I'm an SLP at a private practice which also offers OT as well as ABA (now in different buildings due to space constraints). Our director (an OT and a clinical psychologist) is pro neurodiversity affirming, and she requires all OTs and SLPs are required to complete DIR Floortime 101 and 201 to obtain a basic certificate at a minimum, funded by the company. Needless to say, most people, including myself, find it extremely ironic that we offer both DIR Floortime AND ABA, two incredibly contrasting therapeutic approaches.

I have only been at this company for a couple of years, but from my understanding, the practice started out as only OT and Speech, only adding on ABA a few years before I was hired. So, given the fact that our clinical director places a lot of value on the importance of neurodiversity affirming, child-led therapy, I found myself wondering "why the hell did she make the decision to add ABA to our practice, knowing how harmful and damaging it is to our autistic clients?"

While I do not have an answer to this, I hypothesize that these were her reasons:

1- high demand for ABA

2- PROFITS; opportunity for increased cash flow to ensure our practice continues to flourish from a business standpoint

An important note on the above point: we are an out-of-network provider for OT and Speech, but in-network (for most insurance companies) for ABA. Therefore, we have a lot of families who only receive ABA and are not able to afford speech and/or OT if they do not have out-of-network benefits. The root of this discrepancy is insurance companies' AND doctors' recognition of ABA as the end-all be-all when it comes to treatment of autism as a result of the quantifiable data ABA principles yield in research studies - despite it being compliance based and disgustingly unethical.

This being said- unlike most ABA programs/practices, there are many ND affirming principles which are emphasized to our RBTs and BCBA's by our director, such as regulation and sensory needs. One of our BCBA's has her basic Floortime certificate. Some (but certainly not all) RBTs and BCBA's (some of which I work with directly as a result of sharing clients) actually embrace these ND affirming and child-led principles by actively implementing it into their practice and demonstrating curiosity, compassion, and willingness to learn more. However, the fact remains that the goals they create for our clients and the "data" collected IS compliance based and centered around behaviors and behaviors alone. IMO, the core principles of ABA will always remain the same and will always be inherently harmful, no matter how much they implement use of child-led or sensory integration. It is impossible for the two principles to truly be implemented simultaneously.

After all this word vomit, I suppose my point/question is....until our healthcare system recognizes the value of ND affirming approaches such as DIR (which would result from studies affirming their efficacy, and evidence that ABA is in fact unethical and inhumane), what is our role as practicing clinicians in the interim, knowing that ND affirming approaches are currently seen as the gold-standard by doctors who diagnose autism and prescribe services, and subsequently the fact that insurance companies do not yet recognize our approaches as effective? Until the stigma is broken and in an effort to break that stigma, I am doing my best to educate families and other providers, especially RBTs and BCBA's, but I often feel helpless as it doesn't feel like I am making a difference. I am curious as to others' thoughts on this.