Policy and Funding of ABA Services in Switzerland

At this present time ABA is not a state recognised service discipline in Switzerland. It is applied mainly in the area of EIBI (early intensive behavioural intervention) with children with ASD (Autism Spectrum Disorder) and/or with children, adolescents or adults with ASD other developmental or behavioural disorders. To our knowledge there are no services in the other areas of ABA (see also ABA practice). Today there is a small number of BCBA’s (Board Certified Behaviour Analysts) working in Switzerland (see Practitioners). Currently all practitioners in Switzerland either work privately or bill their services via an alternative profession (e.g. medical/psychological services, special education, speech therapy). There are two centres that offer EIBI services for children with autism: ATZZ Zurich and OVA (see also Providers).

 

The following text is a summary of cited passages out of the article „Implementation of early intensive behavioural intervention for children with autism in Switzerland“ by Nadja Studer et al. (2017) to be found here.

 

Services for children with autism in Switzerland

Health services in Switzerland are provided by public

clinics and hospitals and by private doctors and hospitals.

All 8 million inhabitants living in Switzerland are

covered by a compulsory health insurance. Services for

children with disabilities are organised within the public

sector of the various cantons of the country. Screening

for autism within routine paediatric check-ups in early

childhood is not a standard procedure in Switzerland.

Unfortunately, many paediatricians lack the expertise to

detect the early signs of autism and often advise parents,

who are concerned about the development of their child,

to wait and see how the child develops. This can lead to

a rather late diagnosis and intervention for children with

autism.

 

[…] There are very few specialised interventions available

in Switzerland for children with an early diagnosis. Service

delivery for children with autism depends heavily on

where the family lives. Treatment for a preschool aged

child typically consists of one hour a week of early special

education. In a few regions, up to three hours a

week of early special education intervention is granted.

Furthermore, one or two hours a week of speech therapy

and sometimes an additional hour of occupational therapy

is offered in addition to the hour of special education. Most

of the professionals providing these interventions have little

to no experience working with children on the autism

spectrum. Those professionals that do have experience

usually cannot take in new clients because they have long

waiting lists. According to the recent parent – based report

both preschool and school aged children with autism

receive non- specific treatments like speech therapy and

occupational therapy because these are treatments that are

covered by the insurance companies.

 

[…] In Switzerland, professionals providing EIBI are confronted

with misconceptions and myths similar to those

mentioned in recent reports describing the situation in

other European countries and the US. ABA is

not known as science, it is only known as a form of early

intensive intervention for autistic children. ABA is still

seen as equivalent to discrete trial teaching and not accepted

by many professionals. Very few specialists working

with young children with autism have training in

ABA. Very little ABA is used in schools, most of the

staff that are specialized in autism have training in

TEACCH and the so-called Affolter-model®. The

latter was developed in Switzerland and is based on the

idea that autism is the result of a neuropsychological

problem of perception. It is almost exclusively implemented

in Switzerland. There is only one specialized

school for autistic children in the German speaking part

of Switzerland. This school does not use ABA either and

does not have a Board Certified Behavior Analyst

(BCBA) or Board Certified assistant Behavior Analyst

(BCaBA) staff member or supervisor.

However, the picture exchange communication system

(PECS), a behavioural intervention, is used by some

special education teachers in classrooms and is sometimes

used by early special educators and speech pathologists.

There are only two certified PECS implementers

in the country and both are not BCBAs nor are they

non-certified behaviour analysts. The other professionals

who have taken the basic PECS course do not have in

depth knowledge of ABA either. Since many professionals

using PECS in Switzerland have other theoretical

backgrounds, they often do not use PECS the way a

trained behaviour analyst would. PECS is often confused

with TEACCH and is used to prompt the child’s receptive

language skills or to talk about the child’s day. Systematic

data collection is rarely carried out and the skills

in systematic prompt fading are often insufficient so that

many children are prompt dependent and are left without

an effective form of communication.

 

[…] As of February 2016, there are only eight BCBAs living

in Switzerland and a small additional number living

either in nearby Germany or France and working with

families in Switzerland.

 

[…] The Federal Social Insurance Office selected six centres

in Switzerland to provide early intensive intervention. Not

all approaches are behavioural, two are non-behavioural. In

two of the centres BCBAs are involved in the planning and

implementation of the intensive intervention. In the other

centres psychiatrists, clinical psychologists, special education

teachers, language pathologists and occupational therapists

are in charge of early intensive intervention.

 

[…] This leaves all the families living in the other

cantons paying for over half of the expenses for early intensive

intervention. The service providers try to assist

the families in finding supportive associations that pay

for at least part of the expenses. Since not every family

gets a treatment place in one of the designated centres,

parents have to look for a private EIBI provider and are

left with paying the full cost of the intervention. In conclusion,

despite many years of fighting for an adequate

reimbursement of the high costs of EIBI and despite

various court initiatives, the current situation of financing

early intervention is still very unsatisfactory.

 

[…] Even though a lot has been done for a rather small number

of children and their families, the early intervention

project did not have the kind of impact we had been hoping

for in Switzerland.

 

[…] Because EIBI is mostly not covered by insurance companies

or the government, other Swiss centres have not

adopted the model. There are very few private service

providers serving families with an autistic child in

Switzerland because parents have to pay the program

themselves.

 

[…] Furthermore, the guidelines defined by the Swiss

Federal Social Insurance Office are not meeting the requirements

of internationally accepted guidelines in terms

of credentials and training of experts supervising an EIBI

program as set by the Behavior Analysis Certification

Board (BACB) and defined in the practice guidelines

for ABA and the treatment of ASD (BACB)

designed for funding agencies to set their standards.

 

[…] Also in Switzerland, it would make more sense to set guidelines for supervision according to these international guidelines. Despite of the changes seen in the

last ten years, treatment for a child with autism in

Switzerland still implies a constant battle on all

grounds for the parents. Little has changed in terms of

dissemination and availability. (Studer et al., 2017)

 

References 

Studer, N., Gundelfinger, R., Schenker, T., & Steinhausen, H. (2017). Implementation of early intensive behavioural intervention for children with autism in Switzerland. BMC Psychiatry, 17(1). doi: 10.1186/s12888-017-1195-4