Category: Education

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.

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!

What’s in your IEP? (Individual Education Plan)

Most children with a diagnosis of any kind are provided an
Individualized Education Plan or IEP to help with school.

So what exactly is an IEP?
How do you read it?
And what input can you provide as a parent?

To start, an IEP is a formal education plan written by school professionals that outline how your child will receive support during their school day.

There are 6 major sections included: 

1. Present Levels: The child’s current skill levels in multiple areas are explained in this section. This is also where assessment data is reviewed.
These assessments can get very technical and are mainly for other professionals to read. The most important information to understand is the age equivalences and where the child is compared to the “average” score. This is where “below average”, “average”, or “above average” is determined. 

2. Parent/Student Input: Parental insights are recorded in this section. It is important to review this section carefully before it becomes an official document. Parents must make sure to communicate any concerns or requirements they wish to be considered. This may include behavior tendencies, coping skills or preferred activities!

3. Annual Goals: Here, the goals for each professional working with the child are listed. Teachers, psychologists, speech, OT, ABA, and other therapists should all be included.

Typically there are a couple of goals from each person working with the child. These goals must be specific and feasible to achieve throughout the year. 

A good goal will have a measurable skill to be learned within a specified time. Our good example gives us very specific criteria for determining a mastered task.

A bad goal will have a broad skill with no mention of when the goal should be achieved. Our bad example is too broad and does not provide an outline for the necessary consistency with the skill of addition.

4. Accommodations and Modifications: In this section, all the in-classroom tools the child needs should be listed. These cannot get too detailed, but you do want to make sure each one is listed. When the team trains the next classroom, they can detail the accommodations for them outside of the IEP.

5. State and District Assessments: Most children will not need to participate in state testing. For those who are eligible, necessary accommodations should be listed here.

6. Service Delivery Statement: In this section, each person who works with the child will indicate how many minutes in a set time period they will provide services. Many times speech and OT services have limited time slots and recommend 30-60 minutes per week. 

Most importantly, we always recommend having the IEP reviewed by a professional on the child’s team before signing. It is not required to sign the IEP on the spot.

Colorado ABA Therapy is always available to help with these revisions! Take the necessary time to review it and get feedback from other professionals before making it a legal document. 

We recommend reaching out to your BCBA if you have any questions or concerns about your current or future IEP. 

The ABC’s of Behavior

Why?

This is the number one question parents ask in the field of ABA.

Why is she acting this way? 

Why is he hitting his friends? 

Why won’t he stop screaming?

All behavior follows a predictable pattern when using the right roadmap. Our roadmap in ABA is written using the acronym ABC: 

Identifying the ABCs in our everyday lives:

1. Antecedent

These are the triggers that cause behaviors. Parents can usually pick out this part of the roadmap pretty easily: 

Every time my child is asked to share he…
Every time I tell her to clean her room she…

More often than not, antecedents can be observed right before the behavior occurs. Understanding this section of the ABCs will help us better identify when behaviors happen.

2. Behavior

This may be the easiest one to identify. This is the stand out action and main focus of what we want to influence in the child. Behaviors include crying, screaming, punching, and fidgeting. It is also important to identify appropriate behaviors that we wish to encourage. This can include following directions, sharing, kind words, and manners.

3. Consequences

Consequences can take a little bit of self-awareness to recognize. This happens directly after the behavior. When a child is screaming, crying, or hitting, what is our natural response? How we react to behaviors can show us the consequences we impose.

Consequences can also tell us what the child wants from engaging in the behavior. This could be attention from you, access to an item, escape from an activity or person, or simply because it feels good.

When looking at this roadmap, you may be surprised at what you find!

Let’s look at a few examples!

In this scenario, Julia is alone and wants her mother’s attention. Since Julia does not have her mother’s attention, she decides to implement a behavior (throwing her toy) as a response to her lonely play time. Julia’s mother then comes over to play with her. Julia now has her mother’s attention and will no longer throw the toy.

But here’s the catch!

We know that consequences will either encourage or discourage certain behaviors in the future. In this example, the consequence (Julia’s mother coming over to play) encouraged the behavior (Julia throwing the toy) to occur again!

Next time Julia wants attention, she will be more likely to throw a toy again in order to receive it, since this method has worked for her in the past.

So, what do we do?

In general terms, we prompt! Every case is unique and will have their own intricacies pertaining to behavior severity and the child’s skill level. But with all else being neutral, we can prompt Julia to appropriately ask her mother to play with her. Once Julia asks appropriately, her mother can honor her request by playing with her.

Our new ABC chart will add the prompt component, and look like this:

By prompting this behavior, we are reinforcing appropriate requests for play rather than the throwing of a toy. This will increase the likelihood of appropriate behavior in the future!

Let’s look at another example!

In this instance we see the antecedent, behavior, and consequence working together in a positive way! Mike is asked to do his homework and his appropriate response is to complete it. The consequence for his behavior is access to video games for 45 minutes.

Assuming Mike loves video games, we can infer that the consequence (45 minutes of video games) will encourage the behavior (completing his homework) in the future!

In summary, understanding behaviors will help us identify the antecedents (triggers) and consequences (how we responded) in our everyday actions. We encourage you to take notes on the ABCs of behavior for your child!

Once you find the patterns, ask yourself the following questions: 

  • Can I prepare my child for triggers that are about to happen?
  • Can I prevent/change the triggers in any way to reduce behaviors?
  • Can I help my child get what they want in another way? 
  • How are my own behaviors contributing to my child’s behaviors?
>