Starting your career as a BCBA can be daunting, even with fieldwork experience. Many new BCBAs feel unprepared for the realities of clinical work, especially the initial assessment process. This guide provides a comprehensive roadmap, from pre-assessment preparation to treatment plan development, focusing on learners exhibiting maladaptive behaviors and assuming insurance pre-authorization and caregiver paperwork are complete.
Components of an Initial Assessment
The initial assessment serves two primary purposes: determining medical necessity and developing a treatment plan. It's also a crucial opportunity to build relationships with the learner and caregivers, establish their role in therapy, and lay the groundwork for successful ABA services. The assessment comprises two main components:
- Behavioral Assessment: Identifies the function of challenging behaviors.
- Skills Assessment: Pinpoints skill deficits that may contribute to challenging behaviors.
While these components are interconnected, they involve distinct processes.
Before the Assessment: Preparation is Key
Thorough preparation is crucial for a smooth assessment:
- Review Records: Gain a preliminary understanding of the learner's behaviors and potential skill deficits.
- Gather Materials: Assemble questionnaires, assessment tools, writing materials, engaging toys, and probing materials. Organize materials for efficiency.
- Choose Assessment Methods: Select appropriate behavioral and skills assessments.
- Prepare the Environment: Minimize distractions and create an engaging space.
- Develop Contingency Plans: Anticipate potential challenges and prepare alternatives.
Starting the Assessment: Building a Foundation
The initial interaction sets the tone for the entire therapeutic relationship. Allocate 15–30 minutes to:
- Observe parent-learner interactions.
- Discuss the learner's skills and behaviors.
- Explain the parents' role in ABA services.
- Review questionnaires and build rapport.
- Answer questions about the assessment process and next steps.
Conducting the Behavioral Assessment
A behavioral assessment involves:
- Choosing an Assessment Method: Use FBAs, FAs, or PFAs as appropriate.
- Defining Target Behaviors: Develop operational definitions with examples and non‑examples.
- Indirect Assessments: Gather input through interviews, questionnaires (e.g., QABF, FAST, MAS), and rating scales (e.g., Vineland‑3).
- Direct Assessments: Collect ABC data and observe behaviors directly. Use video recording or caregiver‑collected data as needed.
- Data Analysis: Analyze and graph data to identify maintaining variables and develop intervention strategies.
- Documentation: Record detailed findings, avoiding jargon for non‑ABA audiences.
Conducting the Skills Assessment
A skills assessment involves:
- Gathering Background Information: Collect data on the learner's history, medical concerns, and social interactions.
- Choosing an Assessment: Select tools like VB‑MAPP, ABLLS‑R, or AFLS based on the learner's needs.
- Conducting the Assessment: Build rapport, probe skills, and adapt the process as needed.
- Indirect Skills Assessments: Supplement direct assessment with tools like Vineland‑3 when necessary.
- Prioritizing Target Skills: Focus on areas that promote independence, reinforcement access, and adaptive functioning.
- Documentation: Include assessment results, visuals, and baseline data for new goals.
Developing the Treatment Plan
The treatment plan documents the assessment results and outlines the recommended interventions. It typically includes:
- Client and provider information.
- Assessment information and medical rationale for services.
- Behavior Intervention Plan (BIP) and crisis plan.
- Skills assessment results and goals.
- Parent/caregiver participation goals and progress.
- Plan for monitoring, generalization, and treatment integrity.
- Discharge criteria and treatment recommendations.
- Informed consent documentation.
Next Steps: Preparing for Treatment
After completing the assessment and treatment plan:
- Choose a teaching methodology (e.g., DTT, NET, PRT).
- Gather teaching materials and plan environmental modifications.
- Research client‑specific interventions and seek supervision if needed.
By following these steps and utilizing available resources, BCBAs can conduct thorough assessments, develop effective treatment plans, and build strong partnerships with families—maximizing the positive impact of ABA services.