Please note that this blog is co-written by members of the ABAI Practice Board.
See the ABAI Practice Board website for more information.
In October 2023, Tom Critchfield highlighted how the economics of service reimbursement influence access to all care, not just behavior analytic services (see blog post Access to ABA Services is Demonstrably Not Equitable). Tom asked the Practice Board to consider a response specific to behavior analysis. The role of the ABAI Practice Board is to develop, improve, and disseminate behavior-analytic best practices across a range of practice areas, including applied behavior analysis, clinical psychology, and speech and language therapy. The board members agreed that understanding how different practice areas approach reimbursement and facilitate access to behavior analytic services represented an opportunity for ABAI members to learn from one another.
To this end, the ABAI Practice Board developed a survey that was disseminated by ABAI and Practice Board members in August and September of 2024. We are releasing the insights from survey respondents in a multi-part series.
Overview
- Part 1 of this series (this post) introduces you to the survey and describes the survey respondents. Fair warning, there is a lot of data and tables for this first post.
- Part 2 focuses on the positive and negative impact of insurance and other sources of funding services.
- Part 3 looks at the various efforts respondents reported using to address monetary and nonmonetary barriers to accessing behavior analytic services.
- Part 4 looks at how common it is for individuals to collect data on disparities and barriers to accessing care, including how those data are used, and how community partnerships are leveraged to support care access.
- Part 5 looks at how ethics codes, professional guidelines, and professional associations are used to support providers in addressing issues of care access.
What did the survey cover?
The survey had three sections:
- Information about professional identification and practice context
- Sources for service funding and agency efforts to address monetary barriers to service access
- Types of data collected for a provider/organization to evaluate their ability to produce outcomes for their clients; ethical and other guidelines impacting the accessibility of services
Who responded?
148 respondents provided basic information regarding their practice setting, funding sources, and how their agencies addressed financial barriers to care. Most respondents (n = 100) completed the final section and described how they evaluate their efforts to reach people needing services, regardless of financial, transportation, or other barriers, and the professional ethics and guidelines that influence these efforts.
What can’t the survey tell us?
The survey respondents are not a representative sample of behavior analytic service-providing professionals. This would have required a more rigorous recruitment method than using ABAI email updates and ABAI SIG social media and listserv posts.
85.1% of respondents identified the United States as their country of practice (see Table 1 for country representation). Despite few respondents from outside the US, many of these respondents provide services in very different funding environments. This provides some basis for discussing how financial barriers are addressed outside of the US.
What professions are represented by the survey’s respondents?
Respondents identified with one or more of 15 professional domains (see Table 2). Surprisingly, most respondents (77.7%) identified with working in more than one professional domain (see Table 3).
- “Other ABA” was the highest endorsed professional category at 64.9%. This category captured providers of services for individuals with developmental disabilities across the lifespan (i.e., not just autism or early intervention) as well as ABA providers in other settings, such as criminal justice, foster care, vocational services, traumatic brain injury, and higher education.
- Early intervention ABA was the most commonly endorsed specific category (56.1%).
- The education domain was endorsed by 37.8% of respondents, and 77% of those reported working in pre-k through 12 education and its support.
This broad range of professional domains gives us an opportunity to see how access to services is addressed across very different settings.
What credentials are represented by the survey’s respondents?
Most respondents (87.2%) held a BCBA or similar credential (see Table 4). 27.0% of BCBA (or equivalent) credential holders held more than one credential/license, with a teaching credential being the most common.
Among the multiple credential (BCBA +) holders:
30% held a license in psychology
47.5% held a teaching credential
What size of practices are represented by the survey’s respondents?
22.3% of respondents worked in a solo practice
77.7% of respondents worked in settings with more than one provider (see Table 5)
36.5% of respondents worked in settings with 20 or more providers
What types of population centers are served by respondents?
Additionally, providers indicated the percentage of their clients living in different population centers. On average, 57.7% live in cities, 31.6% live in towns, and 13.2% live in rural areas (see also Table 6). A description of these categories is provided by the World Bank at How do we define cities, towns, and rural areas?
How common are telehealth services?
Respondents also indicated the percentage of their services occurring in person versus via video, telephone, or other interactive technology. On average, 81.4% of services are provided in person while 18.4% of services are provided virtually (see also Table 7).
Whats next?
This concludes our summary of how our respondents professionally identify and where they practice. Part 2 in this series will give a better understanding of the types of funding sources providers accept and how these sources impact service access.