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Key Employment Issues Every ABA Provider Should Know About


  • Vanessa Kelly, Labor & Employment Attorney and a Member with Clark Hill, PLC
  • Melinda Lapan, Vice President of HR Advantage Advisory, a subsidiary of Clark Hill, PLC


Join us on Thursday, May 20 as we discuss common employment issues faced by businesses and entrepreneurs. Learn how to mitigate risk and avoid potential pitfalls of non-compliance.

Learn more about:

  • Employment laws affecting all employers
  • Violating a law you didn’t know existed
  • Where to look for help and guidance in this complex terrain

Vanessa Kelly is a Labor & Employment Attorney and a Member with Clark Hill, PLC, a full-service, global law firm. Vanessa’s clients seek her experienced, confident counsel in addressing their employee management needs. She provides legal services including risk assessment and risk avoidance in employee terminations, accommodating disabilities, addressing workplace misconduct, protecting key personnel and proprietary information, performing reductions in force, and implementation of workplace policies designed to avoid disputes and comply with state and federal law, to name a few. Vanessa also defends employers before federal and state courts and civil rights agencies. Vanessa earned her J.D. at George Washington University Law School, and is licensed in both NJ and NY.

Melinda Lapan is Vice President of HR Advantage Advisory, a subsidiary of Clark Hill. HR Advantage Advisory provides HR outsourcing and consulting services. Melinda has over 20 years of Generalist experience in Human Resources, having worked in various HR leadership roles across multiple industries prior to joining HR-AA. She has a Master of Business Administration (MBA) degree, she holds two HR certifications and is a six sigma green belt.

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Determining Medical Necessity: How Evidenced-based Protocols Can Support Proper Dosage and Clinical Outcomes

Join us on Thursday, April 22 when we will discuss preliminary data from over 6,000 completed assessments and how Rethink’s new Medical Necessity Assessment can help you:

  • Enhance care outcomes by ensuring accurate care plans and the correct level of prescribed hours
  • Align providers and payers on necessary dosage levels and facilitate pre-authorizations
  • Provide evidenced-based recommendations to new BCBAs and support their training process
  • Standardize levels of care across your organization
  • Increase parent satisfaction

There is no cost to attend and this webinar is not eligible for CEUs. The presentation will be posted on our blog within two weeks.

Dr. Diana Davis-Wilson, DBH, LBA, BCBA is a licensed behavior analyst, with several years of experience providing consultation and training to families, school districts, and organizational personnel nationwide. She holds a Doctorate of Behavior Health with an emphasis on integrated health care management and is currently the Chief Executive Advisor for Aspen Behavioral Consulting.

Mellanie Page, BCBA is the VP of Operations and Regional Director at ABS Kids. She is a BCBA who has worked in the field of ABA for several years, utilizing a variety of strategies to teach new skills to children, their caregivers, and providers. She has supported BCBA candidates through supervision and instruction at National University. She is certified in OBM practices and uses this experience to improve and enhance organizational operations.

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ABA Business Insurance Overview: How Insurance Carriers View ABA Businesses (Webinar)

One of the most important aspects of having a business is protecting yourself and the business from legal backlash.

Join us as we walk through some action items to help mitigate risk while also explaining how insurance companies view ABA businesses.

Here are a few items we will discuss:

  • What Worker’s Comp Covers
  • Claims and Safety Tips
  • General Liability/Property/Auto
  • Claim Prevention and Prevention Programs
  • Cyber Liability and Employment Practice Liability

and more!

Our presenter is Jacob Kiley, Vice President at The Liberty Company Insurance Brokers who currently oversees their ABA program. Jacob has been enjoying the insurance industry for over 8 years. The passion comes from working with business owners every day to partner with them on how to mitigate risk. Starting in the claims department gave him a foundation of coverage analysis and how to work through the insurance process.

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Rethink announces first-ever protocol to ensure children with autism get the right level of treatment

Behavioral health providers now have access to an evidence-based standard to guide customized treatment plans.

New York—April 6, 2021—Rethink Behavioral Health, an industry leader in applying technology to support therapy providers in improving clinical outcomes, has developed the first-ever research-backed
protocol to help clinicians prescribe appropriate levels of Applied Behavior Analysis (ABA) therapy for children with autism.

The company’s Medical Necessity Assessment (MNA) analytic provides an objective standard to help practitioners of ABA therapy as they build individualized treatment plans. ABA has been proven to be
highly effective for children with autism and related developmental disorders. While ABA emerged as a promising treatment for autism in the late 1980’s, it is only within the past decade that health plans have been required to cover the cost of treatment. As a result, there are additional demands on practitioners to demonstrate a medical need for the treatment and prescribe a specific level of
intervention. Until now, the Board Certified Behavior Analysts (BCBAs) who deliver this therapy have had few resources to provide guidance in deciding how many hours or sessions of ABA an individual
patient should receive.

This lack of standardization may lead to under-or over-prescription of treatment hours, which can negatively impact outcomes for children. Standardizing the process for prescribing treatment hours can make health insurers more likely to approve treatment plans for reimbursement, and ensure that more patients are receiving a clinically appropriate level of care.

As a comprehensive electronic medical record and practice management platform solution to 600+ behavioral practice groups across the United States, Rethink became aware of the need for an evidence- based standard.

“There has never been a standard protocol available for determining how many hours of care should be delivered to a child based on their specific needs,” said Jamie Pagliaro, executive vice president and chief learning officer for Rethink Behavioral Health. “We designed an evidence-based assessment that may help reduce friction between providers and health plans, ensuring more children receive clinically appropriate levels of care.”

Developed with an expert panel and tested in more than 6,000 individual patient assessments with providers nationwide, the MNA solution allows a BCBA to plug in diagnostic factors for an individual
patient, then synthesizes that input with supporting evidence and research, to produce a suggested dosage range of treatment hours based on evidence.

In tests, clinicians agreed with Rethink’s MNA solution recommendations 70% of the time. Most instances of disagreement were due to functional issues, such as scheduling or transportation availability for families.

“Our clinicians really do like it. It balances them and helps keep emotions and bias from affecting the amount of services we are prescribing to a client on initial and reassessment,” said Karin Torsiello,
president of Behavior Basics, a Florida-based provider. Insurers have indicated to Rethink that they are receptive to the MNA solution and are eager to continue to work with Rethink and providers to ensure children with autism are getting clinically appropriate levels of care.

About Rethink Behavioral Health

Rethink Behavioral Health offers all-in-one, technology-based solutions to behavioral health practitioners, including video-based RBT training, ABA data collection tools and practice management solutions to meet market demands. It is a division of Rethink First, a global health technology company providing cloud-based treatment tools, training and clinical support to schools, employers, behavioral health professionals and payers. Rethink serves thousands of clients globally, including more than 25 of the Fortune 100 and many of the country’s largest public school systems and health plans. Rethink’s SaaS solutions are powered by proprietary, clinically validated content and best practices overseen by a renowned Scientific Advisory Board and include more than 2,000 evidenced-based training modules, extensive Social and Emotional Learning content and ground-breaking neurodiversity and inclusion training and education tools. Rethink is owned by K1 Capital, one of the premier private equity firms focused on high-growth, enterprise software solutions.

Media Contact:
Eric Masters

while male businessman using a magnifying glass to look at a stack of papers

How Rethink is Addressing 2022 Ethics Code Changes

Effective January 1, 2022, all BCBAs and BCaBAs will be required to adhere to the new Ethics Code for Behavior Analysts. The BACB has published a crosswalk to document where standards in the current Professional and Ethical Compliance Code for Behavior Analysts can be found in the new Ethics Code for Behavior Analysts (found here: BACB Ethics Crosswalk).

In addition, there will be 9 new standards behavior analysts will be required to follow. Below is a breakdown of what this means for your staff and how Rethink can assist your staff in maintaining these standards. (You can find the full Ethics Code here: Ethics Code for Behavior Analysts)

New Ethics Standards

2.02: Timeliness

Behavior analysts are required to deliver services and carry out client-related responsibilities in a timely manner.

Rethink allows your staff to track actual start time of services against their scheduled time. In addition, reporting functionality allows administrative staff to track staff productivity, authorization utilization, and more.

2.17: Collecting and Using Data

Behavior analysts ensure appropriate data measures are selected and data collection procedures are implemented correctly. Data should be displayed and summarized in such a way as to make informed decisions for continuing, modifying, or terminating services.

Rethink offers robust data collection options so client outcomes can be easily and effectively monitored and analyzed. Staff can create custom graphs and reports for ongoing evaluation and informed decision making. Our Medical Necessity Assessment is a tool designed to assist clinicians with determining appropriate ABA dosages for clients based on client progress, from initial intake to eventual termination of services.

3.02: Identifying Stakeholders

Behavior analysts identify all stakeholders at the outset of services. When there are multiple stakeholders involved in a client’s service delivery, the behavior analyst will identify their obligations to each stakeholder. Documentation and communication of these obligations to stakeholders occurs at the beginning of the professional relationship.

Rethink provides HIPAA-secure file sharing and other methods of documentation of communication between caregivers and providers. Any identified stakeholders can be added to the client’s contact list, and providers have the option to allow parent/caregiver access to the Rethink platform. Staff can share files directly with caregivers through the client’s File Cabinet, and client notes can be created for documentation of parent/caregiver and provider communication that occurs outside of the platform (i.e. phone calls between provider and client/caregiver).

4.05: Maintaining Supervision Documentation

Behavior analysts manage documentation related to supervisees or trainees by following BACB rules, licensure requirements, and funder or provider policies as outlined. They ensure documentation is accurate and complete and maintain documentation for at least 7 years or as otherwise indicated by law.

Rethink allows supervisors to create documentation for all supervision related activity, including creating Staff Notes, supervision session notes, collecting IOA and PI data, and tracking supervision hours. In addition, Rethink stores provider data indefinitely and will provide all data to the provider upon request.

4.07: Incorporating and Addressing Diversity

Behavior analysts will incorporate topics related to diversity during supervision and training.

Rethink provides content on diversity and related topics in both our webinar series and blog posts.

4.11: Facilitating Continuity of Supervision

Behavior analysts minimize disruption of supervision and facilitate continuation of supervision when there are interruptions to supervision (planned or unplanned). When there is an interruption to supervision, the behavior analyst takes the necessary steps to communicate how they are facilitating ongoing supervision.

Rethink allows for documentation of staff communication through Staff Notes and supervision session notes. A termination plan can be documented in the staff member’s profile, and session notes can be completed with any scheduled appointments between supervisor and supervisee.

4:12: Appropriately Terminating Supervision

When behavior analysts determine to terminate supervision, they work with all parties to develop a termination plan that minimizes the negative impacts to the supervisee and document all actions taken and eventual outcomes.

Rethink allows for documentation of staff communication through Staff Notes and supervision session notes. A termination plan can be documented in the staff member’s profile, and session notes can be completed with any scheduled appointments between supervisor and supervisee.

5.01: Protecting Clients, Stakeholders, Supervisees, and Trainees

Behavior analysts protect and prioritize the rights of all clients and supervisees in all public statements.

Rethink has established protocol for confidentiality when communication occurs between Rethink employees and providers regarding client names and other protected information. Any information shared with confidential client information is password protected and shared via a secure file cloud.

5.10: Social Media Channels and Websites

Behavior analysts educate themselves about the risks to privacy and confidentiality associated with social media and websites. They use both their professional and personal social media accounts according to these requirements. Behavior analysts avoid publishing information about clients on their personal accounts, and only do so on professional accounts when informed consent has been obtained (including a disclaimer of informed consent and that the information cannot be reused without permission), and in a manner that reduces sharing and prevents misuse of information.

Rethink offers a HIPAA secure avenue for sharing information and successes with parents and other family members/significant others. Our TheraWe parent engagement platform allows providers and caregivers to post content, including pictures and videos, of successes to share with all members of a client’s collaborative team.

Empowering Healthcare with Technology: Healthcare Tech Outlook

Rethink was recently featured in Healthcare Tech Outlook's 2020 edition on Top Behaviour or Mental Health Solution Providers! Check it out here, or continue reading below.

The coronavirus pandemic has drastically transformed the healthcare industry with sweeping changes in who can receive care and how they access it. Having prompted a reckoning throughout the country’s healthcare community, the pandemic with its isolation, contact restrictions, and economic shutdown effects has exacerbated the existing challenges.

The gap between the increasing healthcare demands and the supply of trained clinicians to respond adequately has never been wider. When it comes to treating the population with behavioral health issues and disabilities, this clinician shortage poses a massive challenge for the industry.

Moreover, the traditional modes of care and treatment delivery—wherein therapists visited patients at home or patients received therapy at centers—are proving defunct with the social distancing restrictions in place. As a result, many of the individuals are left without access to the required behavioral therapies. It goes without saying that healthcare organizations need to raise the ante and ‘rethink’ their approach to care delivery.

This is precisely where Rethink, a global health technology company, is moving the needle. The New York-based firm is empowering caregivers and the families of individuals with developmental or behavioral disabilities with robust cloud-based treatment tools, training, and clinical support.

With behavioral health e-learning tools, robust data analytics, and best-in-class practice management capabilities–all accessible online—Rethink continues to inspire change and make care more accessible to individuals suffering from developmental disabilities across the world.

“There are only about 30,000 trained clinicians and professionals available globally to deliver clinical treatment to individuals with developmental disabilities such as autism. On the other hand, we have literally hundreds of millions of individuals around the world that need access to behavioral therapy that can’t get access to it. We aim to bridge this gap in the industry,” says Daniel Etra, CEO at Rethink.

Through its unique, integrated platform-driven approach, the Company is supporting government agencies such as the U.S. Department of Defense, public school districts, behavioral health providers, managed care organizations, and families worldwide.

"While we deliver technology-driven solutions, we also bring a wealth of clinical expertise. We have a very deep bench with members who bring decades of experience on the clinical side to the table,” adds Etra, while emphasizing that this ability is clearly a winning differentiator for the company.

Keeping Healthcare a Step Ahead

At the outset, Rethink began serving patients with autism and gradually expanded its solutions and services to cater to broad developmental abilities. Currently, the center of gravity of Rethink’s expertise revolves around behavioral health, employee benefits, and education.

The user-intuitive behavioral health solutions include clinical workflow automation, RBT training, ABA data collection, and practice management tools. Be it a public or private client, Rethink’s comprehensive behavioral health tools offer turn-key solutions.

Through its ABA tools, the company delivers helpful insights to families and care teams and reinforces coordination and care fidelity amongst them. Also, Rethink’s RBT Training facilitates meaningful ongoing professional development, which offers a competitive advantage and better outcomes for individuals.

Furthermore, the Rethink employee benefits platform provides flexible web-based tools and 24/7 virtual consultations with behavioral experts that can be accessed from any location. The company has also built an EMR system that collects real-time data via mobile applications and enables tracking and reporting— all in an automated manner.

It helps caregivers and clinicians prepare the necessary treatment plan based on an individual’s behavioral performance. Putting best clinical practices at the user’s fingertips, Rethink is the industry leading caregiver support system for individuals and children of all ages.

In a similar vein, Rethink Ed–the Company’s education arm, delivers innovative, scalable, and evidence-based tools and resources to support the special needs population in schools and provides social and emotional learning to the general Ed population. Be it the unfortunate incidents of the school shootings in the U.S. or the current surge in mental health issues resulting from COVID-19, this scalable approach to supporting the education system adds another feather to Rethink’s cap.

Unlock Numerous Benefits with Seamless Onboarding

With cloud technology forming the backbone of the company, Rethink provides a straightforward process for client onboarding. Be it any public education system or a large corporate health provider, Rethink’s easy-to-implement platform smoothly creates an intervention plan, trains the clients’ staff, and gets them up and running in a couple of days.

It equips users with behavioral health e-learning tools, robust data analytics, and best-in-class practice management capabilities. Powered by sophisticated technology and years of in-depth knowledge, the company’s web-based solutions are designed to help clients effectively and affordably support the population with a developmental disability.

Elaborating on these unparalleled capabilities, Etra cites a customer success story wherein Rethink collaborated with a large retailer in the U.S. The client deployed the company’s employee benefits program, which provided effective web-based training tools and support, putting clinical best practices treatment solutions at the fingertips of the employees.

Hundreds and thousands of employees were able to benefit from Rethink’s program with employees thanking senior leadership all the up to the president of the company and noting what a difference the Rethink program was making in their lives.

As an entrepreneurial organization, Rethink strives for excellence, and its non-hierarchical structure creates room for each employee to share his/her ideas and bring innovation to the forefront. Driven by progressive work processes and innovation at its core, Rethink further aims to expand by supporting neurodiversity in the workplace–a step toward driving equity and inclusion in workplaces and accepting the cognitive variance of people.

Through its research-based content and clinical support, Rethink is coaching HR professionals, managers, and employers about the value of neurodiverse talent.

“We look forward to breaking the stigma around issues such as mental health and neurodiversity in the workplace by providing the right set of tools, training, and support,” affirms Etra.


Rethink Behavioral Health Announces Strategic Partnership with Tellus EVV System

Rethink BH is excited to announce an official partnership with Tellus, in an effort to help Rethink users comply with the Florida Agency for Health Care Administration's (AHCA) new electronic visit verification (EVV) requirements.

FLORIDA, Dec 21, 2020 -- The 21st Century Cures Act has stated that effective January 1, 2021, agencies providing personal care services (PCS) and home health services (HHCS) must have an Electronic Visit Verification (EVV) solution in place.

The legislation applies to behavior analysis service providers in AHCA Regions 9, 10 and 11, and they can no longer bill through the Florida Medicaid Management Information System (FMMIS). These changes are all in an effort to reduce the rate of Medicaid Fraud throughout the industry.

Rethink Behavioral Health has announced a strategic partnership with Tellus, an EVV Software System designed to help customers comply with the Florida Agency for Health Care Administration's (AHCA) new EVV requirements.

Rethink’s EVV capabilities through Tellus gives service providers the ability to capture visit start and end times, report their corresponding GPS location, and seamlessly submit these visits to the state Medicaid office and track their statuses.

Customers will be able to meet mandatory compliance requirements quicker, easier and more accurately than ever before.

About Rethink Behavioral Health

Rethink is a technology company built with decades of experience in behavioral health. We offer all-in-one behavioral health solutions for businesses that include video-based RBT training, ABA data collection tools and practice management solutions to meet market demands. They are each robust alone, but even better together.

To learn more about Rethink, please visit: www.rethinkbehavioralhealth.com/bh/

Press contact: jamie@rethinkbh.com

Related Links:

white bearded male clinician with a student both writing with pencils

Cultural Humility: From Clinical Practices to Parent Training

By Angela Nelson, MS, BCBA, Vice President & Executive Director of Clinical Services (Rethink Benefits)

I wonder if I recommended something that wasn’t in line with the family’s values, but they did not want to disagree with me because I was the “expert.”

For decades, clinical professionals aimed to practice cultural competency. That is, they adopted behavior, attitudes and policies to work effectively across cultures.

While this is important in our diverse world to honor issues of rapport, treatment success and equity, Tervalon and Murray-Garcia (1998) discuss how competency implies mastery. Mastery is unattainable when applied to culture, especially if that culture differs from our own. This perception of competency limits learning as it affords a sense of completion. This is problematic when working with a diverse population. Understanding of a culture is never mastered.

So, where do we go from here? Enter cultural humility.

Cultural humility is a term that came on the scene in the late 1990s, as it was applied to physicians’ work with culturally diverse patients. It since has spread to other helping professions. Cultural humility debunks the false perception that one can become an “expert” on each person’s culture with whom we work. Instead, Masters et al. (2019) summarize Drs. Tervalon and Murray-Garcia’s definition as cultural humility as:

“A life-long commitment to self-evaluation and self-critique in an effort to address power imbalances and to advocate for others. The practice of cultural humility helps mitigate implicit bias, promotes empathy, and aids the provider in acknowledging and respecting patients’ individuality. The universality of cultural humility principles puts emphasis on the provider’s need to connect instead of being an expert on the patient’s race, culture, or ethnicity.”

Diversity exists in many forms in our world including race/ethnicity, gender, religion, socioeconomic status, sexual orientation and more. The chances of an exact match in culture between a clinician and client or patient is not reasonable, given the incredible range of variables. However, that should not preclude us from striving to address the inequity that currently exists in the delivery of care.

Davis et al. (2016) found that microaggressions (intentional or unintentional indignities that communicate hostility or insult to a person or group with a harmful psychological impact) committed by a therapist resulted in those therapists being rated less culturally humble, causing a rupture in the therapeutic relationship. Similarly, Owen et al. (2015) found that clients who felt their therapists missed opportunities to discuss cultural experiences reported worse therapy outcomes, and those who rated their therapist as culturally humble reported improved therapy outcomes. The importance of cultural humility in medical appointments and counseling relationships is established, but what does being culturally humble look like in other relationships such as parent education and training?

At Rethink, we work with parents from throughout the United States and around the globe. Participating employers provide these parents – their employees – with free and equal access to Rethink’s video-based lessons to demonstrate how to teach a variety to skills, on-demand webinars, printable materials and other resources. Many families, however, prefer to speak with a professional who specializes in teaching new skills and addressing challenging behaviors (i.e., a graduate-level, board-certified behavior analyst [BCBA]) for personalized support.

Through these consultations, we are able to work individually with families, giving them what they need. Moreover, these consultations are opportunities to practice our cultural humility. Each family presents a unique familial structure that requires consideration by the BCBA.

One example of how cultural humility during parent training is reflected in how a BCBA, or consultant, addresses her own agenda of what skills a child should learn vs. what the family’s goals are is this scenario: to become equal partners. From this point forward, the family can state what they would like to learn based on what is important to them. The consultant remains both a learner and a resource.

As a clinician myself, I can recall early in my career some times where I judged a family for not following through on behavior protocols or skill-building programs I created for them, and for not being what I felt was “invested.” It was only after critical self-reflection that I realized my own biases and attitudes and how that affected my relationship with these families.

I wonder if I recommended something that wasn’t in line with the family’s values, but they did not want to disagree with me because I was the “expert.” Maybe I hadn’t adequately addressed that inherent power imbalance?

At that time, I came into each meeting feeling as though I needed to be the expert and have every answer, because why else would they ask for my help? It was only after I started to elevate parents as experts too, asking questions and encouraging them to tell me when I was wrong, did we start to have a more collaborative and effective relationship.

I have been fortunate to consult for years within schools and homes from my hometown of Los Angeles, to native reservations in New Mexico, Detroit, the islands and interior Alaska, the Bronx, New York, and other places filled with diversity. Now I work with parents all over the world.

While I have seen how humans are far more similar than different, approaches to parenting differ significantly. I cannot detach from my own culture, values and experiences, so practicing cultural humility is a conscious decision I make during every interaction with parents, paired with a post-interaction self-critique with an eye towards improvement for my next interaction. I prioritize being culturally humble to ensure empathy, respect and regard for the people with whom I’m collaborating.

So, where do we go from here?

In addition to welcoming a diverse group of consultants, parent training programs should not just talk about valuing cultural humility but rather engage in behavior that reflects those values. Here are some places to start:

A consultant meets the family of a 9-year-old boy, and she quickly learns that his mother is doing “what seems to be everything” for him – dressing him, cleaning up after him, making him snacks upon request, etc. The consultant thinks she is being helpful by brainstorming ways to help the mother teach her son independence skills and suggests they start teaching basic activities of daily living like dressing.

However, in this family’s culture, it is quite common for the mother to complete these tasks for her son and she says she, “wants to make his life easy and happy.” She does not see this as an area in need of change, compared to the consultant, who is looking at this situation from the lens of her own culture and values (other examples of potential cultural differences include making eye contact, co-sleeping, “acceptable” behavior, mealtime practices and social skills expectations).

While the consultant may be an expert on teaching new skills or reducing challenging behaviors, the family is an expert on their child, culture and their values. The consultant should be inquisitive about what brought the family to explore Rethink’s support, saying, “I’m really looking forward to learning more from you about what brought you to our program. Would you like to share with me what you’re interested in working on together?”

She must also elevate them in the relationship to dispel any power imbalance and encourage them by:

  • Offering training and professional development on cultural humility in the form of professional reading, mentorship, membership to equity and diversity special interest groups and attending related conferences.
  • Encouraging parents to voice concerns about microaggressions or discomfort during interactions with consultants (with a clear and established channel) and humbly take action to honor each concern that is raised.
  • Adding specific questions about cultural humility on surveys for critical, objective feedback. One question Rethink asks participants in a follow-up survey is, “My behavior expert was respectful and considerate of my cultural background, and was open to my perspective when giving suggestions/ strategies with 0 being not at all and 10 being very much.”
  • Conducting ongoing quality checks (i.e., sit in on consultations between consultants and parents with prior, parental consent) and include cultural humility items on feedback/performance rating scales.
  • Encouraging completion of online assessments to uncover implicit biases.
  • Creating coaching tools to directly measure cultural humility (Masters et al., 2019)
  • Establishing critical, self-reflection and self-management as ongoing, professional improvement goals (Wright, 2019).

While it might sound counterintuitive for the “expert” to be a learner in a consultative relationship, think for a moment of the connectedness and trust that could be established when each member of the relationship is empowered. While the efficacy of parent training is predicated on a multitude of factors, prioritizing culturally humble behavior in the relationship is a conscious and empathetic way to set us up for success.


Centers for Disease Control and Prevention. (2020, August 17). Cultural competence in health and human services.

Davis, D.E., DeBlaere, C., Brubaker, K., Owen, J., Jordan, T.A., II, Hook, J.N., & Van Tongeren, D.R. (2016). Microaggressions and perceptions of cultural humility in counseling. Journal of Counseling & Development, 94, 483-493.

Harvard University. Project Implicit.

Masters, C., Robinson, D., Faulkner, S., Patterson, E., McIlraith, T., & Ansari, A. (2019). Addressing biases in patient care with the 5Rs of cultural humility, a clinician coaching tool. Journal of General Internal Medicine, 34(4), 627-630.

Owen, J., Tao, K. W., Drinane, J. M., Hook, J., Davis, D. E., & Kune, N. F. (2016). Client perceptions of therapists’ multicultural orientation: Cultural (missed) opportunities and cultural humility. Professional Psychology: Research and Practice, 47(1), 30–37.

Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9, 117–125.

Wright, P. I. (2019). Cultural humility in the practice of applied behavior analysis. Behavior Analysis in Practice, 12, 805-809.

brunette girl holding coffee and using cell phone to check in to work

What is Electronic Visit Verification (EVV) & Why is it Important?

If you have any questions regarding your business or individual state requirements, don’t hesitate to reach out to us. We have a dedicated team standing by to help! CLICK HERE

The 21st Century Cures Act is a federal mandate which states that effective January 1, 2021, agencies providing personal care services (PCS) and home health services (HHCS) must have an Electronic Visit Verification (EVV) solution in place.

If they do not adhere, they are at risk of having their Medicaid claims denied. But what is EVV and why is it so important for ABA practitioners, parents and patients?

Continue reading this article to find out more useful information.

What is Electronic Visit Verification (EVV)?

Electronic Visit Verification, or EVV, is a new method used to verify home healthcare visits.

The purpose behind wanting more visibility is to ensure that visits are actually taking place and that patients are truly getting the care they need. Also, that Medicaid is being billed properly.

EVV helps cut down on home visit fraud by practitioners, and ensures that individual patient care is not overlooked.

How Does EVV Work?

EVV is a technology that allows professionals to track the following data:

  • Time service begins and ends
  • Date of service
  • Location of service
  • Name of individual receiving service
  • Name of individual providing service
  • Type of service and billing code

It’s important to note that while location will be recorded at the time of clock in and clock out, it will not be tracked throughout the actual shift.

Most EVV systems use GPS technology to pinpoint when a caregiver arrives at and leaves a location, while others utilize telephone lines.

In these cases, caregivers must call the agency office from a landline that can be traced back.

Benefits of Electronic Visit Verification

While having a basic EVV solution will help meet state legal requirements, there are more benefits for agencies, businesses and behavior analysis services providers.

Those who follow the rules will enjoy streamlined scheduling and billing, and those currently taking advantage of the system will no longer be able to do so.

Time will be saved as processes will be automated and client care will improve.

The 21st Century Cures Act

As stated in the introduction, The 21st Century Cures Act is a federal mandate directing EVV implementation and oversight.

Although the act sets key data points that must be collected and verified, each state will be responsible for creating and enforcing their own systems.

State governments will decide how to gather and report data used by EVV vendors, and whether or not to create additional compliance rules.

The Impact of Medicaid Fraud

Medicaid fraud has been rising sharply over the past few years.

According to The Wall Street Journal, the U.S. government recovered $3.3 billion federal health program fraud tied to individuals and companies in fiscal 2014.

That’s why effective EVV implementation is so important in preventing fraud, but also providing more accurate reimbursement for those who are following the rules.

Rethink Behavioral Health & EVV

Rethink’s practice management suite currently offers Electronic Visit Verification (EVV). This technology gives us the ability to accurately capture visit start and end times, their corresponding GPS location and seamlessly send these visits to the state Medicaid office via the Authorized EVV Aggregator.

Our goal is to help inform, educate, and train behavior analysis service providers as we move forward together with EVV and state mandatory compliance.

If you have any questions on anything in this article or specifically regarding your business or individual state requirements, don’t hesitate to reach out to us.

mother doing telehealth assessment with child on smartphone

The Shift to Telehealth & Remote Skill Assessments

According to Schieltz & Wacker (2020), telehealth services including diagnosis, management, and education, grew at a rate of over 50% between 2005-2014.

With the recent global pandemic causing an abrupt and necessary shift from in-person to remote service delivery for many behavioral health providers, telehealth is seeing a new increase as a service delivery model. Shieltz & Wacker provide a comprehensive literature review on functional assessment and function-based treatment of challenging behavior provided via telehealth to date.

Wacker and colleagues (Barretto et al, 2006) provided the first known telehealth functional assessment over 20 years ago.

Since then, at least 17 more studies have demonstrated effectiveness in conducting these assessments via telehealth, with at least one study (Tasmi et al, 2019) doing so across countries. Following FA results, function-based treatments were implemented to teach functional communication, with 13 studies reviewed demonstrating treatment fading via telehealth.

With regard to training parents to implement procedures for assessment and treatment, studies have evaluated performance feedback (both live and remote), and training through workshops or online training modules. All have demonstrated success in improving parent performance to varying degrees.

Schieltz & Wacker (2020) emphasize the importance of considering implementation fidelity, services across cultures, time and cost-effectiveness, caregiver preferences, and telehealth limitations when choosing how to implement these procedures via telehealth.

These results indicate that assessments can be successfully conducted remotely, even with a focus on maladaptive behavior. This would suggest that success can be replicated with skills assessments via telehealth.

While there are no studies published to date evaluating the effectiveness of skills assessments in the field of behavior analysis, Waite et al (2010) conducted a language-based assessment, the CELF-4, with 25 participants. Researchers compared online and in-person assessments with each participant, and results indicated there was no significant difference in raw or scaled scores for each subtest, supporting the validity and reliability of CELF-4 telehealth assessments.


Barretto, A., Wacker, David P., Harding, J., Lee, J., & Berg, Wendy K. (2006). Using telemedicine to conduct behavioral assessments. Journal of Applied Behavior Analysis, 39, 333-340. https://doi.org/10.1901/jaba.2006.173-04

Schieltz, Kelly M. & Wacker, David P. (2020) Functional assessment and function-based treatment delivered via telehealth: A brief summary. Journal of Applied Behavior Analysis, 53, 1242-1258. https://doi.org/10.1002/jaba.742

Waite, Monique C., Theodoros, Deborah G., Russell, Trevor G., & Cahill, Louise M. (2010). Internet-based telehealth assessment of language using the CELF-4. Language, Speech, and Hearing Services in Schools, 41, 448-458. https://doi.org/10.1044/0161-1461(2009/08-0131)