The Quality of Treatment for Individuals with Autism is Declining— and it Starts with the Therapist
I absolutely love the field of Applied Behavior Analysis, or ABA, as many parents know this therapy by. The primary application of ABA these days is towards the Autistic and special needs population, and it often implemented in conjunction with other types of therapy such as Occupational Therapy and Speech Therapy. As much as I love the science behind this field, its ability to function as an organized business and produce well-trained staff is a real concern.
For those who are unfamiliar, most early-intervention treatment for young children with Autism consists of a small team who implement an individualized program for the child. The team typically consists of the BCBA, who creates the behavior plan, and the BCaBA and RBTs who carry out that behavior plan. The Registered Behavior Technicians, or RBTs, are the true backbone of the team, because they are the individuals who are actively interacting and teaching the children. This is the level I am most concerned about.
From an educational point of view, an RBT only understands the foundational concepts of ABA.
They also may only understand techniques on a conceptual level and are still learning to implement them correctly. This is quite a dilemma because unless an RBT rigorously practices implementing a technique, they are going to make mistakes. And of course they are going to make mistakes, they are still new to the field of ABA.
Imagine going to the doctor, but only ever getting treated by an intern. Sometimes the doctor is there when treatment is being administered, but for the most part you only ever get treated by the intern. That is what it is like having an RBT implement ABA therapy to a child.
In previous years RBTs were often only high school graduates who may or may not have been exposed to some college level courses. Nowadays most need to have a bachelor’s degree, but they still may be complete novices in the field of ABA. Most individuals teaching children with Autism are still not able to actively think like a behavior analyst. This results in a lack of quality and effectiveness of the service provided.
Lower level staff lack the motivation to provide effective therapy.
From a fiscal perspective, the pay rate for an RBT is often just above minimum wage, depending on the company of course. Yet RBTs often have to work with individuals who can be aggressive and even self-injurious. RBTs also have to work according to the client’s schedule, which can result in long and rather late hours. The sessions may be short, but the commute requires full time RBTs to be out and about for most of the day. These conditions can contribute to low morale and a very low retention rate of staff. This is a significant issue that contributes to poor service quality, because the duration of staff training is disproportionate to staff retention.
Simply put, the majority of hands-on staff leave after a few months of training.
This constant change in staff leaves the field with only novice staff that are implementing the majority of the interventions. Many RBTs use this position merely as a transitional job, and they often leave for higher paying careers. While BCBAs, or Board Certified Behavior Analysts, are compensated much higher, the jump from RBT to BCBA requires a Master’s degree and extensive in-field training. These requirements make it a real struggle for individuals to move up in the field, especially when receiving low compensation for a demanding job.
These concerns merely scratch the surface of staffing issues in ABA.
The foundation of staffing in ABA therapy needs to be directly addressed in order to produce effective change. There is a great need for motivated and well-trained individuals to revolutionize the field of ABA. But with the current staffing methods as they are, there will be a continual lack of efficient therapy being implemented.
