This study examined variation in geographic access to Board Certified Behavior Analysts for children with autism spectrum disorder. Between March and May 2019, we integrated public data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. The study sample included all U.S. counties and county equivalents in 48 states and D.C. ( N = 3108). Using geographic information systems software, we assigned Board Certified Behavior Analysts to counties based on their residence, allocated children via school districts to counties, and generated per capita autism spectrum disorder/Board Certified Behavior Analyst ratios. We calculated the Getis-Ord G* statistics for each county and each ratio and compared counties in high-ratio clusters with counties in low-ratio clusters by socioeconomic variables. More than half of all counties had no Board Certified Behavior Analysts. Counties in the highest accessibility category had ⩽17.1 children with autism spectrum disorder per Board Certified Behavior Analyst ( n = 770), while counties in the lowest accessibility category had ⩾137.1 children with autism spectrum disorder per Board Certified Behavior Analyst ( n = 12). In all, 55 of the 129 counties with the highest autism spectrum disorder prevalence had no Board Certified Behavior Analysts. Higher accessibility counties were wealthier and had smaller uninsured populations. To improve geographic access, we must identify factors driving unequal distribution that can inform provider recruitment and retention efforts in underserved areas. Lay abstract This study looked at whether access to Board Certified Behavior Analysts for children with autism spectrum disorder is different between U.S. counties. The study included all U.S. counties and county equivalents in 48 states and D.C. ( N = 3108). Between March and May 2019, we combined data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. We assigned Board Certified Behavior Analysts to counties based on their address, matched children in school districts to counties, and determined how many children with autism spectrum disorder there were in a county compared with how many Board Certified Behavior Analysts there were in a county. The results show uneven numbers of Board Certified Behavior Analysts between U.S. counties. More than half of all counties had no Board Certified Behavior Analysts. National maps illustrate clusters of high and low accessibility to Board Certified Behavior Analysts. To improve access to Board Certified Behavior Analysts in underserved areas, we must identify what contributes to the differences in access.
Microsoft Excel® is a popular graphing tool used by behavior analysts to visually display data. However, this program is not always friendly to the graphing conventions used by behavior analysts. For example, adding phase change lines has typically been a cumbersome process involving the insertion of line objects that do not move when new data is added to a graph. The purpose of this article is to describe a novel way to add phase change lines that move when new data is added and when graphs are resized.
To examine the relationship between geographic access to Board Certified Behavior Analysts (BCBAs) among children with autism spectrum disorder (ASD) and county sociodemographic factors and state policy, we integrated publicly available data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. The study sample included U.S. counties and county equivalents (e.g., parishes, independent cities) in 49 states and D.C. (N = 3040). Using GIS software, we assigned BCBAs to counties based on their residence, allocated children via school districts to counties, and generated per-capita children with ASD/BCBA ratios. We distributed counties into five categories based on these ratios: no BCBAs (reference), ≥ 31, 21–30, 11–20, > 0–10. We used a generalized logit model to conduct analyses. Highly affluent and urban counties had the highest access to BCBAs with odds ratio estimates for affluence ranging from 2.26 to 5.26. County-level poverty was positively associated with access, yet this relationship was moderated by urbanicity. Race-ethnicity and healthcare insurance coverage were negatively related to access. Other variables were not significant. Targeting non-urban and less affluent counties for provider recruitment and maintenance could most improve access to BCBAs. In addition to strategies specific to BCBAs for improving geographic access, traditional strategies used for other healthcare providers could be useful.
Research has documented inequities in geographic access to Board Certified Behavior Analysts (BCBAs) among children with autism spectrum disorder (ASD). However, research on their accessibility is outdated. Between July 1, 2018 and July 1, 2021 the number of BCBAs in the U.S. increased by 65%, from 27,320 to 45,103. In this study we examined trends in geographic access to BCBAs among children with ASD between 2018 and 2021. The sample included all U.S. counties in 50 states and D.C. (N = 3138). Using GIS software we examined change in county-level access to BCBAs between 2018 and 2021 and mapped ASD/BCBA ratios across all counties in both years. Study results indicate that despite modest improvements (e.g., 266 counties added BCBAs), inequitable access persists.
In the mid-1980s, research reported that people living with HIV were viewed differently on measures of competence, dependence, morbidity, depression, and moral worth from those living with other chronic illnesses. 443 students were surveyed to evaluate present attitudes in comparison to this earlier research. The usefulness of imaginal exposure, i.e., imagining a loved one living with HIV, in reducing stigma toward people with HIV was also investigated. Analysis indicated no difference in the rating of AIDS and cancer patients on measures of competence, depression, and morbidity and patients with heart disease, the latter being rated significantly less competent and more depressed than AIDS or cancer patients. AIDS patients were rated significantly less dependent than cancer and heart disease patients. While these results suggest that stigma associated with an HIV/AIDS diagnosis, in general, may have decreased over the years, ratings of moral worth were still lower for AIDS patients than for patients with cancer and heart disease. Robustness of this specific aspect of stigma may be associated with sexual prejudice. Also, an imagined loved one who lives with HIV was rated significantly more favorably on all 5 composite scales than a generic person living with HIV, suggesting the usefulness of exposure as an intervention for attitude change. Limitations of the research are discussed.
Identifying and isolating individuals infected with COVID-19 are critical steps in stopping the spread of the coronavirus. Until widespread testing and contact tracing systems are implemented, alternative methods must be considered. One way that organizations can protect employees and clients is by creating their own automated health attestation systems. These systems could be used to reduce the spread of the coronavirus by asking providers and consumers to self-identify COVID-19 exposure, as well as to help mitigate liability for organizations by asking providers and consumers to agree to follow relevant policies and acknowledge the risks inherent in providing or receiving services. The purpose of this article is to outline the steps for creating this type of health attestation system using Microsoft Office 365.
Creating phase change lines and their corresponding labels in Microsoft Excel® remains a difficulty for many behavior analysts who want these display features to be integrated into the graph itself. Previous methods designed to address this issue have had limited utility across the types of data sets commonly analyzed by behavior analysts. The purpose of this article is to provide a fully functional method for integrating phase change lines and labels into Microsoft Excel® line graphs. This method is a combination of previous recommendations and allows for easy integration of new data and exportation of graphical displays to other software programs (e.g., Microsoft Word® and PowerPoint®).
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