Last year, the Commonwealth of Massachusetts passed a law mandating health plans cover “medically necessary” services for the diagnosis and treatment of autism. Services covered under this law include habilitative or rehabilitative care such as evidence-based treatment programs including applied behavior analysis.
Often called the “gold standard” of care for autism, behavior analysis as a field has grown exponentially in recent years with the explosion of the disorder. With more than 780 behavior analysts in the state (according to the Web site for the Behavior Analyst Certification Board, or BACB, a private certification corporation), the state is taking a closer look at how these professionals are regulated.
The state legislature is considering three bills that would determine the fate of licensing for behavior analysts. In two, H1901 and S108, the state would create a new, independent governing board. In the third, H1002, the licensing would fall under the jurisdiction of the state’s Board of Registration of Psychology.
Currently, behavior analysts are not required to be licensed in any of the New England states. Outside certification may be obtained by the BACB, which requires a minimum of a master’s degree and training or experience requirements in addition to passing a certification examination. However, beyond these credentials, there is no local board overseeing the practice nor is there any law restricting the use of the term “behavior analyst” to only those with proper training.
There seems to be no disagreement that state licensing would be beneficial to the public and to practitioners to ensure that only appropriately trained professionals will be allowed to practice. However, a debate looms over the question of whether the licensing organization would fall under the jurisdiction of the Board of Registration of Psychology or as its own entity.
In House Bill 1002, proposed by Ruth Balser, Ph.D., (D-Newton), a new committee within the board of psychology would be comprised of two licensed psychologists, one member of the general public, and four behavior analysts. The bill states that behavior analysts must have at least a master’s degree in behavior analysis and have “supervised experience in the practice of applied behavior analysis that is acceptable to the committee on behavior analysts.”
Balser, a clinical psychologist with a practice in Chestnut Hill, worked together with the Massachusetts Psychological Association to write a bill to create a licensing organization for behavior analysts. Following guidelines set out by the American Psychological Association for state licensing of behavior analysts, the bill puts the regulatory responsibility on the shoulders of the Board of Registration of Psychology.
“From our perspective, behavior analysis comes directly out of the field of psychology,” says Balser. “Within psychology, there has always been a division of applied behavior analysis and psychologists train master’s-level clinicians to be BAs. That is where the field belongs in Massachusetts.”
Behavior analysts disagree. They feel, according to Peter Patch, Psy.D., BCBA-D, owner of Northeast Behavioral Associates in Dartmouth, Mass., and Warwick, RI., that behavior analysis is a technique with specific technical methodology that is different from the training that a psychologist would receive.
“Behavior analysts are saying, ‘We are not part of psychology. We diverged from psychology not unlike LMHCs or social workers,’” says Patch, who is both a behavior analyst and a licensed psychologist.
There are concerns within behavior analysis groups that placing their licensing under psychology would result in the need for all behavior analysts to be directly supervised by a licensed psychologist, thus eliminating their ability to practice independently. They also question whether a clinical psychologist would have the training to supervise a behavior analyst.
“If you are a licensed psychologist whose training program didn’t prepare you, how can you supervise a highly technical, sophisticated methodology/discipline? Herein lies the argument,” says Patch.
Kenneth Laytin, Ph.D., a clinical psychologist with a private practice in behavioral psychology in Plymouth and a former board member of the MPA, helped with the writing of H1002. To him, separating the practice of behavioral analysis from psychology would be nonsensical.
“Behavioral analysis is one technique from within psychology. It is behavioral psychology and to say anything else is tantamount to re-writing history,” he says.
He explains that the licensing should be overseen by the Board of Registration of Psychology since it is not a stand-alone technique that can diagnose or treat the entire patient. Behavior analysts are trained, in most universities, by doctoral-level psychologists and the practice and scope of practice needs to be overseen by those with more extensive training in treating the whole patient.
“It is one technique out of psychology and because of that it has to be regulated by psychology. The scope of practice has to be limited because of the fact that it is one technique being extracted from the field of psychology,” he says.
The bills have all been referred to the Joint Committee on Consumer Protection and Professional Licensure and are scheduled to come up for a hearing in late September.
By Catherine Robertson Souter