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By Matt Harrington, BCBA · Behaviorist Book Club · Research-backed answers for behavior analysts

Cool Versus Not Cool Procedure via Telehealth: Frequently Asked Questions for BCBAs

Questions Covered
  1. What is the cool versus not cool procedure and how does it differ from other social skills interventions?
  2. What prerequisite skills should a learner have before starting cool versus not cool instruction?
  3. How is the cool versus not cool procedure adapted for telehealth delivery?
  4. Why is changing the conversation when bored a clinically meaningful target?
  5. What HIPAA and confidentiality considerations apply to telehealth-delivered social skills instruction?
  6. How do you collect data on the cool versus not cool procedure during telehealth sessions?
  7. How do you program for generalization when teaching this skill via telehealth?
  8. What competencies do BCBAs need before providing social skills instruction via telehealth?
  9. How does the cool versus not cool procedure support ethical social skills instruction for autistic individuals?
  10. What does this study contribute to the broader evidence base for telehealth ABA services?

1. What is the cool versus not cool procedure and how does it differ from other social skills interventions?

The cool versus not cool procedure is a social discrimination training program that teaches individuals to distinguish between socially appropriate and inappropriate behaviors using the explicit labels 'cool' and 'not cool.' Unlike social stories, which rely on narrative description, or video modeling, which demonstrates target behavior without discrimination training, the cool versus not cool procedure requires active learner response to labeled exemplars. This discrimination component is considered essential for building flexible social judgment, rather than rote performance of scripted responses.

2. What prerequisite skills should a learner have before starting cool versus not cool instruction?

Learners should demonstrate basic attending, receptive label identification, imitation of verbal and motor behavior, and foundational conversational repertoires before beginning the cool versus not cool procedure. The discrimination training embedded in the procedure requires the learner to observe modeled exemplars, attach the appropriate label, and emit the target behavior. Without these prerequisites, the procedure may need to be preceded by foundational skill instruction in matching, labeling, and listener responding to ensure the learner can benefit from discrimination training.

3. How is the cool versus not cool procedure adapted for telehealth delivery?

Telehealth adaptations include formatting visual materials for digital display, ensuring adequate video resolution for modeling, and structuring role-plays within the video conferencing platform. The practitioner must attend to environmental variables on the learner's end, including distractions, screen positioning, and audio clarity. Data collection may shift from direct observation to video review or caregiver-reported naturalistic probes. The BCBA should conduct a technical dry-run before initial sessions to troubleshoot platform issues that could interrupt instructional flow.

4. Why is changing the conversation when bored a clinically meaningful target?

Perseveration on preferred topics without attending to conversational partner cues is a common behavioral pattern among autistic individuals that can negatively affect peer relationships and social inclusion. Teaching a learner to recognize internal boredom signals and execute appropriate topic transitions directly supports conversational reciprocity, a skill with broad social validity. This target meets the BACB Ethics Code 2.09 standard of clinical meaningfulness because it is tied to outcomes that genuinely improve the learner's social participation and quality of life across natural environments.

5. What HIPAA and confidentiality considerations apply to telehealth-delivered social skills instruction?

BCBAs must use HIPAA-compliant video platforms for all telehealth sessions. Under Ethics Code 2.05, practitioners are responsible for protecting client confidentiality, which includes ensuring sessions are conducted in private spaces, that recordings are stored securely, and that only authorized individuals are present during instruction. Informed consent documentation should explicitly name the telehealth platform and describe data storage practices. Caregivers should be coached on maintaining a private environment on their end to protect the learner's confidentiality during sessions.

6. How do you collect data on the cool versus not cool procedure during telehealth sessions?

Data collection during telehealth sessions can include structured probe trials embedded within role-play scenarios, where the BCBA presents conversational contexts and codes the learner's response as correct discrimination or incorrect discrimination. Practitioners may also review session recordings to code responses not captured in real time. Caregivers trained in basic data collection can provide naturalistic observation data from the home environment. The BCBA should establish clear operational definitions for correct responding that are observable through the video interface to ensure reliable data.

7. How do you program for generalization when teaching this skill via telehealth?

Generalization programming should be built into the intervention from the start rather than addressed after mastery. This includes training across multiple conversational topics, multiple conversational partners (caregivers, siblings, peers), and multiple settings accessible through telehealth and in-person contexts. Practitioners should introduce natural conversational partners into sessions, fade structured prompts systematically, and conduct generalization probes in naturalistic in-person environments. Caregiver coaching to reinforce the skill during daily routines is a critical generalization support.

8. What competencies do BCBAs need before providing social skills instruction via telehealth?

Under Ethics Code 2.01, BCBAs must deliver services within their areas of competence. For telehealth, this includes competence in the specific clinical procedure being delivered as well as telehealth-specific competencies: using the digital platform, adapting instructional materials for remote delivery, troubleshooting technology issues, and training caregivers as in-session supports. BCBAs who are new to telehealth should seek supervision, training, or consultation from practitioners with established telehealth expertise before delivering direct social skills instruction remotely.

9. How does the cool versus not cool procedure support ethical social skills instruction for autistic individuals?

Ethical social skills instruction for autistic individuals requires that goals reflect the learner's own social interests and quality-of-life priorities rather than simply reducing behaviors neurotypical observers find inconvenient. The cool versus not cool procedure can be implemented in alignment with this value by selecting targets collaboratively with the learner and family, framing instruction around the learner's social goals, and ensuring that the behaviors taught are genuinely functional in the learner's social environment. Assent monitoring throughout the procedure is consistent with Code 2.09 requirements.

10. What does this study contribute to the broader evidence base for telehealth ABA services?

This study extends the telehealth ABA literature by demonstrating that structured social discrimination training — not just parent coaching — can be effectively delivered via telehealth with autistic learners. Most prior telehealth ABA research focused on coaching caregivers to implement interventions rather than direct learner instruction. This study provides a procedural model for how BCBAs can conduct direct, structured social skills instruction remotely with fidelity, adding to the growing body of evidence that telehealth can serve as a valid primary service delivery modality for behavior analytic practice.

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Clinical Disclaimer

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.

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