Once Mainly Unregulated, Behavior Analysis Increasingly Requires A License
HARTFORD, Conn. — A long awaited action by the Connecticut legislature has afforded parents of children with autism a level of consumer protection they never had before, and has granted to the behavior specialists in the field a degree of professionalism and responsibility that they have been crying out for since the 1990s.
Starting this month, anyone seeking to practice behavior analysis — long considered the leading approach to helping people with autism learn new skills — must be licensed by the state. And in another important signal that the field has evolved into a proven profession, licensed behavior analysts will from now on be designated as mandated reporters of suspected child abuse or neglect.
“The primary benefit of licensure is consumer protection,” said James Carr, CEO of the Behavior Analysis Certification Board in Littleton, Colo. “Parents and caregivers are going to know that they are getting someone with a defined background in the profession.”
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It has been a long time in coming.
Even as the prevalence of autism exploded and state after state began to license treatment specialists, Connecticut sat back and allowed the practice of behavior to remain largely unregulated.
In fact, a review by the Hartford Courant found that out of a group 60 providers of behavioral services who have been accepted to do work for the state Department of Developmental Services, 17 had no license in any professional field, not behavior analysis, not social work, not special education, not psychology.
Department officials told the Hartford Courant that the agency is reviewing the qualifications of those who are doing behavior analysis work. Those without credentials will be required to work under the supervision of a licensed behavior analyst. Failing that, the person receiving the service will be transferred to someone who is licensed.
While there is, and has been since 1998, a group of board certified, master’s- and doctorate-level practitioners in the state, they have been stretched thin, and the side doors to the profession were always left open.
That allowed people with far less professional training to slip in and find work in family homes and even in schools, particularly during the first decade of the 2000s, as parents with children who were newly diagnosed with autism became desperate for qualified analysts.
A person with a good rap and an affinity for working with children could earn a lot of money, at rates approaching $400 an hour — and they could keep working for months or even years, unless or until a parent or school district recognized that the impostor was skirting the requirements for studied observation, precise assessments of behaviors, careful data collection, an individualized treatment plan and follow-up.
“I called them cowboys — maybe they got a list of programs, maybe they attended a workshop, or they spent time working with someone who was qualified,” said Suzane Letso, the mother of son with autism and a pioneer in the field in Connecticut.
Several years ago, Letso helped win title protection for the real practitioners. It became a felony for someone without board certification to call him or herself a behavior analyst. However, that didn’t stop people with no credentials from offering their services. They just avoided the title, Letso said.
“Of course it can do harm,” Julie Swanson, mother of a son with autism and a special education consultant, said of the work of unqualified behaviorists. “If the intervention doesn’t work, behavior problems can linger into adulthood, and they can become magnified in adulthood. If the assessment is wrong, then the treatment plan is going to be wrong.”
Swanson, of Durham, said her son received effective treatment “and it literally changed his life. His behaviors were largely dealt with in childhood.”
Carol Marcantonio, of Meriden, said finding a qualified behavior analyst to work with her son, Evan, was something of a crapshoot.
She recalled the time that a certified behavior analyst who had had several successful sessions with Even handed the case off to a young assistant.
“I asked her what her credentials were,” said Marcantonio, whose relentless advocacy for Evan was chronicled in The Courant in 2014. “She said she had a bachelor’s in psychology with a concentration in criminal justice. Ok, well, my son isn’t a criminal … Needless to say, during the second session, Evan goes into a behavior crisis and she had no clue how to de-escalate it. I had to take the lead — and she didn’t come back.”
But the jig is up.
Connecticut this month became the 30th state in the country to require the license.
The bill finally cleared the legislature during the last spring session, after a similar measure failed every year from 2012 to 2017. There had always been sufficient support in the legislature and even from other human service professions, but there was pushback from the administration of Gov. Dannel P. Malloy. In order for the bill to pass, Rep. Cathy Abercrombie, D-Meriden, fought to get it tacked on to the larger budget-implementer bill.
The Department of Public Health’s licensing portal for behavior analysts has been open since March, and 600 specialists are licensed so far. The main requirement for a license is board certification in the field. The initial fee is $350 and the yearly renewal is $175.
Letso, CEO of Milestones Behavioral Services in Orange, expects the roster to grow by at least 20 percent a year. She said there are at least 150 certified behavior analysts in the state who have yet to apply for a license. She encouraged them to do so forthwith.
Fittingly, Letso, long a national figure who served for years as one of the directors of the profession’s certification board, became Connecticut’s first licensed behavior analyst in March. She holds license No. 000001. She was already licensed in New York and Massachusetts.
Public health inspectors can now investigate complaints against licensed practitioners and issue cease-and-desist orders against unlicensed people, as they do with doctors, nurses, therapists, and 67 other licensed professions, from hair dresser to funeral embalmer.
As part of their practice, psychologists and perhaps some other highly trained professionals can engage in behavioral analysis without the specific license as long as they have completed training in the field, said Christian Andresen, head of practitioner licensing and investigation for the Department of Public Health.
The agency affected most by the new licensing requirement is the Department of Developmental Services, which provides housing, therapy, job training and other supports to 16,000 Connecticut residents with intellectual disabilities.
Many also have a diagnosis of autism, and the department has contracts with dozens of private agencies and individual providers to offer what is called “clinical behavioral supports.”
The Hartford Courant reviewed a group of 60 individual providers and found that 28 were licensed behavior analysts.
Of the 32 remaining, 15 were professionals licensed in other fields, including psychologists, clinical social workers and counselors. Andresen said that if a complaint comes in that involves a professional who isn’t specifically licensed as a behavior analyst, the Department of Public Health would investigate and determine if the person’s “scope of practice” adequately covers behavior analysis.
Seventeen of the providers of behavioral services had no active state license in any human service or special education field.
Six of them are currently working under contract with the developmental services agency, and Kathryn Rock-Burns, chief of staff for Commissioner Jordan Scheff.
She said the department will either require licensed supervision of those providers “or make plans to transition individuals under the care of these practitioners to qualified vendors.”
Marcantonio wasted no time in looking up her son’s behavior analyst on the Department of Public Health’s e-license lookup (she is licensed), and said the credential offers parents a level of assurance they never had.
She said that with the license comes responsibility — a duty to follow the profession’s ethical standards.
“I know that a license is harder to get back, than it is to get in the first place,” said Marcantonio, a licensed occupational therapy assistant. “They are not going to want the Department of Public Health on their case — that’s what give us as parents the protection.”
© 2018 Hartford Courant
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