ABA Therapy in Concord, NH

Welcome to Concord

Welcome, families, to Concord, New Hampshire! As the vibrant capital city, Concord offers a unique blend of historical charm, natural beauty, and a close-knit community feel. Nestled along the Merrimack River and surrounded by picturesque landscapes, our city provides a wonderful environment for raising children. Whether you’re enjoying the parks, exploring the McAuliffe-Shepard Discovery Center, or participating in local events, Concord strives to be a supportive place for all its residents.

For families navigating the journey of a child with autism spectrum disorder (ASD) or other developmental differences, finding effective support is paramount. Applied Behavior Analysis (ABA) therapy stands out as a scientifically validated and highly effective approach to helping children develop crucial life skills, foster independence, and improve their overall quality of life. This guide is designed to be your comprehensive resource for understanding ABA therapy, navigating the options available in Concord and across New Hampshire, and connecting you with the support your family deserves. We understand that beginning this journey can feel overwhelming, but please know that you are not alone. Our aim is to empower you with the knowledge and resources to make informed decisions and confidently take the next steps toward supporting your child’s growth and development right here in our beloved community.

Understanding ABA Therapy

Applied Behavior Analysis (ABA) is a scientific discipline concerned with applying empirical approaches based on the principles of behavior to improve socially significant behavior. In simpler terms, ABA is an evidence-based therapy that focuses on understanding why a person behaves the way they do and then using that understanding to teach new, more functional skills and reduce challenging behaviors. It's not a "one-size-fits-all" approach; rather, it’s highly individualized, tailored to meet the specific needs and goals of each child and family.

The core principles of ABA revolve around analyzing the relationship between behavior and the environment. This involves identifying antecedents (what happens before a behavior) and consequences (what happens after a behavior) to understand the function of the behavior. By systematically changing these environmental factors, therapists can teach new skills and reduce behaviors that interfere with learning and daily living.

Key methods within ABA therapy include:

• Discrete Trial Training (DTT): A structured teaching method where skills are broken down into smaller components and taught in a clear, consistent manner, often with repetition and positive reinforcement.
• Natural Environment Teaching (NET): Skills are taught in the context of everyday routines and activities, making learning more engaging and facilitating generalization of skills to various settings.
• Pivotal Response Training (PRT): Focuses on "pivotal" areas of development, such as motivation, self-initiation, and self-management, which can lead to widespread improvements in other skill areas.
• Verbal Behavior (VB) Approach: A specific curriculum that categorizes language by its function rather than its form, helping children develop effective communication skills.
• Functional Behavior Assessment (FBA): This foundational component is used to determine the purpose or function of challenging behaviors before developing interventions.

The effectiveness of ABA therapy for individuals with autism spectrum disorder has been extensively researched and documented for decades. It is widely recognized by medical and governmental organizations, including the U.S. Surgeon General and the American Academy of Pediatrics, as a safe and effective treatment. ABA helps children and adolescents develop a wide range of essential skills, including communication (both verbal and non-verbal), social interaction, adaptive living skills (e.g., self-care, daily routines), academic readiness, and play skills. Simultaneously, it can significantly reduce behaviors that impede learning and social integration, such as aggression, self-injury, and tantrums. Modern ABA is compassionate, child-centered, and focused on empowering individuals to achieve their fullest potential in a positive and supportive environment.

Insurance & Coverage in NH

Navigating the complexities of insurance coverage for ABA therapy can feel daunting, but New Hampshire has made significant strides in ensuring access to these vital services for families. Understanding your rights and options is the first step.

New Hampshire's Autism Insurance Mandate (RSA 417-E) New Hampshire is one of many states that has an autism insurance mandate. Enacted under RSA 417-E, this law requires certain health insurance plans to provide coverage for the diagnosis and treatment of autism spectrum disorder, including ABA therapy. This mandate is a crucial piece of legislation that has opened doors for many families in the state.

What Does the Mandate Cover? Generally, the mandate requires coverage for "medically necessary" services for the treatment of ASD. This typically includes:

• Applied Behavior Analysis (ABA) Therapy: Delivered by qualified professionals (Board Certified Behavior Analysts - BCBAs, and Registered Behavior Technicians - RBTs).
• Speech-Language Pathology: To address communication deficits.
• Occupational Therapy: To improve fine motor skills, sensory processing, and daily living activities.
• Physical Therapy: To address gross motor skills and physical development.
• Pharmacological Management: For co-occurring conditions.

It's important to note that for fully insured plans regulated by the State of New Hampshire, there are no age limits or dollar caps on coverage for medically necessary autism treatments, including ABA therapy. This means coverage continues as long as the therapy is deemed medically necessary by a qualified professional.

Types of Insurance and Their Impact on Coverage:

• Private Insurance (Fully Insured Plans): If your health insurance plan is purchased through the New Hampshire marketplace or from a private insurer regulated by the State of New Hampshire, it is subject to RSA 417-E. These plans generally offer robust coverage for ABA.
• Self-Funded (ERISA) Plans: Many large employers offer self-funded health plans, which are regulated by federal law (ERISA) rather than state law. While not directly subject to NH's mandate, many self-funded plans voluntarily choose to cover ABA therapy due to its recognized effectiveness and market demand. It's essential to contact your plan administrator directly to inquire about their specific coverage policies.
• Medicaid (NH Healthy Kids/Managed Care Organizations): New Hampshire's Medicaid program, known as NH Healthy Kids, provides coverage for ABA therapy and other autism-related services for eligible children. Services are typically administered through managed care organizations (MCOs) like AmeriHealth Caritas NH, NH Healthy Families, and Well Sense Health Plan. Coverage usually follows similar medical necessity guidelines.
• Tricare: For military families, Tricare provides comprehensive coverage for ABA therapy and other autism services under its Autism Care Demonstration (ACD) program. This is a robust program, but it has its own specific authorization and provider requirements.

Navigating the Coverage Process:

1. Diagnosis: You'll need a formal diagnosis of autism spectrum disorder from a qualified professional (e.g., developmental pediatrician, child psychologist, neurologist).
2. Prescription/Referral: Obtain a written prescription or referral for ABA therapy from the diagnosing physician or your primary care provider.
3. Insurance Verification: Contact your insurance company (the number on your member ID card) to verify your specific benefits. Ask about:
   • Coverage for CPT codes commonly used in ABA (e.g., 97151, 97153, 97155, 97156).
   • Deductibles, co-pays, and co-insurance amounts.
   • Out-of-pocket maximums.
   • Prior authorization requirements: Most ABA services require prior authorization, which means the provider needs to get approval from the insurance company before starting therapy.
   • In-network vs. out-of-network benefits.
4. Advocacy: Keep detailed records of all communication with your insurance company. If you encounter denials, understand your appeal rights. Resources like the Autism Alliance of NH can offer guidance.

Understanding Costs: Even with robust insurance coverage, families often have out-of-pocket expenses, including deductibles, co-pays, and co-insurance. It's crucial to understand these costs upfront. Some providers may offer financial assistance programs or payment plans. If you have a high-deductible plan, you might also consider a Health Savings Account (HSA) or Flexible Spending Account (FSA) to help manage these expenses with pre-tax dollars.

Finding the Right Provider

Selecting an ABA therapy provider is one of the most critical decisions you'll make for your child's development. A good provider will not only possess clinical expertise but also be a strong partner in your family's journey. Here's what to look for and how to approach the selection process in Concord and the surrounding New Hampshire area.

Key Credentials and Roles:

• Board Certified Behavior Analyst (BCBA): This is the clinical supervisor of your child's ABA program. BCBAs hold at least a master's degree, have extensive specialized training, and have passed a rigorous national certification exam. They conduct assessments, design individualized treatment plans, supervise therapy, and provide parent training.
• Registered Behavior Technician (RBT): RBTs are direct implementers of ABA therapy, working one-on-one with your child under the close supervision of a BCBA. They receive specific training and are certified to deliver services.

Types of Providers and Settings:

• Clinic-Based: Therapy takes place in a dedicated facility. This setting often provides a structured environment, opportunities for peer interaction, and access to a wide range of therapeutic materials.
• Home-Based: Therapy is delivered in your child's natural home environment. This can be highly effective for teaching daily living skills and generalizing skills learned elsewhere into the family routine.
• School-Based: Some providers offer consultation services to schools or direct therapy within the school setting, often focusing on academic or social behaviors in that specific environment.
• Hybrid Models: Many providers offer a combination of these settings, tailoring the approach to your child's evolving needs. For Concord families, providers might be located in Concord, Hooksett, Bow, Pembroke, or Manchester.

What to Look For in a Provider:

1. Experience and Specialization:
   • Does the BCBA have experience with children in your child's age group (e.g., early intervention, school-age, adolescents)?
   • Do they have experience addressing specific challenges your child faces (e.g., severe challenging behaviors, limited verbal communication, social skill deficits)?
2. Individualized Treatment Philosophy:
   • Avoid providers who offer a "cookie-cutter" approach. A high-quality ABA program is always individualized, based on a comprehensive assessment of your child's unique strengths and needs.
   • Inquire about how they conduct assessments (e.g., VB-MAPP, ABLLS-R, Vineland) and how often they update treatment plans.
3. Parent Training and Involvement:
   • Parent training is a critical component of effective ABA therapy. The provider should actively involve you in the process, teaching you strategies to support your child's learning outside of therapy sessions.
   • Do they welcome your input and collaborate with your family?
4. Data-Driven Decisions:
   • ABA is a data-driven science. Ask how they collect and analyze data to monitor progress and make decisions about treatment plan adjustments. You should regularly receive updates on your child's progress.
5. Ethical Practices and Compassion:
   • Ensure the provider adheres to the ethical guidelines set by the Behavior Analyst Certification Board (BACB).
   • Observe the interactions between staff and children. Is the environment positive, respectful, and engaging? Modern ABA emphasizes compassionate care and building rapport.
6. Communication and Collaboration:
   • Look for a provider with clear, open communication. They should be willing to collaborate with other professionals involved in your child's care (e.g., speech therapists, occupational therapists, school staff).
7. Logistics:
   • Consider their location, availability, and scheduling flexibility to ensure it fits your family's needs. Given Concord's central location, providers in Manchester or other nearby towns are often viable options.

Questions to Ask Potential Providers:

• What is your approach to parent training and family involvement?
• How do you ensure treatment plans are individualized?
• What assessment tools do you use?
• How do you measure and report progress?
• What is your staff-to-child ratio, and how do you ensure the quality of RBT supervision?
• What are your policies regarding cancellations and communication?
• Can you provide references from other families?

Trust your instincts. The right provider will feel like a true partner, dedicated to your child's success and your family's well-being.

Getting Started with ABA Therapy

Embarking on the journey of ABA therapy for your child in Concord, NH, involves a series of practical steps. Understanding this process can help alleviate anxiety and ensure a smoother start to therapy.

Step 1: Obtain a Formal Diagnosis The first and most crucial step is securing a formal diagnosis of autism spectrum disorder (ASD) or a related developmental disorder from a qualified professional. In New Hampshire, this typically involves a developmental pediatrician, a child psychologist, or a neurologist. This diagnosis is essential for insurance coverage and for informing the development of an appropriate treatment plan. For families in Concord, diagnostic evaluations may involve travel to larger medical centers like Dartmouth-Hitchcock in Lebanon or Manchester, or Elliot Hospital in Manchester. It's advisable to get on waitlists for these evaluations as soon as concerns arise.

Step 2: Obtain a Prescription/Referral for ABA Therapy Once you have a diagnosis, your diagnosing physician or your child's primary care physician will need to provide a written prescription or referral for ABA therapy. This document typically outlines the diagnosis, the medical necessity for ABA, and sometimes the recommended intensity (e.g., "up to 20-40 hours per week"). This prescription is a prerequisite for most insurance companies.

Step 3: Verify Insurance Benefits and Requirements Before engaging a provider, contact your insurance company (using the member services number on your ID card) to understand your specific ABA therapy benefits. Inquire about:

• Coverage for ABA: Confirm that ABA therapy is covered under your plan.
• Prior Authorization: Most plans require prior authorization for ABA services. Understand the process and how long it takes.
• Deductibles, Co-pays, Co-insurance: Clarify your out-of-pocket expenses.
• In-network vs. Out-of-network: Ask for a list of in-network ABA providers or understand the implications of choosing an out-of-network provider.
• Age/Hour Limits: While New Hampshire's mandate generally prohibits these for fully insured plans, it's always good to confirm.

Step 4: Schedule an Initial Assessment with a BCBA Once you've identified potential ABA providers and verified your insurance, the next step is to schedule an initial comprehensive assessment with a Board Certified Behavior Analyst (BCBA). During this assessment, the BCBA will use various standardized tools (e.g., VB-MAPP, ABLLS-R, Vineland Adaptive Behavior Scales) and direct observation to evaluate your child's current skill levels across domains like communication, social skills, adaptive functioning, and play, as well as identify any challenging behaviors. This assessment typically involves interviews with parents and caregivers.

Step 5: Develop an Individualized Treatment Plan Based on the assessment findings, the BCBA will develop an individualized treatment plan (ITP). This plan will outline specific, measurable, achievable, relevant, and time-bound (SMART) goals for your child. It will detail the strategies and interventions that will be used, the recommended number of therapy hours per week, and how progress will be monitored. This plan is often submitted to your insurance company for prior authorization.

Step 6: Begin Therapy Implementation Once the treatment plan is approved by both you and your insurance, therapy can begin. Registered Behavior Technicians (RBTs), under the close supervision of the BCBA, will work directly with your child to implement the treatment plan. Therapy sessions can occur in a clinic, at home, or in a combination of settings, depending on your child's needs and the provider's model. The intensity of ABA therapy often ranges from 20 to 40 hours per week for comprehensive programs, especially for younger children.

Step 7: Actively Participate in Parent Training and Collaboration Your active involvement is crucial for the success of ABA therapy. You'll participate in regular parent training sessions with the BCBA, where you'll learn the strategies and techniques used in therapy. Applying these strategies consistently in your daily routines will help your child generalize newly acquired skills to different environments and people. Maintain open communication with the BCBA and RBTs, sharing insights and celebrating milestones.

Step 8: Ongoing Monitoring and Adjustment ABA therapy is a dynamic process. The BCBA will regularly monitor your child's progress through data collection and review meetings. The treatment plan will be adjusted as your child masters goals or as new needs arise. This ensures that therapy remains effective and responsive to your child's evolving development.

Local Resources & Support

For families in Concord and throughout New Hampshire, a network of resources and support organizations exists to help navigate the complexities of autism and developmental differences. Connecting with these groups can provide invaluable information, advocacy, and a sense of community.

New Hampshire Specific Organizations:

• Autism Alliance of New Hampshire (AANH): This is perhaps the most vital resource for NH families. AANH provides information, support, advocacy, and referral services. They frequently host events, workshops, and support groups. Their website is an excellent starting point for finding local providers, understanding legislation, and connecting with other families.
• New Hampshire Department of Health and Human Services (DHHS): DHHS offers various programs and services for children with developmental disabilities and their families.
  • Early Supports and Services (ESS): For infants and toddlers (birth to age 3) who have developmental delays or are at risk of delays, ESS provides early intervention services.
  • Area Agencies: NH is divided into ten Area Agency regions, which coordinate services and supports for individuals with developmental disabilities. The "Community Bridges" organization serves the Concord and Merrimack County region, offering case management, family support, and connections to local resources.
• Parent Information Center (PIC) of New Hampshire: PIC is a statewide non-profit organization that provides information, training, and support to families of children with disabilities. They can help you understand your rights under special education law (IDEA), navigate the IEP process, and advocate for your child in school settings.
• Federation of Families for Children's Mental Health – NH Chapter: While focusing on mental health, many children with ASD also experience co-occurring mental health challenges. This organization provides support and advocacy for families dealing with children's emotional, behavioral, and mental health needs.

Concord and Regional Specific Resources:

• Concord School District Special Education Department: If your child is school-aged, the Concord School District's Special Education Department is a key resource. They are responsible for identifying children with disabilities, conducting evaluations, and developing Individualized Education Programs (IEPs) to ensure your child receives appropriate educational support and services. Collaboration between your ABA provider and the school district can be highly beneficial.
• Concord Hospital: While not a direct provider of ABA, Concord Hospital serves as a major healthcare hub for the region. Your child's pediatrician or other specialists at Concord Hospital can be part of your comprehensive care team, providing referrals, medical oversight, and coordinating care with your ABA provider.
• Local Libraries and Community Centers: The Concord Public Library, and community centers like the Heights Community Center, often host inclusive programs, sensory-friendly events, or can be venues for local support groups. Check their calendars for family-friendly activities designed to be welcoming to all children.
• Nearby Diagnostic Centers: For comprehensive evaluations, families may need to access larger centers like the Child Development Clinic at Dartmouth-Hitchcock Medical Center in Lebanon or the Center for Children's Health and Development at Elliot Hospital in Manchester.

Online Communities and Support Groups: Many online platforms, particularly Facebook groups, exist for New Hampshire autism families. Searching for groups like "New Hampshire Autism Families" or "Concord NH Autism Support" can connect you with local parents who share experiences, provide recommendations, and offer emotional support. These informal networks can be incredibly valuable for practical advice and a sense of belonging.

Remember, building a strong support network is essential. Don't hesitate to reach out to these organizations and local groups. They are there to help empower you and enhance your child's journey.

Frequently Asked Questions

Q1: How long will my child need ABA therapy? A1: The duration of ABA therapy is highly individualized and depends on many factors, including your child's age, the severity of their symptoms, the specific goals being targeted, the intensity of therapy, and their individual rate of progress. For many children, especially those starting at a young age, comprehensive ABA therapy can be a long-term commitment, often spanning several years. However, the intensity and focus of therapy will evolve over time. As your child masters skills and gains independence, the program may shift from intensive direct therapy to more consultative models, focusing on generalization of skills into natural environments, school settings, or vocational training. The ultimate goal is to fade therapy as your child acquires the necessary skills to navigate their environment successfully and achieve their highest level of independence. Regular assessments and discussions with your BCBA will guide these decisions.

Q2: What's the difference between home-based and clinic-based ABA? Which is better? A2: Both home-based and clinic-based ABA therapy have distinct advantages, and the "better" option often depends on your child's specific needs and your family's circumstances.

• Home-based ABA: Therapy takes place in your child's natural home environment. This setting is excellent for teaching daily living skills (e.g., potty training, getting dressed), reducing challenging behaviors that occur at home, and generalizing skills to family routines. It also offers significant opportunities for direct parent training.
• Clinic-based ABA: Therapy occurs in a dedicated facility designed for learning. Clinics often provide a structured environment with fewer distractions, access to a wider variety of specialized materials, and opportunities for social interaction with peers in a supervised setting. This can be ideal for developing social skills, group instruction, and preparing for school. Many providers, including some serving the Concord area, offer a hybrid model, combining elements of both home and clinic settings to leverage the benefits of each. Your BCBA will help you determine the most appropriate setting or combination of settings for your child's treatment plan.

Q3: Is ABA only for severe autism, or can it help children with milder symptoms? A3: ABA therapy is beneficial for individuals across the entire autism spectrum, regardless of the severity of their symptoms. While it is highly effective for children with significant developmental delays or challenging behaviors, it is equally valuable for those with milder symptoms who may struggle with social communication, flexible thinking, or executive functioning skills. For children with milder ASD, ABA goals might focus on nuanced social cues, conversation skills, understanding complex emotions, or developing self-advocacy. The beauty of ABA lies in its individualized approach; the treatment plan is always tailored to the specific needs and goals of each child, ensuring that therapy addresses their unique areas of growth, whether they are developing foundational skills or refining advanced social competencies.

Q4: How involved do parents need to be in ABA therapy? A4: Parent involvement is not just encouraged; it is a critical component for the long-term success of ABA therapy. You, as a parent, are your child's primary advocate and teacher, and your active participation significantly enhances generalization of skills and maintenance of progress. High-quality ABA programs include a strong parent training component. This means you will regularly meet with your child's BCBA to learn the strategies and techniques used in therapy, understand the rationale behind interventions, and practice implementing them in your daily routines. By consistently applying these strategies at home and in the community, you help your child generalize skills across different people, places, and situations. The more involved and consistent parents are, the more likely the child is to make meaningful and lasting progress.

Q5: What if I can't find an ABA provider with availability in Concord, NH? A5: Due to high demand, finding an ABA provider with immediate availability in Concord or any specific town can sometimes be challenging, leading to waitlists. If you encounter this, consider expanding your search to surrounding towns and cities in the greater Concord area, such as Hooksett, Bow, Pembroke, or even Manchester, which has a larger concentration of providers. Many families commute a short distance for quality services. Additionally:

• Get on Waitlists: Sign up for waitlists with multiple providers. You never know when a spot might open up.
• Inquire about Hybrid or Telehealth Options: Some providers may offer a combination of in-person and telehealth services for certain components of therapy or parent training, which might offer more flexibility.
• Contact the Autism Alliance of New Hampshire (AANH): AANH is an invaluable resource for finding providers across the state and can offer guidance on navigating waitlists or finding less conventional options.
• Consider Part-Time vs. Full-Time: While comprehensive ABA is often recommended at high intensity, sometimes starting with a lower intensity program or with specific goals can get your child started sooner while you await a more intensive spot. Persistence and broad searching are key, and don't hesitate to leverage state-specific resources for support.