David Quinlan’s 9-year-old son, who has autism, has experienced great progress in how he communicates and copes thanks to 30 to 35 hours a week of applied behavior analysis therapy.
But the only way Quinlan can fit that much specialized therapy into the week is to pull his son out of his Cherry Creek School District classroom halfway through the day, every day. Even so, he doesn’t get home until well after 6 p.m.
“If therapy happened in school, his day would look a lot more like a normal kid,” Quinlan said. “He could go to karate or swimming after school and be home in time for a normal dinner.”
Quinlan and other parents of children with autism are pushing for legislation that would require all school districts to allow applied behavior analysis therapists into the classroom. Parents say ABA therapists can be more effective when they work with children in the classroom and can be an asset to general education teachers.
But school districts are pushing back, arguing that they need to retain authority over who comes into the classroom and over deciding what services children need to be successful at school. The Colorado Association of School Executives, the Colorado Association of School Boards, the Colorado Rural Alliance, and the Consortium of Directors of Special Education all oppose the bill.
So does the organization that oversees the Medicaid Student Health Services program in Colorado. Its director is worried the legislation could open the door to other private providers in the classroom and undermine a funding model that has paid for school nurses, health aides, and medical supplies that benefit all Colorado students.
Faced with so much opposition, bill sponsor state Rep. Meg Froelich, a Greenwood Village Democrat, is planning to significantly amend the bill when it’s set to be heard Tuesday by the House Education Committee. Instead of requiring that therapists be allowed into the classroom, it would require school districts to set a written policy on whether to allow them.
It’s a concession to the principle of local control for school boards — and to political reality, Froelich said.
One parent called the change “heartbreaking,” even as she said she would still support the modified bill.
“My hope is that it will still move us forward,” said Maureen Elliott, who said she was once told she would have to choose between school and therapy for her son, who has autism caused by tuberous sclerosis complex. “Maybe an inch and not the mile we hoped for. If we have a written policy, at least that’s something we can lean on.”
Elliott’s son J.R. gets 24 hours a week of behavioral therapy and has experienced major regressions when he hasn’t had access to it, she said. Beyond the scheduling problems, J.R. needs more help during the school day, she said. Transitions are particularly hard for him, as they are for many children with autism.
Applied behavior analysis therapy is frequently recommended for children with autism. It can help them learn how to communicate and interact with others, gain basic life skills, and, critically, manage the frustration that can lead to angry outbursts. ABA therapists often work alongside children with autism in preschools, helping them apply their developing social skills in context.
But most Colorado school districts don’t allow outside providers, including ABA therapists, into classrooms. Many parents say their children go over a cliff in terms of support when they enter kindergarten.
Froelich said the fact that Medicaid and private insurance covers ABA therapy made it seem like a no-brainer to admit them into the classroom. Her original bill focuses on practical concerns, such as requiring outside providers to undergo background checks and carry liability insurance.
“When these parents first came to me, I said, ‘There are a whole host of things we wish our schools could do, but they’re chronically underfunded,’” Froelich said. “But this therapy is already covered by Medicaid. There is an opportunity here to integrate this without adding to the school budget.”
But school districts still oppose it.
Lucinda Hundley, head of the special education directors group, said the teams that develop educational plans for children with disabilities — and not individual parents — need to retain the authority to decide which services are offered in school. If ABA therapy isn’t one of those, parents can pursue that approach on their own time.
“The district was not party to that decision, and the district may not agree that the child needs those services during the school day,” she said.
Districts also vary in their ability to accommodate outside providers, she said. And even though ABA therapy is covered by Medicaid, lower-income parents are less likely to know how to obtain a prescription for the services, creating inequities among students.
Kimberly Erickson, executive director of The Consortium, the group that administers the Colorado School Health Services Program, said allowing private providers into the classroom threatens to undermine a system that has drawn extra federal dollars for school nurses and other healthcare providers for more than two decades.
Schools can bill Medicaid for certain services. That money is then reinvested in programs that support healthy schools, including hiring more school nurses and developing suicide prevention programs.
But if a private provider bills for a service, “that money doesn’t benefit all kids,” Erickson said. “It only benefits the one child.”
The Consortium expects that schools soon will be able to get Medicaid reimbursement for ABA therapists employed by districts, potentially increasing the number of districts that provide behavior therapy themselves.
Erickson has broader concerns. If private ABA therapists are allowed into the classroom, what’s to stop other providers from joining them?
Denver Public Schools has allowed some private providers, both ABA therapists and others, into the classroom on a case-by-case basis. Robert Frantum-Allen, the district’s special education director, said that wherever students receive services, they make more progress when there is strong communication and coordination between teachers, parents, and outside providers. In some cases, it makes sense to allow a specialist into the classroom. Written agreements governing those relationships establish clear roles for everyone involved.
“We have to maintain the integrity of what we do in school, which is teach, but at the same time, we need to coordinate to meet student needs,” he said.
Robin Koncilja’s 6-year-old son receives ABA therapy in his northeast Denver elementary school through such an agreement. Koncilja calls her case a “success story” that shows what’s possible when districts work with families.
“It’s giving these kids the tools they need to learn,” she said. “We wouldn’t have a blind child in school without Braille. A child with severe behaviors needs their therapist to participate and thrive.”
Jack Robinson, the Colorado attorney who argued the landmark Endrew F. case, which raised the standard schools must meet in educating students with disabilities, said school districts have long made a distinction between educational needs and medical needs, but that distinction often isn’t cut-and-dried, particularly for children with autism. Education includes both academic material and functional skills. Behavior therapy helps children with autism, as well as those with other conditions, get more out of the school day.
“I do think there is a strong argument under the Americans with Disabilities Act that if this is a medical necessity, you have to provide it during school hours, just like a child with insulin,” he said.
For parents, making these therapists accepted in the classroom isn’t just about what their children experience in school today. It’s about those children reaching their full potential as adults.
“I still hold public school as a primary goal for him,” Quinlan said. “If he has any chance of success beyond school, he’ll need to integrate with society at large. The more he can integrate into the public school setting, the more that sets him up for success.”
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