These answers draw in part from “(ENGLISH) Supporting the needs of individuals diagnosed with autism via telehealth: Three case examples (Inglés con interpretación simultánea al español-English with simoultaneous interpretation to Spanish)” by Jennifer McComas, PhD (BehaviorLive), and extend it with peer-reviewed research from our library of 27,900+ ABA research articles. Clinical framing, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →Functional analysis of severe behavior can be conducted via telehealth under specific conditions. The on-site personnel must be thoroughly trained in implementing assessment conditions and safety protocols. Clear criteria must be established for pausing or terminating sessions if behavior escalates beyond safe levels. The video technology must provide sufficient visual clarity for the remote clinician to observe behavior accurately. Backup communication methods must be available if the video connection fails. A comprehensive risk assessment should be completed before initiating telehealth functional analysis, and the decision should be revisited if safety concerns emerge during the assessment. In some cases, a hybrid approach with the initial assessment conducted in person and follow-up sessions via telehealth may be appropriate.
Essential technology requirements include reliable broadband internet with sufficient bandwidth for high-quality video, a HIPAA-compliant video conferencing platform, a high-resolution camera positioned to capture the relevant behavioral context, a microphone and speaker system with adequate audio quality for real-time coaching, and a device with a screen large enough for the clinician to observe behavior details. Additional helpful technology includes a second camera or mobile device for alternative viewing angles, screen recording capability for session review, and a reliable backup communication method such as a phone line. Test all technology before clinical sessions and have contingency plans for common failure scenarios.
Building rapport remotely requires intentional strategies adapted for the telehealth context. Use high-interest activities and preferred items during initial sessions to create positive associations with the telehealth interaction. Maintain a consistent visual presentation including background, lighting, and camera angle to provide predictability. Use exaggerated facial expressions and gestures to compensate for the reduced social information available through video. Keep initial sessions brief and gradually increase duration as comfort develops. Incorporate the client's special interests into session content. If the client has an on-site support person they trust, leverage that relationship to facilitate engagement with the remote clinician. Be patient and recognize that rapport building may take longer via telehealth than in person.
Informed consent for telehealth should include an explanation of the telehealth service delivery model and how it differs from in-person services, technology requirements and the family's responsibilities for maintaining adequate technology, confidentiality considerations specific to telehealth including the security measures used and the importance of conducting sessions in a private space, the contingency plan for technology failures including how the session will proceed if the connection is lost, the circumstances under which the behavior analyst would recommend transitioning to in-person services, the client's and family's right to decline telehealth and request in-person services, and any limitations of the telehealth modality for the specific services being provided. Under Code 2.11, this consent should be obtained before services begin.
Training for on-site personnel should follow a behavioral skills training model: instruction, modeling, practice, and feedback. Provide written protocols that describe procedures step by step. Use video modeling to demonstrate correct implementation. Conduct practice sessions where the on-site person implements procedures while you observe via video and provide real-time coaching. Assess competency through accuracy checks before beginning clinical sessions. Training should cover the specific clinical procedures, data collection methods, safety protocols, technology troubleshooting basics, and communication procedures for reporting observations that may not be visible on camera. Ongoing training and feedback should continue throughout the service relationship.
Communication assessments via telehealth face several limitations. Motor capabilities that affect access to AAC devices may be difficult to assess thoroughly via video. The clinician cannot directly position communication displays or physically prompt communication attempts. Environmental factors affecting communication may not be fully visible on camera. Subtle nonverbal communication behaviors such as gaze shifts and small gestures may be missed. Sound quality limitations may affect assessment of speech production. These limitations can be partially mitigated by using multiple camera angles, having a trained on-site partner who can follow specific assessment instructions, recording sessions for later review, and supplementing live observation with structured interviews about the client's communication in daily routines.
Telehealth practice across state lines requires behavior analysts to understand the licensure requirements in both the state where they are located and the state where the client is located. Many states require the provider to hold a license in the state where the client receives services, regardless of where the provider is physically located. Some states have enacted telehealth-specific exemptions or compacts that facilitate cross-state practice. Requirements have changed frequently in recent years, so behavior analysts should verify current regulations before initiating cross-state telehealth services. Consulting with legal counsel or the licensing board in the client's state is advisable when the requirements are unclear.
Comprehensive contingency plans should address multiple failure scenarios. For video failure with audio maintained, determine which clinical activities can continue with audio-only guidance and which must be paused. For complete connection loss, establish a protocol for the on-site person to follow independently while the clinician reconnects, typically involving a safe pause in any assessment or intervention procedures. Maintain a backup communication method such as a phone number for text or call. Pre-teach on-site personnel what to do if connection is lost during different types of activities, particularly during functional analysis sessions where safety is paramount. Document contingency procedures in writing and review them with on-site personnel before each type of clinical activity.
Vocational training via telehealth leverages the natural environment advantage of remote service delivery. The behavior analyst observes the client in the actual vocational setting via video and provides real-time coaching to on-site support personnel. Key strategies include conducting a thorough task analysis of the vocational activities, training the on-site support person to implement prompting and reinforcement procedures, using video to observe and provide feedback on the client's performance in real time, and developing self-management tools that promote independence. The telehealth modality may actually be advantageous for vocational training because it avoids the social disruption of having a clinician present in the workplace and facilitates coaching in the natural environment where generalization will occur.
Telehealth affects family relationships both positively and negatively. On the positive side, families may find telehealth more convenient, reducing travel time and disruption. The clinician can observe the family in their natural environment, gaining insights that might not emerge in a clinic setting. On the negative side, some families report feeling less connected to their provider via telehealth and may perceive the service as less valuable. Behavior analysts can strengthen the therapeutic relationship by being punctual and prepared for sessions, following up promptly on questions and concerns, maintaining regular communication between sessions, demonstrating genuine interest in the family's experience, and acknowledging the unique challenges of engaging in telehealth while managing a household and supporting their family member.
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Ready to go deeper? This course covers this topic with structured learning objectives and CEU credit.
(ENGLISH) Supporting the needs of individuals diagnosed with autism via telehealth: Three case examples (Inglés con interpretación simultánea al español-English with simoultaneous interpretation to Spanish) — Jennifer McComas · 1 BACB Ethics CEUs · $20
Take This Course →We extended these answers with research from our library — dig into the peer-reviewed studies behind the topic, in plain-English summaries written for BCBAs.
280 research articles with practitioner takeaways
279 research articles with practitioner takeaways
258 research articles with practitioner takeaways
1 BACB Ethics CEUs · $20 · BehaviorLive
Research-backed educational guide with practice recommendations
Side-by-side comparison with clinical decision framework
You earn CEUs from a dozen different places. Upload any certificate — from here, your employer, conferences, wherever — and always know exactly where you stand. Learning, Ethics, Supervision, all handled.
No credit card required. Cancel anytime.
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.