Hi, I’m Rachel, I was born and raised in Houston, Texas and worked as a BCBA in the USA for over ten years. Until this year! When I relocated to the North of England and joined Skybound Therapies. I often get asked how Applied Behaviour Analysis (ABA) therapy differs in the UK to the USA. So, here’s my take on it so far.
Firstly, allow me to acknowledge that my perspective is based solely on my personal experiences. It is important to note that my insights on ABA therapy in both the USA and the UK may vary from those of others who have practised or received ABA in either or both countries.
One thing that remains the same across all the countries I’ve worked or consulted in, is the science of Behaviour Analysis. The science of learning (with all the graphs, data and analysis) is what drew me into this field. However, the people I’ve met along the way are what have kept me in this profession. I feel very blessed regarding the companies, clients and families, training and opportunities I have had during my career.
In the US, I lived in a medium city in Southwest Louisiana with a population of around 80,000 that had a University with a Master’s program in Psychology with a concentration in Applied Behaviour Analysis. Here are my own observations of some of the differences and similarities I have noticed between ABA in the United Kingdom and The United States.
Access to ABA is by far the biggest difference. The sheer number of providers in the US is astounding. I worked for a centre that had 12 Behaviour Analysts who all lived and worked in the same city. The city that I lived in had at least 10 different ABA companies. With that being said most ABA companies still had a waiting list, but finding a BCBA was much easier than in the UK.
Access to obtaining diagnostics is a difference that I really wasn’t expecting, but here it is. From what I’ve gathered during my time in the UK, obtaining a diagnosis of Autism can take up to 5 years. This figure truly astounded me because early intervention is vital to helping an individual. Diagnosis or not, if an individual is having difficulty, having to wait is rarely the answer.
In the US (in most states, if not all), ABA is covered by health insurance. In the state of Louisiana, a diagnosis of Autism is needed for ABA to be covered by most private health insurance. ABA training for teachers and paraprofessionals/teaching assistants can also be written into an Individual Education Plan (IEP). Insurance companies can limit the areas of service (academic, daily living skills, social, medical desensitisation etc), the settings that services can be provided in (home, school, community, clinic) and/or the goals able to be worked during regular therapy.
In the UK, ABA is covered within an individual’s Educational Health and Care Plan (EHCP), Statement or IDP and then funded though the individual’s local authority.
Clinicians, Tutors, Therapists, Aids, Technicians, RBT’s, RLT’s, ABA’s, are all titles that I’ve heard used to describe a person who provides direct adaptive behavioural services for an individual.
A Registered Behaviour Technician (RBT) is the title and credential provided by the Behaviour Analysis Certification Board (BACB) for a person who has received training, passed an exam and is provided supervision by a BCBA for minimally 5% of their direct hours each month.
It is very rare for a Technician to be employed by a family in the United States, whereas it is fairly common for those providing direct services in the UK to be employed by a family. Although, at Skybound, we do employ technicians for our Fully Managed packages.
Hours of Therapy
An individual accessing comprehensive ABA therapy in the United States could receive between 20-40 hours per week of direct services from a Behaviour Technician, with 10-20% of those hours being supervised and observed by a BCBA. All service hours would depend on the individual need of each client.
An individual accessing focused ABA therapy in the United States could receive between 1-20 hours per week of direct services from a Technician with 5-10% of those hours being supervised and observed by a BCBA. Again, all service hours would depend on the individual need of each client.
Consultation is the main service I provide in the UK and it is highly varied between each client. I have found this to be one of the biggest challenges in my transition from the US to the UK. I was accustomed to seeing each of my clients each day or week and now I can go weeks between consultations. The benefits that I see to the consult model are that I am able to have up to 6 hours in one day to solely focus on that one client and that on consult days most, if not all, members of the client’s team (parents, tutors, teachers, etc) are typically available for collaboration and training.
Intensives are also an amazing service that Skybound provides. The family, BCBA’s, Speech Therapist and Technicians all come together for 1 or 2 weeks of intensive assessment, planning, brainstorming, education and focus on a specific need.
There were many things I was VERY nervous about when moving to the UK; however, the practice of ABA was not one of them. One of the many things I love about ABA is that the science is the same no matter where you live, and its principles are always in effect because it is the science of being human.
Find out more about ABA at Skybound here