By Matt Harrington, BCBA · Behaviorist Book Club · Clinical decision guide
One of the most consequential decisions a behavior analyst makes is not just what intervention to use, but how to approach the clinical question in the first place. For due diligence, the difference between an evidence-based, individualized approach and a traditional, protocol-driven one can significantly impact outcomes.
This guide lays out the key factors side by side to support your clinical decision-making.
| Factor | Evidence-Based Approach | Traditional Approach |
|---|---|---|
| Session note specificity | Notes describe specific targets addressed, procedures used, client response with data, and clinical decisions; clearly support the billed CPT code | Notes contain general descriptions of the session with minimal operational detail; may not distinguish between different CPT codes |
| Treatment plan quality | Goals are operationally defined with measurable criteria; procedures are specific; service intensity is individually justified | Goals are stated in general terms; procedures listed without implementation detail; service intensity justified with boilerplate language |
| Time documentation | Start and end times recorded for each session; documented activities consistent with total time billed | Time recorded but activities described may not account for the full billed duration |
| Internal consistency | Assessment, treatment plan, session notes, and progress reports tell a coherent clinical story with traceable logic | Documents may reference different goals or use inconsistent terminology, making it difficult to trace the clinical narrative |
| Response to audit | Records can be provided with confidence; minimal additional preparation needed | Audit triggers a scramble to review and potentially supplement records before submission |
| Organizational culture | Documentation quality is monitored through regular internal audits with feedback and improvement tracking | Documentation quality is not systematically monitored; issues discovered only through external findings |
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Use this framework when approaching due diligence in your practice:
Does the data support a need for intervention? Is there a meaningful impact on the individual's quality of life, safety, or access to reinforcement?
YES → Proceed to assessment NO → Document reasoning, monitor
A functional assessment should guide intervention selection. Avoid defaulting to standard protocols without individual analysis. Consider environmental variables, setting events, and private events.
YES → Select evidence-based approach matched to function NO → Complete assessment first
Goals should be co-developed. Assent and informed consent are ethical requirements. The individual's preferences and values matter in selecting both goals and methods.
YES → Proceed with collaborative plan NO → Engage in shared decision-making
This course covers the clinical and ethical dimensions in detail with structured learning objectives and CEU credit.
Due Diligence — CASP CEU Center · 1 BACB Ethics CEUs · $
Take This Course →1 BACB Ethics CEUs · $ · CASP CEU Center
Research-backed educational guide
Research-backed answers for behavior analysts
All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.