The Council of Autism Service Providers (CASP) released the third version of its practice guidelines for applied behavior analysis for treating those with autism.
The nonprofit trade association for autism therapy companies says its latest guidelines reflect the latest research in the field and input from over 60 board-certified behavior analysts (BCBAs). CASP and a steering committee chaired by Dr. Jane Howard, co-founder of Therapeutic Pathways, “carefully deliberated on every word.
“Because people with autism and their families — as well as the professionals the guidelines are written for — deserve that level of rigor,” Howard said in a news release.
The practice guidelines are intended as a guide for several constituencies when assessing the medical necessity of ABA for autism. They were written with ABA practitioners, government and private payers, regulators and consumers in mind.
“ABA is a highly effective treatment for autism. But it has to be correctly implemented at the highest quality,” Lorri Unumb, CEO of CASP, said in the release. “These guidelines are key to achieving that.”
The specific language of the guidelines reads, just as that: guidelines. The new document presents a few prescriptive mandates for the implementation of ABA for those with autism. It emphasizes the need for clinicians to exercise their best clinical judgment to customize assessments and treatments based on individual needs, making the latter the most important issue.
For example, the practice guidelines state that the intensity or dosage of services for patients shouldn’t be swayed by the patient’s other activities or schedule.
“Practical variables may be considered, but when there is conflict that may impact treatment outcomes, [medically] necessary considerations should be paramount,” the guidelines read.
It also does not specify how long a patient should be in treatment, again deferring to the individual patient’s needs.
“There is no specific limit on the duration of a course of treatment,” the guidelines read, and elsewhere state. “Depending on the person’s needs, treatment can span several months to several years, or even across the lifespan.”
The practice guidelines also call for a balance between objective measures in assessing needs, planning care, assessing progress and contemplating discharge. They call for frequent reassessments of needs during treatment using standardized measures.
However, it cautioned against using assessment tools and measures as the end-all for assessing patients.
“Scores on any single assessment do not solely negate medical necessity and should not be used to deny or discontinue ABA treatment,” the guidelines state, adding that assessments need to be interpreted in other contexts.
The guidelines come at a time in the autism industry where greater calls for greater objectivity at the patient level and care quality and outcomes standardization at the industry level are increasing.
These trends are accelerated by the greater adoption of technology. Several industry observers expect advancements in tech — especially AI — will enable greater data collection and assessment to improve care and alleviate administrative burdens.
