By Matt Harrington, BCBA · Behaviorist Book Club · Research-backed answers for behavior analysts
Blanket policies, whether mandating continuation or cessation of all services, fail to account for the enormous variability in client need and risk. An individual requiring hands-on crisis management for life-threatening self-injury faces a fundamentally different risk calculus than an individual working on social skills. Blanket continuation ignores infection risk; blanket cessation abandons clients whose safety depends on behavioral services. Individualized assessment, weighing the specific risks and benefits for each client, produces more ethical outcomes.
The assessment requires evaluating the specific consequences of service disruption for the individual client (severity of potential regression, safety risks, caregiver capacity) alongside the infection risk factors (health vulnerability of the client and family, feasibility of safety protocols, community transmission levels). Clients at high risk from service disruption and low risk from infection exposure have the strongest case for continued in-person services. The analysis should be documented, revisited as conditions change, and conducted in collaboration with the family.
Telehealth is effective for parent training, consultation, data review, and some naturalistic teaching approaches. It is limited or infeasible for interventions requiring physical prompting, crisis management, and direct skill training where hands-on guidance is needed. Technology access disparities also limit telehealth's reach, as families without reliable internet, adequate devices, or sufficient space are effectively excluded. Practitioners should assess each treatment component individually rather than making blanket judgments about telehealth's adequacy.
Crisis conditions introduce new risks, modified procedures, and limitations that families must understand to provide genuine informed consent. Families should be told specifically what the crisis-related modifications are, what the modified service can and cannot accomplish, what additional risks exist, and what criteria will trigger changes to the modified plan. Consent should be revisited whenever conditions change significantly, and families should be reminded that they can withdraw consent at any time without penalty.
Compassion during a crisis is not simply about being kind. It involves recognizing that families and clinicians are experiencing extraordinary stress that affects their capacity, their priorities, and their emotional resources. Compassionate decision-making considers the full context of the family's situation, sets realistic expectations, provides emotional support alongside clinical guidance, and acknowledges that perfect treatment fidelity may not be achievable under crisis conditions without that acknowledgment representing a failure of clinical standards.
Organizations should actively assess which families face barriers to modified service delivery, such as technology access, language barriers, or caregiving demands, and develop targeted solutions. These might include device lending programs, alternative communication channels, in-person services for families who cannot access telehealth, interpreter services, and flexible scheduling. Simply noting disparities without acting to address them fails the ethical obligation to provide equitable access to effective treatment.
The transition back should be gradual, individualized, and preceded by reassessment. Each client should receive an updated evaluation of current functioning rather than automatically resuming the pre-crisis treatment plan. Some crisis-period modifications may have proven effective and worth retaining. Skill regression during the disruption may require adjusted goals. Families may have developed new concerns or priorities during the crisis that should be reflected in the updated plan.
Develop a crisis decision-making template that includes client risk assessment, service modification feasibility analysis, caregiver capacity screening, and documentation protocols. Review your current caseload proactively to identify which clients are most vulnerable to service disruption and which treatment components are most difficult to deliver through alternative methods. Advocate for organizational crisis planning that addresses clinical decision-making, family communication, staff safety, and service reinstatement.
It is an ethical obligation. A practitioner operating under extreme personal stress is at increased risk of impaired professional judgment, reduced empathy, and errors in clinical decision-making. These impairments directly affect client care. Recognizing personal stress, seeking supervision, adjusting caseload when possible, and accessing mental health support are not indulgences but professional responsibilities that protect clients by ensuring the practitioner maintains the level of functioning required for competent practice.
Document the date, client, specific risk assessment conducted, modification implemented, clinical rationale, alternatives considered, family communication about the change, and planned review date. This documentation should be maintained in a dedicated crisis decision log or within the client's clinical record. The goal is to create a clear record showing that each decision was individualized, principled, and monitored. This record serves as protection, as a training resource, and as a foundation for organizational crisis planning improvement.
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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.