This comparison draws in part from “Who wants to live forever: Using health and wellness routines as contextually appropriate behavior to increase life expectancy and quality of life indicators in clients across the disability spectrum” by Kristina Montgomery, MA, 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 who wants to live forever: using health and wellness routines as contextually appropriate behavior to increase life expectancy and quality of life indicators in clients across the disability spectrum, 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 |
|---|---|---|
| Primary goal | Completing the health routine with compliance | Building toleration and participation skills for long-term independence |
| Approach to avoidance | Override avoidance through prompting, physical guidance, or external management | Address underlying skill deficits and sensory challenges through graduated exposure |
| Client experience | May involve significant distress; routine completed despite resistance | Minimizes distress through systematic desensitization and reinforcement |
| Generalization | Limited; client may tolerate routine only with specific practitioner or under specific conditions | Stronger; skill-building approach targets generalization across settings and providers |
| Long-term outcomes | May require continued external management for each routine occurrence | Builds toward independence and reduced need for support over time |
| Self-advocacy | Client is passive recipient; limited opportunity for communication or choice | Client develops skills to communicate needs, request breaks, and participate actively |
| Caregiver role | Caregiver may be asked to manage or restrain during routines | Caregiver trained in graduated exposure techniques and reinforcement strategies |
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Use this framework when approaching who wants to live forever: using health and wellness routines as contextually appropriate behavior to increase life expectancy and quality of life indicators in clients across the disability spectrum 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.
Who wants to live forever: Using health and wellness routines as contextually appropriate behavior to increase life expectancy and quality of life indicators in clients across the disability spectrum — Kristina Montgomery · 1 BACB Ethics CEUs · $20
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.
279 research articles with practitioner takeaways
258 research articles with practitioner takeaways
252 research articles with practitioner takeaways
1 BACB Ethics CEUs · $20 · 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.