Mandating Applied Behavior Analysis Services in Kansas school districtsAndrea Hartzell
KASB is providing this fact sheet (below) on the issue of Applied Behavior Analysis, which has generated much discussion since House Bill 2410, the proposed school finance measure, was advanced with a provision that would require ABA therapy for public school students in some cases.
The measure has prompted questions about the cost of such therapy, who would pay, who is qualified to provide it and how many students would be eligible.
`Mandating Applied Behavior Analysis Services in Kansas School Districts’ answers these questions and many more. As the school finance bill advances through the Legislature, we encourage education officials to talk with their legislators about this proposal and express any concerns they have about it.
KASB Issue Paper:
Mandating Applied Behavior Analysis
Services in Kansas School Districts
May 17, 2017
By Leah Fliter, Advocacy and Communications Specialist
Sub for House Bill 2410, which has been advanced to the full House of Representatives by the House K-12 Education Budget Committee, was amended to include a provision requiring that Applied Behavior Analysis (ABA) therapy be provided to public school students in some circumstances. The amended bill states that the therapy is not required if the school district does not have qualified providers or the requirement conflicts with state or federal special education law. The amendment also establishes a $2 million fund to reimburse districts for the cost of providing the therapy; it is unclear if the fund will be sufficient to cover school district costs. Furthermore, the effective date of the ABA amendment is July 1, 2018, to give the Legislature a year to study the topic further.
What is ABA?
ABA stands for Applied Behavior Analysis, an intensive methodology that involves 1:1 work with a student to increase or decrease targeted behaviors. Many parents believe this to be the “gold standard” for treatment of autism, while others prefer different treatment (see below).
ABA therapy is designed to be performed by a Board-Certified Behavior Analyst (BCBA) or someone who has been trained by one and is under their supervision. The BCBA is a graduate-level program which first requires a master’s or doctoral degree in behavior analysis, education, or psychology. There are very few of these practitioners working in the field of education in the state of Kansas; as a result, special education teachers and autism specialists deliver the therapy in some public school settings.
How many Kansas students are currently identified as having an autism spectrum disorder?
The Kansas State Department of Education estimates that 4,800 students are identified as having a primary or secondary disability with autism. Autism is one of 13 categories of disability recognized under the federal Individuals with Disabilities Education Act (IDEA) and would be listed as an exceptionality on the students’ Individual Education Plan (IEP). National estimates indicate one in 45 children are on the autism spectrum, raising the possibility that additional Kansas students could be identified as eligible for services.
How many students are currently receiving ABA therapy?
Privacy laws make accurate numbers difficult to ascertain. As an example, however, Olathe USD 233 serves roughly 300 students with an autism diagnosis; 70 of those students, or 23 percent, receive ABA therapy in a school setting.
How is it determined if such students receive ABA?
ABA therapy is considered a medical benefit. School districts typically do not provide medical benefits unless it is educationally necessary. Under the IDEA, the school district determines the methodology to be used. Case law, at least thus far, has been very clear that methodology issues are determined at the sole discretion of the district.
What is the best research on the importance/value of ABA?
Proponents of ABA say research shows it is the best treatment for autism. Proponents of other treatment methods, such as TEACCH (Treatment and Education of Autistic and Communication related handicapped Children), contend those methods are also effective.
Do we have any estimate as to how many parents want ABA therapy and it is not approved?
No, although school district Special Ed Directors may be able to provide anecdotal evidence.
What is the estimated cost of ABA? Does it vary?
ABA practitioners state that students should receive at least 25-30 hours of intensive, 1:1 work for the therapy to be effective. ABA therapy delivered by a private therapist can cost $75,000-$100,000 per year per student. If all of the estimated 4,800 special education students on the autism spectrum in Kansas requested ABA therapy under the provisions of Sub HB 2410, the cost would run in the hundreds of millions of dollars.
More conservatively, the Olathe school district estimates an annual cost of $695,000, after federal reimbursement under the Individuals with Disabilities Education Act (IDEA), to provide ABA therapy for 70 students through its special education program, where the therapy is administered by autism specialists and/or special education teachers. Using this figure of roughly $10,000 per student and applying it to 23 percent (as in the Olathe example of 23 percent of autism students who receive ABA therapy) of the 4,800 Kansas students currently identified as on the autism spectrum equals roughly $11 million in additional costs to school districts to provide the therapy:
4,800 x .23=1,120
1,120 x $10,000=$11.2 million
Sub HB 2410 contains $2 million for districts to access to help fund the therapy. This appears to be far short of the potential cost of the proposed new mandate. However, it is extremely difficult to estimate the actual costs, because most school districts likely to do not have qualified providers residing in the districts. On the other hand, families might move to districts where such services are available.
Are there enough people qualified to provide ABA to meet this requirement?
No, there are a very limited number of those therapists in Kansas.
What is the role of private insurance in ABA?
ABA therapy is funded primarily through private insurance; however, private insurance will not pay for services delivered in the public schools. If schools become eligible for Medicaid reimbursement for the therapy, there will likely be significant up-front cost for additional staff. There are concerns the reimbursement will not be sufficient to cover those costs.
How would funding flow to districts under state SPED aid? Remember, Sub HB 2410 adds $12 million per year to special ed over the next five years.
The districts would seek reimbursement for these additional positions just as they currently do.
How does this fit with federal law?
Requiring ABA therapy for special education students under state law would be contrary to federal law, which, as discussed above, leaves the determination of appropriate methodology to the school districts’ sole discretion. Educators say the appropriate methodology to use will vary from student to student and IEP teams frequently draw upon a variety of methodologies in working with special education students. Likewise, IEP teams cannot by law be held to one specific methodology. Special education teachers contend that if a method is not working with a student, they must be able to try something else.