It is best to communicate with your health insurance provider and/or ABA providers in your area to get specific details on the cost of ABA services. There are a lot of variables such as geographic location and the specifics of your health insurance plan which may factor into the cost of ABA services. If you are curious about private pay rates, we recommend doing a search of providers by zip code on the BACB’s website and reaching out directly to a provider in your area. You can ask them for what is typically referred to in the industry as the “private pay rate”.

We hope you found this post about the cost of ABA therapy helpful! Although many details factor into the cost of ABA therapy, we recommend you reach out to your health insurance provider or your local ABA providers to get the most accurate information for your specific needs.

What ABA Therapists Do

This depends on the clinical needs of an individual, but the work of an ABA therapist is quite dynamic. Typically, an ABA therapist’s job includes implementation of the Behavior Intervention Plan (BIP), skill building lessons (these are commonly called “programs” in the field of ABA), and engaging in play with the learner.

The BIP is specific to each client and will likely consist of one or more ABA based principles to reduce challenging behaviors and increase socially appropriate, desirable behaviors. The techniques ABA therapist may use include positive reinforcement, redirection, shaping, or extinction (just to name a few). The skill building lessons or programs the ABA therapists conduct will also vary from individual to individual based on their clinical needs. These might include lessons such as washing hands, number/letter/color identification, initiating and maintaining play with a peer, reciprocal conversation, motor skills, and so much more.

It is important to note that BIPs and skill building programs are established by the supervising BCBA and are based on the initial and ongoing assessments. ABA therapists do not conduct assessments, and they do not design BIPs or skill building programs. The BCBA on the team is responsible for these roles and will consult the family/caregivers so the most effective and individualized behavioral and skill building goals are designed.

Finally, an ABA therapist will spend a lot of time engaging in play, conversation, and desirable activities with the client. This helps to establish and maintain rapport and positive relationships. Additionally, many learning opportunities can be created and captured during play and conversation. A good ABA therapist will seize these opportunities to work on useful skills even while the learner and ABA therapist are playing and having fun. Some of the skills that can be taught loosely during play and conversation include but are not limited to: sharing and turn taking, reciprocal conversation (asking each other questions and answering each other’s questions), waiting and tolerance (such as waiting for your turn or tolerating winning/losing appropriately), imaginative play (pretending to act like characters), pretend play, environmental labeling, and so much more!

The work of an ABA therapist is based on the scientific principles of ABA. It is also dynamic, creative, educational, compassionate, and fun!

Is ABA Therapy Covered by Medicaid?

As of right now, all 50 states have mandates that require some level of insurance coverage for the treatment of autism spectrum disorder (ASD). Applied Behavior Analysis is considered an evidence-based therapy and is NOT considered “experimental.” With respect to Medi-Cal and Medicare, these insurance entities cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence-based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary; however in these cases, it is best to speak directly with your medical insurance provider to determine the specifics of your family’s coverage (e.g., copays, coinsurance, deductibles, maximums) and to ensure that ABA is in fact, a covered benefit.

ABA Therapy for Autism

Applied Behavior Analysis (ABA) is a scientifically backed, highly individualized treatment method which can be effective in many ways especially for individuals living with autism spectrum disorder (ASD). The ways in which ABA can be effective depend on several factors including but not limited to the individual needs of the learner, frequency of treatment, specific interventions, and the environment in which services are implemented. While it can be said that one of the ultimate goals of ABA is to help individuals living with ASD and their families achieve their goals; thus, improving their quality of life in general.

One of the ways in which ABA therapy is effective is through the identification and treatment of challenging behaviors. Effective ABA programs will identify challenging and undesirable behaviors at the onset of services. The function, or purpose of the challenging behavior(s) will be identified and a comprehensive behavior intervention plan will be established. An effective behavior intervention plan should include researched backed principles to reduce the unwanted behavior and should also include replacement behaviors. Replacement behaviors are behaviors that achieve the same result as the challenging behavior but are considered to be socially appropriate, easy to engage in, and generally speaking, more desirable than the challenging behavior. For example, if it is determined that a learner engages in aggressive behaviors to escape a difficult task, replacement behaviors which will be taught may include requesting a break, or asking for help. Hence, one of the ways in which ABA therapy is effective is through the assessment and treatment of undesirable behaviors.

Another way in which ABA therapy is effective is through the identification and targeting of skill development goals. ABA therapy will typically address skill deficits across several domains. These domains will vary and depend on the individual needs of the learner. For example, skill development goals may be targeted to address deficits in communication, self-help skills, motor skills, social skills, or play skills. Again, the specific skill development goals that are chosen by the family and ABA team will vary based on the current clinical needs of the learner. Ultimately, the goal of skill development programs is to improve the learner’s quality of life and promote more independence.

It is important to note that ABA therapy does not start and end with the learner. High quality ABA programs will involve family members, caregivers, and other stakeholders in the child’s environment. One of the goals of ABA programs is to transfer knowledge of the techniques and strategies that are used in the program to other individuals in the child’s life. This is usually achieved through parent and caregiver training sessions. In these training sessions, a Behavior Analyst or qualified Supervisor will instruct the parent or caregiver on various techniques that are shown to be effective in the ABA program. This is usually accomplished through verbal instruction, role play, modeling, and demonstrations of the techniques by the parent/caregiver while feedback is provided. Hence, the transfer of knowledge from the ABA provider to caregivers in the child’s life is another way in which ABA therapy is effective.

Where to get ABA Therapy?

While this depends on geographic location, in most cases and particularly when an Autism diagnosis is involved, ABA therapy is provided through private organizations such as ABA agencies. In other cases, families may opt to work with private practitioners, school districts, or non-profit organizations to secure ABA services. At this time, most ABA services are provided by private ABA agencies. It is common for properly credentialed and reputable ABA agencies to be contracted with most major medical insurance carriers. Therefore, it is typical for members’ medical insurance carriers to offer lists of local ABA providers to their members after an Autism diagnosis is received. Similarly, many pediatric psychologists and psychiatrists will have a network of ABA agencies with whom they work with and they are typically always prepared to provide referrals. Therefore, it is encouraged for families to request a list of local ABA providers from their medical insurance carrier or diagnosing physician.

Depending on the ABA therapy program that is selected as well as the individual needs of the child, ABA services can be provided in the home, school, clinic, or community settings. Sometimes, and depending on clinical needs, a combination of these locations may be used. ABA agencies are responsible for employing individuals who are properly screened and credentialed (Behavior Technicians, Registered Behavior Technicians, Board Certified Behavior Analysts, etc.) Additionally, ABA agencies are responsible for hiring, training, and placing staff members on a child’s ABA team. Initial and ongoing assessment, modification of treatment goals, and the delivery of ABA services are the responsibility of the ABA agency. It is important for families that are seeking ABA services to have a discussion with the ABA agency they are interested in working with and develop a plan.

For your reference, the following are some questions to ask ABA providers which may help in choosing the agency that best matches your loved one’s needs. Please note this list is not exhaustive: “Are there Board Certified Behavior Analysts on staff and will we have access to one?”, “Does this agency provide ABA services in our area?”, “What can we expect from the initial assessment process?”, “Who will provide services to my child and what are the staff’s qualifications?”, “Are you in-network with my medical insurance carrier?”, “How does the scheduling of my child’s services work?”, “Can sessions take place during community outings or playdates?”, “Who Supervises the staff on my child’s ABA team and how often will we meet with the Supervisor?”, “Does your program include a parent training component?”

We hope this post has provided you with some useful information about where to get ABA therapy and some questions to ask potential ABA providers.

What Insurance Covers ABA Therapy?

As of right now, all 50 states have mandates that require some level of insurance coverage for the treatment of Autism. The U.S. Surgeon general and the American Psychological Association consider ABA to be an evidence based practice. Forty years of extensive literature have documented ABA therapy as an effective and successful practice to reduce problem behavior and increase skills for individuals with intellectual disabilities and Autism Spectrum Disorder. Therefore, ABA therapy is typically funded by most insurances when there is a medical necessity. The criteria for medical necessity may vary from insurance to insurance, so it is best to check with your carrier, however the criteria typically (though not always) include an Autism diagnosis.

With respect to Medi-Cal and Medicare, these insurances cover all medically necessary behavioral health treatment services for beneficiaries. This typically includes children diagnosed with ASD. Since Applied Behavior Analysis is an evidence based and effective treatment for individuals with ASD, it is considered a covered treatment when medically necessary. In many cases, private insurance will also cover ABA services when medically necessary, however in these cases, it is best to speak directly with your medical insurance carrier to determine the specifics of the coverage (copays, coinsurance, deductibles, maximums) and to ensure that ABA is in fact, a covered benefit.

As most of us already know, the landscape of insurance is ever-changing, with information constantly being updated. Overall, insurance coverage of ABA therapy continues to move in a desirable direction, with more and more affected individuals having access to covered ABA services. However, it is always recommended to speak to your individual insurance carrier to get the most up-to-date and accurate information about ABA coverage.

Here are a few questions that may help with gaining more information about ABA coverage from your medical insurance carrier: “Is ABA a covered benefit for my child?”, “What criteria needs to be met for ABA services to be covered (e.g. Autism diagnosis)?”, “What is my co-pay and coinsurance?”, “What is my individual and/or family deductible?”, “Is there a benefit maximum (e.g. some insurances may only fund up to a certain amount for a particular treatment)?”, “Which providers or ABA agencies are in-network?”

Please note, the questions above are meant to serve as examples and are not a comprehensive list. We hope this post has provided you more information about insurance funding for ABA therapy!

Where do ABA Therapists Work?

This depends on the needs of the learner, family preference, and the approach used by an ABA agency or individual provider. However, generally speaking, ABA therapists work in the places where services are needed. These typically include four different environments: home, school, clinic, and community. The home setting is one of the most common places where ABA therapists work. This is where a child and his family spend much of their time and is typically the child’s natural environment. Many of the toys, instructional tools, household items, familiar people, and preferred activities are within immediate access in the home setting. This can be beneficial to learning. For example, let’s say we are teaching a child to wash his hands. In the early stages, teaching a child to wash his hands in his own bathroom sink can promote effective learning – the sink is familiar, it is accessible, and the environment can be modified easily to make the task easier (stepping stool, moving soap/towels around, etc.) However, it is also imperative that once the child learns to wash his hands in his own sink, that he acquires the ability to generalize that skill to other settings and people. This is referred to as generalization across stimuli, environments, and people. We will explore the topic of generalization in depth in a separate post.

The school setting is another very common place where ABA therapists work. Typically, the ABA therapist is part of the child’s IEP team and plays an integral role in facilitating the child’s behavioral, social, communication, and play goals (among others). Sometimes these staff members are referred to as 1:1 aides or IEP assistants.

Some ABA providers will offer ABA services in the clinic setting. These are structured environments that have access to a variety of instructional and play materials where various skills can be targeted. Not all ABA agencies provide in-clinic sessions, so it is recommended to check with the providers with whom you are seeking services.

The community setting is also a very important place for ABA therapists to provide their services. These can include trips to the grocery store, mall, park, play dates, ice cream shops, etc. Community outings are a great way to facilitate generalization (skills the child has learned in home or school sessions that can be applied out in the community) and to work on novel goals that cannot be targeted in the home or school setting. Community goals may include creating a short list of needed items and helping a parent retrieve them at a store or initiating play or a conversation with a peer at a park. One of the great things about ABA is that each program is highly individualized to meet the needs of the learner, therefore ABA therapists can work where the services are needed the most.

ABA Therapy Jobs

Although there may be various job titles or positions in an ABA company, needless to say the variety and number of these titles that grow exponentially once we consider all the companies that provide the services, at a minimum, a company will have two main jobs necessary to provide ABA-based services: a supervisor and a direct service provider (a.k.a. 1:1, shadow, behavior therapist, behavior technician, to name a few)

A supervisor is a Board Certified Behavior Analyst (a.k.a., BCBA) or a Board Certified Associate Behavior Analyst (a.k.a., BCaBA) or an individual working towards their certification.  The last two can function as a supervisor but only under the guidance of a BCBA or a BCBA-D. The supervisor is responsible for developing the treatment plan that may include a behavior intervention plan to address challenging behavioral excesses or deficits, the “curriculum” that comprises goals for skills across several pertinent areas that will be taught to the learner, and parent training goals. The supervisor will also be responsible for making sure that his or her team will be trained to make sure that the learner can learn from the services. Also, the supervisor will be responsible in making sure the parents/family/caregivers will learn pertinent skills in parent training.

A direct service provider is the person that provides the actual direct service.  Other labels used to name this job category are “1 on 1,” “shadow,” ‘behavior therapist,” “or “behavior technician” just to name a few.  These individuals work under the supervision of the BCBA and are responsible for the regular implementation of the treatment plan which also includes implementation of the behavior plans during scheduled “sessions.”  The treatment plan is implemented across settings in which it was prescribed to be used such as home, school, and the community.  To establish a standard and accountability among those providing direct services, the Behavior Analyst Certification Board has introduced a new class certification: Registered Behavior Technician (a.k.a., RBT).  Registered Behavior Technicians go through standardized training, examination, and documented on-going supervision to receive and maintain their certification.  RBT’s function as direct service providers.

As mentioned earlier, each ABA provider may be structured differently with various jobs or positions or titles like “Assistant Supervisor,” or “Lead/Senior Therapist,” or “Consultant” to name a few and that these titles may entail different sets of responsibilities within any ABA company; however, the basic jobs can be categorized in just two: a supervisor and a direct service provider.

ABA Therapy Examples

The science of Behavior Analysis is comprised of three branches: Behaviorism, Experimental Analysis of Behavior, and of course, Applied Behavior Analysis (ABA) with the last more focused on applying researched concepts to promote socially-significant behavior.  From ABA comes the multitude of research-based therapies or interventions which include Discrete Trial Training, Pivotal Response Training, Natural Environment Training, and Incidental Teaching to name a few.

Developed by Ivar Lovass at the University of California in Los Angeles, Discrete Trial Training (DTT) is perhaps the most widely-known ABA-based therapy for individuals living with ASD.  DTT, as the name suggests, simplifies a teaching step into three parts: the instruction, the response specified by the instruction, and the consequence that depends on whether the learner performed the specified response or not.  Not only does DTT break down learning into this short, clear three-part instruction, but it also builds in the repetition/intensity at which these trials are given to teach one concept, for example, responding to the instruction, “What is your name?”  DTT is very useful when it comes to teaching factual information (e.g., learning the alphabet, someone’s address, names, lyrics to a song, et cetera); however, it may be limited when it comes to teaching more abstract concepts (e.g., mathematical operations) or comprehension (e.g., understanding a paragraph the learner just read).

Developed by Robert Koegel and Lynn Koegel at the University of California in Santa Barbara, Pivotal Response Training (PRT) is another ABA-based therapy for individuals living with ASD.   PRT focuses on tapping into a learner’s motivation, teaching the learner to respond to multiple cues, encouraging learner- initiated behaviors, self-management, and empathy development.  In contrast with DTT which may appear very contrived and unnatural, PRT takes place in a learner’s natural environment which includes the participation of the learner’s family or caregivers with treatment coordinated across all of the learner’s environment (e.g., home, school, community).  As mentioned, the key element in a PRT program is the learner’s naturally occurring motivation which significantly increases social validity of the teaching instructions and skills learned as the consequences corresponds with the behavior learned via PRT.

Natural Environment Teaching (NET) is an ABA-based therapy wherein a target behavior to be taught is identified, a learner’s preferred items or activities are identified, the antecedent for the behavior to be taught is contrived, and the proper consequence delivered contingent on whether the learner performed the target behavior or not. In a way, it can be similar to PRT as both do implement the teaching opportunities in the natural environment; however, that’s where the similarities end as PRT is more comprehensive. Not to say NET is the weaker of the two—choosing between the two depends on what goal is to be achieved by the learner.

Incidental Teaching (IT) is an ABA-based therapy similar to Natural Environment Teaching (NET); however, the biggest difference is teaching opportunities are not contrived or intentionally triggered by the instructor.  These naturally occurring situations that includes the learner’s motivation to get or accomplish something makes it a potent teaching technique as, like PRT, the consequence or the “reward” for performing a behavior is directly tied-in with the reward for doing the behavior. For example, after walking a couple of blocks, the learner naturally feels thirst.  The learner grabs for the water bottle held by the instructor at which time, the instructor provides the learner prompts to communicate “water please.” Upon performing the action, the learner gets the water bottle.

As you may have noticed, there is a difference between DTT and PRT/NET/IT as DTT appears to be very limited in scope albeit the teaching technique being intense in delivery whereas PRT/NET/IT appear to be more in-tune with teaching socially significant behaviors taught in a more natural setting.  True.  However, it is very rare for an ABA-based service or program to be solely based on a single ABA-based intervention. Depending on the goals of the ABA-program for your child, the ABA professional may use two or all of the four examples we have gone over or perhaps even more not covered by this blog (e.g., FCT, TA, shaping, et cetera).

For more information regarding this topic, we do encourage you to speak with your ABA provider or email us at [email protected]