A letter of medical necessity is a document that is used to justify the need for certain treatments or services. It can be used to get insurance coverage for services like ABA therapy, or to prove to a school that a child needs special education services.

In this article, we will discuss how to write a letter of medical necessity for ABA therapy to send to an insurance provider, and what to include in it. We will also provide a sample letter of medical necessity.

How do you write a letter of medical necessity for ABA therapy?

There is no one-size-fits-all answer to this question, as the letter will be tailored to the specific needs of the individual. However, there are some general things that should be included in any letter of medical necessity for ABA therapy.

Some key points include:

State the nature of the illness

The letter should state that the individual has been diagnosed with autism spectrum disorder (or another condition that warrants ABA therapy).

Outline the treatment plan

The letter should list the specific goals of ABA therapy that will be addressed, and how they will benefit the individual.

Duration of treatment

The letter should state how long the treatment plan is expected to last.

Summary of letter

The letter should provide a brief overview of the main points that have been discussed.

Some other key aspects for a letter of medical necessity include:

• The letter should be on letterhead from a licensed health care professional such as a doctor.
• The letter should include contact information for the doctor.
• The letter should have a professional tone.

Sample letter of medical necessity for ABA therapy

Here is an example letter of medical necessity for ABA therapy:

To whom it may concern:

I am writing this letter on behalf of my patient, (Patient Name), to document the necessity of ABA therapy treatment. This letter offers information about their medical history, diagnosis, and an explanation for the necessity of treatment.

(Patient Name) has been diagnosed with ASD and currently exhibits symptoms that warrant ABA therapy. The most appropriate treatment here will be operant conditioning and positive reinforcement, which will help to program desired actions.

The rationale behind this treatment is that it’s totally safe. It is simply a positive reinforcement approach. It is just a method of rewarding patients for acting in a manner that is natural to them.

The patient will be left to engage in desirable behavior or else reinforcement incentives will be withheld unless there is a behavioral shift. This is about giving rewards or praise as the need arises.

The treatment plan will last for a total of 36 weeks, and will be supervised by myself or one of my associates. This will be repeated as necessary.

In summary, ABA therapy is a necessary and safe treatment for (Patient Name) that will address their specific needs. I urge you to approve this request and provide the coverage needed for ABA therapy. Please contact me if you have any questions.

Thank you for your time and consideration.

Sincerely,

(your doctor’s name)

How Hidden Talents can help you

At Hidden Talents, we believe that ABA is the key to helping children on the autism spectrum succeed. Combined with the expert care and guidance of our trained BCBAs, your child can achieve more than you thought possible.

We currently offer ABA therapy services in Houston and Atlanta.

Reach out to us to learn more about how we can help.

A behavior support plan (BSP) identifies positive skills and strategies that can help reduce problem behaviors, based on the findings of a functional behavior assessment. In this article, you’ll learn more about how behavior support plans are used to manage challenging behaviors and replace them with appropriate ones.

What Is a Behavior Support Plan?

A behavior support plan (BSP) is a formal written guide intended for teachers, parents, and other individuals working with a child who displays a problem behavior. The plan outlines the strategies that can be used to teach the child new, positive ways to meet their needs in the classroom and at home. 

A BSP has two goals: to reduce or stop unwanted behaviors and to increase appropriate behaviors. In order for a BSP to be effective, the alternative behavior must serve the same function as the problem one, but it must be easier to do, more efficient, and socially acceptable. 

A behavior support plan relies on the information gathered through functional behavior assessment (FBA) to propose new skills, changes in the child’s environment, and reinforcements that need to be implemented in order to reduce the misbehavior. It can include measures such as creating an alternative schedule, allowing early entry to class or activity, or sitting near the teacher, for example. 

Parts of a behavior support plan

Behavior support plans typically consist of the following parts:

• Definition of the challenging behavior
• Interventions needed to replace and reduce the unwanted behavior
• Plan for teaching and reinforcing new skills
• Evaluation plan

Definition of the challenging behavior

The definition of the challenging behavior summarizes the findings of the functional behavior assessment. The behavior is described using clear language and the plan lists its antecedents and consequences, in other words, what typically occurs before and after the disruptive behavior.

This part of the plan also includes a hypothesis on why the child engages in the problem behavior and what is its function. Understanding the reasons behind the unwanted behavior will allow for developing adequate strategies to minimize or replace those behaviors.

Interventions needed to reduce and replace unwanted behaviors

An intervention plan indicates the skills or behaviors that should be taught to the child or the changes that can be done in the child’s environment, activities, or personal support to replace the negative behavior. The intervention plan is based on the information gathered during the functional behavior assessment stage.

Plan for teaching and reinforcing new skills

This section of a behavior support plan documents the ways an intervention and individualized support will be implemented within a child’s daily routines in school and at home. The plan needs to be appropriately tailored to the child’s individual needs and abilities. In addition, it must set reasonable and realistic measurements for success.

Evaluation plan

An evaluation plan includes: 

• A short-term goal based on the child’s current performance
• A long-term goal that focuses on increasing desired behavior
• Specific procedures that will be used to evaluate progress
• Data that will be collected to verify whether the plan was implemented correctly and whether it is having an impact on the child’s behavior
• A specific date for progress review. 

Both short-term and long-term goals need to be written in specific, measurable terms and indicate how the team will know when the child reaches the goal. 

Prevention strategies

Prevention strategies are designed to reduce the likelihood of problem behavior occurring in the future. After implementing these strategies, the child will no longer feel the need to engage in the problem behavior to have his or her needs met. 

Replacement skills

Replacement skills are appropriate behaviors that serve the same function as the challenging behavior and can replace them. For example, a child that reacts negatively to loud noises can learn a more appropriate way to respond, such as going to a safe place or using noise-canceling headphones.

The purpose of replacement skills is to make the behavior of concern ineffective, so that the new behavior becomes a more efficient way to meet the child’s needs. A behavior support plan should explain in detail how the team is going to teach this replacement behavior.

Consequence strategies

Consequence strategies are guidelines on how adults working with the child are expected to respond to problem behaviors. These strategies include positive reinforcement and minimizing reinforcement for problematic behavior.

Positive reinforcement

Positive reinforcement is a reward for the child’s use of new skills or appropriate behavior. Positive behavior should be reinforced immediately and consistently. What’s more, it needs to serve the same function as the negative behavior. 

Minimizing reinforcement for problematic behavior

In addition to positive reinforcement, the response to problem behavior includes: 

• Redirecting the child to the alternative behavior, for example, immediately reminding the child what would be considered a positive behavior in the given situation.
• Extinction of the problem behavior, that is, not allowing the behavior to “pay off” for the child. In this case, the teacher should minimize the attention and limit any verbal interactions when the child engages in challenging behavior. Extinction of the interfering behavior should always be combined with positive reinforcement of appropriate behaviors.

Long term strategies

This section of the behavior support plan indicates the long-term goals that will assist the child and family in meeting behavior targets. It also describes the ways to reach those goals.

A behavior support plan consists of multiple steps. Read on to find out what they are. 

Steps of a Behavior Support Plan

The behavior support process involves the following steps:

• Define the interfering behavior that needs to be reduced or replaced
• Outline the antecedent, consequence, and function for the problem behavior 
• Explain possible causes of the behavior and provide reasoning to justify it
• Develop a plan that suggests actions that will prevent the unwanted behavior
• Identify the skills that need to be taught to replace the behavior 
• Identify short-term and long-term goals for a new behavior or behavior modifications 
• Create an intervention procedure to achieve these goals
• Implement the plan consistently across different settings and environments (school, home)
• Monitor and evaluate the progress of the plan and development of new, positive skills.

Below, we explain the importance of functional behavior assessment in creating an effective behavior support plan. 

Functional Behavior Assessment

The first step in creating a behavior support plan is a functional behavior assessment. 

A functional behavior assessment (FBA) is a process of identifying the behavior that interferes with a child’s ability to learn. It is typically used when habitual school interventions are not effective in controlling the behavior. The FBA is based on the belief that problematic behavior serves a specific purpose. An FBA attempts to look beyond labeling an unwanted behavior as simply being bad and determine what functions that behavior may be serving. 

The main reason for conducting a functional behavior assessment is to understand the relationship between the inappropriate behavior and the environment in order to determine what is causing the challenge. Understanding why a child behaves in a certain way is the starting point for developing suitable strategies for improvement.

An FBA results in a theory about the functions that the behavior serves and a targeted intervention plan—a behavior support plan—for an alternative behavior that will not interfere with the child’s education. The plan focuses on positive outcomes that can help build a better relationship between the child, the teacher, and the family.

A functional behavior assessment can be conducted by a licensed behavioral specialist, a school psychologist, or a teacher. The school counselor and other staff who work with the child may also be involved in the process. Finally, as a parent, you will have a crucial role in advocating for a fair FBA for your child and creating a behavior support plan.

Keep reading to learn more about building a behavior support team. 

Building a Behavior Support Team

A behavior plan is not written by only one person or an expert. To be effective, the plan needs to be developed by a team of individuals who work together to find strategies that will help replace negative behavior with a positive one. This cooperation will allow the team members to focus on the task, establish accountability for completing the plan, and ensure communication and consistent implementation of the interventions. 

The behavior support team can include anyone who is involved in the child’s life. In addition to the child’s parents and educators, it may also involve family members, friends, therapists, and other instructional or administrative personnel. Team members will collaborate in different ways to develop and implement a suitable behavior support plan.

A collaborative approach is one of the key features of positive behavior support for children with problem behaviors and their families. It is particularly important for children whose challenging behaviors occur in multiple settings, for example, at home, at school, during therapy visits, and so on.

Parents’ role in developing and implementing a BSP

As a parent, you should be involved in each step of developing a behavior support plan for your child. In order for the plan to be effective, it is necessary to monitor the child’s behavior not only at school but also at home. At the same time, the school should keep you updated on your child’s progress and provide you with the necessary tools to reinforce the BSP at home.

Person-Centered Planning

An essential part of ensuring an effective behavior support process is to set up a person-centered plan. As mentioned above, the plan is written by a team consisting of family, teachers, caregivers, and other community members who are brought together to discuss their goals for the child. It is crucial that the team’s planning process is focused on the child’s behavior goals.

Besides, the child should be involved in the planning process as much as possible. He or she may be able to offer their own views on the problem and suggest what can be done to solve it. This process not only helps the child to feel included, but it is also a good way to make sure the strategies developed are specific to their needs.

Another crucial success factor of a behavior support plan is appropriate monitoring. Here’s why. 

Monitoring Behavior Support Plans

A behavior support plan is an active document that needs to be consulted and reviewed on a regular basis in order to be effective. Monitoring a BSP is a twofold process that includes: 

• Monitoring changes in problem behavior, and
• Monitoring the achievement of new skills and lifestyle outcomes.

The key to successful monitoring is frequent collection of data that describes when, where, and who implements the plan but also to how the plan is being implemented and whether or not the same intervention steps are followed each time. Direct and indirect measurements, such as rating scales and check sheets, should be done in order to:

• Document whether the plan is implemented with consistency
• Whether the plan is effective in achieving the identified goals
• Whether the replacement skills are maintained over time, and
• Whether the new skills can be applied in a variety of contexts or settings. 

The behavior support team should periodically review the collected data to ensure good communication, make any adjustments if needed, as well as to review progress in the context of the long-term vision for the child’s development.

Data collection for the purpose of monitoring progress is simpler and less extensive than it was in the functional behavior assessment phase. Once the BSP is in place, the data only needs to indicate whether the behavior is staying the same or changing. The team has to track the frequency, duration, and intensity of the behavior. In addition to collecting the data regularly, it is necessary to analyze the information and verify whether there is any improvement in the child’s behavior.

In the next section, we provide useful tips for writing and implementing behavior support plans.

Tips for Behavior Support Plans

Replacing a challenging behavior

• When your child displays unwanted behavior, you should always first rule out health issues such as acute illness, pain, or discomfort before proceeding with functional behavior assessment and creating a behavior support plan.
• Keep in mind that all challenging behaviors serve a specific purpose, function, or fulfill unmet needs.
• The meaning and purpose of behavior may sometimes be difficult to determine. In some cases, it will take lots of time and patience before the team can gain a good understanding of the behavior.
• The purpose of a behavior support plan is not to show how the child should change his or her behavior, but to outline the steps that will be taken by the members of the team to modify the environment and teach the child new skills. 
• It is important to address the interfering behavior immediately as it happens so that the child can successfully change the habit.

When a BSP isn’t working

• Make sure the chosen interventions provide an alternative way to accomplish the function of the problematic behavior. 
• If the proposed plan is not working and the behavior doesn’t improve, there may have been a misunderstanding of the reason or function behind the targeted behavior. In this case, the implemented strategies won’t be effective. 
• Some behaviors have been present for a long time and changing them may take a lot of reinforcement and encouragement.
• If a behavior support plan is not working, the team should document the interventions that are ineffective and look for other alternatives.

Writing an effective BSP

• Behavior support plans should be kept as simple as possible. Simple plans are easier to implement, evaluate, and are often the most effective.
• The interventions in the plan should include enough detail so that the team members are able to understand and implement the proposed strategies.
• It is better to implement just a few carefully selected interventions with confidence than to list many strategies that will not be used consistently.
• It is better to start slow and gradually build on success than to set unreasonable expectations.
• Behavior support plans must be person-centered and specific to each child. In other words, each behavior support plan must be unique. What works for one child won’t necessarily work for another.

Reviewing the plan

• A behavior support plan should be reviewed and updated regularly, approximately every six weeks. As your child grows, his or her behavior will change and it will be necessary to make adjustments to the plan to target new problem behaviors.
• Decide the review date for a BSP at the time of writing the plan. It can be reviewed sooner if needed, but deadlines will increase the chances of the plan being effective.
• If there’s new information or if the child needs a change, the plan should be adjusted as needed.
• If the child changes environments, new information should be gathered to determine if and how the behavior was affected, and whether the team should consider new strategies.
• Failure to update the BSP on a regular basis, especially when it comes to rewards and reinforcements for appropriate behavior, could cause the child to relapse into unwanted behavior.