Issue # 3 - February, 2009
Some Frequently Asked Questions about Credentialing Practitioners of Behavior Analysis
by Gina Green, APBA Executive Director
For multiple reasons, credentialing of behavior analytic practitioners has
become a hot issue of late. 
This article
presents some of the most common
questions we receive, with some
relatively brief responses. Please stay
tuned to the APBA Reporter and
website for further information on this
very important topic.
1. What is the difference between certification and licensure?
Generally speaking, certification programs are operated by professions. Often a professional organization initiates a certification program for practitioners and “spins off” a national or international nonprofit corporation to manage it. In the case of applied behavior analysis, the Behavior Analyst Certification Board, Inc.® (BACB®) initiated the practitioner certification program in 1999, building on the program that had been developed in the state of Florida. The BACB has always been an independent nonprofit organization. It is responsible for determining the requirements for obtaining and maintaining certification; developing, maintaining, and administering the certification examinations; establishing and applying disciplinary standards; administering all aspects of the program (processing applications, maintaining records, etc.); and seeing that the program meets relevant legal and accreditation standards (for more on this, please see question 6). In short, the BACB functions much like a licensing board. Certification is voluntary, and is not usually required to practice unless local laws or rules are adopted that require certification. Because most certification programs are national or international, the credential is recognized in multiple states, provinces, and countries.
Licensure, on the other hand, is usually required by virtue of a law adopted in a particular state or province. The law (also called a statute or act) may specify that a license is required to practice the profession, to use a particular title, or both. Licensure programs are operated by government regulatory agencies, such as state or provincial licensing boards. The regulatory agency typically determines requirements for licensure, administers the licensure examination, oversees the practice of licensed individuals, and enforces all aspects of the licensure law in that state or province. Licensure laws -- and therefore the requirements for obtaining and maintaining a license -- often differ from one location to another, so a license obtained in one state, province, or country may not be valid in other locations.
One important implication of the forgoing is that if ABA practitioners become licensed, their practice will be overseen by state regulatory boards rather than by the profession of behavior analysis. The process of getting a licensure law through the legislative process is complex, expensive, and fraught with possibilities for the law to fail, or for the law and its regulations to end up including provisions that many ABA practitioners would not find desirable. To take just one possibility, even if the original licensure bill seeks to establish a licensing board just for behavior analysts, financial constraints and political pressures may lead a state or province to place the behavior analysis licensure program under the auspices of an existing board that regulates other professions. That licensing board may well include no behavior analysts, individuals who have misconceptions about behavior analysis, or members of professions that compete with behavior analysis for funding and other reinforcers. Another implication is that a licensed ABA practitioner who moves to another state or province may have to get licensed all over again in their new location.
2. Do practitioners of applied behavior analysis (ABA) have to be licensed to qualify for payment from third parties, such as health insurance plans and government agencies?
No. Although many funding sources require providers to hold
recognized professional credentials, certification often suffices if
the certification program is legitimate and the provider is a
certificant in good standing. The BACB certification program is
accredited by the well-respected National Commission for
Certifying Agencies, the accreditation arm of the National
Organization for Competency Assurance. The BACB credentials
are recognized in laws and regulations in several states, which
enables Board Certified Behavior Analysts® (BCBAs®) and
Board Certified Assistant Behavior Analysts® (BCaBAs®) who
are supervised by BCBAs to be reimbursed for providing
services. Additionally, at this writing BCBAs and properly
supervised BCaBAs are recognized as qualified providers
eligible by Medicaid programs in several states, the U.S. military’s health insurance plan
(TRICARE), the health insurance plans of at least 20 self-insured companies in the U.S.,
and some other private health insurance plans. It should be noted, however, that
insurance laws vary from state to state and health plans have their own internal policies,
so licensure may be required for third-party payments in some instances.
3. Does holding a license guarantee that a practitioner can obtain third-party payment for his or her services?
Again, the answer is no. Most licensure laws do not deal with
requirements for third-party payments for services. Those are
addressed in separate statutes, such as the state’s insurance
laws, and in the policies of each of the funding sources (e.g., the
state developmental disabilities service agency, the public and
private health insurance plans that operate in the state). Those
laws and policies typically specify the types of services or
interventions that will be covered, requirements for services to
be prescribed by certain professionals, accountability
requirements, and the like. So being licensed may not be sufficient to obtain third-party
payments.
4. Will licensing ABA practitioners protect consumers from unethical and incompetent practices?
Unfortunately, the reality is that no professional credential guarantees that all who hold it are fully competent and will behave ethically 100% of the time, so other safeguards must be put in place to protect consumers. All legitimate professional certification and licensure programs, including the BACB, have codes of conduct and disciplinary standards, and some legal authority to enforce them. Because licensure is regulated by state and provincial governments, and licensing boards therefore operate at those local levels, the potential for effective enforcement may be somewhat greater with licensure than with certification. But enforcement is labor-intensive and costly, and must be done carefully so as not to encroach on individuals’ legally protected rights. Unless they are very well-resourced, state and provincial licensing boards may not be able to protect consumers any better than national certification boards can.
5. Will licensing applied behavior analysts protect their right to practice?
A licensure law can provide some protection, but a great deal depends on how the law is written. For instance, if a law prohibits those who are not licensed from practicing ABA, individuals who are competent but cannot meet the licensure requirements may have no legally protected right to practice. Remember that those requirements will be established through the political legislative process and by licensing boards that may not include any behavior analysts, or may include members of other professions, so coursework and knowledge in areas that are not very relevant to behavior analysis may be required for licensure. There may even be a requirement for licensed behavior analysts to be supervised by other professionals. If a licensure law defines the scope of practice of applied behavior analysts very clearly, that establishes a statutory basis for the practice and therefore some legal protection for licensees in that state or province. Even then, however, there may be overlap with the scope of practice of other professionals who are licensed in the state or province, and who may challenge behavior analysts’ right to engage in certain practices or to practice independently.
6. Who should determine the requirements for obtaining and maintaining a license to practice ABA?
Developing a new licensure program that will be accepted by funding sources, governmental entities, and other professions is not just a matter of getting some people together to decide what the requirements should be. There are well-established laws and accreditation standards governing legitimate professional certification and licensure programs. In general, all such programs must set out eligibility criteria, which include requirements for formal education (degrees plus specific coursework) and supervised practical training. Applicants who meet the eligibility requirements must take and pass a professionally designed, psychometrically sound examination in order to obtain the certification or license. The eligibility requirements and examination content must be derived from what is commonly called a job task analysis, which is conducted to determine the knowledge, skills, and abilities required to perform the job for which a credential is sought. The well-defined and well-validated procedures for conducting a job task analysis include: collating information from the relevant research and professional literatures; convening panels of experts to go over that information and draft an initial list of knowledge, skills, and abilities; having other experts refine the initial list; conducting extensive surveys to ask members of the profession to evaluate the importance of every item on that list; and analyzing the survey data to cull items that were not rated above specified cut points. Many readers probably recall participating in job task analysis surveys and expert reviews conducted by the BACB.
Once the list of knowledge, skills, and abilities has been finalized, more work must be done. The list must be translated into degree, coursework, and supervised experience requirements by practitioners and trainers of practitioners. It must also be translated into a large pool of objective examination items drafted by members of the profession and refined by expert test developers. There must be procedures in place for selecting items from the pool to construct examinations that adequately sample the full range of knowledge defined through the job task analysis. The examination’s validity and reliability must be evaluated by expert psychometricians and found to meet accepted standards. Secure procedures for storing examination items, administering examinations, communicating with examinees, and storing examination results must be set up and implemented. The job task analysis must be repeated about every 5 years, and the eligibility requirements and examination content revised accordingly. Additionally, the certification or licensing board must establish continuing education and other requirements for maintaining the credential, as well as standards of conduct for those who hold the credential and procedures for sanctioning individuals who do not comply with the program requirements or conduct code. All components of the program must be designed to withstand legal challenges from individuals whose applications are denied, who fail the examination, or who are disciplined in some way by the credentialing board.
As readers have probably surmised, developing and maintaining a legitimate certification or licensure program is a complex, labor-intensive, costly enterprise. From the outset, the BACB certification program was crafted to meet standards established in case law and by accreditation agencies. As noted earlier, it is now accredited by the prestigious National Commission for Certifying Agencies, and the credentials are increasingly recognized in laws, regulations, and policies. If new licensure programs are developed for practitioners of ABA, the lengthy and expensive process just described will have to be repeated – perhaps many times and with many variations, since the licensing board in each state or province will be charged with setting the requirements for obtaining and maintaining the license.
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