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Applied Behavioral Analysis: More With Less for Autism Treatment

Autism2Note: Beacon Health Options is the largest manager of autism benefits in the country, with more than 20,000 individuals receiving care annually through our autism program. Clients who use our Autism Care Management program include employers, commercial health plans, public sector/Medicaid programs, and TRICARE for military dependents.

With April as National Autism Awareness Month, it’s a good time to recalibrate where we are when it comes to the diagnosis and treatment of Autism Spectrum Disorder (ASD). While there is much to celebrate, there is also a reminder for continued vigilance: children receiving Applied Behavior Analysis (ABA) services achieve better outcomes with fewer hours of intervention, but its use is still well below the ASD prevalence rate.

In brief, ABA is a teaching method that specifically focuses on how learning is achieved, such as positive reinforcement. ABA techniques can occur in a classroom as well as in everyday activities, such as how to play with others during recess. Teaching can be one-on-one or in groups.

Much of the celebration regarding ASD is around the growing awareness of ABA’s success. Starting in 2016 and moving into 2017, there is consensus around the opinion that early detection and treatment through ABA services are critical to successful outcomes for individuals with ASD. ASD treatment, primarily organized around ABA, focuses on improving children’s abilities in communication, self-help skills and social interactions to promote the development of greater functioning and independence. Outcomes support ABA’s efficacy: compared to other treatment modalities, children achieve more with less.

A closer look at ABA

Although traditional management models still dominate, Beacon has advanced and sustained a Board Certified Behavior Analyst (BCBA) peer-to-peer collaboration model that results in strong clinical outcomes and provider satisfaction. ABA services are provided by BCBAs, who also develop and monitor the treatment plan, which is implemented in homes by their trained paraprofessionals. When providers are able to pick up the phone and get a colleague, outcomes improve and costs are reduced. The BCBA model is also closely aligned with the position of such advocacy groups as Autism Speaks.

Based on our work with our clients, we have continued to find that the rate of members accessing ABA services is a lot less than the prevalence rate reported by the CDC. We have also found that ABA treatment time is usually shorter than generally expected.

For example, our experience demonstrates that children in active ABA treatment have an average episode length of less than 18 months; after that, there is a transition of the child’s care to families and schools. To get meaningful results, 15 to 40 hours of ABA services per week are often required. Much of the care is provided in the member’s home, averaging 17 hours per week.

Beacon’s approach has resulted in meaningful outcomes. Over the course of 26 weeks, our participants exhibited an average 60 percent drop in behaviors, such as aggression and self-injury, along with a dramatic increase in target behaviors, such as self-regulation and verbal communication.

The future is bright for ABA

ABA is or will be a covered benefit for just about every child in the U.S. by 2017, including those insured through federal employees’ plans. CMS added Behavioral Health Therapy, including ABA services, to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for Medicaid members through age 21 since July 2014.

Additionally, currently 44 states and Washington, DC mandate coverage for ABA services through commercial plans, and we’re likely to finish 2016 with 47 or 48 states mandating coverage. Furthermore, a growing number of large health care insurers will not underwrite coverage without an ABA benefit for autism services, accelerating the adoption of ABA benefits by self-insured companies.

There is also a move toward screening and diagnosing ASD diagnoses at earlier ages with tools such as The Modified Checklist for Autism in Toddlers and ADOS 2. ASD can now be accurately diagnosed between 18 and 24 months, which gives the best chance for improvement, as ages 2 to 6 years is the window when we see the most improvement in adaptive skills using ABA treatment models.

This forward-moving trend of ABA services is hopeful. After all, what’s better than getting more with less?

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