How to Conduct and Document an Initial Assessment for ABA Services

You passed the exam and secured your dream job. Then the doubt sets in. You don’t know how to actually do anything you learned in school. If this sounds like you, you’re not alone.

Despite fieldwork experience, many new BCBAs feel unprepared to perform the duties of a BCBA. Some agencies offer mentorship for new BCBAs but the reality of clinical work, especially for insurance-funded services, is there just isn’t enough time or resources to offer the support they actually need.

If you never assisted with an initial assessment or you’re curious about how others conduct them, this post will cover the process from after the approval for the assessment to writing the final treatment plan. To keep this simple, let’s make the following assumptions:

• The learner demonstrates maladaptive behavior that interfere with functioning
• The learner’s insurance company approved the request for the initial assessment
• The learner’s caregivers have completed paperwork providing some basic background information
• The learner has a scheduled appointment for the assessment

Contents

Components of an Initial Assessment Before the Assessment At the Beginning of the Assessment Conducting a Behavioral Assessment Choosing a Behavioral Assessment Method Defining Target Behaviors Indirect Behavioral Assessments Direct Behavioral Assessments Data Collection for an FBA Data Analysis Complete the Competing Behavior Pathway to Guide Intervention Selections Documentation of the FBA Skills Assessment Choosing a Skills Assessment Conducting the Skills Assessment Indirect Skills Assessments Direct Skills Assessments Prioritizing Target Skills Based on Assessment Results Documenting the Assessment or Treatment Plan Next Steps

Components of an Initial Assessment

The purpose of the initial assessment is to determine medical necessity and develop a plan for treatment. It provides an opportunity to establish a relationship with the learner and caregivers. It lays the groundwork for the future of ABA services by offering you a chance to show the caregivers their role in services. It’s a critical step in an ABA program.

There are 2 main components of an initial assessment:

• Behavioral assessment
• Skills assessment

Although you will often gather information for both components at the same time and they are interrelated, it’s helpful to think of them somewhat separately. Each component has a slightly different process and workflow. This post will cover the process for each and discuss how they are interconnected. The process often feels overwhelming until you break it down and take it one-step at a time.

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Before the Assessment Day

Your assessment work begins well before the day of the scheduled assessment. The more prepared you are for the assessment, the smoother it’s likely to go. Keep in mind that you have to stay flexible because unexpected situations inevitably pop up. Here are the most important things to do to get ready for the assessment:

• Review records and documentation (intake forms, diagnostic assessment, IEP, etc.) to gain a sense of the learner’s behaviors and potential skill deficits
• Gather materials such as questionnaires, assessment books, paper and pens, exciting toys, and materials that allow for probing skills (picture books, photo cards, sorting toys, etc.)
  • Color coding data sheets or note paper to indicate behavioral or skill assessment notes helps you organize your data, sticky tabs on different data sheets help you find the form you need quickly
• Choose a behavioral assessment method (see details below)
• Choose a skills assessment (see details below)
• Prepare the environment (if available) by sprinkling the room with interesting items, removing distractions, and putting some potential favorites in sight but out of reach

Assessments often don’t go as planned. The documentation you reviewed might paint a picture of the learner that doesn’t align with what you see on the day of the assessment. To account for this, consider developing contingency plans. For example, if the learner demonstrates more communication skills than expected, what extra materials might be needed? If the learner resists engaging with you or responding to questions, what will you do? How will you react if the learner engages in risky behavior?

Spend some time visualizing an ideal assessment, then consider what you will do when different pieces don’t go as planned. As you gain experience, you naturally become better at adjusting your methods to meet the needs of new learners.

Each situation is different but here are some ideas of contingency plans to get you started:

• Switch to a different assessment or jump to a different level in the chosen assessment
• Ask another BCBA or the director for backup (in a clinic) or ask the parent to show you how they respond to risky behavior
• Use images from Google Images on your cell phone
• Ask the parent to probe a skill or encourage the learner to participate
• Pair with the learner and schedule a follow-up assessment
• Ask the parents to collect baseline behavioral data if the learner does not engage in challenging behavior during the assessment

At the Beginning of the Assessment

The beginning of the assessment is your chance to set the stage not only for the assessment but also for ongoing ABA services and parent training. Allow up to 15-30 minutes for this part of the assessment to ensure time to answer any questions the parents have.

This step provides the opportunity for you to:

• Observe how the parents interact with the learner
• Ask questions about the learner’s skills or behaviors
• Discuss the parents’ role in ABA services
• Review any questionnaires you want them to complete
• Build a rapport with the parents

Take time here. Avoid the inclination to sweep the learner off and jump into the assessment.

During this time, let the parents or caregivers know what to expect during the assessment. Some parents don’t know which questions to ask, so anticipate as many relevant questions as you can. Answer questions such as:

• How long will the assessment take?
• What will you do during the assessment?
• Can the parents be in the room during the assessment?
• What will the parents do while you assess the learner’s skills?
• What should the parents do if the learner runs to them or engages in challenging behavior?
• Under what conditions might the assessment end early?
• When should the parents complete any questionnaires given to them?
• Will there be follow-up appointments?
• What happens after the assessment?

Most parents coming in for an assessment have already been through several appointments and assessments but each one is a little different. Avoid assuming the parents know what to expect or do. You might feel tempted to create an FAQ handout to expedite this step, but this conversation builds the foundation for your relationship with the parents. Don’t cut corners.

Finally, let parents know how they can find you if they need you. And now it’s time to begin the main event.

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Conducting a Behavioral Assessment

One of the primary roles of a BCBA is to determine why challenging behavior occurs. This is the foundation for everything else in an effective ABA program. Without accurately identifying the function of challenging behavior, any program you create is likely to fail.

Conducting a behavioral assessment requires the following steps:

• Choosing an assessment method
• Defining target behaviors
• Conducting indirect assessments (records review, questionnaires, interviews, etc.)
• Conducting direct assessments (observations, data collection, etc.)
• Data analysis
• Documenting the assessment

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Choosing a Behavioral Assessment Method

ABA offers several options for directly assessing the occurrence of behavior. In addition to indirect assessment methods, nearly all situations require some form of direct assessment, either a descriptive assessment or an analysis. A descriptive assessment (FBA) observes and measures the occurrence of target behaviors but does not manipulate environmental conditions. An analysis (FA) changes environmental variables and then measures the resulting behavior change.

There are 3 primary methods for assessing the function of challenging behavior:

• Functional Behavior Assessment (FBA)
• Functional Analysis (FA)
• Practical Functional Analysis (PFA)

There are a few variations of these methods including informant-based assessments and brief functional analysis, but the above 3 options are the assessments you will hear the most about. These assessments produce results that vary in both their reliability and intrusiveness.

A Functional Behavior Assessment (FBA) is the most common type of assessment used in applied settings and the one we will go into detail about in this post. According to a survey conducted by Oliver, Pratt, and Normand (2015) , most of the 724 BCBAs who responded to their survey (90%) reported using FBA procedures. Of those BCBAs that responded, fewer than half reported using functional analysis (FA) procedures. In fact, most of the respondents selected “never” or “almost never” to questions related to their use of FAs to identify the function of behaviors.

The article is both interesting and validating since FAs are often considered the “gold standard” for identifying the function of maladaptive behavior. Reasons why BCBAs choose not to utilize FAs varies from insufficient time and resources to ethical concerns about placing learners in contrived stressful situations for the sake of precision when other methods might yield satisfactory results.

Dr. Greg Hanley developed the Practical Functional Assessment that combines critical elements of both assessment methods. This methodology attempts to identify all the possible maintaining variables. Behavior is complex and rarely controlled by a single function. Consider this example:

There is a meeting scheduled at work that you absolutely don’t want to attend. Your presence brings no value to the meeting and you suspect they wouldn’t even notice if you didn’t show up. You decide to skip the meeting and stay home until your scheduled supervision sessions later in the afternoon.

What is the function of your “staying home” behavior? Based on the information provided, you can easily assume that you engaged in the behavior to escape the meeting. Simple right? This is where traditional methods for identifying behavioral function stops, but remember, behavior is complex.

In the above example, what did you do when you stayed home? Did you exist in a vacuum of task avoidance? In reality, you probably escaped to a more preferred task or activity. Maybe you spent some of the time on social media or had coffee with a friend. Maybe you stayed home and binged a favorite show on Netflix. Whenever you engage in an escape behavior, you almost always escape TO something else.

When collecting your ABC data, make sure to note specific items or activities the learner escapes from and what they escape to. The reverse is also true. When a learner engages in maladaptive behavior to access something, they often also end up escaping something else. Include all this data in your analysis. This information allows for more precision in your analysis and plan development.

The chart below shows some important advantages and disadvantages of the different assessment methods.

Assessment Method	Advantages	Disadvantages
Functional Analysis	~Provides greater accuracy, predictive control ~”Gold standard” for identifying function	~Requires extensive training to implement ~Risk of reinforcing undesired behavior ~Need to place learner in potentially stressful situations
Functional Behavior Assessment	~Easier to implement ~Information is gathered from various sources ~More efficient in some circumstances ~Avoids reinforcing potentially dangerous behavior	~Less accurate for identifying function ~Form a hypothesis of function
Practical Functional Analysis	~Demonstrates “control” of the behavior by testing your hypothesis ~Uses an interview to narrow down potential maintaining variables ~Minimizes the risk of placing learner in potentially stressful situations	~Need to attempt to evoke then reinforce challenging behavior ~Training not provided in most graduate programs

For more detailed information about choosing a behavioral assessment method, see our post Behavior Intervention Plan (BIP): The Complete Guide to Writing a Comprehensive Plan . In that post we review the differences between a functional analysis and a functional behavior assessment. We discuss when each would be appropriate.

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Defining Target Behaviors

Before you begin collecting any data, you must define the target behaviors. You may adjust or clarify your definitions over the course of your assessment, but you must know what you’re looking for before you collect data. The information for this definition initially comes from your review of records and any conversations you have with stakeholders (parents, teachers, other caregivers, etc.).

The operational definition should include a specific description of the behavior along with at least 2 examples and non-examples. For more information on writing operational definitions, see our post: Operational Definitions: Clearly Define the Behavior.

Here’s an example of an operational definition:

Flopping: Any instance in which the Julian’s body goes limp resulting in his body in a kneeling or lying flat on the floor position.

Examples Include:

• Falling to his knees while walking in the hallway.
• Moving from standing to lying flat on the floor when given a directive by an adult.

Non-Examples Include:

• Lying on the floor in the motor room as part of a game he is playing.
• Kneeling on his mat at circle time.

To get the information you need to define the behaviors of most concern, during the initial interviews, when speaking with parents, teachers or other caregivers, ask them the following questions:

• What behaviors are you most concerned about?
• Can you describe what it looks like when s/he engages in X behavior?
• Can you provide specific examples of what happens when he engages in X behavior?
• Can you think of examples where someone who doesn’t know him well might think he’s engaging in the behavior but he’s actually not? For example, Johnny is not “hitting” when he attempts to give you a high-five but misses and his hand makes contact with your face.

These questions should be enough to get you started. Avoid the temptation to collect data on every challenging behavior the learner engages in. Try to limit the number of behaviors to no more than 4. Focus on those behaviors that were identified as most concerning. If you try to collect data on everything, you’re likely to miss factors that impact the high-priority behaviors.

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Indirect Behavioral Assessments

Indirect assessments refer to a method of gathering information without directly interacting with or observing the learner. The information is gained through the people who know the learner well in a variety of different environments and situations.

They provide an easy and less time-consuming way to collect information about the learner’s behavior. This information is far less reliable than information obtained through direct assessment. Indirect assessment methods are most valuable when used to narrow the focus of your direct assessment.

Indirect assessments include:

• Parent, caregiver, or stakeholder interviews
• Questionnaires such as the QABF, FAST, or MAS
• Rating scales like the Vineland Adaptive Behavior Scales-3

Indirect assessments help identify:

• Physiological or medical factors that influence behavior
• Common setting events, antecedents and consequences
• Potentially relevant skill deficits
• A history of interventions tried in the past

When conducting an interview, it’s important to allow space for the interviewee to share information freely. Parents may feel embarrassed or judged by their child’s behavior or their response to the behavior. Ask open-ended questions and pause to allow time for the interviewee to think about their answer. Ask enough questions to get useful information but not so many the interviewee feels overwhelmed.

Here are some questions to get you started:

Background questions:

• What is the reason for the FBA? 
• What are the learner’s strengths? 
• What are the learner’s language abilities? 
• How does the learner occupy his/her time? 
• What are the learner’s favorite things? 
• What are the learner’s most concerning behaviors? 
• What do these behaviors look like? 
• Are any of these behaviors potentially dangerous? If yes, please explain 
• Does the learner have any medical or psychological conditions that might contribute to the occurrence of the behavior? If yes, please explain 
• Does the learner take medication that might have side effects that contribute to the occurrence of the behavior? If yes, please explain 

Context questions:

• Are there circumstances in which the behavior(s) always occur? If yes, please explain 
• Are there circumstances in which the behavior(s) never occur? If yes, please explain 
• Does the behavior occur only (or more often) during specific activities? If yes, please explain 
• Does the behavior occur only (or more often) at specific times of the day? If yes, please explain 
• Does the behavior occur only (or more often) in specific locations? If yes, please explain 
• Does the behavior occur only (or more often) in the presence of specific people? If yes, please explain 
• If you needed to make the behavior occur, what would you do? 
• If you needed to make the behavior stop, what would you do? 
• What has been done in the past to help change the behavior? 
• What other information might be helpful in understanding the behavior? 

These questions pull relevant information from the interviewee without leading them to make false assumptions about the answers you’re looking for.

Use this information to guide your direct assessments. Are there activities or times of day that provide the best opportunities to observe the behavior occur naturally? What safety concerns might arise during the assessment that you should prepare for?

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Descriptive Behavioral Assessments

A descriptive assessment observes and measures the occurrence of target behaviors but does not manipulate environmental conditions. The type of data you collect will vary depending on your chosen assessment method. The table below shows they common types of data associated with each assessment method.

Assessment Method	Common Types of Data
Functional Analysis	Frequency, rate or duration
Functional Behavior Assessment	ABC and frequency, rate or duration
Practical Functional Analysis	Latency and frequency, rate or duration

In the case of low-frequency behaviors (behaviors occurring weekly but not daily), train family or other stakeholders to collect the data you need.  There is very little research available to determine function of behaviors that occur at very low frequencies (less than monthly; i.e. running away from home).  A study by Witherup et al. (2008) looked at different ways of measuring low-frequency behavior but did not identify effective methods of determining function of very low-frequency behaviors.

Observing a behavior occur is an important step to determining function. Relying on the reports of others often leads to inaccurate outcomes. When behavior does not occur during your assessment, it’s time to get creative. Consider asking families to place a video recorder in the room where the learner spends the most time and try to capture the behavior that way. The family should trim the recording to remove any personal or irrelevant moments.

Since the FBA is the most commonly used assessment, the rest of the post will primarily refer to this assessment method. If you feel an FA would be a better choice for your learner and you need support with it, seek supervision from an experienced BCBA.

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Data Collection for an FBA

When collecting data for your FBA, it’s best to schedule multiple observations, if possible. Try to schedule the observations during times the learner often engages in the target behaviors. If you are conducting a full initial assessment, you can collect some of this data during the skills assessment, especially if elements of the assessment process (i.e. demands, restricted access to desired items) trigger behavior.

One of the most important types of data you collect is the ABC data. An open-ended ABC data sheet like the one in the example below allows you to describe exactly what happened and what the behavior looked like. The major disadvantage to this type of data sheet is the time it takes to document what happened. While you might have time during some assessments, some learners will make this task very difficult.

An alternative is to use a data sheet like the one below that includes check boxes for common antecedents, behaviors and consequences. This allows you to quickly record and tally each of the variables. The major drawback to this data sheet is the lack of specificity. Consider including an additional column for notes of numbering the rows so you can make corresponding notes on a notepad.

No matter how you collect ABC data, you must be able to categorize the antecedents and consequences during your analysis. When you write long narratives in your ABC data sheets this becomes challenging.

For detailed information about ABC data collection, read our post: ABC Data: The Key to Understanding Behavior .

In addition to ABC data, you need to collect occurrence data. These data are often frequency, rate, or duration data and become your baseline data for your treatment plan or BIP. Carefully consider which type of data method is most appropriate for your learner’s behavior. Our post: Data Collection Methods: Continuous vs Discontinuous Measurement in ABA can help you choose the right data collection method.

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Data Analysis

Data for an FBA comes from at least 3 sources. This ensures an adequate sample of the behavior to build confidence in your diagnosis of the function of the behavior. Most commonly, your data will come from a review of existing records (i.e. incident reports from school), indirect assessments, and finally your direct observation. The data you collect during the observation (the direct assessment) connects with the indirect assessment data to help you form a hypothesis.

Just like we do with our learners, it’s easiest to learn this process if you break it down into a task analysis. Here are the steps for analyzing the data you collected:

• Graph ABC data in a bar graph
• Score and graph data from questionnaires
• Enter data in a scatterplot, if needed
• Complete the problem behavior pathway
• Complete the competing behavior pathway

Take the time to look for patterns in the data. Consciously consider any bias that might influence your diagnosis. Bias in data analysis is common and significant impacts the results of your analysis. The table below shows some of the most common types of bias that arise during data analysis.

Type of Bias	Description	Example
Confirmation bias	highlighting data that supports a predetermined conclusion	the learner’s mother believes he engages in the behavior for attention and you find data that supports that belief
Selection bias	data are collected subjectively leading to misrepresentation	only collecting data that’s easy to access, for example, interviewing the learner’s mother but not his father who lives at home
Outliers	data that are much higher or lower than other data	you conduct 3 observations and during one 5-minute incident at home, the learner engaged in 20 acts of aggression which is 5 times as many as occurred in the total of the rest of the observations combined.
Confounding variables	variables outside of the scope of the analysis influence the data	the learner’s siblings come home at 4 pm during the observation and at the same time his mother tells him to turn the TV off and the learner engages in aggression; assuming a cause-effect relationship between the arrival of the siblings and the learner’s behavior is a bias of confounding variables
Information bias	information is missing or misclassified	when analyzing ABC data, you classify the consequence: “learner’s mother removed the iPad from the learner’s hand” as attention and disregard the removal of the item

The best way to avoid bias is by being aware that it may exist. Question assumptions you make when analyzing the data. Are there other ways to interpret the data you’re analyzing? Below is a breakdown of how to analyze the different types of data.

Graph ABC data in a bar graph

ABC data should be graphed in a bar graph like the one pictured below. Graph setting events (if collected), antecedents and consequences on separate graphs as the x-axis will be different for each.

Begin by creating general categories for the setting events, antecedents and consequences. Here are some examples of categories for each:

Common setting events:

• Hungry
• Tired
• Specific person present
• Specific person absent
• Change in medication

Common antecedents:

• Demand
• Item restricted
• Attention restricted
• Unstructured time
• Transition

Common consequences

• Escaped demand
• Reprimand
• Discussion
• Item removed
• Ignored the behavior/restricted attention

Once you have each category determined, tally each of the incidents that fit into each category. Then, enter that information into a bar graph. The tally marks in the image below correspond with the bar graph also pictured below. The x-axis depicts the possible antecedents and the y-axis represents the total number of observed incidents corresponding with the antecedent.

Score and graph data from questionnaires

There are several commonly used questionnaires to help you diagnose behavioral function including:

• Questions About Behavioral Function (QABF)
• Functional Assessment Screening Tool (FAST)
• Motivation Assessment Scale (MAS)

They each serve essentially the same purpose so it’s unnecessary to use more than one. These data should also be graphed on a bar graph since it does not depict changes in the behavior over time. The x-axis depicts the possible functions and the y-axis is the average score (or total score depending on the questionnaire) for each function.

Enter data in a scatterplot

Scatterplot data help you identify if time of day, day of the week, or specific activities play a role in the occurrence of target behaviors. Scatterplots require someone to reliably collect data over the course of a week or more so realistically they may not be a part of your initial assessment. Schools often keep an ongoing record of behavior that results in disciplinary action. If these data are available and the behaviors occur at a high enough frequency, enter them into a scatterplot to look for patterns.

The image below is an example of a scatterplot over a 1 week period of behavior occurring with a preschool-aged child. Data were collected at home, in the daycare setting, and in the community. No data were available from his preschool program.

In analyzing the data below, you can see that the target behavior, “tantrums”, occurred across environments and was most consistently observed from 7-8 pm. When looking at the data, ask the following questions:

• What time of day is the behavior least likely to occur?
• What is going on during that time?
• What time of day is the behavior most likely to occur?
• What is doing on during that time?
• What day of the week is the behavior most likely to occur?
• Is there anything that happens differently on that day?

The answers to these questions may provide valuable insight into factors that impact the learner’s behavior.

Complete the Problem Behavior Pathway

The next step is to put it all together to get a clear picture of when the behavior is most likely to occur. This step allows you to take an objective look at your data to form your hypothesis of the function of the target behaviors. Use the Problem Behavior Pathway (pictured below) as a guide. The final column, the Maintaining Consequences, is the function of the target behavior or what the learner “gets” by engaging in the behavior.

Fill in each of the boxes using the patterns you found in the behavior data. When completing the problem behavior pathway, fill in the blanks for the following sentence: when _ happens, learner _ in order to _.

Include common setting events as you will use this information when completing the Competing Behavior Pathway in the next step. List the most common antecedent based on the data you collected. Include all the behaviors that occur in the context you’re describing, even if they don’t co-occur in every incident. Finally, describe the consequence that maintains the target behavior(s). See the example below where the learner engages in 3 different target behaviors within this one context.

If the learner engages in the same target behaviors in a different context (different antecedents and consequences), complete a separate pathway for that context. See the example below.

Setting Events	Triggering Antecedents	Problem Behavior	Maintaining Consequences
Target behaviors are more likely to occur when Joe is hungry, especially if it has been longer than 2 hours since he last ate	When Joe is told he can’t have something he wants	he engages in yelling, aggression and property destruction	to gain access to the item or activity he requested.

If the learner engages in different target behaviors in another context, complete a separate pathway for those behaviors and the related context. See the example below.

Setting Events	Triggering Antecedents	Problem Behavior	Maintaining Consequences
Target behaviors are more likely to occur when Joe is hungry, especially if it has been longer than 2 hours since he last ate.	When attention is directed away from Joe such as when his parents are busy making dinner or helping his siblings	he engages in SIB, usually head banging	to gain access to his parents’ attention.

Avoid the temptation to complete this process for every possible behavior and context.  The point of the exercise is to arrive at the most common context, but it’s possible that to address the most serious behaviors, you may need to consider more than just one context. When you’re done, move on to complete the Competing Behavior Pathway.

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Complete the Competing Behavior Pathway to Guide Intervention Selection

The Competing Behavior Pathway is a visual representation of the learner’s target behavior with the current maintaining variables and a more desirable pathway that includes functionally equivalent replacement behaviors. The pathway (see the image below) includes space for both:

• Replacement Behavior-an acceptable alternative to the target behavior (usually a communicative response) that allows the learner to access the maintaining consequence
• Desired Behavior-the terminal response that will take the place of the target behavior (this often involves some sort of tolerance)

The top row of the pathway comes from the Problem Behavior Pathway. List the most common setting event, antecedent, behaviors (that occur in this context) and consequence.

Next, identify the replacement behavior. This might not be what you ultimately want the learner to do in this context, but it provides the learner with a better way to get what he/she wants without engaging in the target behavior. This behavior is an intermediate step to your end goal. This should always directly relate to the function of the target behavior.

Finally, the bottom row of the pathway includes accommodations or interventions you recommend to help the learner make the leap from the Replacement Behavior to the Desired Behavior. See the example below.

It might feel somewhat redundant to complete both the Problem Behavior Pathway and the Competing Behavior Pathway. When you start conducting FBAs on your own, it’s good practice to follow each of these steps. Slowing down the process by completing each step allows time to fully consider the environmental factors that impact the learner’s behavior.

As you gain more experience in conducting FBAs, some of these steps may become more automatic. You might choose to think through these steps rather than write them down. This chart won’t go in your final report but it is an important part of the process.

In the end, do what works best for you. You must process all the information you gathered and determine “what’s in it” for the learner or what s/he is communicating with their behavior (the function). As long as you get to the answer, the format of these 2 steps is mainly irrelevant.

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Documentation of the FBA

Documenting the FBA might feel like a daunting task. You collected a lot of information, compiled it in meaningful ways and analyzed it to identify the maintaining variables of the target behavior(s).

The good news is that you now have all the information you need and you will now just be plugging that information into a template. If you work for an agency, they likely have a template with their letterhead/branding that they want you to use. Most templates include the same or similar information including:

• Demographic information
• Reason for referral
• Background information
• Information sources
• Indirect assessment details
• Direct assessment details
• Definition of target behaviors
• Learner strengths
• Summary with hypothesis statement
• Recommendations

Scroll through the images below to see an example of a completed FBA documented. Note that this is a fictional example and you should include as many details from your interviews and observations as necessary to capture what took place. This example is 9 pages long but yours may be significantly longer.

The sequence of the information may vary depending on what makes the most sense to you. Generally, as long as the information is there and easy to find, the order is unimportant. Think of it as telling a story about the learner as well as your process of determining the function of target behaviors and relevant replacement behaviors and recommended interventions.

You want to include all relevant details without adding extraneous information. Include details such as:

• Description of the environment
• Number of people present and their relationship to the learner
• Overall activity and noise level in the environment (if it’s relevant)
• Presence of any previously identified potential triggers (objects or people that might trigger behavior)
• Absence of any desired objects or people that might relate to behavior
• Interactions between the learner and the environment or people
• Interactions between the other people in the environment that might be relevant
• Activities other people are engaging in that might be relevant
• Any relevant sensory stimulation in the environment
• The absence of preferred sensory stimulation if relevant

Avoid including any of the above details if they don’t appear to impact behavior. For example, if you’re observing in the classroom setting and the teacher provides help to a student next to your learner and the learner does not react in any way, it’s probably not relevant or necessary to include this in your documentation. If you’re not sure a detail is relevant, go ahead and include it.

In your documentation, don’t include:

• The names of other children outside of the family unit (i.e. peers at school)
• Subjective information such as how you believe the learner felt (unless the learner reports a specific feeling)
• A complete chart of all ABC data collected (unless specifically requested by your funder)
• Irrelevant details about the learner’s life such as information about their pet goldfish they don’t interact with

Your documentation should be both thorough and concise. Include enough information to describe the maintaining variables without adding any fluff.

Should you use jargon in your report?

To use jargon or not to use jargon, that is the question. When writing your report, use language appropriate to your audience. Who will read your report? The most common audiences for your reports will be:

• Funders (insurance companies)
• Schools
• Parents
• ABA professionals
• Other professionals outside the field of ABA

While you want your report to appear professional, you also want the reader to understand what you write. This makes the language you choose incredibly important. If your report is intended primarily for other BCBAs or ABA professionals to help them understand the learner’s behavior, it’s fine to include jargon.

If the report is intended for anyone outside of the field, it’s critical that you use common vernacular so the reader understands what you’re saying. The report helps no one if the reader doesn’t understand what you write.

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Skills Assessment

The second main component of your initial assessment is a skills assessment. Generally speaking, this assessment should help you identify skill deficits that might contribute to the learner engaging in the target behavior(s), especially if the service you’re providing is paid for by an insurance company.

Conducting a skills assessment requires the following steps:

1. Gathering background information
2. Choosing an assessment
3. Conducting the assessment
4. Prioritizing target skills based on assessment results
5. Documenting the assessment or writing a treatment plan

The skills assessment involves fewer steps than the FBA but it’s critical to developing a comprehensive treatment plan. Learners engage in challenging behavior because they lack the skills to do better. As notable psychologist Dr. Ross Greene said, “kids do well if they can.” It’s the job of the skills assessment to figure out what skills the learner is missing.

Kids do well if they can.

Dr. Ross Greene

In the video below, Dr. Stuart Ablon discusses this concept in a compelling TEDX Talk. He helps create a frame for thinking of challenging behavior as related to the learner’s skill deficits. Adopting this frame before conducting a skills assessment encourages you to look for the connection between the learner’s behaviors and skill deficits.

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Gathering Background Information

Background information helps you prepare for the assessment. You get a general sense of the learner’s strengths and specific areas of need. Parents, caregivers and other stakeholders have the opportunity to share their concerns.

Look for information that influences the learner’s behavior and skill development. Consider the impact of the learner’s past experiences on your current assessment.

To gain insight into the learner’s background, ask questions such as:

• Who lives at home with the learner?
• If both parents don’t live in the home, what are the custody arrangements, if any?
• What are the names and ages of the learner’s siblings, if any?
• Does the learner have any history of abuse, neglect or trauma?
• What first initiated the evaluations for a diagnosis?
• Does the learner have any medical concerns or additional diagnoses?
• Does the learner have any physical challenges that would prevent him from participating in services?
• Does the learner attend school? If yes, what type of supports does s/he receive?
• Does the learner have a history of engaging in risky behavior?
• Does the learner take any medications?
• What is the learner’s history of services including any services provided at school (i.e. speech, OT, PT, ABA, etc.)?
• What is the learner’s most pressing need at this time?
• How does the learner communicate?
• Describe the learner’s interactions with others in the home.
• Does the learner participate in family activities such as having a meal, playing a game, completing chores, etc.
• Describe any challenging behaviors that interfere with learning or participating with the family or at school.

Much of this information will be included in reports from other providers such as the IEP or the diagnostic assessment. Take time with parents or caregivers to give them a voice in the assessment and to make sure all the information is accurate and up-to-date. If the learner has the ability, include him/her in the conversation. Let them speak about their experiences and goals.

Choosing a Skills Assessment

Numerous skills assessments are available to help you identify your learner’s current abilities. This is a quick overview. For a more detailed explanation about choosing the right skills assessment visit our post: Assess With Confidence: How To Select The Ideal Assessment For ABA Programs .

The most common assessments used in ABA programs include:

• The Verbal Behavior Milestones Assessment Placement Program (VB-MAPP)
• Assessment of Basic Language and Learning Skills – Revised (ABLLS-R)
• Promoting Emergence of Advanced Knowledge (PEAK)
• Assessment of Functional Living Skills (AFLS)
• Essential for Living (EFL)
• Early Start Denver Model (ESDM)
• Vineland Adaptive Behavior Scales-3rd Edition
• Social Skills Assessments such as the TRIAD Social Skills Assessment

This is not an exhaustive list of all possible assessments available to choose from. So with so many assessments available, how do you choose the right one? Each assessment listed above looks at different skills and is appropriate for different ages and abilities. When choosing an assessment, ask yourself the following questions:

• Does the funder (insurance company, school, etc.) require specific assessments?
• What is the age or developmental level of the learner?
• What resources are available to you?
• What types of skills are most important for the success. of your learner (i.e. life skills, communication skills, social skills, etc.)?

There is not one right assessment for each learner. Your comfort and ability to utilize an assessment is critical to the decision as well. Some of the assessments such as ESDM, EFL and PEAK require training to implement with fidelity. The Vineland Adaptive Behavior Scales-3 requires any understanding of psychometric scoring or access to the online scoring platform (Q-Global). Many of these assessments are expensive to purchase and may not be available through your agency.

For these reasons, the VB-MAPP and the AFLS tend to be the most widely used assessments. These 2 assessments are affordable, easy to use and cover the most common skills related to challenging behaviors (communication, social skills, self-regulation skills, etc.).

The table below compares some of the most common skills assessments used in ABA programs. Some of the assessments are “age-referenced” which means that it compares skills across typically developing children of the same age. Other assessments are “criterion-referenced” which means they only assess the individual’s progress against their own past performance. Criterion-referenced assessments do not provide a comparison to what other children of the same age are able to do.

Assessment	Main Skill Types	Ages	Age-Referenced or Criterion-Referenced
ESDM	Communication, play, social, fine/gross motor	1-4 years	Age-referenced
VB-MAPP	Communication, play, social, group, emerging academics	0-4 years	Age-referenced
AFLS	Life skills, communication, self-regulation, social skills, leisure skills	2-adult	Criterion-referenced
EFL	Communication, self-regulation, life skills, leisure skills, vocational skills	early childhood-adulthood	Criterion-referenced
ABLLS	Communication, academics, self-help skills, motor skills	0-12 years	Criterion-referenced
PEAK	Language and abstract thinking	1.5 years-teens	Age-referenced (2 modules), Criterion-referenced (2 modules)
TRIAD	Social skills in the areas of cognitive, behavioral and affective	6-12 years	Criterion-referenced
Skillstreaming	Social, emotional and behavioral skills	Preschool-12 years	Criterion-referenced

Use the decision tree below to help you choose an assessment that’s right for your learner.

Generally speaking, you need only choose one assessment. Choose the one that best fits your learner, your skills and your resources. As you get to know the learner, the learner matures, or you gain access to new resources, you may choose to change the assessment that you use. Most funders accept this provided you include a justification for the change in assessments.

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Conducting the Skills Assessment

Many BCBAs develop their own process or style for conducting the initial assessment. Children coming in for an initial assessment often have little or no experience with ABA or the expectation that they demonstrate skills when asked. They don’t know you, and if the assessment is conducted in a clinic, they don’t know the environment.

Many other barriers also impact your ability to accurately measure the learner’s skills. Your assessment results might not be accurate because the learner:

• Is uncomfortable around new people or environments
• Exhibits oppositional behavior
• Doesn’t understand the directions/language you use
• Isn’t motivated to respond correctly
• Has never been away from the caregivers
• Hasn’t generalized the skill to new stimuli
• Has never been asked or expected to perform the skills being assessed on demand

Although it might not be feasible, you often get the most accurate assessment results when the assessment occurs over the course of several days. This provides you the opportunity to build a relationship with the learner and establish some basic expectations. If this is not possible, here are a few ways to improve your assessment results:

• Ask the parent or caregiver to have the learner perform the tasks
• Ask the parent or caregiver to bring familiar objects with them to the assessment
• Conduct the assessment at home, even for center-based services
• Ask the parent or caregiver to send you video of the learner communicating, playing, or engaging in specific skills

Your initial assessment results will rarely provide a truly accurate picture of all the learner is capable of. Learners who attend school or have received ABA services in the past generally perform more accurately during the initial assessment. So what do you do if you believe you don’t have an accurate assessment?

Include in your documentation any barriers to obtaining an accurate representation of the learner’s skills. Report what you attempted to overcome the barriers, and state your plan to gather accurate baseline data for any goals prior to intervention. It’s OK to report the data you collect, but it’s important to make note if you believe the data might be inaccurate (i.e. they don’t align with what the parents report the learner is capable of or what you read in your review of records).

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Indirect Skills Assessments

An indirect assessment is any assessment that doesn’t involve you directly measuring the behavior or skill. Indirect assessments provide an alternative when the barriers discussed earlier prevent you from obtaining accurate assessment data. These assessments typically include rating scales completed by the parent or someone who knows the learner well such as the Vineland Adaptive Behavior Scales-3.

In the video below, Joe Dixon, BCBA discusses the use of the Vineland-3. The video begins with an introduction to assessments which might be of interest, but he starts talking about the Vineland-3 at minute 22.

The Vineland-3 is one of the most widely used indirect assessments in ABA programs. Because it is an age-referenced assessment, it clearly demonstrates skill deficits which may relate to the occurrence of challenging behavior. The assessment includes a section for rating behavior and separates challenging behavior into 3 categories (internalizing, externalizing and critical).

Indirect assessments provide insight into the learner’s abilities but are not always reliable. Some parents, caregivers or teachers are better reporters than others. Although more time consuming, the interview form may provide more accurate information as it provides the opportunity for you to clarify what each response should reflect. For example, the reporter should choose “2” only if the learner demonstrates the skill across people and environments (demonstrates generalization of the skill) and choose “1” if the learner demonstrates the complete skill independently sometimes (i.e. washes his hands from beginning to end without help or prompts, sometimes).

Below is a chart of some of the advantages and disadvantages of the Vineland-3. Other indirect assessments will share these characteristics.

Advantages	Disadvantages
Widely accepted by insurance companies	Provides limited guidance for programming
Easy to administer	Requires an understanding of psychometric scoring if not using online scoring (Q-Gobal)
Doesn’t rely on the learner demonstrating skills with novel adults or in novel environments	Is not sensitive to small improvements in skills or challenging behavior

When should you use an indirect assessment? When:

• The insurance company requires it
• You can’t obtain an accurate representation of the learner’s skills due to challenging behavior occurring during sessions
• Other assessments fail to capture meaningful deficits in the learner’s repertoire
• You want to supplement direct assessments to look at a broader range of skills and behaviors

Indirect assessments provide insight into the learner’s skills that you wouldn’t have otherwise. That being said, they are often unreliable and must be used with caution and supplemented with direct assessments.

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Direct Skills Assessments

Direct assessments are a critical part of developing an effective ABA program. They allow you to measure the learner’s skills and test for generalization since the learner doesn’t know you and may be unfamiliar with the environment.

Planning the Assessment

The better prepared you are for an assessment, the smoother the process will go. Planning the initial skills assessment involves:

• Review documentation
• Scheduling the assessment appointment(s)
• Gathering materials
• Preparing the environment (if possible)

Review documentation

Before beginning any assessment, you must review all available documentation. This is part of the behavioral assessment process so you might have already completed this step. Useful documentation includes:

• Intake forms
• Diagnostic assessment
• Previous assessments
• IEP
• Reports from other service providers (i.e. speech, OT, PT, etc.)
• Any indirect assessment results

Scheduling the assessment appointment(s)

Scheduling enough time for the assessment minimizes any last-minute need to scramble for follow-up appointments. Young learners often perform best during appointments that are 2 hours or less in length. If you anticipate the assessment taking longer than this, it might be best to schedule multiple appointments. If you gather enough information during the first appointment, simply cancel the follow-up.

The length of time required to conduct a full direct assessment varies depending on:

• Developmental ability of the learner
• Attention and cooperation of the learner
• The presence of competing or interfering behaviors
• Your experience as a tester
• Organization and accessibility of materials in the environment
• Distractions in the environment

An assessment with a learner who demonstrates few interfering behaviors and limited communication skills may take only an hour or 2. Generally, the more skills that you must test, the higher rate of interfering behavior, and the lower the level of attending or responding, the longer the assessment takes.

The chart below provides some estimates for how long an initial direct skills assessment might take given the presentation of the learner. Times are estimated and not all different combinations of ages and abilities are represented. The chart should give you some idea of how long to expect the initial assessment to take.

Approximate Age of Learner	Level of Communication	Level of Interfering Behavior	Level of Attending/ Responding	Estimated Amount of Time
2-8	Low	Low	Low	1-2 hours
2-8	Low	Low	Moderate-high	2 hours
2-8	Some vocal communication or use of AAC	Low	Low	2-3 hours
2-8	Moderate-high	Low	Low	3-4 hours
2-8	Moderate-high	Moderate-high	Low	4 hours
8+	Low	Low	Low	2 hours
8+	Moderate-high	Moderate	Moderate	3-4 hours

Different insurance companies allow for different lengths of assessments and the the chart above represents only the direct assessment portion. The rest of the assessment, including any indirect assessments, records review, and documentation of the treatment plan will typically add 2-4 or more hours to the total time it takes to complete the assessment depending on your proficiency with documentation.

Consider if there are time-sensitive concerns with the learner. For example, if the learner may need support with feeding, schedule the appointment during mealtime.

Gathering materials

The materials you need for the initial assessment vary depending on the learner’s needs, interests, age and overall treatment goals. Generally, the materials you need include:

• Questionnaires (FAST, MAS, QABF, PLS, Reinforcer checklist, etc.)
• Pens or pencils
• Assessment book
• Note pad or paper and clipboard
• Any previously identified potential reinforcers or preferred toys/activities
• A variety of toys and/or games to stimulate interest and provide naturalistic assessment opportunities such as:
  • Cars/trucks
  • Books
  • Blocks/Legos
  • Pretend food
  • Balls
  • Bubbles
  • Balloons
  • Dolls
  • Art materials (paper, crayons, markers)
  • Small animals
  • Puzzles
  • Counting bears (with different size and color bears)
  • Beads
  • Miniature common objects
  • Shape sorter
  • Dry erase board and markers
  • Laminated pictures 

Despite your efforts to collect everything you could possibly need, you probably won’t have everything you need or want. Stay flexible and be creative. If you are missing materials, consider using technology to test skills such as tacting, listener responding or even matching or sorting skills. Many apps are readily available that provide quick access to materials and activities. Try BitsBoard or a similar app. Google images is also a quick source of relevant stimuli.

Prepare the environment

If you conduct the assessment in a clinic setting, preparing the environment leads to the best assessment outcomes. It helps you maximize your time with the learner. Each environment is a little different, but generally, to get the environment ready for the assessment you should:

• Place some items in sight but out of reach (i.e. on high shelves or in clear containers)
• Remove clutter or distracting items
• Place some items within easy reach to entice the learner to engage 
• Remove any potentially dangerous items (i.e. staplers, brooms, scissors, etc.) unless they will be needed during your assessment

During the Assessment

Conducting the direct assessment requires patience, creativity, and problem-solving. Your main goal is to get the learner to show you as many of his skills as he can in a short period of time. Given that you’re a stranger, this is a daunting task.

As with every other aspect of this process, the direct assessment appointment can be broken down into smaller steps including:

• Engaging the parent or caregiver in conversation (10-15 minutes)
• Developing rapport with the learner (10+ minutes)
• Exploration (20-30+ minutes)
• Probing skills (1-2 hours)
• Data collection (throughout)
• Follow-up with the parent or caregiver (10-15 minutes)

The times listed above are estimates and vary on the needs of the learner as discussed earlier. Use these times as a guide for the relative proportion of time spent on each part of the assessment.

Engaging the parent or caregiver in conversation

There are many reasons to engage the parent or caregiver in conversation. This is your opportunity to establish their role in ABA services. If you whisk their child off to the treatment room or banish them to a different room of the house, you send the message that their role is limited. If you discuss parent training and include the parents in the assessment process, you send the message that their role is critical. The choice is obvious.

During this conversation, take time to:

• Build rapport
• Establish them as the experts on their child
  • What are their goals for treatment?
  • What are their primary concerns?
  • Does the learner have any activity/food restrictions?
  • Observe the parent/child interactions
  • Ask questions about the commonality of the observed interactions
  • Discuss the assessment process
  • How long you expect the assessment to last
  • The parent(s)’s role in the assessment (can the parent(s) observe/ participate?)
  • What you will be doing during the assessment
  • Under what conditions the assessment will end early (i.e. the learner becomes distressed or engages in dangerous behaviors)
  • Will a follow-up assessment be needed?
• Provide any questionnaires to the parent(s) along with a pen and instructions 

If you work for an agency, they may provide you with additional required information you must convey to the parents before you begin the assessment.

Developing rapport with the learner

Most initial assessments are conducted by the BCBA who will be working with the child once treatment begins. Create an environment where the learner is engaged and excited to be with you. Break out as many fun, interesting and exciting activities as needed to engage the learner. Be silly and follow the learner’s lead.

Exploration

Allow the learner to freely explore the environment. This allows you to conduct a free-operant preference assessment and observe the learner’s play and leisure skills. Engage in parallel play or attempt to enter their play. Resist the urge to jump right in to asking questions. Observe the learner’s natural communication skills, willingness to allow you to interact or be near him, and any spontaneous skills (i.e. matching, puzzles, motor imitation, imaginative play, etc.).

Probing skills

This is the part you probably think of when you think about conducting a skills assessment. During this portion of the assessment test the learner’s abilities to perform the different tasks listed in the assessment you chose (Learn more about choosing the right skills assessment in our post: Assess With Confidence: How To Select The Ideal Assessment For ABA Programs ).

Present each task and provide the learner for a chance to respond. Make note of whether or not the learner responded correctly. Present the tasks in any sequence. Generally, it’s best to follow the learner’s lead and present tasks as the opportunity arises. For example, the learner begins playing with a train set, present some listener responding or tacting tasks related to the trains.

The chart below shows the different skills probed using 3 of the most common assessments.

Skill Domain	VB-MAPP	ABLLS	AFLS-Basic Living Skills
Communication	Manding, tacting, listener, intraverbals, LRFFC, echoic, vocal behavior, linguistic structure	Receptive language, vocal imitation, requests, labeling, intraverbals	Basic communication
Play	Independent and social play	Play and leisure	N/A
Social	Social interaction	Social interaction	N/A
Group	Group instruction, classroom routines	Group instruction, classroom routines	N/A
Academics	Reading, math, writing	Writing, spelling, reading, math	N/A
Motor skills	Imitation	Gross and fine motor, motor imitation	N/A
Daily Living	Toileting	Dressing, eating, grooming, toileting	Dressing, toileting, bathing, health safety & first Aid, nighttime routines
Self-management	N/A	Cooperativeness and reinforcer effectiveness	Self-management

The video below by Good Behavior Beginnings provides a demonstration of the VB-MAPP assessment conducted with a 2-year-old.

It’s not necessary to present every task in the assessment. Probe more advanced tasks (i.e. listener responding in a messy field of 10) and work backward if it seems like the learner might succeed.

If a learner fails to perform the task, refrain from teaching the skill and simply represent the task in a different way during a separate opportunity. For example, you want to test the learner’s listener skills in a field of 4 but the learner did not select the picture of the car when you presented 4 images. Don’t point to the correct response. Simply wait awhile and present the same skill in a different way (i.e. using objects or changing the SD).

Continue presenting tasks until the:

• End of the scheduled assessment time
• Learner demonstrates skills across all testing areas
• Learner meets pre-determined behavioral criteria to end the session
• Learner stops responding

If necessary, schedule a follow-up assessment session. While you don’t need to present every task in the assessment, you do need to complete enough to identify relevant skill deficits, especially those that may relate to target behaviors.

Data collection

Collect data throughout your assessment. Jot down anecdotal information that might be useful in the narrative part of your report. Document the words or phrases the learner uses along with the related context. Make note of the learner’s favorite toys or activities. Document any social interaction, social play, or social initiation. Note if the learner uses the bathroom, washes their hands or has something to eat. Record the learner’s response to demands

The VB-MAPP Scoring Supplement is a printable PDF that provides space and prompts to assign different point values depending on the learner’s performance (see the image below).

This type of supplement is not available for the other assessments. Each of the assessments includes a protocol or workbook where you can document the learner’s skills. These protocols can get expensive if you plan to buy one for each learner. Most BCBAs will buy one and document the results on a separate piece of paper.

Generally, data collected during an initial assessment consists primarily of a messy collection of notes and tallies that you sort through once the learner leaves the session and you begin documentation.

Follow-up with the parent or caregiver

When you finish probing skills, it’s time to follow-up with the parent or caregiver. Discuss the following:

• Clarifying questions about what you observed
  • Are observed behaviors or responses common?
  • Do the parent(s) observe the learner demonstrating skills not demonstrated during the assessment?
• Your likely recommendations for services
  • Frequency/duration of sessions
  • Location of services
  • A quick overview of possible treatment priorities
• The parent(s)’s role in ABA services
  • Parent training
  • Consistency of services
  • Planning and decision-making
• Next steps
  • Any follow-up assessments or additional information needed
  • Timeline for documentation completion and submission
  • Approximate timeline for approval 

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Prioritizing Target Skills Based on Assessment Results

Now that you have collected a wealth of information about your learner, it’s time to start making some decisions. Prioritize skills:

• Directly related to target behaviors (i.e. manding, self-management, etc.)
• That are prerequisites for replacement behaviors
• That allow the learner to access reinforcers in the natural environment
• That allow the learner greater independence

Generally, in your treatment plan you want to address skill deficits that relate. to the target behaviors and promote independence. When a learner encounters reinforcement in the natural environment, they are more likely to engage in prosocial behaviors. Keep these ideas in mind when choosing skills for your plan.

Consider including skills in the following areas:

• Manding-how will the learner communicate what he or she wants or needs?
• Tacting-how will the learner engage in joint attention?
• Intraverbals-how will the learner develop more complex communication skills?
• Play/leisure-how will the learner engage in appropriate activities when attention is restricted?
• Social-how will the learner appropriately obtain attention from peers and navigate complex social interactions?
• Self-management-how will the learner tolerate demands or delays to reinforcement? How will the learner tolerate denied access or restricted attention?
• Reinforcer effectiveness-how will the learner develop more effective or readily available reinforcers?
• Self-care-how will the learner develop new feeding, bathing, toileting, dressing skills?
• Academics (if appropriate)-how will the learner meet IEP goals or tolerate academic demands?

A good rule of thumb is one skill acquisition program for each hour of treatment. For example, if you recommend 20 hours of direct RBT services, you should include 20 skill acquisition programs. It’s often appropriate to have multiple goals within one skill area such as multiple social or manding goals (i.e. mands for a break and mands with attributes).

Use the assessment as a guide to help you choose appropriate goals and targets, but avoid the temptation to “teach to the test” by only selecting goals that help the learner achieve the next milestone on the assessment. Focus on helping the learner overcome the deficits that lead to them relying on challenging behavior.

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Documenting the Assessment or Treatment Plan

The final step in the initial assessment process is to document the results. If you’re seeking approval from an insurance company, you will write a thorough treatment plan. If you completed the assessment for another purpose such as a school or private contract, you might need to include slightly different information in your treatment plan.

Treatment plans generally include:

• Client information
• Provider information
• Assessment information
• Medical rationale for ABA services
• Coordination of treatment with other providers
• Behavior intervention plan (BIP)
• Behavior reduction goals
• Progress toward behavior reduction goals (if a reassessment)
• Crisis plan
• Skills assessment
• Progress toward current replacement behaviors and skill acquisition goals
• Parent/caregiver participation
• Monitoring of the plan
• Treatment integrity
• Generalization and maintenance procedures
• Discharge criteria and projected duration of ABA services (length of care)
• Summary of medical necessity criteria
• Summary of treatment recommendations
• Parent/caregiver informed consent

Scroll through the pages of the template below to see an example of a treatment plan template. Your agency might have a plan that looks somewhat different but most of the information will be the same.

Client information

This section contains simple demographic information. Include the learner’s:

• Name
• Date of birth
• Age
• Diagnosis
• Guardian
• Guardian’s phone number
• Address

Provider information

This section is again simple demographic information. Include the provider’s:

• Name
• Number associated with the funder (if applicable)
• Phone number
• Address
• Email

Assessment information

This section should include basic information about when and who conducted the assessment. This is for a quick reference for the funder and should include:

• Anticipated start date of services
• Initial assessment date
• Date of the current report
• Evaluator’s name

Medical rationale for ABA services

If services are funded by the learner’s medical insurance, complete this section thoroughly and carefully. This is one of the most important sections when attempting to justify the service as medically necessary. Include:

• Psychosocial information including:
  • Who lives in the home
  • Siblings and their ages
  • Any custody concerns
  • Any history of abuse, neglect or trauma
  • School and childcare arrangements including reported challenges in those settings
  • Medical information or other health concerns
  • Why the family originally sought a diagnosis
• Risk assessment
• Diagnosis
• Prescription for ABA services (some funders require you attach the prescription)
• Medications
• History of services including services provided at school and a history of ABA services
• Current areas of need including:
  • Adaptive behaviors
  • Communication skills
  • Maladaptive behaviors

Coordination of treatment with other providers

Most funders require you to coordinate treatment with the learner’s other health care providers. This coordination ensures a fluidity of treatment and leads to the best outcomes for the learners. The funder also wants to ensure that none of the services are duplicated or redundant. Include your plan to coordinate care with the learner’s:

• School
• Doctor
• Psychiatrist
• Occupational therapist
• Speech therapist
• Physical therapist
• Support staff

Behavior intervention plan

Although it’s often best to incorporate the behavior plan into the body of your treatment plan, most funders will accept an attached behavior plan. If you want a thorough description of how to write an effective BIP, read our post: Behavior Intervention Plan (BIP): The Complete Guide To Writing A Comprehensive Plan. This post provides specific details for each component of your behavior plan.

At a minimum, make sure that your plan includes:

• Goal
• Target behavior definitions
• Antecedent interventions (preventative strategies)
• Skill development interventions (teaching functionally equivalent replacement behaviors)
• Consequence interventions (reinforcement strategies)
• Additional strategies or recommendations
• Response to target behaviors

Behavior reduction goals

This section is generally a table that includes a simple list of each behavior with:

• Baseline data
• Current levels (for a reassessment)
• Short-term goals
• Long-term goals

Progress toward behavior reduction goals

Include this section only for reassessments. This should include data for each target behavior along with a description of progress or an explanation as to why the behavior may have increased. For each behavior, include:

• Definition
• Baseline data
• Current level
• Graph
• Narrative describing progress or lack of progress (and any changes to the previous plan to address lack of progress)

Make sure all data reported appear in the same format (i.e. rate, duration, etc.)

Crisis plan

Customize the crisis plan to your unique learner. Your company’s template might include a generic crisis plan, but it’s important that this part of the plan be specific to your learner’s needs. Include:

• Risk factors
• When to implement the crisis plan
• How to secure the environment
• Any approved restrictive procedures (i.e. Safety Care)
• Who to contact following the use of the crisis plan

Skills assessment

A bulk of your assessment will be covered in this section. It’s important to be thorough in your description of the assessment procedures and results. Include:

• Which assessment(s) were used
• A description of the assessment(s)
• Visual depiction of assessment results (i.e. VB-MAPP chart)
• New goals to address skill deficits (often presented in a chart with a goal, rationale, and baseline data)

Progress toward current replacement behaviors and skill acquisition goals

Include this section only for reassessments. It generally includes a combination of a chart and graphs for each of the learner’s current programs. The chart should include:

• Skill area
• Current goal
• Progress (current level/data)
• Status of the goal (mastered or in treatment)
• Date for expected mastery (typically 6 months from assessment date)
• Any new goal that will take the place of this goal if the status is mastered
• Graph for each goal

Your agency’s template might look different or include slightly different information. Different funders might have different requirements but generally you want this section to reflect progress toward the client’s long-term goals and a continued need for services.

Parent/caregiver participation

Most funders require the parents or caregivers participate in services. This participation provides the greatest chance for long-term success and most efficient use of funds. Funders care about the learner’s progress, but they want to ensure that services don’t last forever. Parent training provides an opportunity to teach stakeholders how to address the learner’s needs without life-long ABA services. Generally, include at least 3 parent training goals.

This section should include:

• A narrative of the parents’ participation in parent training (including any barriers to the parents’ participation)
• Description of each goal
• Baseline and/or current level for each goal (if for a reassessment)
• Graph of data collected (if for a reassessment)

Monitoring the plan

This section describes your role in ensuring the ongoing success of the plan. These are the strategies you will utilize to make sure your plan is carried out as intended.  Include a description of how you will:

• Teach others to implement the plan
• Monitor the data collected

Treatment integrity

The treatment plan can only be effective if it’s implemented as planned. Include this section only for reassessments. This section allows you to report any integrity or fidelity data. Include both a description of acceptable integrity criteria and a graph depicting data collected for each RBT working with the learner.

Generalization and maintenance

You’re overall goal for services should include a plan to help the learner overcome existing obstacles so s/he experiences success in the natural environment. This section allows you to describe your plan to ensure the learner demonstrates skills taught outside the treatment environment. Include a rationale for your chosen interventions.

Discharge criteria and projected duration of ABA services

ABA services are not intended to be a life-long intervention. When billing for the service to insurance companies, you should address the presenting problem (reason the parents originally sought services) then discharge. If the parents identify new challenges following discharge, they should seek to resume services. Funders want to know your plan for discontinuing services. Describe the plan for titrating services and the ultimate criteria for discharge. This should be unique to your specific learner and should not simply be that s/he will be indistinguishable from their peers.

Summary of medical necessity criteria

Each funder publishes the criteria for ABA services to be considered a “medically necessary” service on their website. Generally if you Google “medical necessity + ABA + (funder’s name)” you will find it easily. This section should describe how the learner meets each of the funder’s published criteria. For more information about medical necessity, take our course: Understanding Medical Necessity.

Summary of treatment recommendations

In this section describe the services you recommend based on all the information you provided earlier in your plan. Include:

• Service location (i.e. home, clinic, school, etc.)
• Schedule of services
• Treatment hours requested including:
  • Service code
  • Modifier
  • Description of the service
  • Total units requested (a unit is typically 15 minutes)
  • Hours per week on average
  • Location of each type of service

Parent/caregiver informed consent

This final piece is critically important. Review your plan thoroughly with the parents (and client if appropriate). The parents should understand any and all potential risks and benefits to treatment. The plan should include a signature from the BCBA, parents, and client (if appropriate).

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Next Steps

You completed the assessment and wrote an amazing treatment plan. Now the real work of treatment begins. While waiting for the funder to approve services, continue to plan how those services will be implemented by staff and what steps you must take to be ready for services to begin. Before services start:

• Choose a teaching methodology (DTT, NET, PRT, Incidental Teaching, Direct Instruction, Precision Teaching, etc.) that best meets the needs of this specific learner
• Collect necessary teaching materials (stimuli, communication materials such as PECS, reinforcers, etc.)
• Consider necessary environmental modifications
• Research any client-specific interventions or considerations
• Seek mentorship to support any aspect of the plan you want more experience with

Seeking support and mentorship is a sign of strength, not weakness. It shows you want to continue to learn and grow. Join the conversation in our Facebook group: Master ABA for Professionals to ask questions or connect with other professionals!

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References and Related Reading

5 Types of Bias in Data & Analytics. (2022, November 14). Cmotions. Retrieved January 4, 2023, from https://cmotions.nl/en/5-typen-bias-data-analytics/

Cipani, E., & Schock, K. M. (2010). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings. Springer Publishing Company.

Dipuglia, MD, BCBA, A., & Franchock, BS SPLED, L. (n.d.). VB-MAPP Scoring Supplement [Online PDF]. Penn State. https://storage.outreach.psu.edu/autism/70-Handout2_0.pdf

Dr. Ross Greene. (n.d.). https://drrossgreene.com/

Hanley, G. P. (2012). Functional assessment of problem behavior: Dispelling myths, overcoming implementation obstacles, and developing new lore. Behavior Analysis in Practice, 5(1), 54-72.

Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47(1), 16-36.

Hanley, G. P., Piazza, C. C., Fisher, W. W., Contrucci, S. A., & Maglieri, K. A. (1997). Evaluation of client preference for function‐based treatment packages. Journal of Applied Behavior Analysis, 30(3), 459-473.

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior Analysis in Practice, 9(1), 77-83.

Mehrzad, O. (2022, September 28). 3 Common Biases Affecting Your Data Analysis & Compromising Accurate Decision-Making – InnoVyne. InnoVyne Technologies. https://www.innovyne.com/data-analysis-biases-compromising-decision-making/

Oliver, A. C., Pratt, L. A., & Normand, M. P. (2015). A survey of functional behavior assessment methods used by behavior analysts in practice. Journal of Applied Behavior Analysis, 48(4), 817-829.

Pelios, L., Morren, J., Tesch, D., & Axelrod, S. (1999). The impact of functional analysis methodology on treatment choice for self‐injurious and aggressive behavior. Journal of applied behavior analysis, 32(2), 185-195.

United States. (2011). Individuals with Disabilities Education Improvement Act of 2004. § 300.530 (f).

Witherup, L. R., Vollmer, T. R., Camp, C. M. V., Goh, H. L., Borrero, J. C., & Mayfield, K. (2008). Baseline measurement of running away among youth in foster care. Journal of applied behavior analysis, 41(3), 305-318.