The Ontario government says it will regulate the clinicians who provide applied behaviour analysis, known as ABA, the therapy used to treat children with autism.
“We are acting on the clear direction we’ve received from experts and families of children with autism,” Todd Smith, Minister of Children, Community and Social Services, said Tuesday. “Our commitment is that behavioural clinicians will be regulated like other health professionals.”
Access to ABA was at the centre of controversy earlier this year after the province said it planned to reduce waiting lists for the therapy — which can cost $60,000 or more a year — by giving all families of children with autism a “childhood budget.” The one-size-fits-all plan would have severely cut the amount of government funding ABA families with more severely-affected children would receive.
The plan ignited protests across the province. On July 29, the government backtracked, announcing it would increase autism funding from more than $300 million a year to $600 million but warning that waiting lists will persist. A new framework will be in place by April 2020. Details are expected later this summer.
Tuesday’s announcement appears to be part of that package. ABA clinicians anticipate that the province will create a regulatory college, similar to those for physicians and nurses.
“Over the last 15 years, we have been studying this issue. Our No. 1 priority is public safety,” said Kendra Thomson, president-elect and co-chair of the professional regulation committee of the 1,000-member Ontario Association for Behaviour Analysis.
ABA clinicians design and deliver interventions that help people with autism develop new skills, such as learning to speak or dress, and help reduce behaviour such as self-injury or aggression. The therapy involves very close monitoring and making treatment decisions based on this data on a daily basis. Most ABA interventions are implemented by a team.
The association is a professional organization, not a regulatory body. It can provide information to the public about the certification process, but not investigate complaints or discipline practitioners, said Thomson.
“We recognized that we need safeguards in place. Ontario needs a self-governing college. If money is to be provided for services, you want to make sure they’re provided by competent professionals.”
In Ontario, four levels of workers deliver ABA. A “registered behaviour technician” has a high school diploma and 40 hours of training. A “board-certified assistant behaviour analyst” works under the supervision of a “board-certified behaviour analyst,” who has master’s degree. There are currently two master’s-level programs in Ontario, one offered online through Western University and another at Brock University, where Thomson is an associate professor. A “board-certified behaviour analyst — doctoral” has a PhD.
In most U.S. states, practitioners are licensed and can be held accountable through a formal complaints process, said Thomson. In Ontario, a client can make a compliant through the certification board, but the board can’t prevent someone from practising.
Among other goals, regulation will provide consistency in ethics and professional standards to promote a higher level of trust between families and practitioners. Regulation will define educational and ongoing quality assurance requirements to improve consistency in treatment, as well as a way for families to report complaints.
A spokeswoman for the Ministry of Children, Community and Social Services said many families currently do not have enough information to judge the quality of the service they receive.
“Clearly defining the educational and ongoing quality assurance requirements for behavioural clinicians will help improve consistency in service delivery. By improving oversight, we expect to improve outcomes. Parents can find comfort in knowing there are standards of care.”
Kerry Monaghan, who has two children on the autism spectrum, said therapists and parents have both been advocating for regulation. It will ensure autistic children and youth in Ontario will receive quality care, but also that the government’s investment is protected by providing consistency and quality assurance.
“There have undoubtedly been cases in the province where therapists lacking appropriate credentials have been funded both privately by families, and with Ontario Autism Program dollars.”
Parents will continue to implore the government to move forward on a new policy as quickly as possible, said Monaghan.
The Ministry of Children, Community and Social Services, along with the Ministry of Health, is to begin consultations with key stakeholders to seek feedback on the oversight framework, Smith said Tuesday.
There have already been least seven years of consultation, said Louis Busch, a Toronto clinician and past president of Ontario Association for Behaviour Analysis. He points out that ABA clinicians also work with people who have conditions other than autism, including mental illness, developmental delay and dementia.
By Busch’s count, about 300 ABA practitioners have been laid off over uncertainty in Ontario Autism Program and have not been rehired. Some have moved to other sectors, or have left the field completely.
“If regulation comes here, it will give credibility to the profession,” he said. “It has to happen quickly. There will be a point where they won’t be able to fix the service.”
Copyright Postmedia Network Inc., 2019