Autism Care Demonstration: Successful Discharge Planning

Friday, September 16, 2022

Applied behavior analysis (ABA) providers create and change patient discharge plans throughout a patient’s Autism Care Demonstration (ACD) treatment. These discharge plans help ACD patients meet treatment goals and prepare for life after treatment. Please review the following tips to assist with successful discharges.

When is a patient ready to be discharged?

A patient who meets at least one of these criteria may be ready for discharge.

• The patient met treatment plan clinically necessary goals under the ACD and no longer needs ABA services.
• The patient has not progressed toward achieving goals for several consecutive treatment periods and multiple updates to the treatment plan.
• The patient has not shown consistent benefits from ABA treatment for several consecutive treatment periods and multiple updates to the treatment plan.
• The patient cannot maintain skills taught during ABA treatment in a community setting.
• The diagnosing/referring provider or primary care manager (PCM) no longer recommends ABA treatment for the patient.
• The patient’s diagnosis has changed.
• The patient cannot continue to receive ACD treatment. For example, the patient is no longer eligible, or family problems or other factors will keep the patient from participating.

Developing a Successful Discharge Plan

Incorporating the following can help clear a path toward successful discharge.

• Measurable, achievable goals. Provide specific and detailed goals that are not vague. For example, do not use statements such as “when all treatment goals are met.”
• Definitive timeline. Use statements that detail achievable, realistic treatment milestones. The ABA provider should include goals that will help prepare a patient’s parent/caregiver for teaching ABA skills in the home.
• Individualized discharge criteria. Providers should consider:
  • Specific behaviors keeping a patient from effectively interacting with others in the community.
  • Communication and social skills that will help the patient interact with family and others in the community.
  • How the patient will continue to respond to treatment based on symptom impacts noted so far.
  • A parent’s or caregiver’s ability to incorporate strategies for supporting and maintaining ABA skills.
  • A description of how ABA services will be lessened (for example, by recommended units or going from tiered to sole provider to parent/caregiver training program, etc.).
  • Referrals to non-ABA providers for patients with co-existing non-autism spectrum disorder-related medical conditions.

For more ACD-specific information and tips, visit our Autism Care Demonstration page. For more information on discharge planning requirements, refer to Chapter 18 of the TRICARE Operations Manual.