Availability of BCBA Providers As a Barrier to Service Implementation in ASD

Thursday, May 15, 2014
Atrium Ballroom (Marriott Marquis Atlanta)
R. P. Travis1, A. P. Juárez2, C. R. Newsom3 and Z. Warren4, (1)Pediatrics, Vanderbilt University, Nashville, TN, (2)Pediatrics & Psychiatry, Vanderbilt Kennedy Center, Nashville, TN, (3)Peabody Box 74, Vanderbilt University, Nashville, TN, (4)Vanderbilt Kennedy Center, Department of Pediatrics, Department of Psychiatry, Vanderbilt University, Nashville, TN
Background: According to the Centers for Disease Control and Prevention (CDC, 2012), an estimated 1 in 88 children and an estimated 1 out of 54 boys in the United States have an autism spectrum disorder (ASD).  ASD is associated with enormous individual, familial, and societal costs across the lifespan (Amendah et al, 2011; Ganz, 2007).  As such, effective early identification and treatment of ASD across resource-strained environments is often considered a public health emergency (IACC, 2012).   Early, intensive ASD behavioral intervention embedding the principles of ABA is supported by several systematic and meta-analytic reviews (Reichow et al., 2012, Warren et al., 2011).  While clinicians who specialize in the diagnosis and treatment of autism spectrum disorders often recommend behavioral services, there are numerous barriers to access of such services across diverse populations and geographies. While many parents report being able to implement educational and/or early intervention services (e.g., IEP development, speech therapy, occupational therapy), in some communities only a minority of families are able to implement recommendations regarding ABA-based intensive services (Warren et al., 2013).

Objectives: The current study examined availability of providers as a potential barrier to services. 

Methods: Specifically, we examined the number of board-certified behavioral analysts across diverse geographies within the state of Tennessee in comparison to estimated numbers of children identified with ASD.  This was done by county, region, and on a state level and tied to examinations of geography (e.g., rural/ urban) and markers of income (SES).

Results:   There are currently only 260 Board Certified Behavior Analysts (BCBA) registered in the state of Tennessee (Behavior Analyst Certification Board, 2013), which has a 2012 population estimate of 6,453,243 (US Census Bureau, 2013).  Given an estimated annual life birth rate of approximately 88,000, some 1,000 children with ASD are born in TN on an annual basis.  On a state level this translates into 260 BCBAs potentially available to serve 18,000 individuals under 18 with ASD and some 5000 individuals between 12-72 months of age.  Several counties and zip codes did not have access to any BCBA providers with urban and insurance catchments having more access to providers.

Conclusions: Given the available number of BCBAs within our state, specific recommendations for early intensive services delivered or even supervised by BCBAs may not be realistic.  This finding has both potent ethical and service system implications for clinical providers.

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