This comparison draws in part from “Working Toward Client Involvement in Therapeutic Decisions” by Cody Morris, Ph.D., BCBA-D, 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 working toward client involvement in therapeutic decisions, 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 |
|---|---|---|
| Scope of involvement | Limited to monitoring agreement to participate in specific activities | Encompasses goal selection, procedure choice, pacing, feedback, and treatment planning |
| Timing of involvement | Primarily assessed during active treatment sessions | Occurs throughout the service delivery process from intake to discharge |
| Client agency | Client can agree or disagree with practitioner-designed treatment | Client actively shapes treatment through multiple forms of participation |
| Assessment requirements | Requires assessment of assent and dissent indicators | Requires assessment of communication, decision-making, preferences, and comprehension |
| Skill development focus | May not specifically target skills needed for broader participation | Includes teaching self-advocacy and decision-making as treatment priorities |
| Information yield | Provides data on willingness to participate in current activities | Provides multidimensional data on preferences, satisfaction, and treatment acceptability |
| Ethical alignment | Addresses Code provisions related to assent specifically | Addresses multiple Code provisions including goal selection, informed consent, and client welfare |
| Long-term client outcomes | Protects against coercion during treatment sessions | Builds self-advocacy skills and autonomy that extend beyond the treatment relationship |
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 working toward client involvement in therapeutic decisions 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.
Working Toward Client Involvement in Therapeutic Decisions — Cody Morris · 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.
233 research articles with practitioner takeaways
225 research articles with practitioner takeaways
189 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.