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

Delivering Behavior Analytic Services Through Telehealth: Considerations and Best Practices

Overview & Clinical Significance

The delivery of behavior analytic services through telehealth technology represents one of the most significant practice shifts the field has experienced. While telehealth in ABA existed before the COVID-19 pandemic, the rapid transition to remote service delivery beginning in early 2020 forced the profession to develop, refine, and evaluate telehealth models at an unprecedented pace. This session from the CASP Telehealth Task Force, featuring insights from experienced practitioners and researchers, addresses the practical and ethical considerations of delivering ABA services remotely.

The clinical significance of telehealth extends well beyond pandemic-era necessity. Remote service delivery has the potential to expand access to behavior analytic services for families in rural areas where qualified practitioners are scarce, to reduce barriers related to transportation and scheduling, to allow practitioners to observe and provide guidance in the natural environment where behaviors of concern actually occur, and to offer a service delivery model that may be more sustainable for some families than intensive in-person programs.

However, telehealth also introduces challenges that do not exist in face-to-face service delivery. The practitioner's ability to observe behavior directly is constrained by camera angles and technology limitations. The ability to model and physically prompt responses is eliminated. The caregiver's role shifts from observer to active implementer, which may exceed their current skill level or available time. The client's engagement may be more difficult to maintain through a screen, particularly for young children or individuals with limited attending skills.

The clinical significance of the CASP Telehealth Task Force's work lies in its effort to provide evidence-based guidance for navigating these challenges. Rather than simply transplanting in-person practices to a digital platform, effective telehealth requires rethinking how services are structured, how treatment integrity is maintained, and how outcomes are measured. The task force brought together expertise in clinical practice, billing, and service model design to address these issues comprehensively.

For current practitioners, telehealth competence is no longer optional. Even as in-person services have resumed, many families and practitioners have found that telehealth offers advantages worth preserving. Hybrid models that combine in-person and telehealth sessions have become increasingly common. Practitioners who can deliver services effectively through both modalities are better positioned to meet the diverse needs of the families they serve.

Background & Context

The CASP Telehealth Tuesdays series was established during the COVID-19 pandemic as a recurring resource for behavior analytic providers navigating the sudden shift to remote service delivery. The May 26, 2020, session occurred approximately two months into the pandemic-era lockdowns in the United States, a period when providers were actively developing and refining their telehealth practices.

Prior to the pandemic, telehealth in behavior analysis was relatively uncommon and was primarily used to extend services to underserved geographic areas. Some practitioners had experience with remote supervision, consultation, or parent training, but few had delivered comprehensive ABA services entirely through telehealth. The pandemic forced a rapid adoption of telehealth across the profession, creating both challenges and opportunities.

The regulatory landscape for telehealth in ABA underwent rapid changes during this period. Insurance companies that had previously limited or excluded telehealth ABA services expanded coverage. State licensing boards issued emergency provisions allowing practitioners to deliver services remotely across state lines. The BACB provided guidance on telehealth service delivery and supervision. These regulatory changes removed many of the barriers that had previously limited telehealth adoption, though some were temporary emergency measures and their long-term status varied by jurisdiction.

The CASP Telehealth Task Force, which led this session, brought together clinical and administrative expertise to address the practical questions providers were facing. Topics covered in the broader series included how to structure telehealth sessions for different client populations, how to maintain treatment integrity when the practitioner is not physically present, how to handle billing and insurance requirements for telehealth services, how to ensure compliance with privacy and technology requirements, and how to support caregivers in their expanded role as active treatment implementers.

The panelists for this session included practitioners with extensive experience in both clinical practice and service system administration. Their combined expertise in clinical service delivery and healthcare policy provided a comprehensive perspective on the challenges and opportunities of telehealth ABA.

The broader context for this course also includes the ongoing evaluation of telehealth effectiveness compared to in-person service delivery. As the initial emergency period gave way to more deliberate telehealth implementation, the field began generating data on outcomes, family satisfaction, and treatment integrity in telehealth models. This evidence base continues to develop and informs current best practices.

Clinical Implications

The clinical implications of telehealth service delivery affect every aspect of behavior analytic practice, requiring practitioners to adapt their assessment, treatment, and monitoring procedures for the remote context.

Assessment through telehealth requires modifications to standard procedures. Direct observation is constrained by camera placement, video quality, and the physical environment of the family's home. Functional behavior assessments may rely more heavily on indirect methods such as interviews and rating scales, supplemented by direct observation via video when possible. When conducting assessments remotely, practitioners should provide guidance to caregivers on camera placement to maximize the observable area, use multiple assessment sessions to capture behavior across different times and contexts, and supplement video observation with detailed caregiver reports.

Parent-mediated intervention becomes the primary service delivery model in telehealth. Rather than working directly with the client, the behavior analyst coaches the caregiver in real time to implement behavioral procedures. This shift has significant implications. Caregivers need to be trained not only in the specific procedures but also in general behavior management skills, data collection methods, and troubleshooting strategies. The behavior analyst's role shifts from direct implementer to coach and consultant, requiring different communication and instructional skills.

Treatment integrity is a critical concern in telehealth. When procedures are implemented by caregivers rather than trained technicians, the fidelity of implementation may be lower, at least initially. Behavior analysts must develop systems for monitoring treatment integrity remotely, providing real-time corrective feedback, and building caregiver competence over time. Treatment integrity data should be collected regularly and used to guide decisions about when additional caregiver training is needed.

Engagement and motivation may require different strategies in telehealth. Young children and individuals with limited attending skills may have difficulty sustaining engagement with a screen-based interaction. Practitioners should develop strategies for maintaining engagement, including using dynamic and interactive activities, keeping sessions at appropriate lengths, incorporating movement and hands-on activities, and partnering with caregivers to provide immediate reinforcement.

Data collection systems may need to be adapted for telehealth. When the behavior analyst is observing behavior through a video connection, some data collection methods may be less reliable. Consider simplifying data collection protocols, using permanent product measures when possible, and training caregivers to collect supplementary data. Establish inter-observer agreement protocols that account for the limitations of remote observation.

The natural environment advantages of telehealth should not be overlooked. When services are delivered in the family's home via telehealth, the behavior analyst observes behavior in the actual environment where it occurs. This can provide more ecologically valid assessment data and can facilitate generalization of treatment effects because skills are being taught and practiced in the natural context from the outset.

Ethical Considerations

Telehealth service delivery raises several ethical considerations that are addressed by the BACB Ethics Code for Behavior Analysts (2022) and that require thoughtful navigation by practitioners.

Code 2.01 requires practicing within the boundaries of competence. For practitioners who trained and practiced exclusively in face-to-face settings, telehealth represents a different modality that requires additional competence development. Skills in technology use, remote coaching, caregiver training, and telehealth-specific assessment methods must be developed before or during the transition to telehealth service delivery. Practitioners should seek training and supervision specific to telehealth rather than assuming that competence in face-to-face services automatically transfers.

Code 2.03 addresses selecting and designing assessments and interventions based on the best available evidence. The evidence base for telehealth ABA, while growing, is less extensive than the evidence base for in-person services. Practitioners should be familiar with the current research on telehealth effectiveness, including its limitations, and should monitor their own clients' outcomes to evaluate whether telehealth is producing adequate results. When data suggest that telehealth is not meeting a client's needs, practitioners should consider transitioning to in-person services or a hybrid model.

Code 2.04 addresses confidentiality, which has specific implications in the telehealth context. Video connections must be conducted through platforms that meet healthcare privacy standards. Practitioners must ensure that sessions are conducted in private spaces on both ends of the connection. Recordings of sessions, if made, must be stored securely and in compliance with applicable regulations. Families should be informed about the privacy protections in place and any limitations of the technology being used.

Code 2.09 requires meaningful involvement of clients and stakeholders in treatment decisions. The decision to deliver services via telehealth, rather than in person, should be made collaboratively with the family. Some families may prefer telehealth for its convenience and flexibility, while others may feel that in-person services better meet their needs. Families should be informed about the potential advantages and limitations of each modality and should have the opportunity to express their preferences.

Code 2.11 requires informed consent that includes information about the nature of services being provided. When services are delivered via telehealth, the consent process should specifically address the telehealth modality, including the technology platform being used, privacy protections, the caregiver's role in session, and any limitations of the telehealth format. Consent for telehealth should be obtained separately from general service consent.

Code 4.07 addresses supervision, which may also be conducted via telehealth. When supervising remotely, supervisors must ensure that the quality and intensity of supervision are adequate, that they can accurately evaluate the supervisee's performance through the available technology, and that the supervisee has access to support when needed.

Assessment & Decision-Making

Decisions about whether and how to use telehealth should be made based on a systematic evaluation of the client's needs, the family's resources and preferences, and the practitioner's ability to deliver effective services through the remote modality.

The first decision point is whether telehealth is appropriate for the specific client. Factors that support telehealth suitability include the availability of an engaged and capable caregiver who can serve as the in-session implementer, the client's ability to tolerate screen-based interaction for the duration of sessions, treatment goals that can be addressed through caregiver-mediated intervention, adequate technology and internet connectivity in the family's home, and a physical environment that supports the planned activities. Factors that may limit telehealth suitability include the need for physical prompting that the caregiver cannot provide, behavioral challenges that pose safety risks requiring in-person management, limited caregiver availability or capacity, and significant technology barriers.

The second decision point involves session structure. Telehealth sessions typically require shorter duration with more frequent breaks, greater emphasis on caregiver coaching and feedback, more structured planning of activities and materials, and clearer communication protocols to manage the limitations of the medium. Sessions should be planned in advance with the caregiver, including what materials will be needed, where the session will take place, and what the caregiver's role will be during each activity.

The third decision point involves monitoring and evaluation. Establish clear outcome measures at the outset and collect data consistently to evaluate whether telehealth is producing adequate progress. Compare progress rates to what would be expected with in-person services, accounting for the adjustment period inherent in a modality change. If progress stalls or if the family reports dissatisfaction, reassess whether the current telehealth model needs modification or whether a different service delivery modality would be more appropriate.

The fourth decision point involves technology selection and management. Choose a video conferencing platform that meets healthcare privacy standards, is reliable and user-friendly, and is accessible on the devices the family has available. Provide families with clear instructions for setting up and using the technology. Have a backup plan for technology failures, such as a phone number to call if the video connection drops. Test the technology before the first session to identify and resolve any issues.

The fifth decision point involves the hybrid model question. For many clients, the most effective approach may be a combination of telehealth and in-person sessions. In-person sessions may be used for initial assessment, direct skill teaching that requires physical prompting, and periodic treatment integrity checks, while telehealth sessions may be used for caregiver coaching, naturalistic observation, and ongoing consultation. The ratio of telehealth to in-person sessions should be individualized based on the client's needs and the treatment plan.

What This Means for Your Practice

Telehealth is now an established component of behavior analytic service delivery, and developing competence in this modality is a professional responsibility for practitioners who serve families for whom telehealth is relevant.

If you have not yet developed telehealth skills, begin by seeking training specific to telehealth ABA service delivery. The skills required are not identical to those used in face-to-face practice, and assuming they transfer automatically can lead to suboptimal outcomes. Key skills include remote coaching techniques, real-time caregiver feedback delivery, technology management, and adapted assessment methods.

For practitioners who are already providing telehealth services, evaluate your current outcomes. Are your telehealth clients making progress comparable to what you would expect with in-person services? Are families satisfied with the telehealth format? Are you maintaining adequate treatment integrity? If the answer to any of these questions is no, identify the specific barriers and develop solutions.

Consider how telehealth might enhance your practice even when in-person services are available. Telehealth offers natural environment observation opportunities, schedule flexibility, reduced travel time, and the ability to serve families who would not otherwise have access to services. A hybrid model that strategically combines both modalities may provide the best outcomes for many clients.

Stay current with the evolving regulatory landscape for telehealth in your jurisdiction. Insurance coverage, licensure requirements, and practice guidelines for telehealth continue to evolve. Understanding these requirements ensures that your services are both legally compliant and fully reimbursable.

Finally, prioritize the family's experience. Telehealth shifts significant responsibility to caregivers, and this shift must be managed with sensitivity. Provide adequate training and support, check in regularly about caregiver burden, and adjust the service model when needed to maintain a sustainable balance.