Licensing Laws Create Needlessly Long Wait Times for Autistic Individuals

By Jonathan Slack*

Washington and Vermont recently passed legislation that makes it increasingly difficult for autistic individuals to seek services they need. [1] Fortunately, Vermont’s Director of the Office of Professional Regulation and Washington’s Secretary of Health can rectify the legislatures’ mistake. He should act to ensure hundreds of families with a loved one on the autism spectrum have access to essential health care and prevent discrimination against this vulnerable population.

Autism is a neurodevelopmental disorder with a wide spectrum of symptoms.[2] For the past two decades, documented cases of autism have rapidly increased.[3] The Center for Disease Control reports the autism incidence rate has increased from about one in every 10,000 children in the 1970s to about one in every 68 children in 2012.[4]

Health care providers struggle to keep up with the exponential demand for Applied Behavioral Analysis (ABA), an effective treatment for autism symptoms.[5] The national average wait time to start ABA is six to nine months.[6] Currently, the wait time in Washington and Vermont aligns with this national average.[7] The limited quantity of Board Certified Behavioral Analysts (“BCBAs”) cripples the industry’s ability to serve more citizens. [8] BCBAs are the quarterbacks of the therapy team and possess a masters or doctorate degree in behavioral health.[9] They spend extensive amounts of hours learning and implementing the science underpinning ABA and have passed an international certification exam.[10]

In 2015, Vermont passed a new chapter, Chapter 95: “Applied Behavioral Analysis” in Title 26, governing professional licenses.[11] In 2015, Washington also passed Senate Bill 5488.[12]  Like the Vermont statute, it created new licensing laws affecting BCBAs.[13] Their licensing laws do not conform with the industry standard set by the Behavioral Analyst Certification Board’s certificate.[14] The  government’s failure to conform with this industry standard will constrain the number of new BCBAs entering the industry in Vermont and Washington when both laws take effect in 2017.[15]

The Behavioral Analyst Certification Board (BACB) contains rules about how many hours of experience and supervision a potential BCBA needs to have before they can qualify for the credential.[16] An individual can complete either 1,500 hours of supervised independent fieldwork, 1,000 hours of a practicum, or 750 hours of an “intensive practicum to qualify as a BCBA and provide unsupervised therapy.”[17]

Unlike the BACB, Vermont and Washington only allows individuals to qualify for a state license if they complete the 1,500 hours of supervised independent fieldwork.[18] While the BACB does not publish statistics about which experience requirement is used most often by BCBAs, the industry wide estimate is that about 25% of new BCBAs earn their BACB certificate by following the practicum and intensive practicum experience requirements.[19] It usually takes anywhere from a year to two years to complete the independent fieldwork certification requirement.[20] Conversely, it takes about half that time to complete the practicum and intensive practicum requirements.[21] Additionally, private sector BCBAs typically supervise the practicum and intensive practicum applicants.[22] Thus, these BCBAs are often the most experienced at providing ABA therapy outside an academic setting. This allows them to take on new clients more efficiently than BCBAs without this experience.[23]

The new statutes empower the Vermont Office of Professional Regulations Director and Washington’s Secretary of Health to create new rules and regulations governing the license requirements for BCBAs.[24] These officials should use their administrative power to incorporate the BACB’s practicum and intensive practicum hour requirements. Otherwise, the current statutes risk increasing client intake wait times by preventing qualified BCBA providers from practicing.[25]

The extra time on ABA wait lists hurts the citizens of Washington and Vermont. On average, children are being diagnosed with autism when they are two or three years old.[26] Research has shown that ABA is most effective before a child turns four.[27] Researchers have found that a child diagnosed when they are three, who waits a year for therapy, will have a worse outcome than someone who has to wait six months for treatment.[28] There are hundreds of families in each state who want their love one to receive the care they deserve. The statutes, through their non-conformity, make this more difficult. [29]

Vermont and Washington’s legislature erred when they passed legislation that did not conform to the BACB’s industry standard. Fortunately, state administrators in Vermont and Washington have the power to rectify the legislature’s mistake and ensure that hundreds of people do not have to wait any longer than necessary for the therapy they deserve.


The views and opinions expressed in this blog are those of the authors only and do not reflect the official policy or position of the Michigan Journal of Environmental and Administrative Law or the University of Michigan.

*Jonathan Slack is a Junior Editor on MJEAL. He can be reached at jdslack@umich.edu.

[1] Vt. Stat. Ann. §§ 4901–4931; SB. 5488, 64th Leg. (WA. 2015).

[2] Autism Spectrum Disorder Fact Sheet, National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov/disorders/autism/detail_autism.html.

[3] Autism Spectrum Disorder: Data & Statistics, CENTER FOR DISEASE CONTROL AND PREVENTION, http://www.cdc.gov/ncbddd/autism/data.html (last visited November 8, 2016).

[4] Id.

[5] Telephone Interview with Maryanne Nugent, Director of Family Support Services, Autism Home Support Services (Nov. 10, 2016).

[6] Id.

[7] Id.

[8] Telephone Interview with Maryanne Nugent, supra note 2.

[9] Id.

[10] Id.

[11] Vt. Stat. Ann. §§ 4901–4931.

[12] SB. 5488, 64th Leg. (WA. 2015).

[13] Id.

[14] BACB Experience Standards, BOARD ANALYST CERTIFICATION BOARD, 1, 8 (2016), http://bacb.com/wp-content/uploads/2016/11/161101-experience-standards-english.pdf.

[15] Vt. Stat. Ann. §§ 4901–4931; SB. 5488, 64th Leg. (WA. 2015).

[16] Id.

[17] Id.

[18] Vt. Stat. Ann. §§ 4901–4931; SB. 5488, 64th Leg. (WA. 2015).

[19] Telephone Interview with Erica Pozzie, Clinical Director, Autism Home Support Services (Nov. 10, 2016).

[20] Id.

[21] Id.

[22] Id.

[23] Id.

[24] Vt. Stat. Ann. §§ 4901–4931; SB. 5488, 64th Leg. (WA. 2015).

[25] Telephone Interview with Maryanne Nugent, supra note 2.

[26] Autism Spectrum Disorder Fact Sheet, NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE, http://www.ninds.nih.gov/disorders/autism/detail_autism.html.

[27] See Rebecca Macdonald et al., Assessing Progress and Outcome of Early Intensive Behavioral Intervention for Toddlers with Autism, Research in Developmental Disabilities, 35, 3622–3644 (2014).

[28] Id. at 3632–3633.

[29] Telephone Interview with Maryanne Nugent, supra note 2.

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