Clark County School District (CCSD), the largest district in Nevada and the fifth largest in the United States, does not allow outside health care professionals to provide medically necessary applied behavior analysis (ABA) services in its classrooms.

ABA is a therapy based on the science of learning and behavior, tailored to an individual with autism spectrum disorder. It is flexible, adaptive and should be provided in many different locations. Dr. Terence McAlister, vice president of Nevada’s Chapter of the American Academy of Pediatrics, said that learning social skills at school — the most structured social learning environment — is difficult for any child with autism “... so having their therapist with them in school where they are trying to learn these behaviors would greatly assist children to master skills they will need for the rest of their lives.”

Several U.S. states — including Colorado, California and Florida — have laws allowing outside providers to deliver ABA services to students at school. Some public schools in Nevada counties (Churchill, Elko, Lander, Lyon, Nye, Storey and Washoe) allow outside professionals to provide ABA services to students in their classrooms.

However, Clark County School District does not. According to internal CCSD memorandums obtained by public information request, CCSD does not allow outside ABA therapists to provide services during the school day and a student will not be excused from missing school to receive outside ABA services, unless a physician writes a letter to the CCSD Board of Trustees advising the student should not or cannot attend school. The memo goes on to state that the school district provides ABA interventions without defining what those interventions are and who provides them.

In 2020, CCSD enrolled 319,917 students in prekindergarten through grade 12. Of those enrolled, 40,020 students, or 12.5 percent, had Individualized Education Plans (IEPs). In that same year, CCSD reported that 16 percent of its enrolled population carried a diagnosis of autism spectrum disorder, totaling 51,186 students. CCSD data also shows that students with disabilities in Clark County were educated in general education classes at a much lower rate than other districts and were more likely to be isolated. They were also more likely to be suspended out of school than students without IEPs.

In February of this year, CCSD had 1,316 teacher vacancies and entered the

2024-2025 school year in August with 1,131 openings. According to its own data, there are currently 389 vacancies for elementary teachers and 272 vacancies for special education teachers.

Most shockingly, across Nevada the 2022-2023 school year saw a marked increase in the use of restraints and aversive interventions on students with disabilities when compared to 2021-2022. Rates of physical restraint increased by 10.72 percent and rates of mechanical restraint increased by 36.84 percent. Additionally, there was a 52.08 percent increase in aversive interventions and the use of non-permissible restraints increased by 40.45 percent.

Considering the special education teacher shortage within CCSD, the significant rise in the use of restraints and aversive interventions on students with disabilities, and the policies keeping outside professionals from providing ABA therapy in school, Clark County children with autism are being set up to fail. Families struggle to coordinate needed care and are competing for extremely limited after-school appointment times from increasingly lower numbers of providers. Considering insurance coverage, transportation, child care, employment, and the number of hours spent in school, families are fighting an impossible battle. The disjointed system is creating a generation of youth with significantly unmet needs. 

Professionals who provide services to individuals with autism have collaborated on a solution, sending a proposal to the Nevada State Legislature for consideration in the 2025 session. Bill Draft 53 aims to ensure that students with autism spectrum disorder have access to ABA therapy in school settings when deemed medically necessary by qualified health care professionals and approved by the child’s parent/guardian. The bill’s intent is to integrate ABA into the setting where the child spends most of their day.

Nevada professionals have collaborated with their counterparts in Colorado, as they most recently enacted Colorado House Bill 22-1260, ensuring students have reasonable access to all medically necessary services in school, including ABA therapy.

The successful passing and implementation of this bill would increase access to ABA services for more than 50,000 students with an autism diagnosis. Families would not need to choose between their child’s education and ABA services, significantly improving attendance rates in this population.

With more students able to learn in general education with appropriate peer models and medically necessary services, there will be increased acceptance and inclusion.

“As a special education advocate and former special education administrator, allowing outside professionals to provide medically necessary ABA services classrooms will mitigate so many issues currently faced by both families and CCSD,” said Mindy Rodrigues-Habib of NEAT Services, a private tutoring and advocacy agency that promotes full inclusion of those with autism in school classes. “Having licensed and skilled professionals addressing a student’s needs in the environment where they spend the majority of their time will lead to increased teacher and staff safety and presumably more time to perform their assigned duties.

Students would be able to get an education in the least restrictive environment without fear of restraints or seclusion from their peers. With the goal of every child receiving a free and appropriate education, I do not see how CCSD can achieve that without ABA professionals in the classroom,” she added.

Professionals who are licensed and registered to provide medically necessary ABA services in Nevada must undergo thorough background checks and maintain all certifications, licensing, registrations and continuing education hours according to their specific credential. These professionals overwhelmingly meet the safety and security criteria for an outside individual entering a CCSD setting.

As health care professionals, privacy is of utmost concern. At no time would an outside ABA professional have access to a child’s medical or education records who is not a client. In addition, adherence to the Health Insurance Portability and Accountability and Family Educational Rights and Privacy acts in regards to their clients are required by such licensed professionals.

CCSD and other school districts in Nevada should not incur any financial cost by allowing outside ABA professionals to provide services in the school setting. All services would continue to be billed to a client’s health insurance policy as they would if services were provided in a clinic, at home or in another community location.

As Clark County health care and education professionals work to ensure every child with autism can receive medically necessary ABA services during school hours, your voice is needed. When some educators have upwards of 47 students in class, one educator or even one educator and one special educator can only meet the needs of some students,” said Laura Jeanne Penrod, a CCSD teacher and the 2024 Nevada Teacher of the Year. “To have additional support with wraparound community organizations and services for students with ABA or behavioral supports, is a necessary step with how quickly Nevada is growing and expanding. Community is part of the support that schools need.”

Contact the authors to stay current on proposals for the 2025 legislative session or to submit supporting comments once the proposal is public.

Samantha Lemons is a board-certified behavior analyst and a licensed behavior analyst in Nevada, Arizona and Washington, and the chief operating officer at Little Lemons Therapy.

Rebeka Acosta is a board-certified patient advocate and the founder of A+J Patient Advocacy, a nonprofit serving children, teens, young adults and their families. She was named Independent Advocate of the Year at the 2023 Healthcare Advocate Summit and recognized as a Vegas Stronger Champion by KTNV-13.

The Nevada Independent welcomes informed, cogent rebuttals to opinion pieces such as this. Send them to [email protected].