The Evolution of ABA Services for Children with Autism in California & Beyond

How did in-home ABA get started?

Photo by Susan Holt Simpson on Unsplash

Applied Behavior Analysis (ABA) is now a cornerstone of early intervention for children with autism. This article discusses the emergence, resistance, litigation, and eventual institutionalization of ABA services in California—ground zero for the national ABA movement. The evolution of these services is rooted in research, parental advocacy, groundbreaking court cases, and shifts in public and private sector policy.

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The Scientific Foundation: Ivar Lovaas and the UCLA Young Autism Project

In the 1960s, Dr. Ole Ivar Lovaas, a Norwegian-American clinical psychologist at UCLA, began experimental work with children diagnosed with autism, who at the time were often institutionalized or excluded from public education. Lovaas applied principles of behavioral psychology—specifically operant conditioning—to teach communication, social, and adaptive skills to children through discrete trial training (DTT).

His seminal 1987 study published in the Journal of Consulting and Clinical Psychology reported that 47% of children who received 40 hours per week of intensive ABA beginning before age 4 were able to achieve functioning indistinguishable from their typically developing peers by age 7 (Lovaas, 1987).

To bolster their case, advocates and attorneys cited additional peer-reviewed studies that supported the effectiveness and durability of ABA. One of the most frequently referenced was a follow-up study by McEachin, Smith, and Lovaas (1993), which demonstrated that the gains made by children in the original 1987 study were largely maintained several years later. Another commonly cited source was a randomized controlled trial conducted by Smith, Groen, and Wynn (2000), which showed that children receiving intensive ABA had significantly better developmental and cognitive outcomes compared to those receiving community-based treatment. Sallows and Graupner (2005) conducted an independent replication of the Lovaas model and found that about 48% of children receiving intensive ABA achieved near-typical functioning. A meta-analysis by Reichow, Barton, Boyd, and Hume (2012) provided further support by confirming large positive effects in IQ and adaptive functioning across multiple EIBI studies.

These studies were introduced in court through expert witness testimony from psychologists, pediatricians, and Board Certified Behavior Analysts (BCBAs) and were also cited in legal briefs. Collectively, this body of literature transformed the courtroom perception of ABA from an experimental method to a medically necessary and evidence-based intervention.

Use of Paraprofessionals

An important operational aspect of Lovaas’ model was his use of paraprofessionals—college students serving as behavior tutors to deliver discrete trial instruction. In 1987, the idea of psychologists supervising non-licensed individuals in clinical services was not clearly authorized under California law. However, because the therapy occurred under a university-sanctioned study, the model operated in a regulatory gray zone (Green, 2002).

As ABA gained recognition, this gray zone evolved into formalized practice. State licensing boards gradually accepted the delegation of routine therapeutic tasks to paraprofessionals, provided a licensed psychologist or later, a behavior analyst, retained oversight. The formation of the Behavior Analyst Certification Board (BACB) in 1998 marked a pivotal moment. The BACB introduced formal roles including Board Certified Behavior Analyst (BCBA), Board Certified Assistant Behavior Analyst (BCaBA), and later, Registered Behavior Technician (RBT), thereby establishing ethical and professional standards (BACB, 2020).

In litigation and administrative hearings, attorneys cited these roles and supervision arrangements to justify ABA services delivered by paraprofessionals. Courts and public agencies increasingly accepted this arrangement, especially when agencies lacked enough licensed professionals to meet demand. By the early 2000s, these roles were integrated into public service delivery systems. For example in California, SB 946 codified their legitimacy for insurance reimbursement (California Department of Managed Health Care, 2012).

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Parental Mobilization and Initial Legal Pressure

California's developmental disabilities services were administered by 21 regional centers, funded through the Department of Developmental Services (DDS) and regulated under the Lanterman Developmental Disabilities Services Act. Initially, regional centers and school districts denied requests for ABA services, citing cost and the absence of a statutory mandate to provide intensive behavioral treatment.

Parents responded with organized legal action. Public interest law firms such as Public Counsel in Los Angeles began representing families in due process hearings under the Individuals with Disabilities Education Act (IDEA) and fair hearings under the Lanterman Act. Disability Rights California supported these families with legal advocacy and strategic guidance. Advocacy groups such as the Autism Society of America and regional affiliates of Cure Autism Now and Autism Speaks began applying political and social pressure to change policy. Prominent attorneys like Valerie Vanaman, Charles Ferguson, and Shawn McMillan gained reputations as defenders of autism families, filing actions against both regional centers and school districts across California (Disability Rights California, 2003–2015).

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Landmark Court Cases That Reshaped Policy

1. McCarthy v. Department of Developmental Services (1991)
   The parents of a child with autism sued the California DDS and the Golden Gate Regional Center after being denied funding for a Lovaas-model ABA program. The court ruled that the Lanterman Act required DDS to provide necessary services that supported independence and community participation (McCarthy v. DDS, 1991).

2. Hoang v. California Department of Developmental Services (1995)
   The Hoang family filed suit in federal court asserting that denial of ABA services violated both the Lanterman Act and the ADA. The court agreed, ruling in favor of the family and forcing DDS to change policy (Hoang v. DDS, 1995).

3. Harbor Regional Center Cases (Mid-1990s)
   A series of hearings and lawsuits against Harbor Regional Center, supported by expert testimony and public interest law firms, resulted in favorable outcomes for families seeking ABA (Public Counsel, 2000s).

4. California Department of Education Due Process Hearings (1990s–2000s)
   Dozens of IDEA-based hearings forced school districts to either develop in-house ABA capacity or contract with providers to avoid legal penalties (Vanaman, 2005).

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Legislative Turning Point: Senate Bill 946 (2011)

By the early 2000s, the regional center system could not absorb the volume of ABA service demands. Senator Darrell Steinberg introduced SB 946, mandating that private insurers cover ABA as a medically necessary benefit. It became law on July 1, 2012 (SB 946, 2011).

SB 946 included:

• Coverage of ABA as medically necessary

• Recognition of BCBAs and qualified paraprofessionals

• Prohibition of caps or arbitrary limitations

• State oversight for compliance and appeals (California Department of Managed Health Care, 2012)

Medi-Cal followed suit in 2014 under EPSDT guidelines, providing access for low-income families (U.S. Department of Health and Human Services, 2020).

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Other States Follow

California’s model of combining research validation, legal precedent, and legislative mandate became a blueprint for national expansion. In Indiana, a similar effort emerged, influenced by Dr. Eric Larsson, a protégé of Lovaas. Massachusetts followed with its own mandate in 2010, and other states—including Texas, Illinois, and New York—were pushed into compliance through class action lawsuits and federal ADA-based claims. The Affordable Care Act of 2010 reinforced these trends by including habilitative services such as ABA in the essential health benefits of qualified health plans (National Conference of State Legislatures, 2021; Autism Speaks, 2021).

Current Challenges and Future Outlook

While ABA is now more widely available than ever, several challenges persist. Insurance companies are increasingly scrutinizing treatment plans and questioning authorized hours, requiring detailed documentation for every goal and service. Workforce shortages continue to hinder access, with high turnover among Registered Behavior Technicians (RBTs) and growing demand for Board Certified Behavior Analysts (BCBAs). Cultural criticisms of ABA—particularly those related to its perceived emphasis on teaching children to be compliant —are also shaping future practices (Leaf et al., 2016).

The field is moving toward integrated models that combine ABA with speech-language pathology, occupational therapy, and developmental pediatrics. There is also momentum toward value-based care, in which outcomes rather than service volume drive reimbursement. Legislative reforms are likely to focus on ensuring equity of access, improving service quality, and protecting against insurance denials for medically necessary treatment. (See my post on Autism Services 2025)

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References

Autism Speaks. (2021). State Initiatives: Insurance Reform and Access to Care. Retrieved from https://www.autismspeaks.org/state-initiatives

Behavior Analyst Certification Board. (2020). About the BACB. Retrieved from https://www.bacb.com/about/

California Department of Managed Health Care. (2012). SB 946 Implementation. Retrieved from https://www.dmhc.ca.gov/Portals/0/Docs/DO/SB946FAQs_2012.pdf

Disability Rights California. (2003–2015). Advocacy Reports. Retrieved from https://www.disabilityrightsca.org/publications

Green, G. (2002). Technology and the treatment of children with autism. Journal of Autism and Developmental Disorders, 32(5), 373–394.

Hoang v. California Department of Developmental Services, 931 F. Supp. 1529 (N.D. Cal. 1995).

Leaf, R. B., Taubman, M. T., & McEachin, J. J. (2016). Controversial therapies for autism and intellectual disabilities: Fad, fashion, and science in professional practice. Routledge.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55(1), 3–9.

McCarthy v. Department of Developmental Services, Case No. C-91-3871 (N.D. Cal. 1991).

McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal on Mental Retardation, 97(4), 359–372.

National Conference of State Legislatures. (2021). Autism and Insurance Coverage State Laws. Retrieved from https://www.ncsl.org/health/autism-and-insurance-coverage-state-laws

Public Counsel. (2000s). Legal filings and amicus briefs in autism advocacy cases. Retrieved from https://publiccounsel.org

Reichow, B., Barton, E. E., Boyd, B. A., & Hume, K. (2012). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, 10, CD009260.

Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal on Mental Retardation, 110(6), 417–438.

Senate Bill 946, Cal. Legis. (2011). Health Care Coverage: Pervasive Developmental Disorder or Autism. Retrieved from https://leginfo.legislature.ca.gov

Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal on Mental Retardation, 105(4), 269–285.

U.S. Department of Health and Human Services. (2020). EPSDT: A Guide for States. Retrieved from https://www.medicaid.gov/medicaid/benefits/downloads/epsdt_coverage_guide.pdf

Vanaman, V. (2005). Due process rulings in California autism cases. Internal legal summaries.