Dear Ms. Sohn,
We are writing in response to your important article, “Low standards corrode quality of popular autism therapy”, which reviewed the credentialing process for Registered Behavior Technicians (RBTs) and the current impact of this process on the professional practice of applied behavior analysis (ABA). We would like to applaud you for your thorough review of this current issue and how it impacts the autism community. Some of the central issues within the training and credentialing process of RBT’s that you highlighted included:
- RBT’s are currently required to take a 40-hour course, complete a competency assessment in basic principles of ABA, and pass a test delivered by the Behavior Analyst Certification Board (BACB). Unfortunately, in many companies, training stops here, and RBT’s are placed onto cases immediately upon passing the exam.
- According to multiple experts within the field of ABA, and the experience of many individuals with autism and their families, RBT’s with the training outlined above may not yet be capable of effectively delivering quality ABA services. Implications of putting unqualified staff onto support teams include a high turn-over rate, lack of consistency, and worst of all, ineffective treatment that misuses principles of ABA.
- ABA is a science that supports individuals in acquiring independence and success by learning essential skills, such as communication, daily living skills, social skills, and more. To apply such a science requires education, training, and oversight with consistent feedback to ensure those we are serving are provided with safe, effective, and compassionate care.
Over the past decade, several variables have contributed to larger caseload sizes for Board-Certified Behavior Analysts (BCBAs), including demand for services, pressure to fulfil billable hours, and changes in the types of activities that can be reimbursed. Collectively, this may limit the degree to which BCBAs are able to provide the amount of quality supervision needed for RBT’s. This is not an RBT training problem per say (all professionals work at an entry level in their field at one point in time!), but a structural problem that exists within companies and the funding sources that keep them afloat. Typically, direct training and supervision for RBTs is not a billable activity. This directly contributes to the low standards that may corrode the effectiveness of an ABA-based program. It is imperative that companies allow BCBAs to adequately supervise their front line staff, and that insurance companies and other funders provide appropriate compensation for these indirect yet critical activities that enhance the quality of treatment and, in turn, the outcomes for individuals on the spectrum.
As you point out, realistically, a BCBA can oversee 5 to 10 RBT’s with quality but many may see upwards of 15 to 20 RBT’s at a given time. To ensure high standard education, supervision, and treatment, companies should ensure they are mindful of how many RBT’s a BCBA is supervising. Additionally, a progressive ABA approach should be utilized by BCBA’s in their programming, and in the education provided to the RBT’s they supervise. Within a progressive ABA approach, flexibility is taught to the RBT to ensure that they are able to identify and respond to the unique needs of the learner (Leaf et al., 2015).
Your article shines light on the need to continue advocating for advancements within the ABA field that incorporates the following: socially significant goals involving individuals with autism in their own programming; rigorous initial training, continuing education, and oversight of RBT’s delivering ABA services to individuals with autism; and applied behavior analytic therapies delivered within naturalistic environments that are flexible and adjust to an individual’s needs. Your article also highlights the importance of ensuring the RBTs receive ongoing and high quality on-the-job training, supervision, and support, and that these activities are prioritized and appropriately funded. It is our hope that continued research, education, and training will ensure that a greater number of effective practitioners will be able to deliver safe, person-centered, and compassionate educational and behavioral supports to individuals with autism.
Sincerely,
Eilis O’Connell, MA, BCBA, LBA
Elizabeth Callahan, M.A., BCBA
The Association for Science in Autism Treatment
Reference:
Leaf, J. B., Leaf, R., McEachin, J., Taubman, M., Ala’i-Rosales, S., Ross, R. K., Smith, T., & Weiss, M. J. (2015). Applied behavior analysis is a science and, therefore, progressive. Journal of Autism and Developmental Disorders, 46(2), 720–731. https://doi.org/10.1007/s10803-015-2591-6
