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Bridging the Gap

By December 10, 2017June 24th, 2025No Comments5 min read

By Liliane Deaguiar-Rocha, DBH Candidate

In 2017, the World Health Organization (WHO) estimated that 1 in 160 children worldwide has autism. While this estimate is an average, the prevalence of autism in many developing countries is unknown.

Many factors may account for the uncertain reporting in developing countries, for example, lack of awareness about autism, lack of training in diagnostic tools, infrequent screening, and public policies that do not support services for persons with autism.

In December of 2012, the Law 12.764 granted a person with autism the same rights as any other person with special needs in Brazil, which meant they could now attend regular schools, and request special aides to accompany the students with autism to school. While the law is in place, the reality is far different. In an interview, Dr. Márcia de Aguiar, a psychiatrist from the state of Bahia in Brazil, described a convoluted process, where parents take their child to several specialists before obtaining a diagnosis.  The pediatrician or neuro-pediatrician will make a referral to other providers, such as a speech pathologist and an occupational therapist. Usually there is no care coordination, unless the child’s parents are from the upper class and can afford a clinic with multidisciplinary providers. Many times, when the children go to school, the teachers are not prepared to do any work with them, and they may just spend the day, without much structure, in the company of the aide (M.C.M. de Aguiar, personal communication, April 13, 2017).

In a recent review, Paula, Fombonne, Gadia, Tuchman, and Rosanoff (2011) identified reasons why there are so many deficits in the treatment of autism in Brazil, they attributed the scarcity of robust research

and its presence being limited to two main states to the lack of funding, and suggested that a consequence of this lack of funding was the lack of specialized providers and poor services to the families and children affected by autism. Paula et. al collected data during the first Brazilian Meeting for Autism Research (April 2010) to identify challenges and barriers to autism services and research. Among the identified barriers were a lack of trained clinicians and a lack of campaigns to improve autism awareness and understanding in the public and amongst professionals.

Autism Speaks stated that “behavioral therapies are the foundation of treatment for most children on the autism spectrum” (Autism Speaks, n.d.). The New York State Department of Health (NYSDOH) lists ABA as one of the most effective approaches to treating individuals with autism, and recommends behavioral interventions based in Applied Behavior Analysis (ABA) as a treatment of choice (NYSDOH, n.d.). The Center for Disease Control and Prevention (CDC) also lists ABA as a recommended treatment for people with autism, and describes several ABA techniques that are effective in supporting individuals with autism become more independent and gain behavioral control (CDC, n.d.). However, in Brazil, psychology practice is dominated by psychodynamic approaches, and ABA is not widely utilized. In order to address the lack of clinicians trained in ABA, CGI student, Lili Rocha offered two main services, in Portuguese:

  1. Group Supervision and Professional Networking: a group of recent graduates or professionals who have recently started practicing ABA meet weekly to discuss challenges in their cases and brainstorm interventions that may lead to more adaptive functioning if the clients.
  2. Training in Behavior Analysis and its application: Lili offered an online course on the basic principles of behavioral analysis and its application. This course offered a recorded lecture and a live session where students had the opportunity to discuss cases and application scenarios.

CGI takes pride in the diversity of our student expertise in many fields. The DBH program originally set out to meet the needs of having mental health providers in a medical setting, but since the inception of the program, we have seen a need for diversity and inclusion of various providers other than specialty mental health providers in healthcare settings. Lili is a perfect example of how a non-mental health provider can make a powerful impact in a global healthcare system, and we are proud of her accomplishments!

References:
Autism Speaks (n.d.) Autism therapies and supports. Retrieved from:  https://www.autismspeaks.org/what-autism/learn-more-autism/autism-therapies-supports

Centers for Disease Control and Prevention (n.d.) Autism Spectrum Disorders: Treatment. Retrieved from:
https://www.cdc.gov/ncbddd/autism/treatment.html

New York State Department of Health (n.d.). Retrieved from:

https://www.health.ny.gov/community/infants_children/early_intervention/disorders/autism/ch4_pt2.htm

Paula, C. S., Fombonne, E., Gadia, C., Tuchman, R., & Rosanoff, M. (2011). Autism in Brazil: perspectives from science and society. Revista Da Associação Médica Brasileira (1992), 57(1), 2-5.

The World Health Organization (April 2017). Autism Spectrum Disorders. Retrieved from:

http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en/

Testimonials

“As a member of the AAPI community, I’m very familiar with the barriers to mental health services and the need to break through the glass wall of cultural stigma that prevents many from receiving potentially life–saving treatment. I was the only Asian American person in my master’s cohort, the only Asian American person in many of my clinical work settings, the only Asian American person to walk into many of the professional settings that I pushed myself to show up to. In my current practice, I’m constantly reminded by my patients of how difficult it is to find an Asian American mental health provider, though this reminder constantly informs me that more needs to be done for my community. Day after day, I read stories of Asian American people who die by suicide as a consequence of our culture’s avoidance of mental health topics. As a DBH, my biggest goal is to use my expertise in whole–person care to amplify the conversation around mental health and help my community understand that mental healthcare is not a privilege that we are not entitled to, it is a crucial part of our healthcare that will manifest differently in us than what many Western psychology or psychiatry textbooks will describe, and that our unique experience of mental health issues are valid, important, and is time to be part of the larger conversation.”

Willam Chum, LMHCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 16, 2022

“The Doctor in Behavioral Health (DBH) program has changed my understanding of the subject and career path. Before this academic journey, my knowledge of behavioral health was primarily theoretical, including essential ideas and methods. However, the DBH curriculum combined intense academic research with practical application, helping me understand behavioral health from multiple angles. Recognizing mental health as part of total health changed my perspective. The biopsychosocial model, which showed how biological, psychological, and social variables affect mental health, was stressed in the DBH curriculum. This comprehensive approach made me realize how complex human behavior is and how important it is to address mental health issues. Effective interventions must target the individual’s surroundings, relationships, and life experiences, not just symptoms. The curriculum also gave me enhanced evidence-based practice training to execute successful solutions. Studies methods and data analysis classes improved my critical thinking and allowed me to evaluate and apply behavioral health studies. This gave me the confidence to contribute to the field’s knowledge base through practice and research.”

Dr. Rhea Hill, DBH, LPCDBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - February 17, 2025

“This program will change how you present to the world, not just as a professional but as an individual. Understand this is work but the work is worth it and the journey is undeniably transformative. If you are seeking a doctorate for the title, this is not the program for you. If you are seeking a doctorate to interrupt and disrupt the course of healthcare, then this is the program for you. You won’t find a more supportive program with professors who are dedicated to your success and your education. This program is not about the regurgitation of information. It is about the appropriate applied application of knowledge and information to push forward and become an advocate for equitable and quality care for all.”

Brandy K. Biglow LMHC, CCTP, QSDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 5, 2024

“The Doctor of Behavioral Health (DBH) program has definitely transformed my understanding of behavioral health. Understanding the links between physical and mental health has taught how to make better treatment decisions. The DBH program has also given me insights that otherwise would not be possible and allows me to view individuals through a lens that I was previously ignorant of. This program has helped me grow into a more confident individual, provider, and parent.”

Cory H. Cannady, BCBA, LBADBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 13, 2024

“The DBH program has reinforced my vision of viewing behavioral health (BH) as an integrated component of the healthcare system rather than a siloed service. As a practitioner in the focused BH realm of substance use disorder (SUD) treatment, I observe on a regular basis how identifying and serving SUD patients is often missed, ignored and stigmatized in primary healthcare, despite the fact that early intervention at these check-points often has the potential to intervene earlier and lessen the negative SUD outcomes frequently seen by the time a patient reaches specialty SUD services. Reinforcement received in my DBH program has motivated me to promote integration as a leader in my workplace and is a primary factor in considering the long-term trajectory of my individual career path.”

Kenneth L. Roberts, MPS, LPCC, LADCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - November 5, 2024

“Graduating from the DBH program has influenced and enhanced my approach to addressing behavioral health challenges and making a difference in the field by preparing me to become a serious business owner. Through the DBH program, I understand now that becoming a business owner not only assists me in reaping the financial benefits of working for myself, but the program also offers me a sense of freedom to make a difference in an individual’s life.”

Dr. Rebecca K. Wright, DBH, LBA, BCBA, QBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - December 18, 2024

“I have always wanted to pursue a higher degree but never found a program that met my needs. When I investigated the DBH program, I can honestly say I was excited. It was a program that would expand my knowledge in behavioral health but also how it relates to physical health. The philosophy of treating the whole person was exactly what I was looking for.”

Elizabeth Nekoloff, M.Ed., LPCC-S, NCCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - January 16, 2025

“Prior to obtaining my DBH, I practiced behavioral health within the boundaries of behavior analysis. The DBH degree has given me the ability to broaden my scope of competence allowing me to provide a higher quality of care to my clients through a person-centered approach, while still staying within my scope of practice. I was in the beginning stages of opening my business when I enrolled in the DBH program which set my trajectory towards being a stronger leader. The program equipped me with essential healthcare leadership and entrepreneurial skills, allowing me to ensure high-quality services for my clients and foster a supportive work environment for our staff. It has also given me the confidence to expand my business and pursue other healthcare ventures, reaching a broader range of patients in need.”

Dr. Pauline Tolentino Pablo, DBH, BCBA, IBADBH Alumna, Cummings Graduate Institute for Behavioral Health Studies - January 21, 2025

“Although I have worked with many patients who have mental health diagnoses, or behaviors which make managing their medical diagnoses and day to day life difficult, the DBH program at CGI is broadening that knowledge and providing a deeper understanding of behavioral health and how best to help these individuals manage their health and improve their quality of life. This will allow me to provide and advocate for more meaningful and seamless integrated care, providing new tools for my intervention toolbox, and the confidence and skills to collaborate within and lead whole person focused interdisciplinary teams. I also anticipate building upon my knowledge as a nurse case manager and long time caregiver, as well as my personal passions and professional vision, learning about processes and operations, to be in position to start up and lead my own company one day, offering the services and care I know every person should have access to.”

Hollie Wilson, MSN, RN, CCMDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - February 11, 2025

“The DBH program will open opportunities for me to contribute to healthcare system innovation, particularly through trauma-informed care and integrated behavioral health settings. I will be better positioned to advocate for and implement holistic care models that improve health outcomes for underserved populations. Ultimately, this program will help me transition into higher-level roles, such as a director or consultant in behavioral health, where I can influence broader system changes and contribute to the future of healthcare delivery.”

DeKyn Rashad Peters, MPH-CHES,BSW/BA,APCDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 4, 2025

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