One of the biggest challenges facing any recent college graduate is entering the job market and securing an occupation within their field of study and expertise. This is particularly challenging for those entering the field of education and psychology. As a result, prior to potentially seeking options in higher education, many have entered the realm of Applied Behavior Analysis (ABA) and behavioral therapy by way of agencies which provide in-home, in-school and in-clinic services for individuals with special needs, and specifically those diagnosed on the autism spectrum.
While many agencies provide classroom-style and in-field training of their own, some parents and service providers feel that this training is not sufficient to effectively prepare a green therapist entering the home of a child with autism several days a week, and lacks consistent, on-going training. In light of this, the Behavior Analyst Certification Board (BACB), which oversees all Board Certified Behavior Analysts who supervise these programs, have implemented novel requirements for all service providers, other than BCBAs, in the form of Registered Behavior Technician (RBT) training, requiring a 40 hour training, an exam and annual competency assessments. This training will ideally maintain a high quality of service provider in the field, and thereby maximize the success of the special needs population with whom they work.
But when new policies and requirements are put in place, there must also come new costs, with an application fee of $50, an exam fee of $45 and an annual renewal fee of $35, as well as the cost of staff needed to conduct and implement the training. The question then becomes who fronts the cost for this essential training? The individual applicant? The agency they work for? Funding sources in the form of insurance companies or the government?
This conundrum has opened a host of questions in the state of Nevada, which is currently tackling these new requirements and is also suffering from a shortage of service providers. The state currently only employs approximately 95 RBTs and is debating a reimbursement rate for those who provide services under Medicaid of $29.61 per hour, which is comprised of a base wage of $17.33 per hour, plus other factors such as health care and supervision, leading to that final rate. This rate would apply to high school graduates, the minimum education required by the BACB to complete the RBT training. However, many states, including California, require a bachelor’s degree in a related field, which would arguably require a higher rate as a result.
Medicaid currently services about 1,800 children with autism in the state of Nevada alone. At a hearing held this past week, parents and advocates urged state officials to increase this rate to between $40 and $56 per hour in order to cover the entire cost of employing and training therapists, as well as to attract more potential therapists to the field, citing a rate of $50 per hour in New Mexico as an example.
In the state of California, job listings for behavioral therapists at the vast majority of agencies advertise rates ranging from as low as $12 per hour to $18 per hour, far below the proposed standards listed above. It is clear that if national standards are rightfully requiring higher levels of training, education and supervision for individuals working with children diagnosed with autism, that states and the agencies who receive referrals from government agencies, such as regional centers and school districts, and insurance companies, should compensate their employees as such to match this level of required training and education. This will ensure the maintenance of quality of care for the children and families they service, reduce the out-of-pocket costs for families, and lessen the likelihood that those children will continue to require this level of intensive, long-term support throughout their lives.