The Diversity Is in the Details: Unintentional Language Discrimination in the Practice of Applied Behavior Analysis

Individuals with limited English proficiency face more challenges accessing applied behavior analysis (ABA) than their English-speaking counterparts. Many federal and state laws have been enacted to ensure the civil rights of protected classes, and Section 1557 of the Affordable Care Act (ACA, 2010) builds on those laws and explicitly establishes a cause of action (i.e., a basis to sue) against health care providers, including ABA providers, who discriminate against patients on the basis of race, color, national origin, sex, age, or disability. A patient's language falls under the scope of national origin, and most health care providers, including behavior analysts who deliver ABA as medically necessary treatment, have a duty to ensure that patients who are Limited English Proficient (LEP) have the same access to the provider's services as English-speaking patients. Knowledge of this provision of the ACA is critical to its compliance and, more importantly, to ensuring that behavior analysts rise to the challenge that the goal of true diversity represents. Note: Many terms are used interchangeably to describe insurance carriers, insurance issuers, health plans, and managed care organizations, as well as practitioners of applied behavior analysis. In this article, insurance carriers, insurance issuers, health plans, and managed care organizations are referred to as payors, and practitioners of applied behavior analysis are referred to as behavior analysts or ABA providers.