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

Increasing Client Participation and Autonomy in ABA Programming: A BCBA's Guide Across Service Settings

Overview & Clinical Significance

The inclusion of clients in their own care planning and programming development is not merely a best practice recommendation — it is an ethical imperative that is increasingly recognized by funding agencies, accreditation bodies, and the BACB Ethics Code itself. Yet in many ABA service settings, clients remain passive recipients of programming designed entirely by professionals, with minimal input from the individuals whose lives are most directly affected by the treatment decisions being made.

This gap between what the field espouses and what it practices has significant clinical consequences. Research consistently demonstrates that interventions developed with stakeholder input — including the input of the individuals receiving services — produce better outcomes, higher levels of generalization, and greater social validity than interventions designed without such input. When clients participate in identifying their own goals, selecting their preferred activities and reinforcers, and evaluating whether the programming is meaningful to them, the resulting treatment plans are more likely to address what actually matters in their lives.

The clinical significance of this topic spans multiple service settings. In school-based ABA services, students may attend IEP meetings but rarely participate meaningfully in the development of their behavioral programming. In residential settings, individuals may have care plans that dictate their daily routines without their genuine input. In adult day habilitation programs, programming may reflect staff priorities more than client preferences. Across all these settings, the behavior analyst has both the opportunity and the responsibility to increase client participation in ways that are meaningful, feasible, and adapted to each individual's communication and cognitive abilities.

The workshop format of this course reflects the practical nature of the challenge. Increasing client participation is not primarily a knowledge deficit — most behavior analysts agree in principle that clients should be involved in their care. The barrier is implementation: practitioners need specific, practical strategies for incorporating client voices into assessment, goal selection, program design, and ongoing evaluation. These strategies must be adaptable across diverse client populations, communication modalities, settings, and institutional constraints.

The movement toward person-centered planning in disability services provides important context for this work. Person-centered approaches, which originated outside the behavior analysis tradition, emphasize the centrality of the individual's own goals, preferences, and vision for their life in guiding all service delivery. Behavior analysts are well-positioned to contribute to person-centered planning by providing the systematic, data-based methodology needed to translate client preferences into achievable behavioral goals and measurable outcomes.

Background & Context

The history of ABA service delivery reflects a gradually evolving understanding of the client's role in their own treatment. Early behavioral interventions were designed and implemented by professionals with little systematic attention to client preferences or participation. The concept of social validity, introduced by Wolf in 1978, represented an important theoretical advance by arguing that the goals, methods, and outcomes of behavioral interventions should be acceptable to the individuals they affect. However, the practical implementation of social validity assessment has often been limited to post-hoc satisfaction surveys rather than genuine integration of client perspectives into the design process.

The BACB Ethics Code has increasingly emphasized client involvement. Code 2.09 requires behavior analysts to involve the client and relevant stakeholders in the development of treatment plans. Code 2.01 emphasizes the right to effective treatment, which includes treatment that is meaningful and relevant from the client's perspective. Code 4.07 addresses the client's right to participate in decisions that affect their services. These provisions create a clear ethical mandate for the kind of client participation this course addresses.

Funding agencies and regulatory bodies have reinforced this direction. The Individuals with Disabilities Education Act (IDEA) requires student participation in transition planning. State developmental disability agencies increasingly require person-centered planning processes that document individual preferences and goals. Insurance companies and managed care organizations expect treatment goals to reflect the client's and family's priorities. These external requirements create both an obligation and an opportunity for behavior analysts to develop genuine client participation practices.

The challenge of client participation varies substantially across settings and populations. A verbal adolescent in a school setting can articulate their preferences and participate in goal setting through conversation. A nonverbal adult in a residential setting requires alternative methods — preference assessments, observational assessment of engagement and affect, choice-making opportunities embedded in daily routines, and alternative communication systems that allow the expression of preferences. A young child may participate through play-based assessment, caregiver-mediated preference identification, and ongoing assent monitoring during treatment sessions.

The literature on self-determination in disability services provides a strong theoretical foundation for this work. Self-determination theory emphasizes that all individuals — regardless of disability — have needs for autonomy, competence, and relatedness. Programming that increases client participation addresses the autonomy need directly, and the resulting improvements in engagement and motivation can enhance competence and social connection as well.

Clinical Implications

Implementing meaningful client participation requires practical strategies adapted to each service setting and client population. In school settings, the behavior analyst can facilitate student participation in IEP meetings by preparing the student beforehand — reviewing goals in accessible language, practicing self-advocacy statements, and using visual supports that help the student understand and express their preferences. For students who cannot attend or participate in formal meetings, the behavior analyst can conduct preference assessments, structured interviews, or observational assessments that capture the student's perspective and present it to the team.

In residential settings, client participation faces institutional barriers that must be addressed at the systems level. Daily schedules, activity options, and programming goals may be determined by staff convenience or regulatory requirements rather than client preferences. The behavior analyst can advocate for systems changes that create space for client choice — offering options within structured routines, conducting regular preference assessments that inform programming, and designing systems for clients to express satisfaction or dissatisfaction with their daily experiences.

In adult day habilitation settings, programming often follows a group model that may not account for individual preferences and goals. The behavior analyst can work within this model by incorporating individualized goals into group activities, offering choices of activities and reinforcers, and systematically assessing each individual's engagement and affect as indicators of whether the programming is meeting their needs.

Adaptations for clients with limited verbal communication are essential. Choice-making opportunities — presenting two or more options and observing the client's selection — can be embedded throughout the day as a primary mechanism for client participation. Visual schedules with choice points, preference assessments using systematic presentation of stimuli, and technology-based options (tablets, AAC devices) for expressing preferences all extend the reach of client participation beyond what verbal communication alone allows.

Role-playing exercises, as featured in this workshop, provide practitioners with the opportunity to practice client participation strategies in realistic scenarios. These exercises build fluency in the specific verbal and nonverbal behaviors needed to facilitate client participation — asking open-ended questions at an appropriate communication level, waiting for responses, accepting preferences that differ from the clinician's own priorities, and incorporating client input into goals and procedures in a genuine rather than token manner.

The concept of assent — the ongoing indication that the client is willing to participate in treatment — is closely related to client participation but distinct from it. Assent monitoring focuses on whether the client continues to engage willingly; client participation extends this by actively involving the client in shaping the treatment they are engaging in. Both are essential, and the behavior analyst should develop systems for monitoring both throughout the treatment process.

Ethical Considerations

The ethical mandate for client participation is clear and multifaceted. The BACB Ethics Code addresses this topic from several angles. Code 2.09 (Involving Clients and Stakeholders) explicitly requires that behavior analysts involve clients and relevant stakeholders in treatment plan development. This is not a suggestion or a best practice — it is a requirement of the professional ethics code. Behavior analysts who develop treatment plans without meaningful client input are not meeting this standard, regardless of how clinically sound the plan may be.

Code 4.07 (Client Rights) affirms the client's right to make choices and express preferences regarding their treatment. This right exists regardless of the client's communication abilities or cognitive level. The behavior analyst's responsibility is to create the conditions under which this right can be exercised — adapting the format, modality, and complexity of participation opportunities to match the individual's abilities.

Code 2.15 (Minimizing Risk of Behavior-Change Interventions) is also relevant. When clients participate in the design of their own programming, the risk of selecting interventions that are unnecessarily aversive, poorly matched to the individual's preferences, or socially invalid is reduced. Client participation functions as a safeguard against well-intentioned but misguided interventions that prioritize practitioner convenience or normative expectations over the individual's own values and priorities.

The concept of dignity is central to ethical client participation. Involving clients in their care respects their dignity as autonomous individuals, regardless of their disability. Conversely, designing and implementing programming without client input treats the individual as a passive object of intervention rather than an active participant in their own life. The field's historical failures in this area — including the use of highly aversive procedures without meaningful consent — underscore the importance of building genuine client participation into the fabric of service delivery.

Power dynamics between professionals and clients must be explicitly addressed. In many ABA service settings, the behavior analyst holds significant power over the client's daily experience — determining goals, procedures, reinforcement systems, and daily routines. This power asymmetry can inhibit genuine client participation if the client perceives that expressing disagreement or dissatisfaction will have negative consequences. Creating a culture of genuine participation requires that practitioners actively invite dissent, respond non-defensively to client feedback, and demonstrate through their actions that client preferences genuinely influence programming decisions.

The tension between client autonomy and clinical judgment deserves honest acknowledgment. There will be situations where a client's expressed preference conflicts with the behavior analyst's clinical assessment of what is in the client's best interest. These conflicts should be resolved through transparent discussion, creative problem-solving, and a presumption in favor of client autonomy unless there are compelling safety or health reasons to override the client's preference. When overriding occurs, the rationale should be documented and the override should be as limited in scope as possible.

Assessment & Decision-Making

Assessing a client's current level of participation in their own care is the first step toward increasing it. This assessment should examine several dimensions: Does the client have opportunities to express preferences about their goals, activities, and reinforcers? When preferences are expressed, are they systematically incorporated into programming? Does the client participate in formal care planning meetings or processes? Are there accessible mechanisms for the client to provide ongoing feedback about their experience?

Preference assessment is the foundational tool for client participation with individuals who have limited verbal communication. Systematic preference assessment methods — including paired stimulus presentations, multiple stimulus without replacement, and free operant observation — identify the reinforcers, activities, and conditions that the individual values most. These assessments should be conducted regularly, as preferences change over time, and should inform goal selection, activity planning, and reinforcement system design.

For clients with verbal communication abilities, structured interviews and self-report tools can capture preferences, goals, and evaluative feedback. These tools should be adapted to the individual's communication level — using simple language, visual supports, and concrete examples rather than abstract questions. Questions like 'What do you want to learn to do better?' or 'What do you like about your program?' or 'What would you change?' can yield valuable information when asked in an accessible format.

Decision-making about how to increase client participation should consider the individual's current abilities, the setting's constraints, and the specific programming decisions where input is most meaningful. Not every programming decision requires the same level of client input. Goal selection and reinforcer identification are high-impact areas where client participation should be prioritized. Procedural details of specific teaching programs may be less accessible to client input, though the client's experience of those procedures (as reflected in engagement, affect, and assent indicators) should always inform decisions.

Systems-level assessment is also important. Do the forms, templates, and processes used in the service setting include structured opportunities for client input? Are staff trained in how to facilitate client participation? Do the incentive structures and time pressures in the setting support or undermine efforts to include clients? Addressing these systems-level factors often has a greater impact than individual-level interventions because it creates the institutional infrastructure for client participation to be sustained over time.

Outcome measurement for client participation should include both process measures (frequency and quality of participation opportunities offered, percentage of goals reflecting client-expressed preferences) and outcome measures (client satisfaction, engagement levels, treatment outcomes for client-selected versus clinician-selected goals). These data help practitioners evaluate whether their efforts to increase participation are producing meaningful results.

What This Means for Your Practice

Client participation in care planning and programming is an ethical requirement of the BACB Ethics Code, not an optional enhancement — behavior analysts must develop systematic methods for incorporating client voices into treatment design across all service settings. Preference assessment is the foundational tool for client participation with individuals who have limited verbal communication — conduct assessments regularly and ensure results genuinely inform goal selection and programming decisions.

Adapt participation methods to the individual's communication modality, cognitive level, and setting — choice-making opportunities, visual supports, AAC-based preference expression, and structured interviews each serve different populations and contexts. Address systems-level barriers to client participation by advocating for institutional processes, templates, and staff training that create structured opportunities for client input. Role-playing and behavioral rehearsal build practitioner fluency in the specific skills needed to facilitate genuine client participation — asking open-ended questions, waiting for responses, and incorporating preferences into programming.

Monitor both assent and participation as distinct but related constructs — assent reflects willingness to engage, while participation reflects active involvement in shaping the treatment. When client preferences conflict with clinical judgment, resolve the tension through transparent discussion with a presumption in favor of client autonomy unless compelling safety or health reasons dictate otherwise. Document the rationale for any decisions that override client preferences.