Applied Behaviour Analysis Consultation: Regulation Amendments

Applied Behavior Analysis (ABA) is the application of the science of learning to understand and improve behavior that is meaningful to the person and those around them. ABA considers how the environment impacts learning. The term behaviour refers to anything a person says or does, including skills and actions needed to talk, play, and live. Behavior can also be private (e.g., thoughts and feelings).

ABA can help increase helpful or functional skills (e.g., communication) and/or decrease behaviours that are harmful or interfere with learning (e.g., self-injury).

ABA intervention uses evidence-based procedures such as positive reinforcement to address a client’s concerns and needs and to reduce interfering behaviour and increase desirable behaviour.  Behaviour Analysts practice in a variety of settings with many different client populations.   

Resources:

1. The Ontario Association for Behaviour Analysis (ONTABA) has developed this graphic to describe ABA, what it is and what it is not.  The graphic and more information can be found on their website.
2. The Behavior Analysis Certification Board (BACB) has additional information on its website about the profession of ABA and the client populations it serves.

In 2017, the Minister of Health and Long-Term Care asked the Health Professions Regulatory Advisory Council (HPRAC) to provide advice on:

• What activities or aspects associated with ABA therapy pose a significant and inherent risk of harm (if any), and whether the risk of harm of this therapy varies by client population (e.g., children and adults); and
• If there is a risk of harm, what is the range of options for an approach to oversight that could be considered?

In HPRAC’s January 2018 report to the Minister of Health and Long-Term Care, Applied Behaviour Analysis: Risk of Harm and Oversight, it concluded:

“Based on the evidence reviewed, HPRAC affirms that there is a risk of harm associated with most ABA interventions for clients, therefore oversight is recommended. Several oversight options to regulating providers were examined with a particular focus on clinical supervisors.”

With respect to oversight, HPRAC recommended the following:

“Because ABA therapy is deemed to pose a significant and inherent risk of harm across many client populations, HPRAC recommends that ABA providers performing a clinical supervisory role be regulated under an established health regulatory college, governed by the Regulated Health Professions Act, 1991 (RHPA). Other ABA providers would be accountable to the regulated clinical supervisors.”

To protect the public from risk of harm, once regulated Behaviour Analysts who supervise and/or deliver ABA interventions will have to meet clearly defined standards.  These standards will include having the necessary knowledge, skills, and judgement to meet practice requirements and to be allowed to use the regulated title “Behaviour Analyst”.

Anyone who wants to practise a regulated health profession in Ontario, i.e., psychologists, psychological associates, physicians, nurses, dentists, occupational therapists etc., and now, Behaviour Analysts, must be registered with, and be accountable to, a health regulatory College.   A College is not a university, community college, or school. Instead, its mandate is to protect the interests of the public by ensuring that clients receive competent and ethical professional services from qualified providers.

Ontario Health Regulators includes the 26 health regulatory Colleges in Ontario, including the College of Psychologists of Ontario. To learn more about how and why health professions are regulated in Ontario, visit their website.

Regulated professionals are required, by law, to deliver professional services competently and ethically.  They are accountable to the public, through their regulatory body, for their professional behaviour and activities. Once regulated, Behaviour Analysts will have to meet rigorous professional entry requirements, adhere to prescribed standards, guidelines and ethical principles and participate in quality assurance activities to continually update and improve their knowledge and skill.  Complaints and discipline processes hold professionals accountable when a client, or other member of the public, believes that the standards may have been breached.

In contrast, the College has no authority over unregulated service providers.  There is no regulatory body with the authority to set minimum levels of education, training, and competence or to establish and monitor professional and ethical standards of conduct.  There is no professional regulatory body responsible to protect your interests and hold unregulated providers accountable for the services you receive.

On June 3, 2021, the enabling legislation to authorize the College of Psychologists of Ontario to regulate the profession of Applied Behaviour Analysis (ABA),  Bill 283, Advancing Oversight and Planning in Ontario’s Health System Act, 2021 received Royal Assent. Included in Schedule 4 of this Bill is the legislative authority for the College to regulate the profession of Applied Behaviour Analysis. On a day to be named, this legislation will be proclaimed by the government and will repeal the Psychology Act, 1991 to replace it with the Psychology and Applied Behaviour Analysis Act, 2021.

The new Act establishes the regulation of two separate and distinct professions, Psychology and Applied Behaviour Analysis within one College. The current College of Psychologists of Ontario will be the regulator for both professions and will be renamed the College of Psychologists and Behaviour Analysts of Ontario to reflect its expanded role. The legislation maintains the regulatory framework for current members, Psychologists and Psychological Associates, but additionally:

• Defines the scope of practice for ABA: “The practice of applied behaviour analysis is the assessment of covert and overt behaviour and its functions through direct observation and measurement, and the design, implementation, delivery and evaluation of interventions derived from the principles of behaviour in order to produce meaningful improvements”;
• Restricts the use of the title “Behaviour Analyst” to members of the new College registered as Behaviour Analysts;
• Expands the “Representations of Qualifications” restriction to include holding oneself out as qualified to practice as a Behaviour Analyst or in a specialty of behaviour analysis; and
• Updates the size and composition of the current College’s Council to enable fair representation for both professions.

In 2017, the Health Professions Regulatory Advisory Council (HPRAC), at the request of the then Minister of Health and Long-Term Care, undertook to review Applied Behavioural Analysis; its potential for harm and need for regulation. In response to a request for information, the College submitted a letter which stated, in part, that, “Should ABA regulation proceed in Ontario, the Council of the College of Psychologists is prepared to undertake this process within its governance structure”.

On September 19, 2019, the College received a letter from Minister Todd Smith of the Ministry of Children, Community and Social Services and Minister Christine Elliott of the Ministry of Health inviting the College to confirm its interest in undertaking the regulation of ABA as part of its governance structure. In their letter, the Ministers state that, “Strengthening the oversight of behavioural clinicians will protect vulnerable Ontarians from risk of harm and set standard expectations for professional standards and educational requirements for ABA providers across the province. It will also support families in finding qualified providers, and making complaints about providers, if necessary. Our ministries would like to begin with regulating those who are in a supervisory role, and we envision that this will be broadened to include front-line clinicians over time.”

On September 27, 2019, the Council of the College of Psychologists passed a motion confirming the offer to undertake the regulation of ABA within its governance structure.

The College is drafting regulations to be made under the new Act as well as by-law and policy changes that will be necessary to support the regulation of Behaviour Analysts.  This work must be completed before the Act can be fully proclaimed by the government. The new Act and any other legislative changes will come into force on a day to be named by proclamation of the Lieutenant Governor.

Initially, those who practise applied behaviour analysis providing clinical oversight of ABA interventions, or clinical supervisors, must register with the College.  Clinical supervisors are those who provide clinical direction and supervision of ABA activities, which include behaviour assessment, designing an intervention plan, implementing intervention plans, and monitoring and evaluating the plans.  On the day the new Act is proclaimed, and going forward, only those who have registered with the College will have access to the restricted title “Behaviour Analyst”.

At this time, front line providers who deliver ABA interventions directly to a client or caregiver and are accountable to a Behaviour Analyst clinical supervisor are not proposed to be regulated.

The College does not yet have a definite date when it will begin to accept applications but expects it to be before the new Psychology and Applied Behaviour Analysis Act, 2021 is proclaimed.  That is, pre-registration will begin when the registration requirements are finalized, and the regulation-making process nears completion.  At that time, Behaviour Analysts currently in practice and new graduates who are completing a program in applied behaviour analysis, and who meet the registration requirements, will be able to apply to the College.  The goal of the pre-registration period is to ensure that qualified Behaviour Analysts can continue to practice and provide services to their clients on the date of proclamation and after, ensuring continuity of care.

The College will update its website as more information becomes available.  You can also subscribe to the College’s e-newsletter HeadLines to receive updates to your inbox.

For most current members of the College, adding the profession of Applied Behaviour Analysis to the College will have little or no effect.  The College will regulate the two professions separately, therefore Psychologists and Psychological Associates should not see any change in their interactions with the College with respect to their practice or expectations of the College.

Behaviour Analysts will have their own standards of practice, quality assurance program and registration requirements.  The current Professional Misconduct, Advertising and Quality Assurance Regulations will be revised so that they apply to the practice of Applied Behaviour Analysis as well as Psychology.   The College Council will be enlarged and both Council and Committees will be made up of Psychologists, Psychological Associates, Behaviour Analysts and public members appointed by the government.  Decisions made by the College’s statutory committees will rely on the expertise of members of both professions and the public members who participate on each Committee.

There are members of the College who may also want to register as Behaviour Analysts in order to be able to use the restricted title “Behaviour Analyst”.  They will hold two certificates of registration: one authorizing the practice of Psychology and one authorizing the practice of Applied Behaviour Analysis.  These members will be expected to meet the College’s registration criteria and practice expectations with respect to both professions.

There is no connection between the regulation of Behaviour Analysts and the closure of master’s level registration for the practice of psychology.  Any activity related to the closure of master’s level registration will be done separate and apart from activities undertaken to begin the regulation of Behaviour Analysts.

The scope of practice or activities that a Behaviour Analyst performs when providing services to a client are not Controlled Acts or restricted activities. They are therefore, in the public domain.  If one is not registered with the College, one must be aware of the restrictions within the Act regarding how one refers to the services being offered (refer to the following question for more information about Controlled Acts).

Once the Psychology and Applied Behaviour Analysis Act, 2021 is proclaimed, the title “Behaviour Analyst” will be a restricted title that can only be used by individuals registered with the College as Behaviour Analysts. Members registered as Behaviour Analysts may also refer to any earned certification they may have that would assist the public in understanding their qualifications as a regulated health provider registered with the College.  Non-members using the title “Behaviour Analyst” or indicate any certification or designation or communicate in any way that could be considered as holding oneself out as a person who is qualified to practice as a Behaviour Analyst, could be in violation of the Act.

Controlled Acts are health care activities or interventions that are considered to be potentially harmful if performed by unqualified persons.  Some examples of Controlled Acts are administering a substance by injection, setting a broken bone, dispensing a drug, prescribing glasses, performing a surgical procedure, managing the delivery of a baby, and applying a form of energy.  The full list of the 14 Controlled Acts may be found in section 27 of the Regulated Health Professions Act, 1991 (RHPA).

Due to the potential for harm, a Controlled Act may only be performed by a regulated health professional who is authorized, in legislation, to do so.  Not all regulated health professions are authorized to perform Controlled Acts.  Each profession specific act, e.g., the Medicine Act, 1991, Pharmacy Act, 1991, Psychology Act, 1991, or Nursing Act, 1991, etc., prescribes which, if any, Controlled Acts may be performed by members of that profession.

No.  Behaviour Analysts will not be authorized to perform any of the Controlled Acts, including the application of energy in the form of electricity for aversive conditioning.  As noted, a Controlled Act may only be performed by those professions with the authority specified in legislation. The yet to be proclaimed profession specific act related to Applied Behaviour Analysis; the Psychology and Applied Behaviour Analysis Act, 2021, does not authorize Behaviour Analysts to perform any Controlled Acts.

Note: This prohibition on performing any of the Controlled Acts is currently in place for individuals practicing Applied Behaviour Analysis or any form of behaviour therapy and will continue with the proclamation of the new Act.

Yes. The College has developed pathways for both entry level registration (i.e., new to the profession), and transitional registration (or “grandparenting”) for those currently in practice.  To register with the College, experienced Behaviour Analysts will be required to demonstrate that they were practising the profession of Applied Behaviour Analysis prior to proclamation of the Act, and that they are safe and competent practitioners.  Transitional registration will be open for a limited time following proclamation.  Details regarding the qualifications the College will require and the evidence to demonstrate these will be available shortly.

Many professionals registered with other regulatory colleges, including nurses, social workers, occupational therapists, speech language pathologists, educators, and others, may use behavioural techniques in their practice.  As noted above, these will remain in the public domain and are not restricted activities.  If, however, a practitioner wishes to  use the title “Behaviour Analyst” or indicate any certification or designation or communicate in any way that could be considered as holding themself out as a person who is qualified to practice as a Behaviour Analyst, they will be required to also register with the College of Psychologists and Behaviour Analysts of Ontario.

Dual registration occurs often in many sectors as professionals may hold certificates of registration with more than one regulator to practice multiple professions.  It is permissible, and may be necessary, for a Behaviour Analyst to be registered with more than one regulatory College. In this same vein, Psychologists and Psychological Associates, that want to be able to use the restricted title “Behaviour Analyst”, must meet the registration requirements to obtain a second certificate of registration authorizing practice as a Behaviour Analyst.

Professional liability insurance coverage is required for all regulated health professionals.  Behaviour Analysts will be required to hold or otherwise be covered by professional liability insurance in all settings in which they practise.  Insurance must be in place upon registration and confirmed annually with the College during the annual renewal process.

A Behaviour Analyst who is employed by an organization may be insured under their employer’s professional liability insurance policy so long as it meets the minimum requirements to be set by the College.  It is important to know however, that one’s insurance through the workplace covers only the services provided while working for that employer.  If an employed Behaviour Analyst also provides services to clients outside of their employment, they must also obtain individual professional liability insurance.

Professional liability insurance can be obtained through associations, insurance companies and other organizations and coverage must be in accordance with the College By-laws.