This comparison draws in part from “You Down With HRE?: Case Studies In Making ABA More Joyful For All” by Cassidy Myers, 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 you down with hre?: case studies in making aba more joyful for all, 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 |
|---|---|---|
| When appropriate | As the default framework for all ABA service delivery. Particularly critical during initial relationship-building, when working with clients who have histories of aversive treatment experiences, and when addressing behavioral challenges that may be maintained by the aversive properties of the treatment environment itself | When HRE has been established and the client's state is stable, structured instructional demands can be increased gradually. A compliance focus may be temporarily appropriate in genuine safety emergencies where immediate behavioral change is necessary, but should not characterize ongoing treatment |
| Assessment focus | Assesses client emotional and behavioral state (happiness, relaxation, engagement indicators) as a primary treatment variable alongside skill acquisition and behavior reduction data. Environmental conditions are evaluated based on whether they support or undermine the HRE state | Assesses skill acquisition, behavior frequency, and compliance with instructional demands as primary treatment variables. Client emotional state may be noted informally but is not systematically measured or used to guide clinical decisions |
| Ethical alignment | Directly supports Ethics Code provisions on minimizing risk (2.15), providing effective treatment that maximizes outcomes (2.01), and producing results likely to maintain under naturalistic conditions (2.14). Prioritizes client dignity and autonomy by establishing the client's experience as a measurable treatment outcome | May meet procedural standards for evidence-based practice but risks ethical tension when compliance is achieved at the cost of client distress. The focus on behavioral output without equivalent attention to client experience may conflict with the Ethics Code's emphasis on minimizing risk and producing outcomes that serve the client's best interests |
| Treatment environment | The environment is designed to be experienced as positive, predictable, and reinforcing. Session structure begins with establishing HRE conditions, demands are introduced gradually, and environmental modifications are made immediately when HRE indicators decline. The environment is a conditioned reinforcer for approach behavior | The environment is structured around instructional delivery. Session structure may begin immediately with demands, with reinforcement delivered contingent on compliance. The environment may function as a discriminative stimulus for compliance without necessarily acquiring positive emotional valence |
| Client behavior patterns | Clients approach the treatment environment, initiate interaction with therapists, display positive affect during sessions, and demonstrate willingness to attempt challenging tasks. Behavioral challenges during sessions are rare because the conditions that typically evoke them are proactively managed | Clients may comply with demands during sessions but display avoidance behavior during transitions to therapy, emotional distress during challenging activities, and limited spontaneous engagement outside of structured instructional contexts. Compliance under observation may not generalize to unsupervised contexts |
| Long-term outcomes | Skills acquired in HRE conditions are more likely to generalize across settings and maintain over time because the positive associations with the learning context support approach behavior in naturalistic environments. Treatment relationships are experienced positively, supporting continued engagement with services and generalization of therapeutic gains | Skills may be demonstrated during structured sessions but generalization and maintenance may be compromised by the client's negative associations with the learning context. If compliance was maintained by therapist-delivered consequences rather than naturalistic reinforcement, behavior may not maintain when those consequences are removed |
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 you down with hre?: case studies in making aba more joyful for all 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.
You Down With HRE?: Case Studies In Making ABA More Joyful For All — Cassidy Myers · 1 BACB Ethics CEUs · $10
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
233 research articles with practitioner takeaways
231 research articles with practitioner takeaways
1 BACB Ethics CEUs · $10 · 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.