This comparison draws in part from “Transitioning from the Medical Model to the Social Model of Disability: Practicing Affirming Goal Writing” by Mary Rose Winters, 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 transitioning from the medical model to the social model of disability: practicing affirming goal writing, 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 |
|---|---|---|
| Goal Origin | Social model goals originate from the individual's and family's priorities, focusing on what the person wants to achieve and what barriers prevent their full participation in valued activities | Medical model goals originate from professional assessment of deficits relative to developmental or social norms, focusing on bringing the individual closer to typical functioning |
| Language and Framing | Affirming language emphasizes skill development, choice, and participation — 'Client will demonstrate,' 'Client will choose,' 'Client will independently access' | Deficit-focused language emphasizes reduction and remediation — 'Client will reduce,' 'Client will refrain from,' 'Client will eliminate inappropriate behavior' |
| Target Selection | Targets include environmental modifications, accommodation strategies, self-advocacy skills, and functional alternatives that respect the individual's natural behavioral repertoire | Targets focus on individual behavior change, often aiming to replace behaviors deemed atypical with behaviors that approximate neurotypical norms |
| Success Measurement | Success is measured by quality of life, participation in valued activities, self-determination, and stakeholder satisfaction alongside traditional behavioral data | Success is measured primarily by changes in behavior frequency, rate, duration, or latency relative to predefined criteria based on normative standards |
| Client Agency | The individual is an active participant in goal selection, with their preferences and assent guiding the treatment planning process from the outset | The professional identifies targets based on clinical assessment, and the individual's role is primarily to participate in the intervention designed to address those targets |
| Environmental Focus | Assessment and intervention explicitly address environmental barriers — physical, social, and systemic — that limit participation, consistent with behavior analysis's emphasis on environmental determinism | Assessment and intervention focus primarily on the individual, with environmental modifications serving as supports for individual behavior change rather than primary intervention targets |
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 transitioning from the medical model to the social model of disability: practicing affirming goal writing 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.
Transitioning from the Medical Model to the Social Model of Disability: Practicing Affirming Goal Writing — Mary Rose Winters · 2 BACB Ethics CEUs · $30
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.
280 research articles with practitioner takeaways
279 research articles with practitioner takeaways
258 research articles with practitioner takeaways
2 BACB Ethics CEUs · $30 · 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.