State policies and practices in behavior supports for persons with intellectual and developmental disabilities in the United States: a national survey.

The team mailed a 48-item survey to the IDD director in every U.S. state and territory. They asked how each state defines behavior support, who can provide it, and how services are watched. Forty-four states answered. No clients were tested; the paper simply maps the rules.

States use 11 different job titles for the same work. Some require a BCBA, others accept a 20-hour certificate. Only half the states track how many people get behavior plans. In short, no national playbook exists.

Davison et al. (1995) first showed that adult programs rarely use functional assessment. Fahmie et al. (2013) now shows why: most states still don’t require it in their rules.

van der Miesen et al. (2024) later pulled every long-term outcome study and found most states don’t even measure quality of life. Together the three papers trace a straight line—weak policy leads to weak practice leads to unknown results.

Lulinski et al. (2021) surveyed community agencies and found many lack staff trained in behavior health. Their finding mirrors A et al.’s rule chaos: both reveal a workforce gap that policy has yet to close.

If you write behavior plans across state lines, check the local rules first. One state may accept your BCBA credential; another may demand extra paperwork. Use this map to avoid surprises and to push your state for clearer, BCBA-level standards.