Treatment Planning

• Summary of standardized assessments (VB-MAPP, ABLLS-R, AFLS, Vineland-3).
• Functional behavior assessment results with identified functions.
• Skills assessments and current functioning levels.
• Caregiver priorities and input from the initial intake.

Writing Measurable Goals

Every treatment goal must specify three elements: Condition → Behavior → Criteria.

Structure

Given [condition/antecedent], [client] will [observable behavior] in [criteria: accuracy, frequency, or duration] across [generalization parameters] for [number of consecutive sessions/probes].

Examples

• Given a visual schedule and verbal prompt "check your schedule," Aiden will independently transition between activities within 30 seconds of the prompt with 80% accuracy across 3 consecutive sessions in the clinic and home settings.
• During structured play with a peer, Maya will initiate a social interaction (verbal greeting, offering a toy, or asking to play) at least 3 times per 15-minute observation across 4 of 5 consecutive sessions.

Common Errors in Goal Writing

• Vague behavior descriptions ("will improve social skills").
• No measurable criteria ("will demonstrate progress").
• No condition specified (when, where, with what materials).
• Criteria that are too easy (already at that level) or unreasonably ambitious.
• No generalization parameters.

Prioritizing Treatment Targets

When assessment reveals many potential targets, prioritize using this hierarchy:

Tier 1: Health and Safety

• Behaviors that pose immediate danger (SIB, aggression, elopement, pica).
• Prerequisite safety skills (responding to name, stopping on command, basic compliance).

Tier 2: Prerequisite and Foundational Skills

• Attending and cooperation skills needed for all other learning.
• Functional communication (manding for needs, protesting appropriately).
• Imitation (motor and verbal) as a learning channel.

Tier 3: Skills That Increase Access

• Skills that open opportunities: toilet training, self-feeding, dressing.
• Academic readiness skills if school-age.
• Skills identified as high priority by caregivers.

Tier 4: Age-Appropriate and Quality of Life

• Social skills, play skills, leisure skills.
• Community skills (shopping, ordering food, using public transportation).
• Self-management and independence skills.

Additional Prioritization Criteria

• Caregiver priority: What matters most to the family? Respect their input.
• Produces the broadest positive impact: "Behavioral cusps" that open access to new environments and contingencies (Rosales-Ruiz & Baer, 1997).
• Likely to generalize: Targets with natural contingencies to maintain them.
• Developmental appropriateness: Aligned with developmental sequence and chronological age.

Linking Interventions to Goals

Each goal must have a specified intervention approach.

Service Recommendations

Service Types and Descriptions

• Direct 1:1 (97153): Technician-delivered ABA, supervised by BCBA.
• BCBA protocol modification (97155): Direct observation, program modification, data analysis.
• Caregiver training (97156): Training family members in ABA strategies.
• Group services (97154): ABA services delivered to 2+ clients simultaneously.
• Assessment (97151): Initial and ongoing reassessment.

Determining Hours

• Consider severity of the presenting behaviors and skill deficits.
• National guidelines and research base (e.g., Lovaas 1987 for early intensive; Linstead et al. 2017 for dose-response).
• Practical constraints: family schedule, school schedule, available providers.
• Justify recommended hours with assessment data—not boilerplate language.

Medical Necessity

Link every service recommendation to a specific assessment finding.

Framework

1. What does the assessment show? (e.g., VB-MAPP shows significant delays in manding, tacting, and intraverbal skills).
2. Why does this warrant ABA services? (e.g., skill deficits impair daily functioning, social participation, and independence).
3. Why these specific hours? (e.g., severity of deficits and number of targets require intensive intervention; research supports X hours for this population).
4. What will happen without services? (e.g., skill gaps will widen; problem behaviors may intensify).

Projected Timeline and Review Schedule

• Short-term goals: 3–6 month targets.
• Long-term goals: 12-month outcomes.
• Review schedule: Formal plan review every 6 months minimum; many insurers require every 6 months.
• Progress reports: Monthly or as required by the funder.

Discharge Criteria

Define discharge criteria at the start of treatment, not when discharge becomes necessary.

• Client has met all treatment goals and no new goals are clinically indicated.
• Client can be maintained with less intensive services (step-down).
• Caregiver can implement strategies independently.
• Client is transitioning to a setting that will provide continued support (e.g., school-based services).
• Client or family withdraws consent.

Caregiver Involvement Plan

• Specify the caregiver training goals and schedule.
• Define caregiver participation expectations (observation, practice, data collection).
• Plan for generalization of skills to the home and community through caregiver implementation.

Key References

• Behavior Analyst Certification Board. (2020). Ethics Code for Behavior Analysts.
• 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, 77–86.
• Rosales-Ruiz, J., & Baer, D. M. (1997). Behavioral cusps: A developmental and pragmatic concept for behavior analysis. JABA, 30, 533–544.
• Linstead, E., et al. (2017). An evaluation of the effects of intensity and duration on outcomes across treatment domains for children with autism spectrum disorder. Translational Psychiatry, 7, e1234.