CalABA Task Force: Suggested Service Standards for ABA Treatment

Feb. 12, 2011: CalABA convened a task force several months ago to begin developing service delivery standards for ABA treatment. Members of CalABA's Board of Directors, along with other CalABA members and allied professionals with expertise in these areas, have been working on writing these standards. While the final version of this report has not yet been released, the task force has prepared the following guidelines for the two service areas of the Department of Developmental Services service standards online survey in which behavior analysts are primarily involved.

March 2011: The final version of this task force report has been released.

Please contact us with any comments or questions.




Early Start Services     (top)

  1. Suggested service standards about who should receive these services:

    • Consumers who are under age 3 and "at risk" for an ASD diagnosis or already have a diagnosis on the autism spectrum are appropriate for an early start applied behavior analysis (ABA) treatment program.

    • Children are able to be diagnosed earlier, meaning intervention can begin sooner; "at risk" conditions including having an older sibling on the spectrum; decreased social referencing, loss of or delay in language combined with decreased social referencing are all "at risk" conditions.

  2. Suggested service standards about how often a specific service should be provided:

    • Young children who are "at risk" for an autism spectrum disorder are appropriate for 10-18 hours of 1:1 applied behavior analytic (ABA) treatment per week. Children awaiting diagnosis should receive fewer hours of intervention.

    • Time spent away from therapy is considered time where children may move even farther away from the desired developmental trajectories. Therefore, children with an autism spectrum diagnosis should have increasing hours of treatment up to 25 hours as they near age 3. Child's availability for therapy (endurance, need for naps, etc.) is one guide to therapy length and duration. Sessions of 2 to 2 hours in length are appropriate.

    • Treatment is provided in their home, unless for some reason this is not possible. Treatment can also be effectively provided in a treatment center that is set up for young children.

  3. Suggested service standards about how to make sure the services provided are useful and effective:

    • A developmentally appropriate assessment will determine the appropriate treatment plan. The treatment plan should identify goals, objectives, measurable outcomes and level of service for the child. Given the young age of the children, frequent review of the data and the treatment plan is needed; usually plans are reviewed every 3 months.

    • Direct observation data should be reviewed by the supervisor on a weekly basis to determine if changes are needed. Supervision ratio should be 1 hour of supervision for every 10 hours of treatment.

    • Services could be determined to be ineffective for various reasons: inability or unwillingness of family to participate in the program, frequent absences, or cancellation of treatment sessions, or mastery of skills to the point that the child no longer demonstrates deficits.

  4. Suggested standards about the qualifications and performance of the person or organization that provides these services:

    • The qualifications of those conducting the assessments, developing the treatment plans, and providing consultation, parent education/training, ongoing monitoring and supervision of behavioral services should be:

      • Board Certified Behavior Analysts (BCBAs) preferred

      • If not a BCBA, then Master's degree in a related field, 12 units of graduate level coursework in behavior analysis and 3-5 years of experience delivering and supervising treatment programs for children with autism.

    • The qualifications of those providing one-to-one services should include:

      • Bachelor's degree in psychology or a related field with relevant experience preferred;

      • If no Bachelor's degree then high school diploma with competency-based training and in all cases a background check.

  5. Suggested service standards about the payment for these services:

    Funding for behavioral services for school-aged children should be pursued through generic resources such as health insurance plans. However, legal and procedural mechanisms for realistic pursuit of such funding do not widely exist. The State of California will need to assist families if they are to successfully pursue this type of funding.

  6. Suggested service standards about the responsibilities of parents and consumers for those services; e.g., copayment, time commitment, etc.:

    Family training is an integral part of early start applied behavior analytic (ABA) treatment for young children at risk of or with autism. Training is provided at least once monthly. Additional training is included for parents who are able to observe sessions and for skills that are rapidly changing and need to be carried over outside of the sessions.

  7. Suggested service standards about self-directed or self-determination option for these services:

    No recommendation for response to this question.


Behavioral Services     (top)
  1. Suggested service standards about who should receive these services:

    • Focused Applied Behavior Analysis (ABA) Services:

      1. Consumers who engage in behaviors that may be a barrier to his/her ability to remain in the least restrictive setting and/or may be limiting his/her ability to participate in family and community life (e.g., aggression, self-injury, noncompliance).

      2. Consumers who display behaviors that may be a barrier to his/her health or safety or the health or safety of others (e.g., aggression, self-injury, property destruction).

      3. Consumers who have failed to acquire developmentally-appropriate adaptive or functional skills (such as toileting, dressing, feeding) that are fundamental to the attainment of social inclusion and increased independence.

    • Comprehensive Applied Behavior Analysis (ABA) Autism Treatment Services for Children
      over age 3:

      1. Consumers between the ages of 3 years through 8 years of age with a diagnosis of Autism Spectrum Disorder are appropriate for comprehensive intensive ABA autism treatment.

      2. Intensive comprehensive ABA programs have research support for children up to age 8 years.

      3. This age range assumes that children started treatment before age 5 and assumes services are fading in terms of intensity between the ages of 6 and 8 years of age.

      4. If child is not fully independent, transition to school district supports is the goal.

  2. Suggested service standards about how often a specific service should be provided:

    • Focused Applied Behavior Analysis (ABA) Services:

      • Behavioral services should be individualized to the needs of the consumer and be based on the function of the presenting problem behavior as well as its frequency, duration and severity.

      • ABA treatment services may range from 2 hours per week of consultation and parent education/training to 20 hours per week of one-to-one services in combination with consultation and parent education/training depending on the function, frequency, duration and severity of the problem behavior(s).

    • Comprehensive Applied Behavior Analysis (ABA) Autism Treatment Services for Children
      over age 3:

      • Initially 30-40 hours per week (6-7 hours daily, 5 -6 days/week) of 1:1 applied behavior analytic treatment co-funded with public schools or other secondary funding agency (i.e., health insurance) are what is supported by research and is appropriate for this age level.

      • Treatment is initially 1:1 in a very structured teaching session, incorporating naturalistic teaching techniques as soon as child demonstrates s/he benefits from this type of teaching. As child progresses and is meeting established criteria for placement in small group settings, s/he will receive treatment in a group setting (i.e. preschool).

  3. Suggested service standards about how to make sure the services provided are useful and effective:

    • Focused Applied Behavior Analysis (ABA) Behavioral Services and Comprehensive ABA Autism Treatment Services for Children over age 3:

      • All behavioral services should follow the principles of applied behavior analysis (ABA) and should be designed to assist consumers in learning important social and adaptive skills in combination with educating parents or primary caregivers in the effective use of positive behavior supports. Behavioral services should be individualized to the needs of the consumer.

      • A behavioral assessment, functional behavioral assessment or functional analysis of the problem behavior(s), or skill deficits should be conducted and used to develop an appropriate treatment plan. The treatment plan should identify goals, objectives, measurable outcomes, and level of service for consumers and for their parents and/or primary caregivers. In addition, periodic assessments should be conducted every 3-6 months in order to evaluate progress. The plan should also indicate that the consumer would be a good candidate for comprehensive or focused behavior intervention and that the family/caregiver agrees to participate in and implement, as appropriate, the recommended treatment plan.

      • Supervision of a comprehensive treatment program for children with autism should be on a ratio of 1 hour of supervision for every 8 hours of treatment.

      • Before making a determination for continuing, modifying, or terminating behavioral services, objective measures of the behaviors (e.g., frequency, duration, or intensity) identified in the agreed-upon treatment plan must be available for review. Measurement of parents'/caregivers' ability to implement treatment plans across all environments must be included to ensure the generalization of learned skills.

      • The IPP process requires sensitivity to individual needs of consumers; however an average duration of focused behavioral services would be 3 months to one year, depending on severity of the behavior(s).

      • Duration of comprehensive treatment for children with autism is two to four years, with the intensity of services fading at that time.

  4. Suggested standards about the qualifications and performance of the person or organization that provides these services:

    • Focused Applied Behavior Analysis (ABA) Behavioral Services and Comprehensive ABA Autism Treatment Services for Children over age 3:

      • The qualifications of those conducting the assessments, developing the treatment plans, and providing consultation, parent education/training, ongoing monitoring and supervision of behavioral services should be:

        • Board Certified Behavior Analysts (BCBAs) preferred;

        • If not a BCBA, then for Focuses ABA a Master's degree in a related field and 12 units of graduate level coursework in behavior analysis and

          • for Focused ABA 3-5 years of experience delivering and supervising treatment programs for children and adults with developmental disabilities.

          • 3-5 years of experience delivering and supervising treatment programs for children with autism.

      • The qualifications of those providing one-to-one services should include:

        • a bachelor's degree in psychology or a related field with relevant experience preferred;

        • If no Bachelor's degree then high school diploma with competency based training and in all cases a background check.

  5. Suggested service standards about the payment for these services:

    • Focused Applied Behavior Analysis (ABA) Behavioral Services and Comprehensive ABA Autism Treatment Services for Children over age 3:

      • In addition to funding obtained through regional centers, funding for behavioral services for school-aged children should be pursued through generic resourcessuch as schools and health insurance plans. However, the legal and procedural mechanisms for such services have yet to be established. The State of California should help facilitate and assist consumers and their families in accessing coverage of these services through all responsible parties.

      • Depending on the individual needs (comprehensive treatment programs for children with autism) of the consumer, a combination of funding sources may be utilized (e.g., school, insurance, regional center).

  6. Suggested service standards about the responsibilities of parents and consumers for those services; e.g., copayment, time commitment, etc.:

    • Focused Applied Behavior Analysis (ABA) Behavioral Services and Comprehensive ABA Autism Treatment Services for Children over age 3:

      • The assessment should identify parent and/or primary caregiver goals regarding implementation of recommended behavioral strategies. There is a need for ongoing training in the application and maintenance of programs that will ensure significant behavior change.

  7. Suggested service standards about self-directed or self-determination option for these services:

    No recommendation for response to this question.