“Costs,” Insurance, “Treatment,” ABA
October 12, 2008 by Kristina Chew, PhD
Filed under Health
The cost of treatments and therapies for autism and how to pay for them. The question of what is the best/right/appropriate “treatment” for autistic children and is an educational/behavioral method like Applied Behavior Analysis (ABA) really a treatment that should be covered by insurance companies, or is is something that school districts (under IDEA, the Individuals with Disabilities Education Act) should be providing? Who pays, or who can pay, or who should pay, for what—-and what about speech therapy, occupational therapy, and physical therapy? And while ABA is widely used as a methodology for teaching autistic children, especially younger children in early intervention, what about for older autistic children? Given the troubled history of ABA and behavior therapy, it’s contested whether or not it’s a “therapy” that should be used.
Today’s News-Tribune (Tacoma) asks Who should pay for treating children with autism? and describes an effort in the state of Washington to mandate insurance coverage for autism and related disorders, with these specific points noted:
• Require coverage for ABA-based treatments, along with coverage for medication, occupational, speech and other types of therapy – as long as they are prescribed by a licensed physician or a licensed psychologist.
• Prohibit insurers from dropping coverage of individuals with autism based solely on their diagnosis. Forough and other parents say this has happened.
• Remove limits on the number of visits an individual can make to an autism treatment provider.
• Cap benefit payouts for treatment of autism at $50,000 a year – a figure that would be adjusted for inflation annually.
While we haven’t always agreed with ABA consultants about the best way to proceed in teaching Charlie, ABA’s been the mainstay of my son’s education since shortly after he was diagnosed. We’ve tried other teaching methodologies and—while I’ve my own questions about what I’ll refer to as the philosophical underpinnings of behaviorism—ABA’s helped Charlie to learn. We were able to provide for home ABA when Charlie was young (our families were quite generous). After that, since he was about 5 years old, Charlie’s received most of his ABA through his public school classrooms here in New Jersey, where the emphasis is not at all about “recovering” or “treating” autism but, of course, on educating students to do as best as they can.
Some families have noted that insurance companies and school districts have worked together to provide treatments for autistic children. ABA provided by the public schools (and integrated into classroom settings) has helped my son’s learning. That’s been our experience and I’m not sure what is the best situation and there’s plenty of room for debate and dissent about what is the best and the right teaching methodology and classroom situation for autistic students (and some discussion about ABA as a teaching methodology for autistic children ensued on this post about Framing Autism).
The precedent is set for specifically qualifying a medical treatment for insurance coverage. The decisions as to which would be funded appear spurious only to those who have no insights into the mesh of business, medicine and culture. Early-on, contraceptives were not covered, but later, Viagra was widely subsidized by insurance. An insurer may completely exclude coverage for a whole class of medication or any single surgical technique, any single diagnosis.
So, for the record, “ABA” helps some families. All should have access to it, therefore.
Giving an educational technique a monetary moniker equal to a pharmaceutical seems bizarre. Generic ABA, or behavior modification is an endemic interpersonal behavior in our society. Many people interact on a level of exchange in every interpersonal interaction – ‘though not obviously with the exchange of tangible food (reward).
Excellent post. Hope I’m not to late to leave a comment on the framing of autism. Thanks for both your post and the links.
thanks and thanks for your comment on the framing of autism—–at least a little behaviorism runs is present in a lot of teaching (what are letter grades to students?).
I have very mixed feelings on ABA- it was helpful to one of my children, and very destructive to another (although there were some other factors at work there as well).
One of the things that concerns me with the growing governmental and insurance acceptance of ABA as “the” therapy is that I am afraid that other therapies and services will be cut in order to provide it alone. By far the 3 best things that we’ve ever done with my children are OT for sensory needs, speech, and behaviour therapy (which in our case was basically a therapist helping me to understand behaviours, and then helping to come up with practical strategies to make them more manageable).
Now that we have ABA (or as they call it in Ontario, IBI- Intensive Behavioural Intervention) in the schools, not only are school boards and individual teachers and aides having a lot of trouble implementing it (in my experience), but the other services are dropping off- we’ve had shortages of speech therapists and OTs in schools for at least as long as 10 years (the length of time that my kids have been attending schools), and I find that very sad.
I don’t know what the answer is- I know that some families find ABA very helpful, but I also find it frustrating that both schools and insurance companies seem to be going the “ABA or nothing” route.
That’s really interesting to hear about, Jen–ABA has been very helpful for Charlie, but not from every provider. One behavior consultant (hired by a school district) set up some programs that led to an increase in the very behavior he was supposed to be addressing (head-banging……). A speech therapist who had an ABA background was one of the most helpful therapists/teachers that Charlie ever had and I’ve found that ABA has been the most helpful for Charlie when therapists have been very open-minded and included an emphasis on teaching communication and understanding sensory needs. ABA is pretty widely used in schools in New Jersey and I think there is a lot of variety. Some schools and school districts use more of a verbal behavior approach.
My concern is that the mandate will be construed by the parents of newly dx’ed as government endorsement, or as Jen put it, “the” treatment. In MA, two of the specialty providers in the zero to three program offer both ABA and floortime. In my view, this is the progressive and better model for specialty providers. If I were to draft the legislation, I would cover both therapies, in the alternative (to keep it cost-neutral), to promote the progressive specialty provider model.
Since M just began the center that bases most everything on ABA, as I understand it reading this reminds me that I need to stay very involved. I don’t like the idea of forced eye contact and even some forced communication. I know the people are very kind and loving and seem to have her best interest at heart…but, do they know her like I do? No. Today we were told she began crying because she refused playing along with a telephone game. A way they are trying to get her interested in remembering short bits of info and passing it on. I am concerned that they will push her too far and have the opposite affect.
Needless to say when I read the posts you link to here I begin to panic. Sigh.