DAILY NEWS CLIP: February 4, 2025

Some children’s behavioral health centers in Connecticut not licensed, report states


CT Insider – Monday, February 3, 2025
By Cris Villalonga-Vivoni

For years, certain behavioral health providers for children diagnosed with autism have operated with minimal legal supervision, leading to variations in standards, processes and inter-agency communication holes, according to a new report from the state Office of the Child Advocate.

Despite finding a few policies that help provide oversight, the report states that the rules make up a “patchwork” of standards across Connecticut. Since no overarching statutory or regulatory framework oversees the work of applied behavior analysis providers, significant information gaps in the system impact the safety and well-being of the children they serve.

Applied behavior analysis, also known as ABA, is a research-based therapy that uses positive reinforcement to change behavior for children diagnosed with autism and other developmental disorders. There are several centers across the state that provide these types of therapies, which Christina Ghio, acting child advocate, described as “critically important” for children and their families. However, she said these centers are relatively new to the provider scene and regulatory laws often take time to catch up.

“These are medically necessary treatments, so they should continue, and we, as a state, should work diligently to put a framework around that,” Ghio said. “There are some specific things that we recommend that we can do right now.”

The goal of the report was to identify oversight gaps in the network, not criticize the quality of the services. However, the report said it was prompted by concerns over the fact that these specific entities did not need to be licensed under current state law.

Ultimately, the report found that no state agency licenses, inspects or regulates standards at ABA clinics specifically.

All child care centers and similar spaces for children, like schools, have statutory frameworks and regulations that staff need to meet before working with children, like specific operating licenses, regulations on sanitation and food, and legally required background checks for employees.

Ghio said the ABA centers technically don’t fall into the legal “day care” category since they provide medical treatment. As a result, they don’t have the same safety requirements and inspections set up despite working with young children for long periods without their parents present.

“Children with significant disabilities, many of whom are non-verbal, spend large portions of the week in environments that mirror child care centers in many ways, without the same level of oversight,” the report reads.

The report analyzed data collected from four Connecticut-based ABA centers paid by Medicaid and private insurance between 2022 and 2023. It looks at the regulatory information about staffing, patient treatment plans, and more to identify potential legal gaps. The report also cross-referenced data with other state agencies, like the state Department of Children and Families and the Department of Public Health, which work with ABA clinics, to identify information flow gaps.

The report also said that state agencies don’t have the administrative power to investigate certain conduct from ABA staff that doesn’t equate to abuse or neglect under the Department of Children and Families standards but is still inappropriate in a youth behavioral health setting. Although Ghio said there are “pockets of oversight” when reporting concerns around ABA centers, there’s no overarching structure, making it challenging when the concerns don’t fall under a specific agency’s jurisdiction.

“If it doesn’t rise to the level of abuse and neglect, DCF does not have authority,” Ghio said. “If it’s not a child care center, [Office of Early Childhood] does not have authority. So who does?”

There are also significant gaps identified in legal requirements to operate an ABA center, such as background checks for prospective employees and state licenses to work as an ABA provider, instead of placing the responsibility on organizations to voluntarily comply. For example, although each organization conducted a background check as part of the hiring process, how in-depth they were varied.

To Ghio, one of the most concerning findings from the report is the lack of communication between ABA centers and state agencies, like the Department of Children and Families and the Office of Early Childhood. The report found limited or no communication between the departments and ABA centers since there’s no legislation to mandate it, causing information to fall through the cracks.

There is no legislation that allows the state Department of Children and Families, for example, to notify ABA providers if one of their employees is placed on its Child Abuse Registry. The report found that at least one current employee was convicted and registered on the Child Abuse Registry for neglect after his employer ran a background check.

Some identified legal gaps contrast Connecticut regulations and laws already established for other entities working with children, like schools and childcare centers. Ghio said these draw essential parallels to the types of rules and standards that could be applied to create a framework for ABA centers while meeting the center’s and its clients’ needs.

Ghio said there’s a placeholder bill already in play regarding the oversight of autism service providers. She said they plan to work with legislators and agencies to implement the changes, some of which can be addressed immediately through statute, like requiring fingerprint background checks on prospective employees and allowing notifications around investigations relating to ABA providers.

The report also recommends setting up a task force with stakeholders from across the field to create a regulatory framework. Ghio said it may take a long time to develop and implement the framework, but it’s essential to get something “as quickly as we can” that is safe and appropriate for the centers and the clients they serve.

“Let’s get a working group, bring everybody together, include a parent, an advocacy organization, a psychiatrist who works with children who received this kind of service, a board certified behavior analyst,” she said. “Let’s get everybody at the table together to really figure out what kind of framework is appropriate for these kinds of providers.”

Access this article at its original source.

Digital Millennium Copyright Act Designated Agent Contact Information:

Communications Director, Connecticut Hospital Association
110 Barnes Road, Wallingford, CT
rall@chime.org, 203-265-7611