Monday, February 27, 2012

The future of treatment for autism

I just returned from the 30th Annual Calaba (California Association for Behavior Analysis) conference. A lot was discussed there about the future of Applied Behavior Analysis services for individuals with autism. One thing we know is that in fact we do not know what the future looks like. July 2012 will be the start point for the bill Gov. Brown signed a few months ago. This bill mandates that Health Insurers must provide ABA services for autism. A number of people and organizations worked very hard for a long time to see this becoming a reality.  However, we cannot say this is the end of the road and we will live happy ever after. Health Insurance companies will not make it easy. And one cannot blame them. Insurance companies are for profit corporations and will still make it difficult to obtain coverage because ABA services are expensive and insurance companies are not in the business of losing money.  
One main obstacle will be that we will need to justify the “medical” need for services, not an easy thing to do in a field that targets learning, social and communication skills. Additionally, we will need to learn the complex rules and protocols of the system. Health Insurance providers are a completely different beast than the School and Regional Center systems we (agencies, professionals, parents) are used to navigate. In the meanwhile funding for services at state agencies continues to decrease. Schools and Regional Centers are state bounded, meaning they are at the mercy of budget cuts. The times when we received more referrals than we can handle are over. And when we get referrals, the fees they pay hardly covers the cost of delivering quality services.
What can we do to smooth the process? Well, a whole lot. For starters we need to learn to work in collaboration with the insurance companies, and not in confrontation. If they do not like us, it will be very difficult to enter their networks. Customer Service is the key, and they are the customers. Agencies have to understand new procedures, from the contractual process to billing. And clinicians need to provide high quality services. No more babysitting the kids, or magic interventions that promise results based only on hopes and good intentions. We should deliver scientific evidence proven, data based effective interventions. That is why the bill is clear: Applied Behavior Analysis is the intervention for autism. No more services “forever”. Goals have to be clear. And we have to achieve them. Intervention programs need to have an exit strategy. No more requesting continuation of services even when the client is not showing progress. If we would sell cars, it would have to be a Mercedes Benz; less than that is not enough anymore.
And parents should be savvy and fight for the services their children need. And be ready for co-payments and deductibles. The idea of receiving free services might be over. This is not different than when we visit our physician or need surgery.
Willingness and commitment to learn, involvement, responsible conduct, business oriented customer service will be required. It will be a team effort. It has to be because there is a lot at stake.

Daniel Adatto, BCBA.

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