This comparison draws in part from “Supporting Equitable Access to Services with Telehealth” by Karen Nohelty, M.Ed., BCBA (BehaviorLive), and extends it with peer-reviewed research from our library of 27,900+ ABA research articles. The decision framework, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →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 supporting equitable access to services with telehealth, 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 |
|---|---|---|
| Geographic access | Telehealth: Eliminates geographic barriers, enabling access for rural and underserved areas | In-person: Limited by provider availability and client proximity to service locations |
| Technology requirements | Telehealth: Requires reliable internet, compatible device, and video platform familiarity | In-person: No technology requirements for the family |
| Caregiver involvement | Telehealth: Requires active caregiver participation as the hands-on implementer during sessions | In-person: Provider can implement directly while training the caregiver in parallel |
| Environmental control | Telehealth: Limited ability to control the session environment; home distractions common | In-person: Provider can arrange the environment and manage distractions directly |
| Cultural comfort | Telehealth: Some families prefer the privacy of screen-based interaction; others find it impersonal | In-person: Allows relationship-building through physical presence; some families find home visits intrusive |
| Scheduling flexibility | Telehealth: Eliminates travel time, enabling more flexible and efficient scheduling | In-person: Travel time limits the number of sessions per day and scheduling flexibility |
| Physical prompting capability | Telehealth: Physical prompts must be delivered by caregiver with remote coaching | In-person: Provider can deliver physical prompts directly as needed |
| Cost to family | Telehealth: No transportation costs but may incur technology costs | In-person: Transportation costs may be significant for some families |
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 supporting equitable access to services with telehealth 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.
Supporting Equitable Access to Services with Telehealth — Karen Nohelty · 1 BACB Ethics CEUs · $19.99
Take This Course →We extended this decision guide with research from our library — dig into the peer-reviewed studies behind each approach, in plain-English summaries written for BCBAs.
225 research articles with practitioner takeaways
194 research articles with practitioner takeaways
187 research articles with practitioner takeaways
1 BACB Ethics CEUs · $19.99 · BehaviorLive
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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.