[Stephen Sutherland]

Does anyone have any experience with Kirsten Domaszewicz. She says she is a Behaviour Consultant in the Vancouver area. She is looking to move to Winnipeg in a year or two and has asked Manitoba FEAT for help finding local employment. I am willing to bend over backwards to help a legitimate consultant, but I don't want to waste my time (and the time of families and children) helping an imposter.

Email: Stephen Sutherland
Website: Manitoba FEAT

[Stephen Sutherland]

Here are the items I read on the topic (from the FEAT newsletter). It is not clear if Microsoft is making this a policy concerning health coverage for all its employees, or just US employees, but it may be worth checking.

1) Oct. 4, 2001
Microsoft 1st National US Corporation To Cover ABA Treatment For Autism
http://www.feat.org/scripts/wa.exe?A2=ind0110&L=FEATNEWS&P=R3174

2) October 8, 2001
On Contacting Microsoft Regarding ABA Health Coverage Policy
http://www.feat.org/scripts/wa.exe?A2=ind0110&L=FEATNEWS&P=R3748

[Stephen Sutherland]

Lise

I checked this out a year ago with my colleagues (I work for a human resources consulting firm that helps companies distinguish coverage of different group insurance carriers). At that time none of the major carriers included ABA treatment as part of their standard contract. Nor had anyone ever seen ABA treatment as a contact amendment.

A company can request an insurance company's standard group contract be amended to include coverage of specific items. However, this inevitably increases premiums. Since we're talking group insurance (as opposed to personal insurance), the increased cost is spread among all insured employees.

Last year Microsoft introduced ABA treatment in its insurance coverage for all its employees, and challenged other employers to follow suit. It also challenged the insurance industry to update their standard contracts to include ABA treatment. Subsequently I haven't heard if there was any response to this challenge.

Stephen Sutherland
Jacob's Dad

[Stephen Sutherland]

Dear Anonymous

At the risk of being flamed, I'd like to respond to your observations.

I think your original observation is an important one. Demand for ABA treatment has always exceeded supply of qualified, capable ABA professionals. If direct government funding for ABA finally comes through for BC parents, there will be a lot of demand. Where is the extra supply of professionals going to come from?

WEAP and others do not have an endless supply of professionals idly waiting for work. Qualified, experienced ABA professionals are fully employed wherever they are now. And it takes time to develop ABA professionals. Parents looking to hire ABA professionals today are going to find the best and brightest are already fully employed elsewhere. Until the supply of ABA professionals catches up with demand, parents are either going to have to do without ABA treatment, or they will seek available people who are less qualified and less experienced than ideal.

The main issue is how do parents differentiate between the ABA professionals available to them? This is a tough question. Even highly intelligent and educated parents do not innately have the tools and knowledge necessary to make an informed decision on this specific question. ABA treatment is complex, and many parents new to ABA are expected to hire the expert first, and then let the expert educate them. But how do they know if their expert really knows his or her stuff?

There are very few recognized standards. A Ph.D. is nice, but there are many areas within psychology. Applied Behaviour Analysis is one area, and even then, treatment of autism is but a small part of that!

Board Certified Behavior Analyst and Board Certified Associate Behavior Analyst are slowly becoming one standard qualification. Again, it is for the broad definition of ABA, not specifically autism.

Years of experience using ABA with children with autism is nice too. A large part of those years, however, should be supervised by other qualified experts to ensure experience is being gained, skills are being developed, and the person is not just collecting a paycheque.

Many needed skills are subjective, such as how a professional interacts with children, parents and others. Communication and problems solving skills are also important, but unlikely to be quantified on a resume.

I am unfamiliar with the situation in British Columbia. How are parents new to ABA oriented and supported in their quest to establish their ABA program? Is this orientation available throughout the province? Does FEAT of BC have a written definition of ABA treatment that includes recommended qualifications for consultants, senior therapists, and therapists?

Ideally there would be an organization that would review qualifications and experience, and certify those ABA professionals that meet the requirements (similar to many other professions). Such certification would be a major effort to accomplish, but would go a long way towards differentiating between Lovaas-type ABA, and other inadequate wannabes.

[Stephen Sutherland]

I'd like to add to Stephen Schertzer observations.

Lovaas did not compare 40 hours of ABA to 40 hours of another therapy. His study compared 40 hours of ABA to 10 hours of other therapies. The conclusion most people draw is that Lovaas's technique is effective. A different, but equally valid conclusion, is that 40 hours of good therapy time is effective. Subsequent studies certainly indicate 40 hours of ABA is better than 20 hours of ABA, which seems to support this argument. Until someone actually does a study comparing 40 hours of ABA to 40 hours of something else, we'll never really know what technique works better. So I don't disagree with Stephen Schertzer on the science.

Proving the validity of other techniques is in the realm of science. The real issue here is in the realm of politics and policy.

Governments have largely ignored their responsibility to children with autism. "Ignore" seems too weak a word, since governments have actively worked against those trying to help these children.

A valid technique to treat children with autism needs to be firmly established. Government has the funds and the power to do this. Government needs to be held accountable to its responsibility for helping children with autism.

FEAT of BC has had a laser sharp focus on getting services established. It distinguishes itself from other groups of indignent advocates by having volumes of research-based evidence back up their assertions.

By saying any treatment technique "may" be equally valid causes that focus to be lost. One of the main reasons autism has gone so long without research or funding is that parents and professionals in the autism community could never reach a concensus on a plan for action. Without a common vision, parents and professionals could never effectively lobby government to take action. Government has taken advantage of divisions in the autism community, and paying more attention to special interests in other areas who have found and articulated a common objective.

Acknowledging that any treatment "may" be equally valid also encourages government to spread limited autism funding among various treatment providers. This would certainly make non-ABA parents happy, as well as existing service providers threatened by ABA. This may sound fair, but there is a danger. For any treatment to be truly established, it requires a certain critical mass of funding. When you reach that funding level, you start getting other benefits, such as the development of university programs, professionals developing important sub-specialties, centers of excellence, and so on. These things firmly establish a therapy locally, and continuously improve the quality of technique. Giving government reason to divide up funding decreases the likelihood that that critical mass of funding will be attained.

The science is in ABA. Options, Floor-time, TEAACH, and other treatments may have their merits, but they don't yet have the science. Don't make the mistake of muddying the issue. Firmly establish one treatment first.

Stephen Sutherland
President, Manitoba FEAT
Father of Jacob

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