An assessment is only useful if it leads somewhere. Once you have reviewed records, interviewed caregivers, observed, and perhaps run a functional analysis, the real question is: what does this person need, and are you the right person to provide it?
Why it matters
Your recommendations shape a client's daily life. Recommend too little and important needs go unmet. Recommend too much and you burden the family's time and resources. Miss a medical, hearing, or mental health concern and you may spend months treating behavior that a different professional could have addressed directly.
In practice questions and real cases, watch for data that point outside behavior analysis, outside your own training, or toward a different level of service. The best decision usually matches the recommendation to the data, keeps the client safe, and brings in the right people without dropping the client.
Key ideas
- Assessment data answer three questions.
- Is behavior-analytic service indicated? Are there socially significant behaviors or skills that environmental intervention can change?
- What should it look like? Which targets, settings, implementers (staff, caregivers, teachers), and intensity fit the needs you found?
- Does anyone else need to be involved? Do the data suggest medical, communication, motor, sensory, or mental health concerns that another professional should evaluate?
- Converge your sources. Base decisions on several kinds of data: records, interviews, direct observation, skill and preference assessments, and functional assessment results. One rating scale or one teacher's comment is not enough to set a service plan.
- Match the level of service to need. Broad deficits across many skill areas may call for a comprehensive program at higher intensity. A limited set of targets, such as one problem behavior and its replacement skill, may call for a focused program. Recommend what the data support, not what a funder approves or a schedule needs.
- Refer when the need is outside behavior analysis. Possible pain or illness, swallowing problems, seizures, hearing or vision concerns, signs of depression or trauma, and speech or motor needs all call for the appropriate professional. You don't diagnose or treat these yourself.
- Refer or get support when the need is outside your competence. A need can sit inside behavior analysis but outside your own training, such as a new population or a specialized procedure. Then you either refer to a qualified behavior analyst or get training, supervision, or consultation before you take it on.
- Referral is often "in addition to," not "instead of." Many clients need behavior-analytic services and another professional at the same time. With the client's or caregiver's consent, share data and coordinate so everyone's work fits together.
- Sometimes the answer is "not now." If the data show behavior analysis isn't needed, or another service should come first, say so, explain why, and help the family find what they need.
- Explain your recommendations in plain language. Share the reasons, options, and likely benefits and costs. Respect the client's and caregivers' choices, and write your reasons down.
Definitions
- Referral: recommending that a client be evaluated or served by another professional whose expertise fits a need you identified.
- Scope of competence: the populations, problems, and procedures you are qualified to handle based on your education, training, and supervised experience.
- Focused services: behavior-analytic treatment aimed at a limited number of targets, often specific problem behavior or a few key skills.
- Comprehensive services: behavior-analytic treatment addressing many skill areas at once, typically at higher weekly intensity.
- Coordination of care: sharing relevant information, with consent, and aligning goals with the other professionals who serve the client.
Examples from a session
Decisions across settings
- Clinic: Assessment of Amara, age 3, shows delays in communication, play, daily living, and social skills, with no problem behavior of concern. Her BCBA recommends a comprehensive program, includes caregiver training, and suggests a speech-language evaluation to support her communication goals.
- School: Diego, 13, has strong academic and social skills. A functional analysis shows that leaving class is maintained by escape from group work. His BCBA recommends focused services: teaching him to ask for a break, adjusting group tasks, and coaching his teacher.
- Home: During intake, Mei's parents describe coughing and gagging at most meals. Her BCBA recommends a swallowing evaluation before any feeding intervention and plans to coordinate with that provider.
- Adult services: Samuel, 38, recently started hitting the side of his head. Staff notice he also tugs at that ear and sleeps poorly. His BCBA recommends a prompt medical checkup for possible pain, keeps collecting data on head hitting, and shares those data with his doctor.
Common mistakes / exam traps
- Treating every concern as a behavior problem. If something biological, sensory, or psychiatric may be involved, refer for evaluation first or alongside your work.
- Letting funding or business needs set the dose. Hours and focus should follow assessment results and the client's needs.
- Diagnosing. Say "these data suggest an evaluation," not "she has depression."
- Deciding without the family. Recommendations should reflect the client's and caregivers' goals, values, and resources.
Exam trap
Outside behavior analysis vs. outside your competence. Ask who could meet the need. If it takes another discipline (a physician, audiologist, or mental health provider), refer to that professional. If a qualified behavior analyst could meet it but you lack training with that population or procedure, get training, supervision, or consultation first, or refer to that analyst. The trap: declining because "ABA doesn't fit" when only your training is missing, or reading up as you go instead of getting support.
Exam trap
Refer and coordinate vs. refer and end. The deciding feature is whether the data still show a behavior-analytic need. If they do, keep serving, keep collecting data, and share them with the other provider with consent. End services only when the data show no need, and then with a planned transition.
Quick check
Nadia, a BCBA, completes a skill assessment with Eli, 4. He follows gestures and picture prompts well but often doesn't respond to spoken instructions, even for items he clearly prefers. His records show no hearing test since birth. What is the best next step?
Related topics
- Reviewing educational, medical, and historical records at intake (F.1)
- Prioritizing socially significant, client-informed, culturally responsive goals (F.8)
- Building and keeping competence through professional development (E.3)
- Recommending interventions: assessment results, evidence, preference, and contextual fit (H.2)
- Collaborating with others to strengthen client services (H.8)