Autism Learning Partners: Navigating ABA Therapy and Reviews

Autism Learning Partners (ALP) has been a significant provider of Applied Behavior Analysis (ABA) therapy since 1988, offering early intervention services for children with autism spectrum disorder (ASD). ABA therapy is a scientific approach customized for each child and their family, focusing on developing social, language, and learning skills while reinforcing positive behaviors and reducing less desirable ones.

The Importance of Early Intervention

Starting autism therapy services early, when a child’s brain is rapidly developing, is crucial. Early ABA therapy can help children develop social, language, and learning skills that will set them up for long-term success. Early intervention is also key to reinforcing positive behaviors and reducing less desirable ones. By providing essential information early on, you pave the way for a smoother and more efficient path towards your child’s developmental progress. Research indicates that early, high intensity intervention, often birth to five years old may have the best outcomes for improving your child’s development.

Services Offered by Autism Learning Partners

ALP provides a range of services tailored to meet the unique needs of each child and family. These services, which may differ by region and clinician, include:

Early Intervention: Focused on children from birth to five years old, this high-intensity intervention aims to improve a child's overall development.
Center-Based ABA Therapy: Comprehensive and focused ABA services are provided in a structured environment at autism centers, allowing children to learn a variety of skills.
Home-Based ABA Therapy: Teaching occurs in the child’s natural environment, incorporating learning within the child’s natural routine.
Diagnostic Services: On-site diagnosticians are available in select locations to provide autism diagnoses. For those outside these locations, ALP can connect families with qualified diagnosticians in their area.
Parent Collaboration: ALP emphasizes the importance of actively involving parents in their child's therapy to foster greater progress. The clinical team is trained to build success for the entire family unit.

Geographic Reach and Insurance

Autism Learning Partners extends its reach across the nation with dedicated locations strategically placed to provide comprehensive services. From bustling urban centers to tranquil suburban communities, our nationwide network ensures accessibility and excellence in care for individuals navigating the complexities of ASD. ALP has locations in numerous states, including Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming and District of Columbia.

To determine which insurance plans are accepted, families can visit the ALP website and select their specific location to view a list of accepted providers in their area.

ALP is dedicated to providing evidence-based, family-oriented autism therapies. Their blended model and naturalistic approach are tailored to each individual case, empowering our clinicians to passionately practice the art of their science while providing our patients and their families with the skills, resources, and confidence they need to progress towards becoming successful, effective family units.

Addressing Common Questions

ALP addresses several frequently asked questions to help families understand their approach to therapy:

Parental Presence: Family participation is considered vital for a child to make progress. While parents are encouraged to sit in on sessions as often as they can, a caregiver over the age of 18 must be at home for the duration of each session for home-based services. For clinic-based appointments, the child may be dropped off.
Diagnostic Services: If your child needs a diagnosis, our on-site diagnosticians are available to complete this process in select locations. If your child is outside of these locations, we’ll connect you with a qualified diagnostician in your area who can conduct the evaluation and provide all necessary documentation to move forward.
School-Based Services: ALP can provide school-based services if deemed medically necessary and recommended by their clinical staff, with the approval of the insurance company and the school.
Weekend Services: Yes. We regularly provide sessions on weekends. ABA is a daily treatment program, and we offer some of those hours on weekends. Before treatment begins, our client services team will inform you about the options available and finalize your schedule with you.
Minimum Number of Hours: ALP requires parents to commit to what is medically necessary for their child to make progress. The BCBA will prescribe a level of service (number of weekly hours) based on your child’s needs that will lead to the best opportunity for behavioral improvements.

Concerns and Criticisms Surrounding ABA Therapy

While ABA is widely recognized as a beneficial therapy, concerns have been raised regarding its implementation and potential drawbacks.

Individualized Treatment vs. Cookie-Cutter Approaches

Some families and clinicians have expressed concerns that ABA providers, including large chains, may use standardized treatment plans instead of tailoring them to each child's unique needs. Some said the providers, which are meant to deliver highly individualized treatment plans for each patient, instead used cookie-cutter templates. Many parents described being hounded to bring their kids to more and more therapy. When Julie Bauer worked as a technician at Autism Learning Partners in San Diego, for example, she’d often find a different client’s name in a new client’s plan. “It would literally be copy-pasted from somewhere else,” Bauer said. Bauer recalls having four long-term clients who had been given oddly similar treatment goals, many of which she questioned to her supervisor. One board-certified behavior analyst - the master’s-level clinicians who supervise ABA technicians - said she was shocked when she started working at Autism Learning Partners in Texas. There, she noticed every child’s plan called for the same number of hours. “I started to push back and say, ‘I’m not comfortable with these treatment plans because I haven’t observed these deficits,’” recalled the analyst, who spoke on the condition of anonymity because she still works in the industry. “I’m supposed to be delivering medically necessary services. I can’t say with confidence that this is medically necessary. The biggest complaint Trivedi, of The Arc of Indiana, hears from parents of kids with autism is that the treatment isn’t individualized.

ABA providers reject assertions that they’re failing to provide individualized treatment plans. To the contrary, they said tailoring services to each client is their top priority. From its start, ABA was intended to be tailored to each person. Before kids start therapy, they get an in-depth assessment of their language and social skills and a plan to specifically address their needs.

In response to these concerns, companies like Autism Learning Partners state that every treatment plan is customized to the individual patient, informed by the Behavior Analysis Certification Board guidelines and the assessment of their Board Certified Behavior Analysts after meeting the patient and their family.

Excessive Therapy Hours

Some parents have reported feeling pressured to increase therapy hours, leading to concerns about overburdening children. Elissa Couron and her husband loved their Vancouver, Wash., ABA provider when they first sought therapy for their son “T,” back in summer 2020. From there, it got worse. The new clinician reassessed T, whose full name is being withheld to protect his identity, and insisted he needed 30 hours per week, more than double his regimen at the time. Couron balked. Not only was she working, but T was also in physical therapy, speech therapy, occupational therapy, and day care. Couron’s experience was shared by four other parents who used private-equity-owned ABA providers, and 10 former and current clinicians described similar practices where they had worked. Many kids with autism are receiving multiple therapies like speech and occupational therapy in addition to ABA, plus they’re attending school. That’s a packed schedule for a 5-year-old.

The conversation about hours is complicated by the fact that ABA was founded on the principle of intensive intervention beginning as early as possible. ABA pioneer Ole Ivar Lovaas touted 40 hours per week as the optimal dose based on his 1987 study, and some practitioners still insist on that. Recent literature reviews, however, have cast doubt on the evidence supporting that many hours. The founders behind another private-equity-owned ABA provider, Kyo Care, headquartered in California, said they actively avoid pushing high-intensity programs. “We really strive to be that provider that is making the most efficient use of people’s time and payers’ dollars,” said Melissa Willa, Kyo’s chief clinical officer.

Financial Pressures and Ethical Concerns

The increasing involvement of private equity in ABA therapy has raised concerns about prioritizing profit over quality of care. It appears that ABA, broadly, is in crisis, too. Providers across the country have been billing insurers for more therapy than they could possibly deliver, or even double billing, according to lawsuits and audits in multiple states. One single person in Nevada, for example, asked to be paid for providing 65 hours of therapy in one day - an obviously impossible feat. Families and clinicians who once believed fully in the promise of ABA say the financial investors’ fixation on profit has degraded the quality of services kids receive, turning it into the equivalent of fast food therapy.

Jon Bailey, who is on the faculty of Florida State University’s master’s program in ABA, has operated an ABA ethics hotline for the past decade that fields inquiries from people working in the field at both private-equity-owned and independent ABA firms. He’s heard about the practices private-equity-owned companies use to rake in hours. In some cases, he’s heard of management telling behavior analysts, who oversee the technicians, to threaten to fire clients for missing therapy sessions.

Some also say insurers deserve blame for what’s happened to the industry. Larsson, of the Lovaas Institute Midwest, said providers - private-equity-owned or not - can be forced into standardized treatment approaches because insurers won’t fully cover the cost of performing thorough assessments and treatment planning.

Billing Practices

Audits and lawsuits have uncovered instances of fraudulent billing practices, including billing for excessive hours, services not provided, or services delivered by unqualified personnel. The state of Nevada audited behavior analysis providers from 2016 to 2020. These tables show individual providers who billed for the most days of excessive hours (left) and the five dates with the most excessive services paid (right). The allegations come from nearly every corner of the country, and involve both providers with private equity backing and those without. In Nevada, some 1,000 individual clinicians sent bills to the Medicaid program that suggested they delivered 24 hours of therapy in a single day - or in some cases, more hours than that, according to an audit of four years of paid bills. Florida ABA providers, too, bill for those “impossible days,” or send bills to the state’s Medicaid program that suggest they provided more than 40 hours of therapy in a week, Medicaid’s limit - impossible weeks. Sometimes providers send bills for so many consecutive days of service that it would mean they never took a break for weekends, holidays, or sick days. Tricare, the agency that handles veterans’ health care, has found ABA companies frequently billed for services as though they were delivered by a supervisor when they were actually delivered by a lower-level provider. In one example, the agency paid $125 per hour when it should have paid $50 per hour. In South Carolina, an ABA provider illegally billed the state’s Medicaid program and Tricare for services it never provided, or for time traveling to and from meeting clients, sitting in restaurants, or waiting in driveways.

Workforce Issues

Burnout, low pay, and high turnover rates among ABA technicians are significant concerns, potentially affecting the consistency and quality of care. Mukherji had to hit a billing quota, with bonuses if she surpassed it. Gaps in her calendar had to be explained and made up. “But I don’t have time because now I have the pressure of billing, I have the pressure of completing my quota,” she said, “and then I have 14 more clients to go to who all need pretty significant time and effort from me. Burnout is a common experience among ABA providers, some of whom said they left large chains for smaller companies or quit the industry altogether. The work can be grueling. Not only are the hours long, but clients can have challenging behaviors. Employees say they’re not treated well by the large chains, often denied lunch breaks, for example. Not only that, technicians are low-paid paraprofessionals with little training, a population that tends to see higher turnover. Cycling through providers each month is bad for kids with autism, who need consistency and time to build rapport with new people, many clinicians and parents agreed. When turnover is high, technicians provide less actual therapy because so many weeks are devoted to just getting to know one another. Especially in cases when kids are nonverbal, clinicians have to learn the best ways to communicate.

Autism Learning Partners paid almost $1 million in 2021 to settle former California employees’ allegations that it used a time rounding system that failed to pay workers for all hours worked, including overtime.

Alternative Perspectives on Autism

Some organizations, like the Autistic Self Advocacy Network, oppose ABA, believing it aims to make autistic individuals appear less autistic and can be harmful. Gross said it’s concerning that kids would spend so much time in a therapy that her organization believes is harmful because it’s designed to make autistic people appear less autistic. Her group is especially worried about private equity’s involvement in ABA because it’s expanding the number of kids getting the treatment and maximizing the number of hours they take on.

Positive Impacts of Private Equity

Despite the criticisms, some argue that private equity has positively impacted the ABA industry by expanding access to services through the addition of more centers and virtual services. Anna Bullard said after her daughter was diagnosed with autism in 2007, she had trouble finding ABA providers that served rural Georgia, where they live. “I didn’t have to drive one and a half hours one way,” said Bullard, who serves as vice president of government relations for the Behavioral Health Center of Excellence, an accrediting body that develops industry standards.

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