ABA therapy can be a large commitment for your family and the process to start and end it can be confusing to navigate. We've put together the following guide to help you through the main steps:

Step 1: Autism Diagnosis

Total Time Commitment: 1–6+ months (The evaluation process can take a few hours or a few weeks to complete depending on the type of provider and practice as well as the child’s age and profile. Patience might be required when scheduling appointments because waitlists are common and range from a few weeks to possibly a year.)

 

The first step in the ABA process is ensuring that you have all of the documentation needed to pursue services. These documents are also helpful for your future ABA provider to understand your child’s diagnosis and specific strengths and weaknesses associated with their diagnosis. ABA services are typically covered by your child’s insurance plan and insurance requires specific documentation in order to approve services. You can always double check with your insurance company before beginning services to ensure that ABA will be covered.

 

Typically insurance requires a formal autism spectrum disorder diagnosis. A formal diagnosis will need to be completed by a psychologist, neurologist, behavioral pediatrician, developmental pediatrician or another speciality provider. Sometimes your child’s pediatrician will be able to complete the diagnostic exam, but many do not. It is important to discuss with your child’s pediatrician so they can refer you to a specialist if needed.

 

An ASD diagnosis is required to be updated every few years. It is very helpful to maintain a relationship with your diagnosing provider. This will benefit you and your child as you may continue to need updates to the original diagnosis.

 

Step 2: Referral & Consultation

Total Time Commitment: 1–6+ months

 

Once you have the diagnosis, you will want to send a copy to your preferred ABA provider. If your diagnosis does not include a referral or in some states a Letter of Medical Necessity for ABA services — you may need to request this from your child’s pediatrician or diagnostician for ABA services.

 

When you find an ABA provider in your area, be sure to check their website for contact information. Most providers will have an enrollment process or contact form to begin the intake process. Sometimes there may be a phone number or email address as well.

 

The provider will likely have a member of their intake team contact you within a few business days to begin their intake process. At this time, they will likely share whether they are currently enrolling or if they have a waitlist. It is helpful to complete the intake process even if the provider has a waitlist, that way your child can start services as soon as the provider is ready.

 

The intake process will typically begin by verifying insurance coverage. ABA is usually covered by insurance but approval for coverage requires an autism diagnosis and often a referral from a physician in order to authorize services (called prior authorization).

 

The ABA provider will handle the prior-authorization but this will require the need to share information and documentation. Be prepared to share some information like your child’s date of birth, diagnosis, behavioral concerns and medical history.

 

The provider will only submit prior authorization once you both have agreed to move forward with services and agreed on a start date. If the provider has a waitlist, this will not take place until you have come off the waitlist.

 

*It is important to note that your insurance company will only allow 1 ABA provider to submit prior authorization for services at a time. If you find that many providers in your area have a waitlist, it is helpful to get on as many as you feel comfortable with. Once you get off of the waitlist and decide to move forward with a provider, they will then submit the prior authorization. You can cross-reference the list of ABA providers in your area with your insurance’s in-network ABA providers to ensure that you are getting onto waitlists for providers that will be covered by your insurance.

 

Step 3: Evaluation

Total Time Commitment: 2 weeks to 1+ months

 

Before therapy can begin, your family will need to complete an evaluation with a Board Certified Behavior Analyst. The assessment will include interviews with parents (and sometimes teachers) and direct observation of the child. It’s important to share all relevant medical and social history, as well as any previous therapies that have been attempted in the past.

 

Additionally, an evaluation tool is administered to learn more about your child’s strengths and which skills need development. Some common assessment tools include the Verbal Behavior Milestones Assessment and Placement Program (VBMAPP) and the Vineland Adaptive Behavior Scales, 3rd Edition (Vineland-3). A Functional Behavior Assessment (FBA) is conducted when there are behaviors of concern.

 

Once the BCBA has collected all relevant information and data, they will write a report including recommendations for goals and frequency of therapy. Following completion of the treatment plan, the BCBA will set up a meeting with the family to review. If everyone is happy with the recommended plan, then the ABA provider will submit this report to the insurance company for authorization to begin services. The timeline for completion of this phase may vary by provider but generally, clinicians have up to 30 days to complete an evaluation and submit to the insurance.

 

Step 4A: Therapy

Total Time Commitment: 3 months to 3+ years

 

A Board Certified Behavior Analyst (BCBA) will oversee the development and implementation of your ABA program. A high quality, competent BCBA will use a person-centered approach when designing the ABA program so it is customized to each person’s skills, interests, preferences, and family goals.

 

Complex goals (i.e. improve self advocacy skills) are often broken down into simpler, concrete steps and are taught one by one (i.e. will ask for help when stuck in a game). Therapists will monitor your child’s progress by collecting data every session. This data is routinely analyzed to measure progress with skill development.

 

The data collected will drive decision making when deciding which goals have been mastered, which skills are still in progress, and which goals need to be adjusted. The BCBA will meet regularly with the family and clinical team to review information about progress.

 

Step 4B : Family Training and Involvement

Total Time Commitment: 3 months to 3+ years

 

Parents and caregivers play an essential role in ABA therapy. Parent training is a critical piece in a high quality ABA program. Participating in parent training ensures you are supporting your child’s success in accomplishing their goals, learning new skills, and reducing harmful behaviors.

 

In addition to learning how to support skill development and manage challenging behaviors, family training is also an opportunity to meet with your therapist and talk about things that are going well, areas where you need extra support, and changes to goals. When parents actively participate in their child’s therapy, the child is more likely to be successful and have better outcomes.

 

Step 5: Ending ABA Services

Total Time Commitment: a week or 2 to transition smoothly

 

Depending on the individual, some people show significant improvements with skills in 6 months and some people need a few years. Deciding to end services is a personal decision that should be made in collaboration with your care team. Some considerations for ending ABA therapy include:

• Your child has met mastery on all current goals and there are no other immediate concerns related to behavior or safety.
• Your child would benefit from spending more time socializing with friends than in therapy.
• Your child is no longer making progress in therapy despite making changes to treatment plans and sessions.
• Problem behaviors have been reduced/eliminated and your family is able to manage challenging behaviors without the support of a BCBA
• The therapy schedule can longer be accommodated by your family
• You do not feel that your child is receiving high quality therapy and the concerns cannot be resolved with the provider.

 

Terminating ABA services is a big step and should be done thoughtfully. When services end, the ABA provider should complete a discharge report outlining the progress on therapy goals and how the family can maintain any new skills.