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Juvenile Justice Services in Florida - ABA is an Essential Element

Contents of this page:

  • What is ABA or Applied Behavior Analysis?

  • What is FABA - the Florida Association for Behavior Analysis?

  • What are Board Certified Behavior Analysts, Board Certified Assistant Behavior Analysts, and Registered Behavior Technicians?

  • Youth state strong preferences for ABA supports

  • Leaders and professionals in Florida programs and facilities appreciate the value of ABA

  • ABA is an Evidence-based Treatment

  • Joint Efforts to Meet the Behavioral Service Needs of Youth and Staff

  • Questions, comments, or concerns?


What is ABA or Applied Behavior Analysis?

  • ABA is the application of the science of behavior to improve the human condition. ABA has a long history that began in the early 20th century.
  • ABA is based on the premise that attempts to improve the human condition through behavior change (e.g., education, behavioral health treatment) will be most effective if behavior itself is the primary focus.
  • Behavior-analytic scientists have conducted thousands of studies to identify the laws of behavior—the predictable ways in which behavior is learned and how it changes over time. We have learned that behavior is a product of its circumstances, particularly the events that immediately follow the behavior.
  • Behavior analysts have used this information to develop numerous techniques and treatment approaches for analyzing and changing behavior, and ultimately, to improve lives.
  • Since ABA is largely based on behavior and its consequences, techniques generally involve teaching individuals more effective ways of behaving and changing the social consequences of existing behavior.
  • Treatment approaches based on ABA have been empirically shown to be effective in a wide variety of areas, including juvenile justice programs. (See ABA is an Evidence-based Treatment below.) 

Adapted from source: https://www.bacb.com/about-behavior-analysis/


What is FABA (Florida Association for Behavior Analysis)?

  • FABA was founded in 1980 to promote the ethical, humane, and effective application of behavior principles in all segments of society, including education, business, rehabilitation facilities, and government, and to facilitate access to appropriate, high quality, and beneficial behavior analysis services for residents of the state of Florida who are in need of such care.
  • FABA has over 5,000 members. More than 4,000 are professionals trained and certified to provide ABA services in the state of Florida.
  • FABA is the largest statewide organization in the nation committed to the promotion and support of quality behavior analysis services.
  • FABA's principal address is 3116 Capital Circle NE, Suite 2, Tallahassee, Florida, 32308.

What are Board Certified Behavior Analysts, Board Certified Assistant Behavior Analysts, and Registered Behavior Technicians?

Board Certified Behavior Analysts® (BCBA) are the highest level certified professionals who provide ABA service, To become certified, the professional must:

  • hold a Master’s or Doctoral degree
  • Complete coursework specific to the science and ethical practice of behavior analysis
  • Complete supervised experience, and
  • Pass a psychometrically valid examination

To maintain certification, compliance to a code of ethics and continuing education is required.

BCBAs oversee Board Certified Assistant Behavior Analysts® (BCaBA) and Registered Behavior Technicians® (RBT). These credentials also require rigorous training and supervision.  

RBTs are para-professionals with skill sets that are an excellent fit for direct support staff in DJJ programs. RBTs must be frequently supervised by a BCBA or BCaBA.

The Behavior Analyst Certification Board (BACB®, www.BACB.com) operates the BCBA, BCaBA and RBT credentialing program which is accredited by the National Commission for Certifying Agencies (NCCA).


How have Behavior Analysts supported DJJ programs and facilities in Florida and across the US?

  • Behavior analysts have worked for many years as employees and consultants in juvenile and criminal justice programs and facilities across the US
    • Many research journals and other professional publications include positive demonstrations of the impact of ABA on juvenile and criminal justice services (See ABA is an Evidence-based Treatment below.) .
  • Behavior Analysts and RBTS work well together with mental health professionals and problem-solving teams. Click here to learn more.
  • Behavior analysts develop evidence-based interventions that can be implemented 24/7 with high integrity by direct support staff, including:
    • Positive reinforcement approaches (that stop or minimize the use of coercive methods)
    • Skill training, including:
      • Replacement and alternative behaviors that prevent or minimize youth self-harm, aggression, property destruction, and more
      • Prosocial and vocational skills that support successful re-integration in schools and community settings
      • Functional skills of daily life
    • Highly effective educational strategies that increase classroom success, including fluency-based instruction, differentiated instruction, and classroom management techniques
    • Facility-wide behavior management systems (BMS, PPS), including level systems, token economy, and behavior contracts
    • Positive Behavior Interventions and Supports (PBIS) and Multi-Tiered Systems of Support (MTSS)
    • Safe and appropriate crisis management systems that focus on effective de-escalation methods, including how to prompt and reinforce youth use of replacement behaviors
    • Staff training, coaching, and performance management systems
      • includes BCBA supervision of RBTs, reducing the need for oversight by other professionals

      Click here to learn more about Educational Interventions and Academic Gains

      Click here to learn more about Common Features of Intervention Plans Prepared by Behavior Analysts

    • Click here to learn more about Staff Training and Coaching

  • Behavior analysts produce:
    • objective goal statements
    • reliable and continuous measurement of progress
    • fast intervention changes to maximize behavioral improvement
    • achievement of evidence-based outcomes necessary for program evaluation:
      • number of youth meeting treatment plan goals
      • success with exiting programs, maintaining placements in the community
      • reductions in recidivism, Baker Acts and costs with long-term, intensive services
      • reductions in staff injuries, Workers Compensation claims, turnover
      Click here for more information on Cost Analysis - Case Studies

Youth want ABA supports

Please click here to see Survey results. Additional examples:
  • “(Youth name redacted) was able to build great rapport and finally trust with his treatment team that he personally requested to stay in a county almost 2 hours away from his house so he could continue working with and receiving ABA services once he was released from DJJ.”
            Mary Johnson, Florida Certification Board - Child Welfare Case Manager

  • “I (youth name redacted) found a mentor while incarcerated, a Behavior Analyst, who not only helped me change my ways, but who also motivated me and taught me how to go about achieving my dreams. I actually began my college career while incarcerated. I completed my entire first semester with a 4.0 GPA while at my commitment program."
            Youth, age 19 High Risk Residential Program

Leaders and professionals in Florida programs and facilities appreciate the value of ABA

Please click here to see Survey results. Click here to read letters of support. Additional examples:
  • “When child and adolescent psychiatric trainees rotate with me through the juvenile justice system, I often remark that for many difficult cases, the behavior analyst is the most important person on the treatment team. This is in large part because youth in the juvenile justice system typically have limited and inconsistent motivation for traditional psychotherapies and mental health approaches, yet show maladaptive, dangerous and self-defeating patterns of behavior.”

               Dr. Kristopher Kaliebe, MD, Associate Professor, Psychiatry, USF Health

  • “I was fortunate enough to have a full-time Board Certified Behavior Analysts (BCBA) on staff. However, I can only imagine the benefits, and efficiency of interventions recommended, if the resources allocated to the mental health professionals were similarly afforded to the behavior analysts working within our programs. As a corporate leader, I continue to utilize the insight and consultation of BCBAs to assist us in stabilizing programs with deteriorating cultures or high occurrences of youth problem behavior. Interventions at this level use the same behavior science principles but primarily focus on changing the staff’s behaviors.”
Torris Bennett, Director of Operations, TrueCore Behavioral Solutions, Inc.

  • “Behavior analyst’s use of data driven methods to manage highly problematic behavior while increasing new skills in a measurable way is something that has been needed. Moreover, the practice employed by the analysts is to not only deliver these teaching methods themselves, but to train our staff who work most closely with our youth how to deliver these services to the youth throughout the day and by constantly creating opportunities for learning new skills.”

          Joseph Nixon, Vice President of Florida Operations


ABA is an Evidence-based Treatment

Evaluations of the professional literature indicate ABA programs are highly effective for reducing aggression, self-injury, elopement, and other high risk behaviors. ABA is also highly effective with social skill development, self-management, academic learning, and the prevention of post-release recidivism.

Brief List of Sources: (an extensive reference list is available on request)
  • Kieffer, E., Fuesy, S., Morosohk, E., Harris, N. (2022), The Many Applications of Applied Behavior Analysis in Juvenile Justice Settings. FABA Conference, https://behaviorlive.com/faba/instructors/nicole-harris123
  • Morris, E. K. (1980). Applied behavior analysis for criminal justice practice: Some current dimensions. Criminal Justice and Behavior, 7, 131-145.
  • Morris, E. K., & Braukmann, C. J. (Eds.). (1987). Behavioral approaches to crime and delinquency: A handbook of application, research, and concepts. New York: Plenum. 
  • Crime, Delinquency, and Forensic Behavior Analysis - an ABA International Special Interest Group. https://iba.abainternational.org/2022/02/23/crime-delinquency-and-forensic-behavior-analysis/
  • Sprague, J., Scheuermann, B., Wang, E., Nelson, C., Jolivette, K. & Vincent, C. (2013). Adopting and Adapting Positive Behavior Interventions and Supports (PBIS) for Secure Juvenile Justice Settings: Lessons Learned. Education and Treatment of Children. 36. 121-134. 10.1353/etc.2013.0031. https://www.researchgate.net/publication/258031511_Adopting_and_Adapting_PBIS_for_Secure_Juvenile_Justice_Settings_Lessons_Learned
  • Nelson, C.M., Jolivette, K., Leone, P. E., & Mathur, S. R. (2010). Meeting the needs of at-risk and adjudicated youth with behavioral challenges: The promise of juvenile justice. . Behavioral Disorders, 36, 70-80.
  • Nelson, C. M., Sprague, J. R., Jolivette, K., Smith, C. R., & Tobin, T. J. (2009). Positive behavior support in alternative education, community-based mental health, and juvenile justice settings. In W. Sailor, G. Dunlap, R. H. Horner & G. Sugai (Eds.), Handbook of positive behavior support (pp. 465-496). New York: Springer.
  • Nelson, C.M., Scott, T.M., Gagnon, J.C., Jolivette, K., & Sprague, J.R. (2008). Positive Behavior Support in the Juvenile Justice System. Positive Behavior Interventions and Supports Newletter, 4(3).
  • Walker, H., Ramsey, E., & Gresham, F. (2004). Antisocial behavior in school: Evidenced-based practices. Florence, KY: : Cengage.
  • Lipsey, M.W., Wilson, D.B., & Cothern, L. (2000, April). Effective intervention for serious juvenile offenders. Paper presented at the Juvenile Justice Bulletin, Washington, D.C.
  • Fixsen, D. L, Blasé , K. A., Timbers, G.D. & Wolf, M. M. (2007). In search of program implementation: Replications of the teaching-family model. The Behavior Analyst Today, 8(1), 96-105. www.baojournal.com
  • French, S. A., & Gendreau, P. (2006). Reducing prison misconducts: What works! Criminal Justice and Behavior, 33, 185-218.
  • Kingsley, D., Ringle, J. L., Thompson, R. W., Chmelka, B., Ingram, S.(2008). Cox proportional hazards regression analysis as a modeling technique for informing program improvement: Predicting recidivism in a boys town five-year follow-up study. The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention, 1(1), 82-97. www.baojournal.com
  • O’Donohue, W. & Ferguson, K. E. (2006): Evidence-based practice in psychology and behavior analysis. The Behavior Analyst Today, 7(3), 335–35. www.baojournal.com
  • Redondo-Illescas, S., Sanchez-Meca, J., & Garrido-Genovaes, V. (2001). Treatment of offenders and recidivism: Assessment of the effectiveness of programs applied in Europe. Psychology in Spain, 5, 47-62.
  • Phillips, E. L. (1968). Achievement Place: token reinforcement procedures in a home-style rehabilitation setting for “pre-delinquent” boys. Journal of Applied Behavior Analysis, 1(3), 213–223. ​
  • Hobbs, T. R., & Holt, M. (1976). The effects of token reinforcement on the behavior of delinquents in cottage settings. Journal of Applied Behavior Analysis, 9(2), 189–198.
  • ​Milan, M.E., McKee, J.M., (1976). The cellblock token economy: token reinforcement procedures in a maximum security correctional institution for adult male felons . Journal of Applied Behavior Analysis, 9(3), 253-275.
  • ​Wolf, M.M., Braukman, C.J., & Ramp, K.A. (1987). Serious delinquent behavior as part of a significantly handicapping condition: cures and supportive environments​
  • Biglan, A. (1995). Translating what we know about the context of antisocial behavior into a lower prevalence of such behavior. Journal of Applied Behavior Analysis, 28, 479-492. ​
  • Mayer, R. (1995). Preventing antisocial behavior in the schools. Journal of Applied Behavior Analysis, 28, 467-478.
  • Marlowe, D.B., Festinger, D.S., Dugosh, K.L., Arabia, P.L., & Kirby, K. C. (2008). An effectiveness trial of contingency management in a felony pre-adjudication Drug Court. Journal of Applied Behavior Analysis, 41, 565-577. ​
  • Cullen, F.T & Gendreau, P. (2000). Meta-Analysis: Assessing Correctional Rehabilitation: Policy, Practice and Prospects. ​Criminal Justice.
    “The treatment services should be behavioral in nature. In general, behavioral interventions are effective in changing an array of human behavior. With regard to crime, they are well-suited to altering the “criminogenic needs”— antisocial attitudes, cognitions, personality orientations, and associations that underlie recidivism.”​

Joint Efforts to Meet the Behavioral Service Needs of Youth and Staff

FABA wants to work with DJJ leaders, FJJA, facility administrators, and ABA service providers to achieve some important goals:

Identify causes and reduce wait lists for youth to receive ABA services
Streamline the process for youth needing access to ABA
Clarify objective guidelines for referring youth who need access to ABA services. This may involve:
  • data-based triage process completed by a team including administrators, staff supervisors, medical professionals, psychiatrists, mental health professionals, and behavior analyst.
  • require a written referral or prescription from an independent physician or psychiatrists and primary care physicians who provide care (this referral may also support eligibility for Medicaid-funded behavior analysis services)

Clarify that ABA services should not be withheld and used as a “last resort.” Early identification and intervention is more likely to improve progress for youth. Delayed access to ABA services is harmful and can result in increases in problem behavior intensity, frequency and duration. This may cause injuries to the youth and staff, property destruction, or other safety risks.

Clarify facility contract negotiation processes that relate to authorizing, continuing, or adjusting funding for ABA services
Review recent contract negotiations to identify any needs to restore ABA service funding to prior levels, or to increase related funding to meet needs of youthIdentify and address any biases, myths and misrepresentations that may be hindering access to ABA services

Fully utilize Medicaid resources to support youth access to behavior analysis service while placed in DJJ programs and as wrap-around supports when returning to the community

Develop or enhance program evaluation methods (e.g., youth progress, recidivism rates) and technologies (e.g., data sharing, dashboards)

Clarify methods for oversight and supervision of Behavior Analysts and RBTs. This may involve the development of clear performance standards by administrators.  Behavior Analysts understand the value of performance feedback and are responsive when objective feedback is provided by administrators, supervisors, and colleagues. It will be helpful to clarify the role of mental health professionals who may have less training or supervised experience. 

Click here for established standards for supervision of Behavior Analysts and RBTs.

Another process for assuring proper oversight of ABA services is the Peer Review Committee. Behavior intervention plans and data can be periodically reviewed and monitored by a committee made up of BCBAs with a high level of competency (e.g., adolescent treatment, severe behaviors, juvenile delinquency, trauma-informed care). The committee also should include psychiatrists and/or physicians, especially when reviewing the most complex and challenging youth cases. The Peer Review Committee can ensure that quality ABA services are being delivered for the youth. Those BCBAs receiving oversight will be able to learn from the highly qualified professionals on the Peer Review Committee. The Agency for Persons with Disabilities (APD) has developed the Local Review Committee (LRC) process that can provide some guidance in the development of Juvenile Justice Peer Review Committees:  https://www.apd.myflorida.com/providers/behavioral/docs/7.0-lrc-model-bylaws-101810.pdf

Attract Behavior Analysts and RBTs to work in juvenile justice facilities and programs.

Possible strategies include:

  • increasing juvenile justice educational presentations for FABA members at annual conferences and local chapter meetings.
  • involving DJJ leaders, FJJA representatives, and facility administrators as presenters at these events.
  • sharing information about available positions and opportunities with FABA members

Questions, comments, or concerns?

Please email the Public Policy Committee at [email protected]

We'd be pleased to have a telephone discussion or a virtual or face-to-face meeting. We can also provide training on-site or via virtual presentations (live or recorded) on a variety of topics including reviews of highly effective approaches and program designs; reviews of case examples demonstrating effective collaboration with Psychiatrists, Psychologists and Mental Health Clinicians; and Q and A sessions.

 

 


 

 

 

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  • With Service Providers: We may share Your personal information with Service Providers to monitor and analyze the use of our Website, to contact You.
  • With business partners: We may share Your information with Our business partners to offer You certain products, services or promotions.
  • With other users: when You share personal information or otherwise interact in the public areas with other users, such information may be viewed by all users and may be publicly distributed outside. If You interact with other users or register through a Third-Party Social Media Service, Your contacts on the Third-Party Social Media Service may see Your name, profile, pictures and description of Your activity. Similarly, other users will be able to view descriptions of Your activity, communicate with You and view Your profile.
  • With Your consent: We may disclose Your personal information for any other purpose with Your consent.

Retention of Your Personal Data

The Association will retain Your Personal Data only for as long as is necessary for the purposes set out in this Privacy Policy. We will retain and use Your Personal Data to the extent necessary to comply with our legal obligations (for example, if we are required to retain your data to comply with applicable laws), resolve disputes, and enforce our legal agreements and policies.

The Association will also retain Usage Data for internal analysis purposes. Usage Data is generally retained for a shorter period of time, except when this data is used to strengthen the security or to improve the functionality of Our Website, or We are legally obligated to retain this data for longer time periods.

Transfer of Your Personal Data

Your information, including Personal Data, is processed at the Association's operating offices and in any other places where the parties involved in the processing are located. It means that this information may be transferred to — and maintained on — computers located outside of Your state, country or other governmental jurisdiction where the data protection laws may differ than those from Your jurisdiction.

Your consent to this Privacy Policy followed by Your submission of such information represents Your agreement to that transfer.

The Association will take all steps reasonably necessary to ensure that Your data is treated securely and in accordance with this Privacy Policy and no transfer of Your Personal Data will take place to unless there are adequate controls in place including the security of Your data and other personal information.

Delete Your Personal Data

You have the right to delete or request that We assist in deleting the Personal Data that We have collected about You.

Our Website may give You the ability to delete certain information about You from within the Website.

You may update, amend, or delete Your information at any time by signing in to Your Account, if you have one, and visiting the account settings section that allows you to manage Your personal information. You may also contact Us to request access to, correct, or delete any personal information that You have provided to Us.

Please note, however, that We may need to retain certain information when we have a legal obligation or lawful basis to do so.

Disclosure of Your Personal Data

Law enforcement

Under certain circumstances, the Association may be required to disclose Your Personal Data if required to do so by law or in response to valid requests by public authorities (e.g. a court or a government agency).

Other legal requirements

The Association may disclose Your Personal Data in the good faith belief that such action is necessary to:

  • Comply with a legal obligation
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  • Protect the personal safety of Users of the Website or the public
  • Protect against legal liability

Security of Your Personal Data

The security of Your Personal Data is important to Us, but remember that no method of transmission over the Internet, or method of electronic storage is 100% secure. While We strive to use commercially acceptable means to protect Your Personal Data, We cannot guarantee its absolute security.

Children's Privacy

Our Website does not address anyone under the age of 13. We do not knowingly collect personally identifiable information from anyone under the age of 13. If You are a parent or guardian and You are aware that Your child has provided Us with Personal Data, please contact Us. If We become aware that We have collected Personal Data from anyone under the age of 13 without verification of parental consent, We take steps to remove that information from Our servers.

Links to Other Websites

Our Website may contain links to other websites that are not operated by Us. A third party’s sponsorship of an advertisement on our Website is not an endorsement by FABA of the third party’s services, practices, or products. If You click on a third party link, You will be directed to that third party's site. We strongly advise You to review the Privacy Policy of every site You visit.

We have no control over and assume no responsibility for the content, privacy policies or practices of any third party sites or services.

Changes to this Privacy Policy

We may update Our Privacy Policy from time to time. We will notify You of any changes by posting the new Privacy Policy on this page.

You are advised to review this Privacy Policy periodically for any changes. Changes to this Privacy Policy are effective when they are posted on this page.

Contact Us

If you have any questions about this Privacy Policy, You can contact us:

 

 

 

 

 

NEW September 2024 - Use of ABA Practitioners as Private Instructional Personnel (PIP)

Click here for FABA's Recommendations for the Use of ABA Practitioners as Private Instructional Personnel (PIP) in Educational Systems

 

 

Collaboration with Public, Charter and Private Schools:

How Registered Behavior Technicians (RBT) and Behavior Analysts Can Work as Private Instructional Personnel (PIP) to Support School Teams Working with Students with Behavior and Learning Challenges

10 minute video overview of the Florida Law with a short story of successful collaboration:

Please download the documents below that were designed to assist School Administrators and Teams (as mentioned in the above video):

Presented by the Florida Association for Behavior Analysis - Public Policy Committee

Please email your questions, concerns, and recommendations to [email protected]

Special thanks to Rachel Davis, BCBA, for her narration of Ethan's Story 

 

 

 

 

April 11, 2022

Agency for Health Care Administration
Bureau of Medicaid Policy
2727 Mahan Drive, Mail Stop #20
Tallahassee, FL 32308


Re: 59G-4.125, Behavior Analysis Services Coverage Policy

The Florida Association for Behavior Analysis would like to thank the Agency for Health Care Administration for working with FABA and providers of behavior analysis to make this transition to CPT codes as smooth as possible and to make certain that effective and ethical behavior analysis services are available to all Florida Citizens.

There are improvements in the proposed policy. One notable improvement is the emphasis
on parent involvement and the allowance for up to two hours per week of telehealth to allow for increased connection at times that are convenient to the recipient. However, as FABA and many others have discussed in prior meetings and in the workshop on 4/8/22, there are significant concerns with a number of aspects of the draft policy:

2.2 - Requires that the referral includes a comprehensive diagnostic evaluation (CDE) that recommends behavior analysis services. This is problematic in that some families are not able to find a provider to conduct a CDE in a timely fashion. FABA recommends that this be modified so that if a CDE has not yet been done but the recipient has a physician’s recommendation for behavior analysis, they would be eligible for services if a CDE was scheduled.

If is also the case that not every professional completing a CDE will recommend ABA. Perhaps ABA was not needed at the time the CDE was initially done, but was later deemed necessary out of concerns for safety, communication, or ability to perform major life activities. The CDE may have been completed in a state that did not have ABA services. FABA recommends that if the CDE did not recommend behavior analysis services but shows that the individual meets criteria for functional impairment, another physician, licensed profession or BCBA-D assess and make a recommendation the individual receive behavior analysis services.

4.2.1 – Requires two specific tools – The Vineland and BASC be administered with each prior service authorization request. These two tools are not sensitive to measuring improvements in recipient behavior, thus the benefit for their repeated use is unclear. The cost of purchasing the tests, obtaining training to administer and administering on a repeated basis are significant. FABA recommends that the pool of allowable assessments be expanded to include other tools such as the ABLLS, AFLS, PEAK, VB-MAPP and Essentials for Living. The professional conducting the assessment should select the tools most appropriate for the individual being assessed.

4.2.2 - The first paragraph indicates that the parent or guardian must participate in treatment. FABA supports the idea that parents participate in treatment, however, there are concerns over what “participate” means. There are also concerns about how this applies to situations when the recipient is over 18, lives in a group home, or has other primary caretakers. FABA recommends that the first paragraph of this section, and subsequent sections that address parents and guardians also include caretakers. Caregivers could be defined as person or personnel that must participate in treatment (e.g., grandparent, home staff, teacher, etc.). Consideration could also be given to providing specific activities that can demonstrate participation (assist with implementation, review data, etc.).

4.2.2 – The listing of procedures does not include all procedures on the fee schedule (e.g., T codes, supervision code. FABA recommends that all procedures on the fee schedule be defined in the policy.
4.2.2. - FABA continues to be concerned about the lack of modifiers when medically necessary treatment is implemented by BCBA, BCBA-D, BCaBA or FL-CBA.
4.2.3 - Supervision - FABA members have raised concerns about the requirement to bill a non-reimbursable code for supervision. For many providers, this will add additional administrative costs in generating and approving notes, entering into billing systems, etc. If supervision occurs in the middle of an RBT’s session, they will have to write 3 notes instead of one.
4.2.4 - Discharge – This section implies that individual would no longer be eligible to receive services if any of the items were true. For items three, four and five, this is problematic since the absence of maladaptive behavior should not be the only criteria for discharge. FABA recommends combining items 3-6 into one item such as “Data indicates the frequency and severity of maladaptive behaviors(s) or level of functional impairment no longer poses a barrier to recipient’s ability to function in their environment”
5.2. – Exclusion – FABA is concerned about the number of new exclusions added to this section. These exclusions will eliminate recipients from getting medically necessary services in environments where the behaviors occur, in situations that will allow the person to integrate into their communities and will interfere with ability to choose the most appropriate educational environment for their child. An unintended consequence of these exclusions will increase the delivery of services in clinics only, perhaps with only the those needing acquisition skills, leaving those bigger stronger, more violent recipients without any providers. Limiting provision of services in some setting will have an adverse affect on some families ability to work.

Concerns with specific exclusions:

  • What is the definition of an Autism Specialty School? Why is the ASD diagnosis singled out?
  • Recreational, leisure or educational camp? Although an RBT should not be used merely to provide 1-1 care in these settings, if these services are deemed medically necessary to treat severe or intense behaviors, or teach skills related to the recipients functional impairment, why is it excluded?
  • Extracurricular activities – In some areas, this may be the best situation to train social skills rather than in contrived social situations.
  • Caregiver of Childcare settings – This can be a valuable area to train skills and address challenging behaviors in integrated setting.

FABA recommends that the exclusions section be re-evaluated and concerns about the environments that services be provided be addressed through the prior authorization process. Perhaps some general guidance could be written into the policy.

6.2.2 This list is similar, but not identical to the Model Coverage Policy provided by the ABA
Coding Coalition. FABA recommends a number of items be modified:

  • The third item requires a “Thorough Medical History…”. This seems excessive and goes beyond the scope of practice of behavior analysts. This should be modified to “Brief background information including available relevant medical history”
  • The Supervision Plan requires the name of the person who is providing supervision. This should be modified to clarify that this is the plan for providing clinical oversight on this plan. Requiring the name of the actual person is problematic as it implies that the plan will need to be updated if there is turnover or coverage issues at the agency.

6.2.4. – FABA members have raised concerns about the practicality of session notes signed. It may not be clinically appropriate to get each note signed. Some electronic medical record systems allow for signatures, but the system do not show all the clinical items listed. It does not appear that this is a requirement for other Medicaid services. In lieu of requiring that each session note be signed, perhaps the parent, guardian or caretaker could sign a verification log that indicates the date, time in, time out, name and credentials of the provider. If the goal is to ensure parent/guardian/caregiver inclusion, the above verification log, along with parent training records, and signatures on assessments would appear to meet that objective.


FABA looks forward to working with AHCA to improve this policy. Please let us know if you
have any additional concerns.


Eric Prutsman – [email protected]
Tiki Fiol - [email protected]
Mary Riordan - [email protected]

 
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