How Many Hours of ABA are Actually Necessary? Session 221 with Melissa Willa and Colin Davitian

In Session 221, I had the opportunity to talk with Melissa Willa and Colin Davitian. These guys are a husband and wife team who founded the ABA provider, Kyo, formerly known as the Gateway Learning Group.

Our conversation focused on two hot-button topics when it comes to providing services to individuals with Autism: Treatment Dosage and Value Based Care.

With regard to the former, Melissa and Colin, along with their colleagues, conducted a retrospective analysis of treatment outcomes for learners in under their care. In doing so, they looked at the role that treatment dosage had on their overall progress, as measured by standardized assessments.

You may already be wondering what they found, so don't worry, we get into that and lots more in this episode. We also try to place their findings in the context of existing studies that examined the relationship between treatment dosage and treatment outcomes.

As I mention during the interview, there's lots of discussion of this topic that's happening, particularly in the various ABA social media groups, and as is true with so many other things, it's refreshing to elevate the discourse by looking at empirical analyses as opposed to anecdotal observations and hunches.

If you're a clinical director or practice owner who's also interested in this topic, Melissa and Colin suggest strategies for mining the data you probably already have access to via client electronic health records.

Towards the end of the podcast, we turned our attention to Value Based Care. Colin and Melissa define what that is, and contrast it with the more traditional fee-for-service approach for health care reimbursement. Not to spoil the punchline here, but these guys seemed pretty bullish on the potential for shifting Autism services to a Value Based Care model.

As a sidetone, for a longer discussion on the topic of VBC, check out Session 194 with Amanda Ralston. I have other guests that I've been meaning to bring on to talk about this as well.

Lastly, I want to thank Melissa and Colin for patiently responding to all of my "yeah, but…" questions. Even though I don't personally provide services in an insurance funded model, I am old enough to remember the days when accessing ABA services was next to impossible due to the lack of both funding and providers, so I'm fairly reluctant to cede ground as it relates to how many hours individuals can receive authorization for, and my line of questioning most likely revealed this.

I've also seen cases where learners have received very intensive early intervention, and made so much progress that they entered kindergarten with little to no supports. As such, I think it's fair to say that I had some level of bias heading into this conversation.

Long story short, these are complicated topics, and whether you agree or disagree with the findings we discuss in this episode, I think you'll find the conversation thought provoking. Lastly, if you want to read up on this topic in more detail, I have several of the articles we referenced in this episode's show notes. I also have Melissa and Colin's LinkedIn profiles, so I'd encourage you to connect with them if you have questions or thoughts about these topics.

To learn more about Kyo or to connect with Colin and Melissa:

• www.kyocare.com
• Melissa Willa - LinkedIn
• Colin Davitian - LinkedIn

Here are some links to studies we directly or indirectly referred to in this episode:

• Ostrovsky, A., Willa, M., Cho, T. et al. Data-driven, client-centric applied behavior analysis treatment-dose optimization improves functional outcomes. World J Pediatr (2022).
• Rogers SJ, Yoder P, Estes A, Warren Z, McEachin J, Munson J, et al. A Multisite Randomized Controlled Trial Comparing the Effects of Intervention Intensity and Intervention Style on Outcomes for Young Children With Autism. J Am Acad Child Adolesc Psychiatry. 2021;60(6):710-22.
• Virués-Ortega, J. (2010). Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose–response meta-analysis of multiple outcomes. Clinical Psychology Review, 30, 387-399.
• Cohen, H., Amerine-Dickens, M., & Smith, T. (2006). Early intensive behavioral treatment: Replication of the UCLA model in a community setting. Developmental and Behavioral Pediatrics, 27, S145-S155.
• Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive behavioral treatment at school for 4- to 7-year-old children with autism: A 1-year comparison controlled study. Behavior Modification, 26, 46-68.
• Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359-383

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