Politique et financement des services ABA en Suisse
À l’heure actuelle, l’ABA n’est pas une discipline de service reconnue par l’État en Suisse. Il est appliqué principalement dans le domaine de l’ICIP (intervention comportementale intensive précoce) avec des enfants atteints de TSA (trouble du spectre de l'autisme) et/ou avec des enfants, des adolescents ou des adultes atteints de TSA et autres troubles du développement ou du comportement. À notre connaissance, il n’y a pas de services dans les autres domaines de l’ABA (voir aussi Pratique de l’ABA). Aujourd’hui, il y a un petit nombre de BCBAs travaillant en Suisse (voir Praticiens). Actuellement, tous les praticiens en Suisse travaillent en privé ou facturent leurs services par le biais d’une profession alternative (par exemple, services médicaux/psychologiques, éducation spéciale, orthophonie). Il existe deux centres qui offrent des services ICIP (intervention comportementale précoce et intensive) pour les enfants autistes: ATZZ Zurich et OVA (voir aussi Professionnels).
Le texte suivant est un résumé des passages cités de l’article «mise en œuvre d’une intervention comportementale intensive précoce pour les enfants autistes en Suisse» par Nadja Studer et coll. (2017) à trouver Ici.
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)
Références
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