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COVID-19 Update 12/1/2020

We are still here!

Colorado ABA Therapy and the ABA field have been hit hard by COVID-19. Our frontline heroes have been doing their best to continue to provide high quality therapy services while following the health orders from the state and federal government. We are still here to support you and your family during this time! 

Just how has COVID-19 affected us and our field?

  • We closed down our early intervention therapy center in March 2020. 
  • Several other ABA providers in the Denver Metro area have also closed permanently or temporarily.
  • Some services had to be moved to telehealth in order to reduce foot traffic within the homes.
  • Many families needed to pause ABA services due to the increased health risks of their children and other family members.
  • Some families still have not been able to restart services with their provider.
  • Some insurance companies did not allow for telehealth ABA services, therefore, those services were temporarily paused or canceled.
  • ABA professionals have had to change their direction due to family members being sick, spouses losing jobs, or just wanting to be closer to home. 
  • ABA has had to adapt to a whole new service delivery model utilizing telehealth.

What is Colorado ABA Therapy doing to keep our services going AND overcome this pandemic stronger than before?

  • First and foremost, we don’t give up! We understand our services are essential for your child’s success. That’s why we still provide in home 1:1 services. 
  • Our RBTs have stayed committed to our mission to provide great services in home despite the risks.
  • Our BCBAs and BCaBAs have rose to the occasion to support our families by completing continuing education and ethical trainings about telehealth.
  • We have utilized any and all government available assistance to maintain the services we do have in place. 
  • Our therapists follow safety guidelines during therapy to include PPE, increased hand washing, cleaning materials, and completing health screenings before each session.
  • We are looking for new therapists to join our team! We know the unemployment rates are high right now, so we are doing our part to hire and train new and experienced staff members.

We are so very proud of our professionals and we look forward to a bright future in 2021! 

How do I Afford This? ABA Coverage and Insurance

What does the law say about ABA coverage?

Section 10-16-104 (1.4), C.R.S

All health benefit plans issued or renewed in the state must provide coverage to assess, diagnose, and treat autism spectrum disorder (ASD).
Treatment covered includes:

  1. Evaluation and assessment services;
  2. Behavior training and management;
  3. Habilitative or rehabilitative care, which includes speech, occupational, and physical therapies. Speech, occupation, and physical
  4. Therapies may exceed 20 visits if deemed medically necessary;
  5. Pharmacy and medication if covered by the individual’s health plan;
  6. Psychiatric care;
  7. Psychological care, including family counseling; and
  8. Therapeutic care, which includes speech, occupational, and applied behavioral analytic physical therapies.

Any treatment for ASD must be deemed medically necessary. The law specifies that early intervention services, which are currently mandated under law, shall supplement, but not replace, ASD services

IMPORTANT: If your child does not have an Autism diagnosis we may be able to still help! Call us at 303-997-0305 for more information.

Although Colorado Statutes require that ABA is a covered benefit by insurance companies, many benefit plans are exempt from this statute. How does a parent know if their benefits are covered or how do they receive this benefit? Parent must know the law and understand how your individual policy in effected or not applicable to that law.

KNOWING THE LAWS

  1. The sate mandates only apply to policies within the Colorado Division of Insurance (DOI) jurisdiction.
  2. Health plans covered by the DOI include Colorado Medicaid and commercial insurance plans licensed by the state of Colorado.
  3. Health plans that fall outside of the DOI may include: self-funded plans, union plans, and federal employee plans.
  4. Mandated coverages are independent of individual policies for deductibles, co-pays, and co-insurances.

UNDERSTANDING YOUR POLICY

What type of policy do you have?

  1. Fully Insured: Your employer pays an insurance premium each month into a large pool with a group of other employers.
  2. Self-funded: Your employer pays a specific amount that is set aside for admin fees, stop-loss insurance, an an expected amount to cover doctor bills for employees.
  3. Union plans: Your insurance is provided by a labor union.
  4. Federal Employee plans: An independent group plan for federal employees that offers fee for service, HMOs and Point of Service product plans.

To find out which policy you are covered under, speak with your Human Resources Department.

VERIFY YOUR BENEFITS

If your policy falls under the Colorado DOI, then your policy MUST cover ABA! You can verify this by speaking with your HR department or calling the customer service number on the back of your insurance card.

Now that you know you are covered, what happens next?

  1. You need to meet the insurance requirements for ABA as medically necessary.
  2. Most ABA services require a pre-authorization for services.

Not to worry, we do this part for you!

If you are interested in finding out if you qualify for ABA services or just need help understanding your benefits, we can help!

We work with families every day navigating them through the insurance process to make sure their ABA is covered and you have the lowest patient responsibility possible.

We believe in high quality care and high quality service! Call us today 303-997-0305.

Finding and Evaluating Service Providers

When the doctor gives a parent a referral for ABA Therapy, the most common response is, “What is that?” Without any further guidance, you go home to sit at your computer and type in the only phrase you know, “ABA therapy”. Up comes page after page of resource centers, providers, informational websites, blogs, Facebook pages, and everything in between which you are expected to sift through in order to find the best fit for your child. This is the point at which most parents become overwhelmed, confused, lost, and end up feeling around in the dark as to how this whole process comes together. It can be an overwhelming maze for parents to find the right services they need for their child. You need to know the key elements and questions to get where you need to go.

            In this article, we are going to look at how to streamline your search using key community resources, understanding the different types of ABA service providers, and key points you should be looking for in an ABA provider.

Community Resources

Community resources are the best first step in your search for service providers. Most have resource pages with lists of providers in the area all in one place. In the Denver metro area, here are a few to check out:

  1. Autism Society of Colorado
  2. Autism Speaks
  3. Colorado Department of Health Autism Resources
  4. Colorado Community Center Boards

Some of these organizations can also connect you with additional service providers such as Speech, Occupational Therapy, Physical Therapy, and Respite care.

Types of ABA Providers

Although all ABA providers have the same type of services, they are not all alike in their practices, service locations, and program tools. It is important for parents to understand their child’s needs and discuss them with each provider to find the right fit. Here are some major points of interest you should know about each provider you choose to interview:

  1. In-Home, Center-based, community based, or a combination
  2. Age range for services
  3. Specialties within the clinic i.e. non-verbal, high behavior
  4. Specialties in teaching methodology i.e. natural environment or teaching at a table

Each of the above options gives the provider strengths and weaknesses within their therapy practice, which makes your choice as a parent even more important in finding the right fit for your child. For example, if you child is in need of intensive therapy for high behaviors with more than 4 therapy hours per day, a center-based program may be most appropriate. Likewise, if your child needs therapy to prepare for independent living, a community-based approach would be most beneficial. Another example would be if your child needs intensive instruction that can only be taught in a highly structured setting. You would want to find a provider who focuses on what is called Discrete Trial Training, where skills are typically taught at a table similar to a classroom.  

Evaluating Potential Providers

Once you have selected the providers you are interested in, it is best to have an idea of what qualities to look. You should also be prepared with questions you would like to ask each of them in order to compare their services.

Here are the top questions you should ask when choosing the best provider for you:

What type of assessments do they use?

Here we are looking for standardized assessments such as ADOS-2, Vineland, VB-MAPP.

Do they offer parent training?

How is it structured? It is covered under your insurance policy?

What types of service levels do they offer?

Do they have small groups, trainings, consultations, IEP support, or advocacy?

What are their emergency policies?

Most companies use physical restraint programs all of which are different.

How many therapists are assigned to each family?

The lower number on your team the better.

How does your scheduling work?

Some providers will have therapy only Monday through Friday while others do weekends and nights.

Desired Qualities in an ABA Provider

  1. Have a good rapport within the community and other families.
  2. Respond promptly to all calls and/or emails.
  3. Have a means of contacting the owner directly
  4. Give timely reports and updates of progress
  5. Have continuity of care, i.e. consistent staff members; collaborate with other providers the child may be seeing.
  6. Data is collected and reviewed with you after each session
  7. Training is provided consistently to all staff

Have more questions? We would love you help you! You can set up an appointment with us by email at admin@coloradoabatherapy.com or find us on Facebook to request an appointment.

Understanding Data

Meetings with your service providers will often present you with a lot of data that may not be easy to understand. Your child’s school and therapy services will more than likely collect and assess progress information.

Data is a crucial part of our programming. When we review it, we want all of our parents to feel comfortable with what it is and what it means. Obtaining data is one of the most important aspects of ABA.

Data can show us if your child: 

1. Is improving or regressing with a skill.
2. Needs a new intervention.
3. Is ready to move on to more advanced skills.
4. Needs to focus on different skills to become more successful.

BCBAs use data to make decisions for the direction of programs in order to make your child most successful. Without it, we cannot progress onto more difficult tasks and skills to develop. 

When we look at the data, your BCBA will be able to explain what the graph means in regards to the progress of your child. Sometimes we want the graph to slope upwards, and sometimes we want it to slope down. This depends on whether the goal is for the behavior to increase or decrease. Either way, a flat line means something needs to change. 

How do we collect data?

ABA utilizes a variety of methods to obtain useful and relevant data, but here are a few to start.

1. Baseline Data: This data collection method is the first to be implemented. Before any treatment or therapy can actually take place, we must have a better understanding of where the child’s skill levels are.

Baseline recording takes place without any intervention from the therapist. We simply observe and record the behavior in order to have a starting point for comparison. This allows us to see the effectiveness or ineffectiveness of implemented strategies.

2. Frequency Recording: This method records the number of times a child exhibits a behavior or response. The therapist will tally up every occurrence throughout the session.

3. Rate Recording: This type of data is the same as frequency recording, except the number of occurrences is measured over time.

For example, if a child spills their milk 4 times over a 2 hour session, the data recorded will show that the child is spilling 2 times per hour. This method is used for consistency over sessions that are different lengths of time.

4. Task Analysis: If a behavior you are trying to influence is complicated or has multiple steps how do you measure it? With a task analysis!
This method breaks down the behavior into individual steps in order to better understand where progress is being made, and where struggles are taking place.

Here we can see a task analysis for the target behavior “Washing Hands.” It is broken down into 5 steps, and your RBT will record whether the step was completed independently, or if a certain prompt was needed.

This is what a graph for a task analysis might look like. As we can see, the % correct is steadily dropping over time. A BCBA that recognizes this trend will know new implementations are needed in order to help the child better learn the skill.

5. Duration Recording: This method measures how long a behavior occurs. For some behaviors, it is more beneficial to measure its length rather than its frequency.

For example, if we want to document a child doing homework, frequency may not be the best method. Measuring the duration of homework time can help us show how it has increased or decreased over time. This will let us know whether our intervention strategies are effective.

In Conclusion:

Data can be confusing, but is extremely informative! Keep yourself in the know about your child’s progress and their behaviors. Ask your provider questions about what certain data points mean and what their goals are!

Coming Together: ABA in Schools

The State of Colorado will soon vote on one of the most important bills for the ABA community.  This bill would essentially allow ABA providers to offer therapy services for students within the school setting. You can read the entire bill here.

If this bill gets passed, it is important for all families, providers, and schools to work together effectively to successfully support our students. In my experience as both a Special Education Teacher and a BCBA, I have identified 3 barriers to successful collaboration between ABA providers and school personnel as well as viable solutions. Both sides of the house have equal responsibility in the success and failure of collaboration.

Barrier #1: Misunderstanding of Roles

ABA providers have been collaborating with schools for years without a lot of structure. Some schools allow providers to come, observe, and provide written feedback. Other schools do not allow outside providers at all. The schools that do allow BCBAs to observe and participate in the IEP, do not have defined roles for each professional to ensure productive collaboration. This has created tension between BCBAs and educators that hinders progress of the child. Often times, relationships can become strained without guidelines and protocols for the professionals to follow.

Solution #1: Clear Role Definitions

Roles and responsibilities must be defined and agreed upon in writing by the professionals. Some common roles and responsibilities may include:

  • Who is responsible for behavior IEP goals?
  • How to provide feedback to either party on the fidelity of the behavior plan?
  • Structured mediation practices – what will they look like? How do you document?
  • How do you distinguish between skill acquisitions that the teacher and the ABA provider are responsible for?
  • How does the RBT receive instruction from both professionals? Whose recommendations take priority and for what content area?

Barrier #2: Differences in Education and Training

It is very important to know that each professional has a different set of training and skills. Over the course of time, behavior analysts have increased their research in some areas related to education. This includes precision teaching, DTT, and various other teaching modalities that are often used in ABA to teach academic content. However, it must be clear that BCBAs are not trained in education. Although BCBAs have successfully taught academic content through interventions based on behavior analysis, they are not trained in curriculum design and instruction. I have often experienced BCBAs recommend behavior-based programming that requires more time and attention than the teacher can feasible accomplish.

On the other hand, teachers are not trained in behavior management which is much different than classroom management. My personal experience in my Master’s program for Special Education did not prepare me to handle the extreme behaviors I had in my classroom. These behaviors, unfortunately, kept me from teaching as much academic content as I needed to.

Solution #2: Cohesive and Comprehensive Education and Training

Both teachers and BCBAs need to continue their education on topics within each other’s fields. In the larger scope, I would love to see the blending of these two topics at the university level as well as more offerings of CEU trainings on both topics.

BCBAs need to be trained in the content of IEPs, general classroom management, and understand the full scope of the teacher’s role. They need to be able to implement effective behavior programming in the classroom while accounting for the teacher’s capabilities as they meet the needs of all children in the classroom.

Both general and special educators need to be adequately prepared for the behaviors of the students they are teaching. Often times, basic classroom management skills are not enough to manage these behaviors without advanced training. As inclusion continues to be more and more prevalent within the classroom, it is important to ensure that our educators are adequately prepared to support these children.

Barrier #3: LRE (Least Restrictive Environment)

LRE, or Least Restrictive Environment, is a part of the Individuals with Disabilities Act (IDEA) which was established to help provide students with disabilities proper educational accommodations. Establishing ABA services within the school has posed challenges with meeting LRE requirements because ABA is technically a related service. Related services are additional services provided to the child which are outlined in the IEP. These services often include speech, occupational, and mental health. If an ABA provider is servicing the student in the educational setting, should this service be counted as minutes of related services on the IEP? If so, how does this affect the Least Restrictive Environment? When attempting to help service students in the classroom in the past, this has often come up because a direct therapist was not listed as a service.

Solution #3: IEPs with ABA therapy?

There needs to be a consensus made on how to write ABA as a related service into the IEP. It is going to be very important that a 1:1 ABA provider is reflected accurately in the child’s LRE considerations, and that the child’s present level of performance is accurate. Some very important questions need answers prior to implementing this level of services

  • Will the ABA provider be listed at all in the IEP?
  • If not, and it is just an outside service, how will the next school know how to best support the child?
  • For districts and schools, how is this going to reflect on their legal obligations if an RBT is currently unavailable and they are not meeting their required ABA service hours?

Final Thoughts

In summary, as with all big changes, it will take time and a group positive effort to ensure a smooth transition to this model. There will, of course, need to be accommodations made, policies written, and an open mind from all of the providers to set up a clear path of success for the collaboration of direct ABA providers, BCBAs, educators, school staff, and districts. With some of the solutions and questions proposed, I am hopeful that all BCBAs and educators (like me) are looking forward to this door opening as an opportunity to expand our reach and help more students succeed.

As they say, it truly takes a village!

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