One argument that continues to surface in discussions about ABA in Nebraska is this:
Because rural areas face workforce shortages, ABA must rely more heavily on remote supervision to preserve access.
Access challenges in rural Nebraska are real. No serious person denies that. The question is not whether access matters. The question is how it should be addressed.
And whether ABA should be treated differently than every other pediatric medical discipline.
ABA does not operate in isolation.
Before a child receives ABA, a licensed psychologist must complete a diagnostic evaluation. In practice, nearly every child receiving ABA also receives other medically necessary services — most commonly speech-language pathology and occupational therapy, and often physical therapy as well.
Those disciplines face the same rural workforce challenges.
To put numbers behind that reality, I reviewed current state licensing data:
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Psychologists: 624 licensed statewide; 190 (30.4%) located outside Omaha and Lincoln metro areas
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Occupational Therapists: 1,741 licensed statewide; 602 (34.6%) outside metro areas
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Speech-Language Pathologists: 1,539 licensed statewide; 599 (38.9%) outside metro areas
Across these fields, roughly 60–70 percent of providers are concentrated in the Omaha and Lincoln metropolitan areas, primarily Douglas, Lancaster, and Sarpy counties.
Outside those metros, provider presence becomes fragmented.
A few non-metro counties such as Buffalo (Kearney) and Hall (Grand Island) serve as regional anchors, often tied to hospital systems or larger school districts. Beyond those hubs, many rural counties have only one provider in a given discipline — or none at all. In some areas, speech-language services are available only through schools, with no local psychology or occupational therapy presence.
It is also important to note that these figures reflect all licensed providers, not just those practicing in pediatrics. The number of clinicians actually serving children in rural areas is smaller still.
In other words, the workforce distribution challenge is not unique to ABA.
Despite this reality, we do not respond in other pediatric disciplines by lowering clinical standards or defaulting to remote delivery for high-intensity services.
Pediatric psychological evaluations remain overwhelmingly in person. Occupational therapy and speech-language pathology for complex cases rely on hands-on assessment, modeling, and direct clinical judgment. Physical therapy requires physical presence by definition.
These standards exist because the nature of the work requires them.
ABA should not be treated differently.
The argument that ABA must rely more heavily on remote supervision to preserve access assumes that ABA can tolerate a lower or different standard than the other therapies these same children receive. That assumption does not align with how pediatric healthcare functions across the system.
Remote tools can be valuable supplements. They can improve continuity and consultation. But relying on remote supervision as a structural solution to workforce shortages in high-intensity, in-person medical treatment shifts risk onto children and families rather than solving the underlying problem.
If Nebraska wants to meaningfully expand rural access to ABA, there are stronger tools available:
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Targeted student loan repayment or forgiveness for BCBAs practicing in rural areas
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Increased investment in in-state BCBA training pipelines
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Incentives that support sustained clinical presence rather than remote oversight
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Workforce development strategies that mirror what other pediatric disciplines use
Those approaches strengthen the system.
Redefining supervision standards does not.
Children in rural Nebraska deserve the same clinical expectations as children in Omaha or Lincoln. Geography should not determine whether high-intensity medical treatment is delivered under robust oversight or diluted standards.
Access matters.
But so does quality.
And the solution to workforce shortages should be workforce development — not lowering the bar for what counts as supervision.
