Primer: Applied Behaviour Analysis, the therapy at the heart of Ontario’s autism controversy

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Most ABA interventions are implemented by a “team” of ABA therapists, which involves supervising therapists and front line therapists. In Ontario, front-line therapists, often referred to as Instructor Therapists in IBI programs (intensive behaviour intervention), generally have a college diploma or undergraduate degree in a related field. In 2005, the government invested in the development of an autism and behaviour science program which is offered in 10 colleges province-wide. This program is a post-graduate diploma program that provides specific training in behaviour intervention and autism spectrum disorder. Many instructor therapists are graduates of this, or related, behaviour science programs.

Instructor therapists receive ongoing training and supervision by a graduate-level behaviour analyst — known as a “Board Certified Behaviour Analyst” or BCBA. This is the gold standard for certification in ABA training. BCBAs have a graduate level degree in behaviour analysis, over 1,500 hours of supervised practice, and must pass a psychometrically-valid exam similar to many regulated health professionals in Ontario. Some BCBAs have doctoral degrees (PhDs) and are known as BCBA-Ds. BCBAs must also follow a professional and ethical compliance code.

Behaviour analysts are not currently regulated in the province of Ontario. However, the Ontario Association for Behaviour Analysts has advocated for over 20 years for regulation of the profession.

Q: How many trained therapists are there in Ontario? Can they fulfill existing demand?

A: There are approximately 650 BCBAs and BCBA-Ds in the province. This is not a sufficient number to meet the needs of the demand for ABA services within the autism program (this is part of the reason for existing waitlists). BCBAs also work in many other sectors, including developmental services, education, geriatrics and mental health. So the total number includes professionals working in other disciplines.

Q: Parents say full-time ABA costs $60,000 a year — or more. Why does ABA cost so much?

A: Intensive forms of ABA require teaching across the majority of a child’s waking hours, for example, between 25 and 40 hours a week. This intensity is required as children often need support in developing skills across many areas. For example, an IBI program may be teaching skills in: learning readiness, receptive language, expressive language, imitation, visual performance, pre-academics, self-care, play, social interaction, and more. Skills that typically develop in children with very little help may need to be broken down into very small steps, and practiced with support in order for children with autism spectrum to learn them. A child in an IBI program should have a structured learning opportunity every few seconds. Data are collected on every one of these trials and used to make important decisions about programming. So the number of hours of intensive one-to-one intervention is part of the cost of IBI.

It’s important to remember that the hourly rate of IBI/ABA (the former Ontario Autism Program budgeted $55 and hour) is much less than other health professionals such as psychologists and speech and language pathologists. However, unlike other interventions which may be offered for one or two hours every other week, IBI/ABA may be required for some people with autism for up to 40 hours a week for optimal outcomes.

Equally important to the intensity of the program is the level and type of supervision within ABA and IBI programs. For example, most IBI programs involve a three-tier hierarchy of supervision: an instructor therapist, who is supervised weekly by a senior therapist or BCBA, and then a third level of supervision by a more experienced BCBA or BCBA-D. The job of the supervisors is to ensure that the intervention is being implemented as intended and that the child’s progress is monitored closely, through continuous review of the data. This level of supervision, as well as the close monitoring of treatment implementation and data collection, has been supported by research to be a part of the reason why IBI is so effective.

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