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 →The shift from medical model to social model goal writing is not a wholesale rejection of behavioral measurement—it is a reorientation of what gets measured and why. Practitioners who complete this transition find that the behavioral technology they already have is fully compatible with social model goals; what changes is the upstream process of deciding which behaviors are worth targeting. Al Aqel et al. (2026) documented that how practitioners communicate with families about autism shapes family perceptions and engagement—and goal language is one of the most visible expressions of a practitioner's underlying model. The comparison below illustrates how the two approaches differ across the dimensions most relevant to clinical practice.
| Factor | Evidence-Based Approach | Traditional Approach |
|---|---|---|
| Starting point for goal selection | Medical model: Normative developmental assessment identifies deficits relative to age-matched peers; goals target deficit remediation | Social model: Participation inventory identifies desired activities and environmental barriers; goals target barrier reduction and participation expansion |
| Who defines the target | Medical model: Practitioner and payer criteria drive goal selection; client preference is secondary to clinical and eligibility criteria | Social model: Client and family collaboratively identify priorities; practitioner contributes evidence-based strategies, not the values hierarchy |
| Language of goals | Medical model: Goals often describe behavior reduction, normative compliance, or approximation of neurotypical performance standards | Social model: Goals describe participation, autonomy, communication, and self-advocacy; behavioral topography is secondary to functional access |
| Measurability | Medical model: High measurability; normative criteria provide clear benchmarks for behavior occurrence frequency and accuracy | Social model: Equally measurable using participation-based operational definitions; requires more creative operationalization but no sacrifice in precision |
| Assent alignment | Medical model: Goals may proceed over client resistance if guardian consent is present and clinical justification is documented | Social model: Goals must be endorsed by the client through active assent; client resistance to a goal is treated as information about goal validity |
| Payer compatibility | Medical model: Well-aligned with most current payer authorization language, which uses medical necessity criteria built on pathology assumptions | Social model: Requires translation skills to satisfy payer criteria; practitioners may need to advocate within authorization processes for participation-based goals |
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.