James Macon, M.Ed., BCBA
I recently won a scholarship from Centria Healthcare to travel with the Global Autism Project for 2 weeks and help disseminate ABA to another partner site across the world. It was an incredible experience, especially seeing how a small group of dedicated behavior analysts on the ground were paving the way for effective autism treatment country-wide.
For those that don’t know, Global Autism Project is a nonprofit organization dedicated to expanding evidence based treatments for people diagnosed with autism across the globe. They recruit and send volunteers (e.g., BCBA, RBT, SLP, etc.) to a dozen or so different partner sites around the world. Centria has committed to help bolster this mission by sending members of its clinical staff to join them.
After an initial 2 day training in NYC, myself along with 45 other people were officially members of Global Autism Project’s Skillcorp® group. From there, we broke up into our respective smaller teams and headed to the airport.
I was part of a 5 person team sent to Prague, in the Czech Republic. Our partner site, ABA-Centrum, was started in early 2017 by Katrin Telin, a behavior analyst pursuing her BCBA credential. Her and another behavior analyst, Katerina Cizkova, supervise about 5 technicians working with around 20 clients. ABA Centrum was the very 1st ABA clinic in Prague, and 1 of only 2 in a city of 1.3 million people.
Working in Prague and at ABA-Centrum was incredible. We were staying in an Airbnb apartment outside of the city center, and about a 5 minute walk from the clinic. Prague itself is a remarkably beautiful and vibrant city, both old and modern, but until very recently, there was no ABA in the country. There are many reasons for this, but the most impactful reasons were:
- Lack of funding for ABA services
- Lack of institutions teaching ABA
- Limited parent groups (consumers of ABA)
Despite these challenges, ABA Centrum put together a very impressive clinic, bolstered by support from Global Autism Project and the trained staff of Skillcorp. Both Katrin and Katerina were highly educated professionals who understood what good ABA looked like. They similarly understood the challenges they were facing, and were making significant inroads against them.
Lack of Funding for ABA Services
ABA as a treatment for autism is very new to the country, and as such, they don’t have the infrastructure that we are accustomed to in the United States. Without insurance coverage, access to ABA services are limited to private pay clients. And because ABA can be cost prohibitive early on, the average client that they saw only received 3 hours of ABA per week.
While ABA Centrum would have gladly increased the treatment dosage of ABA, they were limited by the out of pocket expenses associated with paying for services without insurance. The healthcare system in Czech Republic, while modern and comprehensive, has not caught up to best practice treatments for Autism Spectrum Disorder (ASD), including ABA therapy.
This problem is not unique to Czech Republic. The United States faced similar challenges getting funding set up across the different states. It’s taken decades to reform how healthcare and ABA work together, and it’s still changing. Czech Republic (and Europe in general) are picking up the mantle and continuing with these hard fought lessons back in the U.S.
Lack of institutions teaching ABA
Universities have little incentive to offer the study of behavior analysis to their students, since ultimately, those students might not be able to find good paying, local jobs. At least, that might be the concern. But without trained BCBA on the ground, parents and stakeholders won’t get to experience the life changing effects ABA can have on autism. It’s a classic chicken or egg problem.
Masaryk University, in Brno, Czech Republic (about 2.5 hours away from Prague) is the only University in the county to offer a BACB verified course sequence, through partnerships with FIT and Belfast University. Dr. Panchocha, Associate Professor of Special Education, Vice-dean for Strategy and International Relations, and head of the Institute for Research in Inclusive Education, set up the partnership a couple years ago, and is very much responsible for training behavior analysts in the county.
Interestingly enough, before our trip concluded, we had a chance to meet a couple BCBA-D from Ireland, Dr. Karola Dillenburger (Queens University) and Dr. Mickey Keenan (Belfast University), who work with Dr. Panchocha to supervise the university’s BCBA program. Behavior Analysis is a small field and having the opportunity to meet some impact educators changing the field was very cool.
Parent Groups
Back to our chicken and egg problem… without BCBA, kids with autism don’t receive much if any ABA therapy. And without ABA therapy, parents don’t get to experience the results of this amazing science. Once parents learn that there is an effective, evidence-based treatment for autism, they usually lobby for access to it. But, they have to know about it first. Enter Jana Gandalovicova, a cardiologist and mother of a son with autism, who has been instrumental in lobbying for access to ABA.
Jana has done some work with Dr. Panchocha, and also sits on the board of the Czech Society of Applied Behavior Analysis. This is a group of professionals formed to advance the field of ABA in the Czech Republic. She has also successfully lobbied the government to recognize behavior analysts as health care professionals. For all practical purposes, she has formed the first parent group pushing for more access to ABA therapy.
The Work
Part of our charter with Global Autism Project’s mission was to create sustainable solutions for our partner sites. For us, that meant not only providing clinical expertise, but also leveraging OBM to help them design better processes and systems. Together with Katrin and Katerina, we met with different clients and staff, and designed tools to help the clinic perform better as system. This included designing a Procedural Integrity Assessment and setting up a process for its use.
The most important job in ABA service delivery is unequivocally the technician, and Katrin and Katerina had recruited and trained a remarkable team of behavior technicians. I’m incredibly thankful and proud to have met and worked with all of them, including Misa Kasalicka, Natalia Marian, Kacka Jandackova, Martina Fabianova, and Lucie Junkova.
Moving Forward
As behavior analysts, we’re often indoctrinated to “save the world with behavior analysis.” I’ve spent my career trying to live up to this mission, if nothing more than as an ambassador to the field. Having the opportunity to travel across the globe and help a small group of behavior analysts in their country may have been the most impactful work I’ve ever done, and I’m truly grateful for it. Seeing the work that Katrin and Katerina were doing, along with their university contacts and the Czech Society of Applied Behavior Analysis was incredible, and I hope in earnest to help them in their journey as they move forward.
As a final thought, if you’re interested in getting involved, there’s a couple things you can do. Certainly checkout Global Autism Project‘s website, and consider volunteering. You can also check with your employer to see if they offer scholarships, like Centria Healthcare does. And lastly, feel free to comment or reach out to me.
