School Based Health Services and Applied Behavior Analysis (ABA)

For over a decade I’ve led efforts towards ensuring children and adults with autism have access to medically necessary services regardless of the person’s financial background. Through these efforts I’ve sought out to address obstacles that prohibit access to services.

Here at WAAA, our guiding principals are that all individuals with Autism Spectrum Disorder (ASD) can learn. Best practice guidelines recommend remediation programs that are effectively designed and delivered by the medical community, therapy providers, families, schools and other service providers, working well together and achieving consensus. This has been particularly challenging for school-aged children and adolescents with autism.

Although never intended, many children, including those involved with the social welfare system rely on schools as their primary health care provider. For this reason I set out to study the School Based Health Care Service (Program) to learn what health technologies these children can access in schools.

School-Based Health Care Service (SBHS) is a program run by the Health Care Authority (HCA) which reimburses school districts (SDs) for Medicaid covered health care related services provided to Medicaid eligible children. The services must be included in the student’s current Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) and must be provided by a licensed health care provider.

Covered services include evaluations, as well as health care-related services including:

(a) Audiology;
(b) Counseling;
(c) Nursing;
(d) Occupational therapy;
(e) Physical therapy;
(f) Psychological assessments; and
(g) Speech-language therapy
Topping the list of Noncovered services is Applied Behavior Analysis (ABA)!
To learn more about ABA, it’s role in accessing education and how these professionals are trained, and certified in Washington I turned to Dr. Nancy Rosenberg, PhD, BCBA-D, the director the ABA program at the University of Washington and a Senior Lecturer in the Special Education department.
Dr. Rosenberg described the role of behavior analysts in observing very diverse students’ learning environments and how they design modifications to leaning environments to support students’ learning socially significant behaviors and accessing education curriculum. She also described how UW prepares these professionals (Read more about Nancy Rosenberg’s presentation on ABA in Schools).
Many students with ASD’s have co-occurring mental health and medical conditions. In many parts of the state, especially rural areas, schools often present an unnatural bifurcation of mental health, education and Autism services. In reality, there exists a spectrum or continuum of care that crosses lines, but most schools struggle to access either. Providing ABA services without access to mental health services or educational interventions without regard for mental health concerns is nonsensical.
To learn more about how schools are grappling with this challenge, I consulted Dr. Lionel Enns, PhD, BCBA-D, NCSP, of Under One Roof Psychological Services. All of the above means he is very busy. His current approach includes:
  • Provide expert advice to schools and parents in regard to challenging students
  • IEEs, FBA’s, staff training in Autism
  • Fill the gap that exists between educational psychology and mental health challenges

I also wanted to learn about public schools’ and educators’ perspectives. To learn more about how ABA is currently integrated into various SDs and conditions where children are able to access ABA in schools I reached out to Dr. Vanessa Tucker, Ph.D., BCBA-D, LBA, of Pacific Lutheran University.  Dr. Tucker began her career as a special education teacher in various settings including self-contained EBD, self-contained autism/multi-categorical education, inclusive 1st/2nd and 3rd/4th grades, resource room and special education preschool. She left the classroom in 2003 to work with Tacoma Public Schools as a Coordinator for their Autism and Assistive Tech programs. She left TPS in 2010 to work for University of WA Tacoma, where she was a lecturer and Teacher Certification Program Coordinator.

With a BA in general and special education, M.Ed. in Low Incidence Disabilities and and a Ph.D. in Special Education and Applied Behavior Analysis, Dr. Tucker’s perspective regarding ABA Services in Schools is invaluable.

In addition, I also consulted 3 Special Education Directors at Educational Service Districts (ESD) in Eastern, Central and Western Washington, in addition to 8 special education directors in area public SD’s. It turns out many districts are grappling to fund ABA, but face many obstacles. Currently the only way districts are able to fund ABA is through safety net funding, only after exhausting attempts through SBHS, which clearly considers ABA a non-covered service and only after reaching a certain expenditure threshold. For the majority of children in public schools, this threshold is not reached and therefore no funding is available to schools.

To make matters more challenging, schools are not able to hire BCBA’s as certificated staff unless they are also certificated teachers. This further constrains the already limited capacity of qualified ABA providers throughout Washington.

There are no single and quick answers, but WAAA is committed to finding solutions. We are doing this by:

  • Working with ESD’s and SD’s supporting efforts towards improving public schools’ ability to hire more qualified ABA providers and improved funding streams and
  • Leading an ABA Workforce AdHoc Committee. Members include BCBA’s representing a variety backgrounds, Autism Centers, Birth-3 centers, Washington Association of Behavior Analysis (WABA), ABA agencies and academia.

To learn more or to support these efforts, please consider volunteering as a WAAA Autism Ambassador. We look forward to working with you!


Please follow these links to learn more about what is required to add ABA under SBHS  as well a more comprehensive webinar on what SBHS currently funds (You will need to enter your name and email address in order to view the presentation.


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