Has anyone read this article? It was posted in another ABA group I am in by a BCBA. It gives a good overview of the issues with ABA that need to be worked on.

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I saw it.

The concerns are true but it reads an awful lot like throwing RBTs under the bus. RBTs exist to cut costs; a good behavioral plan can be implemented with fidelity by most highschoolers with very little training. The low-bar set by the BACB combined with market contingencies means a lot of RBTs aren't given the tools to pick up the slack that they shouldn't have to pick up. There's an implication that RBTs are the source of abuses in the field and I'm not sure that holds true, especially if you take a browse through the BACB published sanctions.

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u/RobinInBlack5 Nov 01 '20

Yeah I can see how it could be read like that. I took it more that the structure is failing the RBTs rather than faulting the RBTs. I am also not sure if the move to 80 hour training would have a direct effect on what the real issue is which seems to be overworked BCBA's, a lack of supervision and companies looking to profit rather than implement the most effective therapy.

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u/12IndustryK BCBA Nov 02 '20

This.

RBT's are not the problem, they are just an easy scapegoat.

The problem is that as BCBAs we do not get the time we need to properly train or supervise our RBT's. The issue is these greedy companies pay RBT's so little, they are like a revolving door. Or they get tired of no benefits. Or they get tired of unstable paychecks.

I think lack of proper training is the #1 issue we have in this field, as it applies to quality of intervention.

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u/[deleted] Nov 01 '20

Speaking of the disciplinary page, if you've looked at it in the past month alone, about 30 RBTs just lost their certificates and a BCBA lost hers as well. They're all located in Florida. Sounds like there was just some huge bust; I'm guessing insurance fraud. That doesn't necessarily mean the RBTs did anything wrong, but they all failed to respond to the board. I'm very curious.

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u/madskilzzzzz Nov 02 '20

I am an RBT in Florida and can say the field seems VERY corrupt here. I had BCaBA tell me to lie about the hours she was there and have the mother sign, clients parents tell me I'm the first RBT they've had taking data, parents telling me the old RBTs would hand them blank time logs and ask to sign then seeing they would bill 28 hours when they only worked 15 and asking the parents to not tell the BCBA, parents tell me old RBTs would take the client outside and see them through the window just sitting on their phone, RBTs not doing anything but the same three puzzles for over a month. The list can go on. Luckily, Medicare is implementing EVV system which will have our GPS location to make sure hours being billed are being worked. It is clear some people are in it for the money and bullshit their way through the training to get their, then neglect these children's therapies. This makes me believe there needs to be formal in person schooling/training not just online training for the 40-hours and mandatory shadowing shifts. I'm interested in knowing if this is just a Florida thing or if these things occur at this rate everywhere.

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u/[deleted] Nov 01 '20

This is a very thoughtfully written article. I like how it emphasizes both the strengths and weaknesses of the field instead of just providing criticism. Further, I like that it is solution oriented and provided ways to address these issues. Thanks for sharing!

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u/LeaMonster2 Nov 03 '20

As BCBA's we need to look at the data and then respond. Maybe, we need levels of RBTs. Number of hours worked, formal tests after a number of hours, crisis management training ect. As the level of the RBT increases so should the pay.

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u/Pinoh Nov 01 '20

Definitely one of the best articles I have read regarding criticisms of the field. I did feel like it places, some information was skewed. Like BCBA hourly rate seemed really high ($60-$80), and insurance reimbursement rate seemed really high. Maybe that's just high for where I live and practice. I would have loooooved to see more information on the impact insurance companies are having on the field. Overall, really enjoyed this article!

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u/bcbamom Nov 01 '20

I think this statement is profound: "There are scant data to support any benefits from ABA delivered by RBTs, Warren adds. “I think there’s a limited amount of information” about outcomes for children who work with RBTs, Warren says. “They’re probably not the ones that are making these huge gains or the big gains that we’re seeing in some of the studies for some of our kids.” I think as scientists and BCBAs, we have an ethical obligation to implement evidence based practice. I have worked with some phenomenal RBTs. That doesn't mean that the intervention provided is effective or aligned with the research.

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u/[deleted] Nov 02 '20

I'd say it's a red flag that they're claiming 'gains' are possible at all, with a neurological condition. That's not how neurology works. The objective should be to ensure a child with ASD lives as happy a life as possible within the constraints placed on them by their condition. A lot of the criticism of ABA comes from the fact that people are misreading PTSD-style shutdowns for 'progress'. In reality the child has been severely harmed beyond anything related specifically to their condition.

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u/RobinInBlack5 Nov 01 '20

Definitely a good point. I will have a look anyway but I am curious as to the effect of specialised training of RBTs vs what is currently in place. The author talked about varying training quality over different RBT training providers but I would be curious to see if specific training modules could be linked to higher RBT performance or client outcomes. Specifically, one could isolate the most effective ways to teach RBTs and the effect of those modules on client outcomes. Definitely a difficult experiment to carry out and could also have ethical qualms also. It seems like it would be the first step towards increasing the efficacy of RBTs and empowering them with more specialised training.

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u/gemeraldi RBT Nov 01 '20

As a newly credentialed RBT I can appreciate the criticism in the article. I think that you get what you pay for and get what you give. As long as (some of) the industry treats RBTs as minimally trained, minimal requirements, minimum wage, day laborers that is what they will get. I love this work, and want to go on to get my BCBA eventually. But many of the very young RBTs I work and train with don’t care about the kids, the autistic, ABA, or psychiatric communities, they are there for a pay check, the regular hours and good benefits, until it gets too hard or something better comes their way. This is not an easy job. And for the same pay You can go work customer service or retail and not deal with aggression or diapers or kids or whatever it is that stresses people out in this field. RBT are for ABA like CNA are for Hospitals. Cheaper & “unskilled”(yeah right) labor. We do the heavy lifting and dirty work that further education removes you from. I love my job, it matters to me that I do it well but it is disheartening that others with the same initials behind their name don’t take it as seriously as I do. That they are hurting the credential, the field and worst of all the clients we serve.

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u/AdorableCucumber534 Nov 02 '20

Yup. I actually just quit a BT job partially for this reason. I’m a college student who had never worked in ABA before. I had one week of training on Zoom plus Relias modules, and nothing in person. My first day, the BCBA talked to me about my client for 5 minutes and didn’t explain any of her programs or have me shadow. I saw the BCBA pretty rarely and was literally just told to run the session without supervision my very first day after minimal training. It’s not fair to these kids

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u/thedigostrian Nov 02 '20

FYI the autistic advocate was misquoted in the writing of this article. Its great that its more palatable, but it comes at the cost of once again censoring autistic voices

https://neuroclastic.com/2020/10/28/spectrum-news-interviewed-me-for-what-seemed-like-a-deep-dive-into-aba-i-was-very-disappointed-with-the-version-published-heres-what-i-actually-told-them/

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u/RobinInBlack5 Nov 02 '20 edited Nov 02 '20

I read the linked article but I am not sure exactly what was missed in the posted article. Apologies if I am being ignorant perhaps I need to have another look at the article above and compare. Could you explain it to me what was missed?

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u/dontcaredairyair Nov 01 '20

Great article! My take aways- have solid hiring process to ensure quality candidates, have own quality RBT training, & get parent satisfaction quarterly. I also found it interesting that the article states 3/4 bcbas are working with autism so about 1/4 are working with other populations (I expect this will continue to grow in the future). What was the other group you saw it posted in?

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u/RobinInBlack5 Nov 01 '20

It was my own countries Facebook group for ABA. Posted by Alan Schee BCBA-D. In saying that, my own country does not have the problems that America has with insurance companies at the minute but it definitely has the potential to go that way. Overworked BCBA's is definitely a reality here. Too much work, not enough compensation and not enough people to do it.

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u/SuzieDerpkins OBM Nov 01 '20

If you haven’t seen this yet, it’s a cool collection of data about where BCBAs work: BCBA Data

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u/EatYourCheckers Nov 01 '20

So, I only read the first half, but I agreed with the title right away. However, it goes on to complain about the RBT credential and that RBTs need more training. I would not necessarily agree with that. I first started working in home with kids with no credential - I think some sort of even footing and basic knowledge is an improvement. From what I see, the issue with RBTs practicing is not their qualifications, but their supervision. The supervising BCBAs spend far too little time really assessing the case and providing in-situ supervision once the case is rolling. However, with the huge shortage of BCBAs already, i don't know the solution.

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u/RobinInBlack5 Nov 01 '20

I am currently in a similar situation. Even though I have a good understanding of the theory of ABA, the lack of supervision for what I do and the responsibilities expected of me is somewhat shocking.

Part of the solution could be dissemination and recruitment. Yet I also feel like more needs to be done to address the wide range of BCBA's responsibilities. They seem to have way too much stuff to do in varying departments( I.e supervision, talking with parents, drawing up programs etc) and on top of that they may run their own company.

There is definitely a need for a different role which does not require a BCBA cert. I am aware of the BcaBA cert but in my own country anyway it is very seldom recommended as a pathway. Edit: just looked at the data for the numbers of individuals with BCBA/BCaBa/RBT qualifications. 4000 BCaBAs for 45000 BCBA's definitely highlights the issue. This number should be higher than the number of BCBA's for proper division of work.

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u/EatYourCheckers Nov 01 '20

Yes, i had my BCaBA for 5 years before I got my BCBA, but this was before the RBT existed. I wonder if the BACB realized they were essentially going to squeeze that middle guy out of existence.

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u/RobinInBlack5 Nov 01 '20

They definitely shot themselves in the foot. RBTs are great for direct implementation of the program but around all that, there is still way too much work to do for a BCBA.

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u/thedigostrian Nov 02 '20

Would you say autistic children have a right to well-trained therapists or not?

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u/EatYourCheckers Nov 02 '20

Yes, but my point is the article made it sound like the RBT credential was a move in the wrong direction. But before the credential, people were doing that same job with no standardized or measurable training. I think the issue has more to do with the BCBAs overseeing the cases than the RBTs themselves.

I work in a completely different area now than children with autism, but from what I see on this sub and the other, RBTs are thrust into situations they are not prepared for, their clients are not given well-rounded or lengthy assessments, and the case oversight is severely lacking. ABA is supposed to be individualized therapy, but it sounds like there is cookie-cutter, one-size-fits-all intervention happening at a lot of places.

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u/[deleted] Nov 02 '20

[deleted]

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u/EatYourCheckers Nov 02 '20

I don't think that's feasible. I think this would just lead to a severe shortage of providers. There is already a BCBA shortage. Besides that, insurance companies are not going to reimburse and families cannot afford to pay a BCBA to provide all hours of service.

There is no reason someone needs to be an expert to properly implement behavior plans, take data, and report progress and concerns. We train families and caregivers to do this already. Trial-based FAs, which can be daunting when you first see them, are successfully trained to proficiency to non-practitioners. (1) (2). There is no reason an RBT cannot be better trained to do these things efficiently and well if there is appropriate oversight and case management.

Journal Article Discussion Has anyone read this article? It was posted in another ABA group I am in by a BCBA. It gives a good overview of the issues with ABA that need to be worked on.

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