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How Have Autism Services for Children Changed During the Last 10 Years?

Image via Unsplash by Alireza Attari

By Nick Chappell and Diana Wolf

This summer, Verbal Beginnings celebrated our 10-year anniversary. Wow! Looking back, we realized that so much has changed for parents, children and providers since 2011 that we wanted to take a moment to explore what’s changed and what’s changing when it comes to ABA (applied behavior analysis) services. What exactly have we seen over the last decade?

Insurance Mandates

First, insurance mandates. Hands-down, this area is the most significant change in the last decade around ABA therapy. Endorsed by the U.S. Surgeon General, ABA has been proven to be an effective therapy for children diagnosed with autism spectrum disorder. Before 2014,  it was difficult to see that families were only able to schedule two to four hours of therapy per week when many children were actually in need of 20 to 30 hours of intensive therapy per week. The passing of insurance mandates provided families with the opportunity to finally access the services that they needed. With this change, Verbal Beginnings saw significant changes in the speed at which children made progress and witnessed many success stories as children graduated from services.

Shift From Fee-Based to Value-Based Care

Another major change which we’re actually seeing right now relates to the shift from fee-based to value-based care. This shift is a huge win for parents because it will distinguish providers based on the quality of services that they deliver. While insurance made accessing a higher number of therapy hours possible, it will now be the responsibility of the agency to make sure these hours are delivered effectively. Due to the individualization of children diagnosed on the autism spectrum and unique needs of their family, “quality” is still to be defined. Progress can be vastly different among children. One child may take years to achieve a certain outcome and another child only months. It’s not that one child’s therapy isn’t effective; it’s just that each child needs to learn certain milestones differently.

When it comes to outcomes and value-based care, we have also seen a focus in the field moving toward family satisfaction with services. ABA practitioners have been excellent with making clinical progress but often have missed what’s important to families: how they actually feel about therapy.

In a human services field, much is left to perception. With the focus of ABA being to make meaningful changes, we must constantly evaluate whether these changes were meaningful.

At Verbal Beginnings, we actually developed our own Pledge of Care in addition to external certifications from the BHCOE, ACE, and other professional organizations. Our pledge is focused on Compassionate Care Through Effective Treatment and serves as our standard to meet the expectations of families. Clinical progress is closely monitored, but it is equally as important to know if the family is happy with the direction of therapy, whether they have the resources they need for success, and whether their lives are simplified with collaboration among providers. This area is one way we’ve sought to deliver the best outcomes possible with the highest standards, regardless of what others are doing.

Acceptance of Center-Based Models

Finally, a significant area of development in ABA during the last 10 years has been the acceptance of center-based models. In 2016, Verbal Beginnings was the first standalone ABA-exclusive center in Maryland to open its doors. Since then, having opened many other centers along the way, we’ve learned so much about the value of early intervention and how it is the driving force behind a quality center model. By focusing on early detection, early treatment, peer social engagement and 1 to 1 service delivery, we’ve been able to see children set up for success in a far more robust way than other models could accomplish. Providing this intensive center-based therapy has a short window of time. It’s been amazing to see the center model taking root as a great solution for parents and kiddos alike.

Having seen it all during the last 10 years of watching ABA services evolve, one thing is certain. ABA has to be focused on measurable outcomes for the children with uniform quality of care intersecting every touchpoint of a provider’s culture. That’s what drives us and that’s what excites us about the future of ABA!

Nick Chappell, MS, BCBA, LBA, co-CEO, Verbal Beginnings
Diana Wolf, MA, BCBA, LBA, co-CEO, Verbal Beginnings

Nick Chappell, MS, BCBA, LBA and Diana Wolf, MA, BCBA, LBA, are the founders and co-CEOs of Columbia, Maryland-based Verbal Beginnings. Now celebrating 10 years, the firm has expanded to serve families with center and home-based ABA services in Maryland, Virginia, Pennsylvania, Delaware and Washington, D.C. Visit for more information. 

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