Starting with advocacy efforts in the 1960s with the help of stakeholders like the Autism Society of America, collective awareness about autism spectrum disorder (ASD) has helped give rise to a care industry currently estimated to be worth $2 billion.

Various providers have emerged specializing in applied behavior analysis (ABA), which involves therapy for areas like communication skills, language and focus. One such provider at the vanguard of ASD care is Autism Learning Partners (ALP), an early adopter of ABA that today has a presence from coast to coast.

Founded in 1988, Pasadena, California-based ALP provides treatment in 19 states. Owned by private equity firm FFL Partners, ALP employs a workforce of 3,000 that includes 300 board certified behavior analysts (BCBAs), along with a number of behavior technicians that provide in-home and clinic-based care.

“[ABA] has been out there since the ‘60s, and it’s still evolving today,” Rachael Schneider, a Buffalo, New York-based regional executive director for ALP, told Behavioral Health Business. “We have focused on a family approach since the very beginning of ALP. That was always the mission.”

An estimated 1 in 54 children nationwide have been diagnosed with ASD, marking a 10% rise in incidences since the 2010s, according to the Centers for Disease Control and Prevention (CDC). The ASD rate increase has presented more opportunities for therapists to provide ABA therapy, which has been cemented as a gold standard of autism care.

ABA has long enjoyed scientific support, backed by years of research as well as developments like the debut in 1968 of the Journal of Applied Behavior Analysis, a scholarly publication devoted to the therapeutic practice that is still in circulation.

According to Schneider, it was critical for states to begin ensuring that funding sources were available to pay for ABA services. As states did that, ALP would be among those early autism care providers to take advantage.

“Part of it was navigating the different funding available for the services,” Schneider said. “That’s a large part in accessing ABA for clients. The science was always there. It’s just helping families access that.”

More states now have laws requiring insurance companies to pay for ABA. ALP itself accepts a variety of commercial insurances along with Medicaid.

Schneider said that because of the differences in Medicaid pay rates at the state level — if a state pays for it at all — it can be an issue for providers like ALP when it comes to increasing ABA access to certain populations. Schneider cited her home state of New York as an example, which does not recognize ABA as a service for ASD and thus does not pay for the therapy.

That particular issue, she said, is something ALP has been working to help change.

“We are advocating with many groups to work on increased access to care for those individuals with autism,” she said. “They may have an autism diagnosis, but still have limitations to actually getting the services they need, and that is our biggest thing. Across the different states, we’re advocating towards increased access to care.”

Schneider acknowledged that the autism care sector, in general, could benefit from more concerted lobbying efforts similar to those in other segments of health care. She believes the relatively minor level of advocacy could be due to a lesser number of workers like BCBAs working in autism services, compared to those working in other segments of health care.

“It’s such a small field, even though it’s growing rapidly,” she said. “ABA is not known by everybody, so we do continue to work at the county, state, and national levels to increase the awareness of ABA specifically.”

In the meantime with ALP, Schneider is excited about near term opportunities for the company to capitalize on, which includes working with school districts to implement ABA services in classrooms. ALP also continues to ramp up its footprint nationwide, as in the last few months it has welcomed patients and families to new facilities in Salt Lake City as well as in suburban New York.

Additionally, she said that ALP hopes to have new facilities opened soon in Pennsylvania, Virginia, Maryland, Indiana and Michigan, which make up states in the region that she oversees.

Overall, Schneider said there is more room for the autism care industry to grow. Nonetheless, she is encouraged by the progress that has been made, particularly when it comes to more payers coming around to fund ABA services.

“What I’ve seen is some great movement where insurers are hiring board certified behavior analysts to do report reviews and becoming very knowledgeable in their needs,” she said. “It’s still an ongoing effort. But there is a lot more awareness of the services and the needs of the clients that come our way.”