By Matt Harrington, BCBA · Behaviorist Book Club · April 2026 · 12 min read

Cool Versus Not Cool Procedure via Telehealth: Teaching Conversational Skills to Individuals with Autism

Overview & Clinical Significance

The cool versus not cool procedure is a structured social discrimination program originally developed to address the complex challenge of teaching socially appropriate behavior to individuals diagnosed with autism spectrum disorder (ASD). Unlike traditional social skills curricula that rely heavily on rote memorization or scripted responses, the cool versus not cool procedure leverages discrimination training to help learners identify when a behavior is socially valued versus when it is not. This distinction — what is "cool" and what is "not cool" — maps directly onto naturalistic social feedback that individuals encounter in everyday environments.

In this particular application, the procedure was adapted to teach a highly functional conversational skill: changing the topic or exiting a conversation when bored. This is a nuanced social behavior that requires the learner to read internal states (boredom) and external cues (conversational partner's engagement level) and then execute an appropriate response without being rude or abrupt. The addition of telehealth as the service delivery modality adds another layer of significance, given the rapid expansion of remote service delivery following the COVID-19 pandemic and the ongoing need to validate behavioral interventions in digital contexts.

For BCBAs, this topic is directly relevant to both service delivery and supervision. Many practitioners have been asked to extend their clinical reach through telehealth platforms, often without adequate empirical guidance on which procedures translate well and which require modification. Understanding that a socially complex procedure like cool versus not cool can be effectively implemented via telehealth provides practitioners with evidence-informed confidence to do so. It also invites consideration of how to structure the remote learning environment, manage antecedents and consequences through a screen, and maintain treatment fidelity without in-person prompting capacity.

The study design described in this course also models how practitioners can conduct single-case research in telehealth contexts, which is valuable for behavior analysts interested in contributing to the growing literature on remote ABA service delivery.

Background & Context

The cool versus not cool procedure emerged from a recognition that many social skills interventions for individuals with ASD lacked the discrimination component necessary for generalization. Teaching a learner to say "hello" is straightforward; teaching a learner to recognize when saying "hello" is appropriate versus when it would be socially awkward requires discrimination training. The cool versus not cool framework structures this by explicitly labeling behaviors and then reinforcing correct identification and performance.

Historically, social skills instruction for individuals with ASD has drawn from a range of methodologies including social stories, video modeling, behavioral skills training (BST), the teaching interaction procedure (TIP), and peer-mediated instruction. Each approach has a distinct evidence base and set of implementation requirements. The cool versus not cool procedure adds to this landscape by focusing specifically on the discrimination between appropriate and inappropriate social behavior, using a label system that is concrete and memorable for learners.

The telehealth context for this study reflects a broader trend in ABA service delivery. Telehealth has expanded access to behavior analytic services for families in rural areas, those with transportation barriers, and those navigating public health constraints. However, the empirical literature on telehealth-delivered ABA has historically focused on parent training and coaching models rather than direct skill instruction with the learner. This study extends the evidence base into direct telehealth instruction using a structured social skills procedure.

Changing the conversation when bored is a particularly important target because it reflects a real-world challenge for many autistic individuals, who may perseverate on preferred topics without attending to conversational partner cues. This behavior pattern can negatively affect peer relationships and social inclusion. Teaching flexible conversational behavior requires addressing both the discrimination of conversational context and the execution of appropriate transitional language — a dual-component skill that the cool versus not cool procedure is well positioned to address.

Clinical Implications

For BCBAs providing telehealth services, this course offers several immediately applicable clinical insights. First, the study demonstrates that the cool versus not cool procedure can be implemented with fidelity in a remote format, meaning practitioners do not need to restrict this intervention to in-clinic or in-home settings. This expands the contexts in which social discrimination training can occur and supports continuity of care during transitions between service settings.

Second, adapting the procedure for telehealth requires deliberate attention to how discriminative stimuli are presented on screen. Visual materials used to depict cool versus not cool examples may need to be formatted for digital display, and the practitioner must ensure the learner can clearly see and engage with these materials through video conferencing software. Lag, resolution, and screen size all become relevant variables that the behavior analyst must monitor and troubleshoot.

Third, the specific target behavior — changing the conversation when bored — has strong functional value. When practitioners are selecting social skills targets, the BACB Ethics Code (Code 2.09) requires that goals be based on individualized assessment and be clinically meaningful. Teaching a learner to navigate conversational transitions meets this standard, as it directly impacts social participation and quality of life.

Fourth, this course highlights the importance of programming for generalization from the start. Skills taught via telehealth must transfer to in-person social environments, which differ substantially in sensory input, social complexity, and prompting conditions. BCBAs should build in generalization probes across settings, conversational partners, and topics from the outset of instruction. Telehealth can serve as one context in a matrix of generalization training rather than the sole instructional medium.

Ethical Considerations

Delivering social skills instruction via telehealth introduces ethical considerations that BCBAs must navigate thoughtfully. Under BACB Ethics Code 2.01, behavior analysts are required to provide services only within their areas of competence. For practitioners who have not previously delivered telehealth services, this means acquiring the necessary training in telehealth-specific competencies before implementing procedures like cool versus not cool in a remote format.

Confidentiality is another critical concern under Code 2.05. Telehealth platforms must be HIPAA-compliant, and behavior analysts are responsible for ensuring that sessions are conducted in private settings on both ends of the connection. Parents and caregivers should be educated about the importance of maintaining confidentiality during telehealth sessions, including ensuring siblings or unauthorized individuals are not present in the learner's environment during instruction.

Informed consent under Code 4.02 must explicitly address the telehealth modality. Caregivers should understand that services are being delivered remotely, what platform is being used, how data will be recorded and stored, and what the limitations of the telehealth format might be compared to in-person services. This informed consent process should be documented and revisited if the service delivery model changes.

There is also an ethical dimension to target selection for social skills. Behavior analysts must be careful not to impose neurotypical social norms on autistic individuals without the individual's input and meaningful assent (Code 2.09). The goal of teaching conversational flexibility should serve the learner's own social goals and quality of life, not simply reduce behaviors that neurotypical observers find inconvenient. A value-aligned approach to social skills instruction acknowledges the learner's perspective and involves them in goal-setting to the greatest extent possible.

Assessment & Decision-Making

Before implementing the cool versus not cool procedure, BCBAs should conduct a thorough skill assessment to determine whether the learner has the prerequisite skills necessary for social discrimination training. These prerequisites typically include attending to modeled stimuli, imitation of verbal behavior, receptive identification of labeled stimuli, and basic conversational repertoires. Without these foundational skills, the discrimination training embedded in the cool versus not cool procedure may not be effective.

Functional assessment of the conversational target is also relevant. Understanding why a learner continues discussing preferred topics when conversational partners have disengaged — whether due to skill deficits, motivating operations related to the preferred topic, or lack of sensitivity to social cues — informs how the intervention is structured. If the behavior reflects a skill deficit (the learner does not know how to change topics), then skills training is the appropriate intervention. If the behavior reflects a performance deficit (the learner knows how but does not do so), then motivational variables and reinforcement contingencies need to be addressed.

Data collection in telehealth contexts requires adaptation. Traditional probe data may need to be collected via video observation, and the practitioner must establish a reliable system for coding responses through the digital interface. Structured role-plays conducted during telehealth sessions can serve as probes, and caregivers can be trained to collect naturalistic observation data in the home environment and report back to the BCBA.

Decision rules for the procedure should be established before intervention begins. At what accuracy threshold will training move to the next exemplar set? When will generalization probes be introduced? What criteria indicate mastery and readiness for fading telehealth support? These decisions should be documented in the behavior plan and revisited at regular progress monitoring intervals.

What This Means for Your Practice

The cool versus not cool procedure implemented via telehealth represents a meaningful intersection of two important trends in contemporary ABA practice: the growth of naturalistic social skills intervention and the expansion of remote service delivery. For BCBAs working in outpatient, school, or home-based settings, this course offers a replicable model for extending evidence-based social discrimination training into telehealth contexts.

Practitioners who integrate this procedure should attend to the fidelity requirements carefully. The procedure relies on consistent use of the cool and not cool labels, systematic presentation of exemplars and non-exemplars, and differential reinforcement of correct discriminations. Any drift in these components compromises the discriminative function of the labels and may slow skill acquisition. If supervising RBTs or BCaBAs who are implementing the procedure via telehealth, BCBAs should conduct frequent fidelity checks through live observation or recorded session review.

The broader takeaway for practice is that telehealth need not be a diminished version of in-person services. With careful procedure adaptation, attention to environmental variables on both ends of the connection, and systematic data collection, behavior analysts can implement rigorous, evidence-based instruction remotely. This course contributes to that evidence base and equips practitioners with the confidence and procedural knowledge to do so for social skills targets specifically.

Finally, practitioners should stay engaged with the growing literature on cool versus not cool procedure variations, as researchers continue to extend the procedure to new skill domains, learner populations, and service delivery contexts. Adding this procedure to your clinical toolkit — including its telehealth application — strengthens your capacity to individualize instruction for autistic learners across a wide range of social goals.