In this episode of the Do Better Podcast, Dr. Megan and Joe discuss considerations around determining treatment intensity.
Meeting Purpose
Live recording of the Do Better Podcast discussing how to determine appropriate service intensity for ABA therapy clients.
Key Takeaways
- There's a lack of standardized training/processes for determining ABA therapy hours
- New tools like POP-C (Patient Outcome Planning Calculator) are emerging to help guide decisions
- Many factors impact appropriate service intensity beyond just client needs (e.g. family capacity, funding constraints)
- More research is needed to determine optimal ways to prescribe treatment intensity
Topics
Current State of Service Intensity Decision-Making
- Historically, funding limitations often dictated hours (e.g. 6-10 hrs/week)
- Many BCBAs receive no formal training on how to determine appropriate hours
- Some organizations developing internal tools/processes, but no industry standard
- New research-based tools like POPC starting to emergePOP-C (Patient Outcome Planning Calculator)
- New tool published in 2023 to help determine service intensity
- 33-question assessment placing clients into high (30-40 hrs), medium (20-30 hrs) or low (up to 20 hrs) tiers
- Considers factors like diagnosis, behavior severity, communication skills, social avoidance
- Still in early stages
- authors seeking beta testers
Challenges in Determining Appropriate Hours
- Balancing clinical recommendations vs. family/logistical constraints
- Insurance requirements may not align with clinical judgment
- Difficulty measuring impact of prescribed vs. actual hours received
- Varying capacity of families to supplement therapy hours
- Considering opportunity costs (e.g. school time) of intensive 1:1 therapyFunding and Industry Trends
- Some providers only accepting clients who can meet minimum hour thresholds - Medicaid/insurance cutting back on covered services in some areas
- Potential for very limited covered hours (e.g. 4 hrs/month) in future
- Need for efficiency and prioritization if hours become more constrained
Next Steps
- Interested BCBAs can reach out to POP-C authors about beta testing
- Continue monitoring emerging research and tools for determining service intensity
- Consider how to adapt practices if funding becomes more limited in future