Letter to the Editor: An Autism Parent’s Response to Papatola and Lustig’s Paper on Navigating a Managed Care Peer Review in Behavior Analysis in Practice
Parents can help deliver ABA, but asking them to replace the BCBA crosses an ethical line.
01Research in Context
What this study did
Beier (2018) wrote a letter to the editor. The author is a parent of a child with autism.
The letter answers a paper about managed care reviews. It argues against payers asking parents to act as the BCBA.
What they found
The letter says shifting full ABA duty to parents is wrong. It says this risks care quality.
Parents are not certified. They should not replace trained behavior analysts.
How this fits with other research
Singh et al. (1982) seems to disagree. That survey showed parents liked being cotherapists at home. Half still quit the skills. The old study praised shared roles. Beier (2018) warns against full hand-off.
Martin et al. (2023) extends the talk. They showed parents can run short telehealth training with high fidelity. The key is clear limits and BCBA support. This fits Beier’s point: parents can help, but not solo.
Mathur et al. (2024) and Keenan (2025) echo the ethics call. Both say ABA must protect clients and keep professional standards.
Why it matters
If an insurer tells you to let parents “take over,” cite this letter. Parents can co-treat, but they are not BCBAs. Set contracts that keep you in the case. Offer parent training with set hours and clear goals. This keeps care safe and reimbursable.
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02At a glance
03Original abstract
An autism parent disputes the authors’ premise that the role of the BCBA is to “transition treatment to parents.” Parents cannot simply “take over” all the advanced degrees, thousands of hours of coursework practicum and exams, or depth and breadth of scientific knowledge required to earn a BCBA any more than we can (or should) “take over” our kids’ pediatric care or prescribe their meds. Papatola and Lustig’s employer, Cigna Behavioral Health, recently made “transition treatment to parents” a criterion of medical necessity for ABA.
Behavior Analysis in Practice, 2018 · doi:10.1007/s40617-018-0263-7