Exploring Quality in the Applied Behavior Analysis Service Delivery Industry

Abstract

As the applied behavior analysis (ABA) service industry ("the industry") continues to rapidly expand, it faces three major problems. First, ABA service delivery quality (ASDQ) is undefined in ABA research and the industry. Second, we cannot rely exclusively on professional organizations that oversee licensure and certification to control ABA service delivery quality because they do not have control over the relevant contingencies. Third, without objective indicators of ABA service delivery quality, it is difficult for ABA organizations to distinguish the quality of their services from competitors. In this article, first we explain the need for more critical discussion of ASDQ in the field at large, briefly describe a sample of common views of quality in ABA research and the industry, and identify some of their limitations. Then we define ASDQ and present a cohesive theoretical framework which brings ASDQ within the scope of our science so that we might take a more empirical approach to understanding and strengthening ASDQ. Next, we explain how organizations can use culturo-behavioral science to understand their organization's cultural practices in terms of cultural selection and use the evidence-based practice of ABA at the organizational level to evaluate the extent to which methods targeting change initiatives result in high ASDQ. Lastly, in a call to action we provide ABA service delivery organizations with six steps they can take now to pursue high ASDQ by applying concepts from culturo-behavioral science and total quality management.

Trends in Geographic Access to Board Certified Behavior Analysts Among Children with Autism Spectrum Disorder, 2018–2021

“…Given this larger context in healthcare, to expect that the U.S. will experience equitable geographic access to BCBAs in the near or distant term is impractical. Still, as the number of practitioners continues to increase, and as the issue of quality becomes a central focus of the profession (Critchfield, 2015 ; Silbaugh & El Fattal, 2021 ), it will be important to determine where geographic gaps can be filled and in what manner (in person vs telehealth vs hybrid). To begin, professional associations and researchers representing the interests of ABA service providers could determine why 266 counties added BCBAs between 2018 and 2021 and how these developments could be promoted in other counties.…”

Alliance for Scientific Autism Intervention: System Components and Outcome Data from High-Quality Service Delivery Organizations

“…What remains less clear, however, are the variables associated with the development of a high-quality autism-intervention program. Silbaugh and El Fattal ( 2022 ) make a compelling argument for the need to define and describe the components of service delivery organizations that consistently produce the desired outcomes for the consumers of the organization, and thereby can be considered high quality. As noted by Silbaugh and El Fattal, it is imperative for the field to move beyond program descriptions (e.g., Handleman & Harris, 2005 ; McGee et al, 2020 ) to demonstrations of program effectiveness that include client progress towards functional goals, consumer satisfaction, and overall improvement in quality of life (Dixon, 2014 ).…”

“…Silbaugh and El Fattal ( 2022 ) propose a “call to action” encouraging ABA service providers to implement six steps that benefit an organization in moving towards the provision of high-quality services. Although there is much work to be done, as noted by these authors, they suggest organizations begin working on making practical changes.…”

“…Although there is much work to be done, as noted by these authors, they suggest organizations begin working on making practical changes. These six steps include: (1) strategic planning; (2) definition of QD-KPIs; (3) monitoring of progress; (4) inclusion of both professional and consumer standards in the QD-KPIs; (5) total quality management system implementation; and (6) regular review—and publishing—of results (see Silbaugh & El Fattal, 2022 , for a full discussion).…”

“…Members of this organization, all having been mentored by Drs. McClannahan and Krantz, embrace the establishment of the service delivery systems they developed and are committed to being high-quality service-delivery agencies that are aligned with the six steps identified by Silbaugh and El Fattal ( 2022 ).…”