This comparison draws in part from “Telehealth and Cultural Adaptations” by Anissa Jepsen, EdD, BCBA, LBA (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 telehealth and cultural adaptations, 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 |
|---|---|---|
| Language Accessibility | Standard: Services delivered in English by default; families with limited English proficiency navigate language barriers as best they can with ad hoc accommodations. | Culturally Adapted Telehealth: Language assessment at intake; certified interpretation services provided; all materials translated before services begin; data collection tools accessible across language backgrounds. |
| Cultural Barrier Assessment | Standard: No systematic assessment of cultural barriers at intake; cultural factors addressed reactively when they produce engagement problems or clinical complications. | Culturally Adapted Telehealth: Structured intake assessment identifies language, beliefs, structural, technology access, and prior service experience barriers; adaptations planned proactively based on identified barriers. |
| Parent Training Delivery | Standard: Parent training uses standardized materials and delivery formats; families are expected to adapt to the training format regardless of educational background, language, or cultural context. | Culturally Adapted Telehealth: Training materials translated and adapted; explanatory frameworks use culturally relevant metaphors; pacing reflects family educational background; role assignments reflect family cultural norms. |
| Goal Selection Process | Standard: Treatment goals selected based on assessment results and clinical priorities; family input incorporated but cultural priority differences may not be systematically explored. | Culturally Adapted Telehealth: Goal selection explicitly explores family-defined priorities within their cultural context; goals reflect both behavioral clinical targets and family cultural values and daily living priorities. |
| Engagement and Retention | Standard: Engagement challenges and dropout attributed to family motivation or compliance; cultural barriers as drivers of disengagement may not be identified or addressed. | Culturally Adapted Telehealth: Engagement challenges assessed for cultural barrier contributions; adaptations revised when engagement data indicates current approach is not working; dropout proactively addressed. |
| Technology Access | Standard: Telehealth assumes adequate technology access; families without reliable devices or internet are accommodated on a case-by-case basis. | Culturally Adapted Telehealth: Technology access assessed systematically at intake; families connected with device and internet resources when barriers identified; alternative delivery options planned where technology barriers persist. |
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 telehealth and cultural adaptations 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.
Telehealth and Cultural Adaptations — Anissa Jepsen · 1 BACB Supervision CEUs · $25
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.
233 research articles with practitioner takeaways
183 research articles with practitioner takeaways
183 research articles with practitioner takeaways
1 BACB Supervision CEUs · $25 · BehaviorLive
Research-backed educational guide
Research-backed answers for behavior analysts
You earn CEUs from a dozen different places. Upload any certificate — from here, your employer, conferences, wherever — and always know exactly where you stand. Learning, Ethics, Supervision, all handled.
No credit card required. Cancel anytime.
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.