Article archive / December 1, 2012
Originally published: . Volume 4, No. 4. Source pages: 1, 3, 4, 5.
Heat’s On As Commission Nears Vote Psych Board Offers Unprecedented Change Two Positions on LSBEP To Behavior Analysts
In what some considered an unexpected move, parent members of the Behavior Analysts Licensure and Regulation Study Commission, Chair Ashley Munn and Vice Chair Catherine Morrell, presented an option for behavior analysts (BAs) to merge with the Licensed Professional Counselors Board of Examiners.
The parent Chairs delivered a poke in the eye to the psychologists, listing disadvantages to BAs linking up with the psychology board. They noted an “Established Economic Conflict of Interest,” and “Mistrust/Antagonistic Relationship.”
Munn’s and Morrell’s proposal came as one of four presentations to Commission members, outlined at the November 2, 2012, regarding the arrangement for BAs regulation, ideas to be given to the legislature for a bill that Senator J.P. Morrell has said he will offer in 2013.
The Munn and Morrell proposal for BAs to join the LPC board prompted a hurried and unprecedented offer from the Louisiana State Board of Examiners of Psychologists (LSBEP) for a similar arrangement between the BAs and the LSBEP. This offer included two positions on the psychology board, one for a doctoral level behavior analyst and one for a masters level behavior analyst.
This is the first time such an offer has been made since the board was created in 1964.
The members of the LSBEP discussed ideas with leaders of the Louisiana Behavior Analysis Association (LABAA) at their Friday, November 9 psychology board meeting in Baton Rouge. LSBEP Chair Dr. Lee Matthews called for the motion and made the offer to Dr. Grant Gautreaux, president of LABAA, and behavior analyst Janice Huber, also of LABAA, who attended the board’s meeting.
At the meeting, Gautreaux said that the presentation by “Morrell and Munn presented the behavior analysts with very attractive ideas.” This was because there was no overlap in scope of practice with the LPCs, he explained.
In considering a merged board option with LSBEP, Gautreaux also said, “Obviously, if we can be part of something, and have a seat at the table, with a real voice, then I think we can entertain that.”
Chair Dr. Lee Matthews said, “What comes out of this is how to configure a seat at the table. It would involve some drastic changes.”
Gautreaux said, “We would have to be assured of some autonomy.”
Dr. Gautreaux had also met that morning (November 9) with the Licensed Professional Counselors (LPC) board, according to a posted agenda from the LPC board.
Other presentations at the BA Study Commission’s November 2, 2012, meeting (See Box) included a proposal for an independent, stand alone board, presented by Gautreaux, and for an “umbrella” arrangement, presented by the LSBEP and also the Louisiana Psychological Association represented by Dr. Lacey Seymour, a psychologist and a board certified behavior analyst.
Following the negotiations between the LSBEP and LABAA leaders, the psychology board sent a formal communication to BA Commission members dated November 13, 2012, outlining their new offer and modified position.
LSBEP Modified Position
The psychology board’s November 13 message confirmed that the LSBEP voted “unanimously to work with your association [LABAA] to establish a model licensure act as a merged board.”
“… The LSBEP offers to the LABAA, the opportunity to have 2 seats for behavior analysts on the psychology board as well as a committee of behavior analysts. The psychology board would change from 5 to 7 members,” they wrote.
The letter confirmed that all BA members would be nominated by LABAA and selected by the Governor, that the committee would include a variety of licensure levels, have responsibility for rules, procedures, evaluating candidates, and so on.
They asked the LABAA group for a decision by November 25, 2012. The Times tried to reach Dr. Gautreaux for comment, but did not hear from him by press time.
The 17-member Study Commission is scheduled to meet on December 7, 2012, to vote on these options.
Poke in the Eye
As the Chair and Vice Chair proposed the merger with BAs with the LPC board, they also restated criticisms about the LSBEP and psychologists in general, circulated in the spring.
Munn and Morrell noted their view that psychologists aren’t covered under Foil’s Bill, and have only been concerned since 2008 when autism care was mandated in Louisiana. They also noted their view that psychologists want to force BAs under their supervision.
“Currently psychology is not covered under Foil’s Bill unless they are also BCBA,” they noted, “this creates an economic incentive for them to be ‘in charge’ of Behavioral Analysts.”
They listed also that the LSBEP invited parents to a town hall meeting and then “… laid out step by step how they would shut down services if their bill didn’t pass.”
Some of the criticisms reflect the comments circulated on the web by various groups, including autism support groups, during the spring legislative battle when the LSBEP, led by medical psychologist Dr. John Courtney, and Senator Dan Claitor, put forth SB 185. Opposition was immediate and strong.
An online petition was created at Change.org, which was said to have reached 1,500 signatures. The message was that the psychology board was involved in “… another ‘turf’ battle waged by psychologists in an attempt to stake claim to another profession. The Psychology board has a long history of initiating turf battles in Louisiana with physicians, LPC’s [sic] and now Behavior Analysts,” noted the petition.
The complaints included that the psychology board was claiming that consumers were in danger but the petition noted that SB 185 would be detrimental to consumers due to “imposed supervision” and increased costs.
In April the Butterfly Effects.com Editorial Staff, a commercial healthcare organization led by a marketing professional, published a “Call to Action” imploring parents and voters to “step up and demand that their legislature do the right thing for Louisiana’s children …” The authors called it a “different kind of Amber Alert is sweeping across the state of Louisiana this week, as those trusted with the care of the state’s children are threatening to make it much more difficult for nearly three thousand children diagnosed with autism to step out of harm’s way.”
Autism Speaks published an April news story high- lighting Dr. Gautreaux in an interview with New 2 in Baton Rouge, after the LSBEP bill was initially killed.
The Louisiana State Chapter of the Autism Society reported in the spring 2012 newsletter saying that the BAs in Louisiana report that SB 185 will make it difficult to “recruit or retain BCBAs.”
The news story also noted, “One rule adopted recently by the Louisiana Board of Elementary and Secondary Education (LBESE) allows public schools to hire BCBAs as employees. The LSBEP was the only opponent to that rule, arguing that ABA is in the scope of practice of licensed psychologists so behavior analysts should be licensed as psychologists or supervised by psychologists or physicians.”
“Supporters of that rule argue that the practice of ABA is very different from the practice of clinical psychology, and they feel the supervision of behavior analysts by licensed psychologists is unnecessary and costly,” the authors of the newsletter wrote.
LSBEP’s attempts to counter these and other criticisms appeared to have had little impact. Despite the public opposition, Courtney and the board continued their effort with a substitute bill.
According to several sources, Dr. Courtney had worked with psychology professors at McNeese to develop the legislation, but was not successful with the Nicholls group, located in the education department.
At the November 9 LSBEP discussion with LABAA leaders, Gautreaux said, “We wrote things into the bill and when we got back, they had been taken out.” And he explained that there were other things that occurred. “That’s where we started, on very shaky ground,” he said.
Courtney said that he had been discussing matters with others, in particular professors from McNeese, and that items were removed because of negotiation with others in the community. Earlier, Courtney had commented to the psychology board members, “We first went to them with a model we thought they’d really like. Our agenda was to smooth the path.”
Response to Poke in the Eye
The LSBEP responded to the ideas in the Munn and Morrell presentation, and perhaps to other undisclosed communications, with another letter to Commission members on November 14, 2012.
“First and foremost,” they wrote, “the Louisiana State Board of Examiners of Psychologists takes seriously allegations of inappropriate financial gain, accusations alluding to ‘shutting down autism clinics,’ and general exaggerations that appear to intentionally misstate our Board’s repeated and carefully crafted positions, statements and/or actions. These actions on the part of some committee members can have chilling ramifications, as we value the Board members reputations as well as those of our staff members.”
The letter goes on to note that the board has a “statutory obligation and duty to protect the citizens of Louisiana from the unlicensed practice of psychology.” They note that the AG concurs and so do other jurisdictions in the US.
They also wrote that Autism is considered a “serious mental illness” and “It should be of serious concern to commission members that anyone would suggest that the LPC board provide regulation for administrative mentoring for a newly formed board of professional behavior analysts, whom the majority deal with Autism Spectrum Disorders while LPCs do not have such clinical authority within their scope of practice. This is exactly the opposite of how one protects consumers and reinforces why the relationship with the Psychology Board makes so much sense.”
The authors, Chair Dr. Lee Matthews and Vice Chair Dr. John Courtney, cited their modified position and their intention to work with LABAA to create a model licensure act and wrote, “We believe that this proposal is consistent with their [the behavior analysts] wishes, our hopes, and most importantly, what best protects the consumer.”
They confirmed that their proposal “… does not require supervision … at all. No patient would have to see a psychologist to access care from a behavior analyst. Behavior analysts would maintain independence in their practice.” They note their opinion that a merged option with the LSBEP is the only appropriate relationship and that the LSBEP is both the board and professional field familiar with the practice of behavior analysis, behavior modification and behavior therapy.”
Economic/Healthcare Context
The context of the Commission’s effort comes amid alarmingly high rates of prevalence, with a CDC estimate of 1 in 88 children has been identified with an autism spectrum disorder (ASD). [Community Report From the Autism and Developmental Disability Monitoring (ADDM) Network – 2012.]
Applied behavior analysis has been shown to be one of the most effective treatments, and most helpful when it is early and intensive, as much as 30 hours per week.
The CDC writes that the “annual medical expenditures per child with an ASD range from $2,100 to $11,200. Additionally, we know that intensive behavioral interventions for a child with an ASD can cost from $40,000 to $60,000 per year and that the nonmedical costs of special education for a child with an ASD are about $13,000 per year.”
Background
The Behavior Analysts Licensure and Regulation Study Commission was created by a Senate Resolution authored by Senator J. P. Morrell of New Orleans.
The Commission is a 17-member panel led by Chair Ashley Munn and Vice Chair Catherine Morrell, Senator Morell’s wife. The Chair and Vice Chair were appointed by the president of the Senate and the chair of the Senate Health and Welfare Committee, and to be parents or guardians of a child who currently receives or has received ABA (applied behavior analysis) services, according to Senator Morrell’s resolution.
Representatives of 17 groups and agencies, including Dr. Cheryl Knight from Department of Health & Hospitals, Kim Percle from the state Superintendent of Education, and representatives from Nicholls and McNeese universities where masters training of behavior analysts is provided, Drs. Steven Welsh and Dena Matenzbacher, are included.
Also included are representatives of the state boards from medicine (Dr. Robert Marier), psychology (Ms. Kelly Parker), social work (John McBride), and counseling (Mary Alice Olsan).
The professional groups from BAs, psychology, speech & language, and representatives from two autism treatment facilities, the Disability Council, and from the LSU law center, were also included. Doctoral programs, such as LSU where international autism expert, Dr. Johnny Matson teaches, were not represented.
According to the minutes of meetings from July 2012 to October 2012, the group was able to define it’s role, study the evolution of the BA profession and training, and make the decision that BAs should have state regulation.
In September members developed and voted on a definition, and in a 7 yea, 5 nay, 1 abstain vote, decided to remove the phrase “by a behavior analyst,” from definition of applied behavior analysis, which passed with a 7-5-1 vote, also.
“’Applied behavior analysis’ means the design, implementation, and evaluation of systematic instructional and environmental modifications to produce socially significant improvements in human behavior. It includes the empirical identification of functional relations between behavior and environmental factors, known as functional assessment and analysis. Applied behavior analysis interventions are based on scientific research and the direct observation and measurement of behavior and environment. They utilize contextual factors, establishing operations, antecedent stimuli, positive reinforcement, and other consequences to help people develop new behaviors, increase or decrease existing behaviors, and emit behaviors under specific environmental conditions.”
The commission members also agreed on requirements, fees, and standards. In a discussion about degree requirements, psychology was added to the list, but four members voted against the move, which would have limited the training to behavior analysis. The group adopted the national board’s qualifications, without objections.
Analysis and Opinion
The Munn and Morrell presentation and the upcoming vote this week bring out key issues for the Commission members.
As consumers of BA services, it is understandable that for Munn and Morrell, which likely includes Senator Morrell, the most important aspects are access to treatment and keeping costs down. This seems supported by the Chair’s and Vice Chair’s comments noted in the minutes over the months.
Certain issues such as psychologists forcing “super- vision” and featherbedding have stuck with both parents and BAs, due in part to what appears to be poor communication on the part of the LSBEP leaders. Attempts to explain appear to have solidified opposition.
It is not clear how the psychologists could fiddle with supply of BAs or costs by way of a publically accountable regulatory board, although it could be done if someone sets their mind to it. It is not clear if parents are equally concerned by the growing commercial efforts in the BA services area, or the tiered structure that exists already in BAs, both of which could also result in higher costs.
Regardless, both parents and BAs appear to be looking at past behavior from the psychology board with concern. Masters degreed individuals in psychology and education, and also school psychology, including the specialist, have historically met with very firm opposition from the LSBEP. This includes the behavior analysts. As recently as June 2011, Dr. Joseph Comaty, as Liaison to Professional Organizations and Boards, reported in LSBEP minutes, “… that an objection letter was sent to Board of Elementary and Secondary Education in response to Bulletin 746 Louisiana Standards for State Certification of School Personnel: 421 which promulgated rules to employ behavioral analysts.”
The lack of trust accounts for why, after repeated attempts to clarify issues like supervision and featherbedding, the LSBEP has failed in changing parents’ and BAs’ views. The most recent “merged board” option may help, but probably not as much as the LSBEP might hope.
It is also not clear why, and why now, the LSBEP took up legislation. No clear explanation was in the minutes. The issues had received ongoing attention at the national association of state psychology boards, however.
And there is also the issue of professional identity, reflected in the consistent message from the LABAA president, Dr. Gautreaux, who while leading a small group, is insistent that applied behavior analysis is a separate profession.
Just before publication, the Times sources indicated that the State Medical Board moved to support the LSBEP’s recommendations.
The Commission members may have their hands full separating politics from science and healthcare at the vote this Friday.
(Conflict of Interest Statement: J. Nelson is a licensed psychologist. She practices part- time in general applied psychology but not in healthcare, applied behavior analysis, or with clients with autism.)
Dr. Grant Gautreaux, LABAA president, listens to Dr. Darla Burnett (far left) while LSBEP Ex. Director Kelly Parker takes note.
Dr. Marc Zimmermann (L) and Dr. John Courtney, members of LSBEP, at November 9 board meeting with behavior analysts.
November 9 LSBEP meeting with behavioral analysts’ representatives.
Behavior analyst Janice Huber, representing LABAA, and Dr. Marc Zimmermann listen to discussion at recent LSBEP meeting. The LSBEP voted to offer behavior analysts two seats on the LSBEP.
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