Trends in Geographic Access to Board Certified Behavior Analysts Among Children with Autism Spectrum Disorder, 2018-2021.
Marissa E Yingling, Matthew H Ruther, Erick M Dubuque
PMID 34985719WHAT IT FOUND
From 2018 to 2021, counties with no Board Certified Behavior Analysts fell from 54% to 46%, but many still lacked one.
ABA service availability cannot be assumed for families in those counties.
Key findings
01The share of counties with no Board Certified Behavior Analysts fell from 54% in 2018 to 46% in 2021.
02In 2021, 1,430 counties had no BCBA, and 256 of those were counties with no BCBA and no BCBA in a bordering county.
03Counties with fewer than 10 children with ASD per BCBA rose from 170 to 379, while counties with more than 50 children with ASD per BCBA fell from 314 to 215.
STILL TO COME
How it was doneWhat they found
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What it does not show
The number of children with ASD was held at 2017-2018 school data, so a falling ASD/BCBA ratio may overstate improved access. School records count only children whose primary educational disability is ASD, so children with ASD plus another primary disability may be missed. State eligibility rules vary for a primary ASD disability, which may affect county-level counts. The BACB registry does not show BCBA caseloads, treatment models, service hours, or whether a BCBA works with children with ASD. An estimated 73% of BCBAs work with individuals diagnosed with ASD, so the BCBA count may not match ASD service capacity. Telehealth and service delivery across county lines were not counted, so some families may have access not captured by the county map. ZIP codes and school districts were allocated to counties by population or business addresses, not exact service locations. Iowa county rates were missing from some maps because state data did not report disability type by county.
The easy way to misread this
Do not read the decline from 54% to 46% of counties with no Board Certified Behavior Analysts as proof that ABA services are available. The child count was fixed at 2017-2018, not all BCBAs work with children with ASD, and actual caseloads and telehealth were not measured.