Applied Behavior Analysis
What is Applied Behavior Analysis?
Greater Oregon Behavioral Health, Inc., as the delegated administrator of behavioral health services for Eastern Oregon Coordinated Care Organization, is committed to the treatment of children experiencing autism.
“Applied behavior analysis is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior.”
(Baer, Wolf & Risley, 1968; Sulzer-Azaroff & Mayer, 1991)
At its core, ABA is based on the science of learning and behavior. This science includes general “laws” about how behavior works and how learning takes place.
ABA therapy applies these laws to behavior interventions in a way that helps increase useful or desired behaviors or to reduce behaviors that may interfere with learning or that may be harmful.
Applied Behavior Analysis Program Fast Facts
ABA is a covered service, for qualifying Members, by Coordinated Care Organizations starting July 1, 2016.
Members must have a referral, by a qualified physician or psychologist with experience or training in the diagnosis of autism spectrum disorder, for ABA services that states the ABA services are medically necessary to treat the Member’s autism symptoms.
Members, physicians, or families requesting ABA services should be referred to their local community mental health program (CMHP), or GOBHI for more information.
Members must be enrolled with local CMHPs for intake and assessment for behavioral health services.
CMHPs will request ABA services for their Members using GOBHI’s prior authorization form and process.
Individual Eligibility for Applied Behavioral Analysis Treatment
Prior to receiving services, individuals receiving ABA shall have an evaluation by a physician or psychologist experienced in the diagnosis and treatment of autism using the current DSM criteria that includes:
- A Diagnosis of an autism spectrum disorder or stereotypy with self-abusive behavior due to neurological dysfunction;
- Documentation of and results from a standardized tool that has been used to substantiate the autism disorder or questionnaires or observation that have been used to substantiate a diagnosis of stereotypy with self-abusive disorder due to neurological dysfunction;
- Documentation of behaviors that are considered to have an adverse impact on the individual’s development or communication;
- Documentation of behavior that is injurious to themselves or others and that interferes with everyday functions or activities;
- Documentation that less intensive treatment or other therapy has been considered or found insufficient;
- Any other documentation that would substantiate the diagnosis of autism or stereotypy with self-abusive behavior due to a neurological dysfunction;
Referrals for ABA Treatment Must Include
- A diagnosis of autism or stereotypy with self-abusive behavior due to a neurological dysfunction;
- A copy of the evaluation described above;
- A referral for ABA treatment without specifying hours or intensity.
Recipients ages one through twelve are eligible for intensive and less intensive interventions:
- Intensive interventions include therapies that address multiple behaviors at once, are more comprehensive in nature, and start at an earlier age;
- Less intensive interventions focus on a few targeted behaviors and generally are used with older children.
Recipients age 13 and older are eligible for less intensive services only.
For more information individuals can contact their local community mental health program.