TRICARE autism demonstration proving positive

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During the recent 2011 Military Health System Conference, Michael O'Bar, deputy director for TRICARE policy and operations, reported on the Department of Defense Enhanced Access to Autism Services Demonstration.

"We have begun the process to determine how best to make the board-certified behavior analyst-tutor model a permanent benefit of the extended care health option," he said.

The demonstration allows eligible beneficiaries to receive applied behavioral analysis, or ABA, intervention services from paraprofessionals (referred to as tutors) working under the supervision of board certified behavior analysts, or BCBA. The demonstration covers intervention services that implement basic principles of ABA.

"The purpose of the demonstration is to explore the means of lessening the difficulty of accessing ABA services," Mr. O'Bar said. "It's helping determine the effectiveness of expanding the applied behavior analysis provider base through tutors. Our goal is to increase access to ABA services."

In a 2010 TRICARE Health Program Analysis and Evaluation Division survey, parents with children participating in the demonstration expressed overall satisfaction with the quality of ABA services. Approximately half of the parents with children enrolled in the demonstration said their child's condition was much better since receiving ABA.  The majority of parents indicated the child's condition was at least a little better.

ABA is a method of behavioral conditioning that teaches and reinforces desired behaviors while extinguishing undesired behaviors. This technique is an educational intervention that has been found to help teach new skills and improve communication abilities for children with autism spectrum disorders.

ABA is covered under the Extended Care Health Option. Within ECHO, TRICARE specialists are permitted to provide various non-medical services to active duty family members with qualifying conditions. However, ABA is not covered under the TRICARE basic program, which covers only medical services and equipment.

The demonstration covers intervention services that implement basic principles of ABA.

Tutors work one-on-one with children implementing a behavior plan designed and maintained by the BCBA supervisor. They gather data necessary for the BCBA supervisor to evaluate the effectiveness of the plan. A tutor may not conduct behavioral evaluations, establish a child's behavioral plan or bill independently for services provided to TRICARE beneficiaries.

The Centers for Disease Control and Prevention officials estimate that 1 in 110 children in the United States has an autism spectrum disorder. ASD is a collection of different types of autism that affect the brain's normal development of social and communication skills.

The demonstration, which started in March 2008, has been extended to March 2012. Learn more about ECHO at and the TRICARE Autism Services Demonstration at