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Early Intensive Development and Behavioral Intervention Manual

Early Intensive Development and Behavioral Intervention Manual

Treatment modalities

Page posted: 2/17/17

Page reviewed: 7/2/24

Page updated: 7/1/25

Legal authority

CMS-approved state plan amendment – 2017 (PDF), CMS-approved state plan amendment – 2018 update (PDF), CMS-approved state plan amendment – 2019 update (PDF), Minn. Stat. §256B.0949

Overview

A person may receive treatment intervention according to one of the DHS-recognized treatment modalities.

This page explains the treatment modalities and the process for revising them. For more information about intervention as a covered service, refer to EIDBI – Intervention.

DHS recognizes the following treatment modalities:

  • · Applied Behavior Analysis (ABA).
  • · Developmental, Individual Difference, Relationship-based (DIR)/Floortime model.
  • · Early Start Denver Model (ESDM).
  • · Relationship Development Intervention (RDI).
  • Advanced certification requirement

    All EIDBI provider organizations must have at least one advanced certification provider. That provider is likely a qualified supervising professional (QSP) or level I provider with advanced certification in one of the treatment modalities listed on this page.

    Applied Behavior Analysis (ABA)

    ABA is a set of data-driven practices grounded in behavioral science. Providers can apply this approach to people of all ages.

    ABA focuses on increasing positive and appropriate behaviors through reinforcement while decreasing interfering/unwanted behaviors or behaviors that interfere with learning.

    Under ABA, the provider systematically analyzes factors in the person’s environment that interfere with their success and teaches new and more helpful ways of responding.

    ABA uses a combination of treatment strategies, including:

  • · Discrete trial training (DTT): Breaks down a desired behavior or response into individual steps and teaches each of those steps as a series of trials.
  • · Pivotal response training (PRT): Targets teaching behaviors that make the largest impact on the person’s overall development (e.g., increasing motivation, self-monitoring and functional communication skills).
  • · Verbal behavior intervention (VBI): Focuses on teaching verbal communication skills with the principles of ABA.
  • · Naturalistic teaching (NT): Uses a play-based strategy that follows the child’s lead and incorporates their strengths and interests to create learning opportunities in their natural environment.
  • Certified providers

    For information about provider qualifications, training and locating a provider, refer to the ABA section of EIDBI – Treatment modalities – Certified providers.

    Resources

    For more information, refer to:

  • · Association of Behavior Analysis International (ABAI).
  • · Behavior Analyst Certification Board (BACB).
  • DIR/Floortime Model

    The DIR/Floortime Model provides a framework for a provider to conduct a comprehensive assessment of the person and develop a program tailored to their unique needs and strengths. Providers can apply this approach to people of all ages.

    DIR/Floortime creates opportunities for learning through spontaneous exchanges. These exchanges help the person build critical developmental abilities, including the ability to:

  • · Attend to environments and people in the environments.
  • · Engage and relate to others.
  • · Initiate and respond to communication.
  • · Participate in shared, social problem-solving.
  • · Think and play creatively and flexibly.
  • DIR/Floortime focuses on:

  • · The person’s natural interests and emotions, which have shown to be essential in building on their social, emotional and intellectual skills.
  • · The role of the parent and other primary relationships in the person’s life.
  • Certified providers

    For information about provider qualifications, training and locating a provider, refer to the DIR/Floortime section of EIDBI – Treatment modalities – Certified providers.

    Resources

    For more information, refer to:

  • · Greenspan Floortime Approach.
  • · The Interdisciplinary Council on Development and Learning (ICDL).
  • · Profectum.
  • Early Start Denver Model (ESDM)

    ESDM integrates a relationship-focused, developmental model with ABA teaching practices. The program typically serves children ages 12 to 48 months.

    The program:

  • · Focuses on the powerful pairing of interpersonal exchange and positive affect to promote shared engagement and teach social language and communication skills, play skills, cognitive and motor skills and personal independence.
  • · Supports parents’ involvement.
  • · Is designed to be implemented in natural settings.
  • · Uses behavioral and developmental strategies and increases opportunities to promote typical development.
  • Certified providers

    For information about provider qualifications, training and locating a provider, refer to the ESDM section of EIDBI – Treatment modalities – Certified providers.

    Resources

    For more information, refer to ESDM.

    Relationship Development Intervention (RDI)

    RDI is a family-based, behavioral treatment that builds on the theory that “dynamic intelligence” is key to improving quality of life for people with ASD and related conditions. Providers can apply this approach to people of all ages.

    Dynamic intelligence is the ability to think flexibly and includes:

  • · Appreciating different perspectives.
  • · Coping with change.
  • · Integrating information from multiple sources (e.g., sights and sounds).
  • RDI aims to help people with ASD and related conditions form personal relationships by gradually strengthening their ability to build social connections.

    Certified providers

    For information about provider qualifications, training and locating a provider, refer to the RDI section of EIDBI – Treatment modalities – Certified providers.

    Resources

    For more information, refer to RDIconnect.

    Other approved, evidence-based treatment practices

    In addition to the DHS-recognized modalities, the following evidence-based practices are beneficial throughout any intervention service programming:

  • · Modeling.
  • · Prompting.
  • · Task analysis.
  • · Visual supports.
  • · Reinforcement.
  • Selecting an appropriate treatment model is only the beginning. These evidence-based practices and treatment modalities depend on the skills and education of the provider. The provider must ensure they apply the practices and modalities with high fidelity.

    Autism-Focused Intervention Resources and Modules (AFIRM) are designed to help explain a step-by-step process to plan for, use and monitor an evidence-based practice with people who have ASD from birth to age 22. Supplemental materials and handouts are available for download.

    Revising treatment modalities

    DHS may revise covered treatment modality options (i.e., add or remove options) as needed based on outcome data and other evidence. Anyone can request a revision (e.g., stakeholders, providers, advocates, parents).

    Before revisions in DHS-recognized treatment modalities become effective, DHS must:

  • · Provide public notice of the changes, the reasons for the change and a 30-day public comment period to those who subscribe to the electronic mailing list (i.e., eList). To sign up for the EIDBI eList, refer to the “more information” tab on DHS – EIDBI benefit.
  • · Receive legislative approval for the revisions.
  • EIDBI treatment modalities approved in legislation must:

  • · Cause no harm to the person or the person’s family.
  • · Be individualized and person-centered.
  • · Be developmentally appropriate and highly structured, with well-defined goals and objectives that provide a clear direction for treatment.
  • · Be based in recognized principles of developmental and/or behavioral science.
  • · Use sound practices that are replicable across providers and maintain the fidelity of the specific modality.
  • · Demonstrate the modality is evidence-based.
  • · Have goals and objectives that are measurable, achievable and regularly evaluated and adjusted to ensure the person is making adequate progress.
  • · Be provided intensively with a high staff-to-person ratio.
  • · Include participation by the person and the person’s legal representative in decision-making, knowledge and capacity building and developing and implementing the person’s individual treatment plan (ITP).
  • Proposing new or revised treatment modalities

    If you would like to recommend an additional treatment modality or revisions to the current list, use EIDBI Treatment Modality Change Form, DHS-3807A.

    Additional resources

    CBSM – Person-centered practices
    DHS – EIDBI benefit
    EIDBI – EIDBI services
    EIDBI – Intervention
    EIDBI – Treatment modalities – Certified providers

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