Finding the Right Therapist for Your Child

I quickly learned that my options with ABA Therapy were not as vast as with accessing speech and OT therapy services.  Some of the providers listed in the directory did not offer center-based therapy, which is what I was looking for.  Many provided home-based therapy where the therapist comes to the home to provide services to your child. If you have the space and a separate room in your home where these services can be provided, than certainly that would be a great option, as it is important for the desired behavior to be modeled in the home environment.  But center-based therapy can be very convenient, particularly during the parents' work hours. 

Initially, we went with the center that the nurse had recommended.  It seemed great, at first.  The facility had more than ample capacity to accomodate over 11 children at the same time.  There were surveillance cameras installed in each therapy room where the supervisor and parents could monitor the therapy session.  The parents would gather in a viewing room where they could oversee the therapy session with a monitor and earphones. However, the sessions were limited to two hours a day and they did not offer Saturday sessions, which for a working parent could serve as a wonderful break on the weekend.

The real problem I realized was the shortage in competent and qualified therapists.  There are several classifications of therapists based on educational attainment, board certification, etc.  The insurance provider caps payment to the provider based on this criteria.  Reagan, whose needs were very high, was being treated by an uncertified behavioral therapist without a college degree who relied on the supervisor to devise and help implement the program.  For this type of therapy, the insurance would only pay the provider a little less than $19/hour. The result was high turnover.  In just 6 months Reagan went through three different therapists - the first therapist only worked with him for one day and the last therapist, well it was evidently clear that she did not want to be there often telling me at pick-up that "they didn't get anything done."  After hearing that statement three times in less than two weeks, I knew I had to remove Reagan from the center all together.  The center's inhouse training program for staffing therapists was not adequately meeting my son's needs and I was wasting my money.  I was really sorry to see the second therapist go whose personality meshed well with Reagan, but this work was not her career as she had yet to finish her college studies.  To do this type of work, I believe you need to have a passion and a love for working with autistic children. And your education should reflect this work.

For the therapy to be effective in the long-term, you want to look for a therapist that is board certified by the Behavior Analyst Certification Board.  These therapisst command more money from the insurance provider.  Bachelor's level BCaBA's are paid about $46/hour by my insurance provider. A Master's level BCBA is paid about $64/hour. My search for a board certified therapist was not easy as  they are not generally listed individually in the insurance directory and the BACB online directory of those they certify does not disclose who they work for.  Finding a provider in the neighborhood that I desired was also a challenge.  Several providers were accepting new clients at the time.  Others had to hire a therapist specially for my son.  One center was just way to expensive requiring payment above the out-of-pocket limit allowable by the insurance company.  We waited 6 more months before he was able to be seen by his new therapist at his new therapy center. But the wait was worthwhile as all the therapists that are hired by this center are board certified. The spatial capacity at this center is more limited, and parents are not able to monitor the therapy sessions with surveillance cameras, but results are undeniable.  These therapists are dedicated, are passionate about their work, and they all at some point end up working with and getting to know your child through group therapy sessions and season rotations.    

It's really hard to keep up with the daily co-payments required by my insurance provider for ABA Therapy.  $15/day adds us very quickly, and this is with great health insurance through my government employer.  I've met other parents whose insurance copayment obligations were as much as $50/day.  And I've met other parents whose health insurance coverage was insufficient and they could not afford the co-payment so their autistic child went without treatment.

I always thought that Medicaid covered ABA Therapy services for their clients, but a recent article published in Autism Speaks enlightened me with the fact that Florida Medicaid had been denying coverage for these services all along- that is until November 10, 2013 when a federal judge ordered the Florida Medicaid program to immediately cover ABA therapy services.

It has not been long since private insurance providers in Florida have been covering ABA Therapy services.  In 2008, the Florida Senate approved the Florida Autism Legislation (Senate Bill Number 2654) specifically mandating that private insurance cover services of a Board Certified Behavior Analyst (BCBA) in the treatment of individuals whom have a diagnosis of Autism Spectrum Disorder.   But the coverage is limited.  You can only bill the insurance for a maximum of $36,000 a year for a lifetime maximum of $200,000.  And only 35 states currently have adopted autism insurance reform laws. I could not imagine what these parents living in the other states must go through just to get their child the treatment that they need.  Being that autism has become a national epidemic, I truly believe that autism insurance reform should be a Federal mandate applicable across all states,  I'm hoping that the implementation of Obamacare will hopefully help those families receive the coverage that they need. I think I read somewhere that certain autism advocate legislators like Congressman Menendez made sure to include this language in the federal Affordadable Care Act bill. Still, even if every state were to adopt autism insurance reform laws, I still believe it would not be enough.  We need to have in place federal appropriations to cover ABA Therapy services for all children on the spectrum - a mechanism that will offset the out-of-pocket costs that inurance companies are not obligated to pay.