A Proposed Process for Risk Mitigation During the COVID-19 Pandemic
Being called "essential" does not trap you in homes—run a quick risk-benefit check and feel free to use telehealth.
01Research in Context
What this study did
Cox et al. (2020) wrote a how-to guide for BCBAs. They asked: Does the label "essential worker" force us to keep seeing clients in person?
The paper gives a step-by-step risk-benefit checklist. It tells teams to pause, look at infection data, and choose telehealth unless stopping in-person care would cause serious harm.
What they found
The authors found no rule that says "essential" equals "must stay in-home." They show that ethical practice means you may need to stop or switch to telehealth.
The guide puts safety first. If risk outweighs benefit, you suspend services or go virtual.
How this fits with other research
Wine et al. (2022) extends this idea. They ran a school-wide safety program for the students with autism. Staff used behavioral skills training and hit near a large share mask use. Zero COVID cases were traced to the school.
Nijhof et al. (2025) give hard numbers. Autistic adults had 30-a large share higher rates of hospitalization and death from COVID even after adjusting for age and vaccines. This data feeds the risk side of Cox's risk-benefit scale.
Hedley et al. (2021) looked at mental health. Pandemic stress slightly lowered wellbeing and raised depression, but did not increase suicide risk. The small drop in wellbeing helps justify choosing telehealth when infection risk is high.
Why it matters
You now have a clear tool to defend telehealth choices to families and funders. Use Cox's checklist at team meetings. Plug in local infection rates and Dewy's autism risk numbers. If risk is high and goals can be met online, shift to telehealth. If you must stay in person, borrow Wine's behavioral safety tactics to keep everyone safe.
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02At a glance
03Original abstract
Recent executive orders have led some applied behavior analysis (ABA) providers to interpret themselves as “essential personnel” during the COVID-19 pandemic. In this article, we argue against a blanket interpretation that being labeled “essential personnel” means that all in-person ABA services for all clients should continue during the COVID-19 pandemic. We believe this argument holds even if ABA providers are not in a jurisdiction currently under an active shelter-at-home or related order. First, we provide a brief description of risks associated with continued in-person ABA service delivery, as well as risks associated with the temporary suspension of services or the transition to remote ABA service delivery. For many clients, continued in-person service delivery carries a significant risk of severe harm to the client, family and caregivers, staff, and a currently overburdened health care system. In these situations, ABA providers should temporarily suspend services or transition to telehealth or other forms of remote service delivery until information from federal, state, and local health care experts deems in-person contact safe. In rare cases, temporary suspension of services or a transition to remote service delivery may place the client or others at risk of significant harm. In these situations, in-person services should likely continue, and ongoing assessment and risk mitigation are essential.
Behavior Analysis in Practice, 2020 · doi:10.1007/s40617-020-00430-1