These answers draw in part from “Virtual Oncology Care Delivery – a 'Nice to Have', or a New 'Standard of Care'?” by Peter Manning, MBA (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 →Caregiver training and coaching are among the most well-suited services for telehealth because the behavior analyst can observe the caregiver implementing procedures in the natural environment while providing real-time feedback. Clinical supervision via video observation of RBT sessions, team meetings and clinical case reviews, and some structured skill acquisition programs also translate well to virtual formats. Services that require physical prompting, complex environmental arrangement, or close observation of subtle behaviors may be better suited to in-person delivery. Many effective service models use a hybrid approach that matches the delivery format to the specific service component.
Evaluate four categories of variables. Client variables: Can the target behaviors be adequately observed via video? Can the client engage through a screen? Are there safety concerns requiring in-person proximity? Caregiver variables: Is a caregiver available, willing, and capable of participating as a mediator? Environmental variables: Is reliable internet available? Is there suitable physical space? Technology variables: Are appropriate devices available? Consider each variable systematically and document your clinical rationale for the delivery format selected.
Key ethical obligations include obtaining specific informed consent for telehealth services (Code 1.11), ensuring that the telehealth format provides effective treatment for the specific client (Code 2.01), practicing within your competence in virtual delivery methods (Code 2.03), selecting assessment methods appropriate for the remote format (Code 2.14), minimizing risks associated with technology and remote observation (Code 2.15), and addressing access equity so that telehealth does not exacerbate disparities (Code 1.07). Each of these obligations requires active assessment and documentation rather than blanket assumptions about telehealth adequacy.
Develop telehealth-specific data collection protocols that account for the limitations of remote observation. Train caregivers or direct service providers in data collection procedures if they will be the primary data recorders during virtual sessions. Conduct regular interobserver agreement checks by having a second observer view recorded or live sessions. Use technology features like screen recording and session replay to supplement real-time data collection. When data quality cannot be maintained at an acceptable level through telehealth, consider whether that service component requires in-person delivery.
Begin by assessing each client's technology access during the intake process. Identify barriers including lack of devices, unreliable internet, insufficient bandwidth for video, and unsuitable physical environments. Develop organizational solutions such as device lending programs, mobile hotspot provision, and partnerships with community organizations that offer internet access. Advocate with payers for reimbursement of technology costs as part of treatment access. Maintain in-person service options for clients who cannot access telehealth. The goal is that the service delivery format is determined by clinical need, not by technology access.
Telehealth-specific consent should cover the nature and format of telehealth services, the technology platform being used and its privacy features, how session data will be transmitted and stored, the limitations of virtual observation compared to in-person services, the client's right to request in-person services, backup plans for technology failures, who will be present in the room during sessions, recording policies, and the potential for emergency situations that cannot be managed remotely. This consent should be separate from general treatment consent and should be reviewed and updated as the telehealth service model evolves.
Telehealth supervision offers flexibility in scheduling and can increase the frequency of supervisory contacts by eliminating travel time. However, it also introduces limitations: camera angles may not capture all relevant aspects of a session, audio quality may obscure verbal interactions, and the supervisor cannot physically intervene if a safety concern arises. Effective telehealth supervision requires explicit protocols for camera positioning, strategies for providing real-time feedback, and criteria for when in-person supervision visits are necessary. A hybrid supervision model that includes both telehealth and periodic in-person observation typically provides the most comprehensive oversight.
Prioritize HIPAA-compliant video platforms with reliable connectivity. Camera quality and positioning are critical for behavioral observation; coach families on optimal camera placement that captures the session environment. Audio quality affects the behavior analyst's ability to hear verbalizations and the caregiver's ability to hear coaching instructions. Screen size matters for observing behavior; laptop or tablet is preferable to phone for the provider end. Have backup communication plans for technology failures, such as a phone call protocol. Test technology before the first session to troubleshoot issues in advance.
Some components of FBA can be conducted effectively via telehealth, including caregiver interviews, record reviews, and indirect assessment measures. Direct observation of behavior via video is feasible for behaviors that are visible on camera and that occur with sufficient frequency to be captured during a session. However, the quality of the observation depends on camera placement, video quality, and the caregiver's ability to manage the environment while the behavior analyst observes. Analog functional analyses that require controlled manipulation of antecedent and consequence conditions are significantly more challenging via telehealth and may require in-person implementation with remote coaching.
Collect outcome data systematically across both delivery formats. Compare skill acquisition rates, behavior reduction trends, and social validity ratings between telehealth and in-person sessions. Use single-case design logic to evaluate whether format changes coincide with changes in progress trajectories. Collect caregiver satisfaction data specific to each format. Monitor treatment integrity data across formats, as implementation differences between telehealth and in-person sessions may account for outcome differences. If telehealth outcomes are consistently lower for a specific client or goal, this is data supporting a format change rather than a treatment plan modification.
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Virtual Oncology Care Delivery – a 'Nice to Have', or a New 'Standard of Care'? — Peter Manning · 1 BACB Ethics CEUs · $30
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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.