'P' is for Priority

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The "Why" of Selecting Intervention Goals

A large part of the BCBA role is designing treatments/intervention. There are many tools to help facilitate this process, such as caregiver or client interview, administering a full assessment, record review, observation, Functional Analysis, etc. A competent BCBA will collect information from a variety of sources and then compile the information to come up with a plan of action.

In an ideal world, this plan of action would be as comprehensive, detailed, and lengthy, as it needed to be for the individual client to benefit from treatment. But since this is rarely an ideal world, all kinds of issues and constraints can lead to having to prioritize treatment goals. Basically, this means to ask (and answer) the question: "What are the MOST important things to work on?".

While many clients may need some level of support for the rest of their lives, often therapy services have a specific timeframe or clock to work within, as well as limits on how services must be provided (what location, at what intensity, etc.) that are set by the funding source and not by the clinician.

The 1st thing to know before jumping into prioritizing goals, is to throw any pre-formed ideas out the window. I will give some general guidelines below, but even with these guidelines the most important variable to consider when prioritizing ABA treatment goals is the individual receiving treatment. Yes, this is more important than looking at the assessment grid.

The context of the learning environment, individual reinforcement history, the needs and concerns of caregivers, level of family stress, and the functionality of specific skills are all highly important variables that must be weighed carefully against clinician recommendations.
Just because I think an 8 -year- old should know how to independently ride a bike, that doesn't mean bike riding is an important skill for the family. It also doesn't mean that bike riding is functional for the particular client, or even a preferred interest. So it would be foolish to attempt to prioritize treatment goals without looking through the lens of the individual receiving services.

Once a thorough assessment of client needs and strengths has been conducted, then the guidelines below should be helpful for deciding what needs to be targeted, and in what order of priority:

  1. Developmental Functioning - For the clients chronological age, what should they be able to do? Particularly with very young clients (under 5) I recommend having a solid knowledge of developmental norms to be able to help the client contact success across settings. Being able to sit and attend in a group for 10 minutes may not be a big goal for the parents, but you can bet it's a big goal at school. ASD impacts developmental functioning, so it's important to prioritize intervention goals that will help the client access age-appropriate settings, activities, and social experiences.
  2. Current Problem Behaviors/Barriers to Improvement - This is likely the #1 reason why consumers reach out to ABA professionals for help, so it's usually no mystery which challenging behaviors are causing the most stress to the household. Tantrums, spitting, elopement, biting, no play skills, etc., all put a strain on the entire family. However, it will be very important to prioritize where to begin with behavioral intervention as to avoid overwhelming either the client or the household with an 88- page behavior plan. Start small, but with high impact.
  3. Functional Skills/Daily Living Skills - This is my 2nd favorite area to target for intervention, because most consumers who initiate ABA therapy services due so because daily life is hard. In order to make daily life less hard, it's critical to focus on practical, self-help skills. For example: requesting, making choices, toileting, dressing, tooth-brushing, establishing a bedtime routine, independent eating, etc. When daily living skills improve, it lessens the weight and stress placed on other members living in the household. Improving daily living skills also helps to increase the independence of the client, for years to come. 
  4. Parent & Caregiver Training- My favorite area to target for intervention! If the client has low treatment hours, minimal availability for therapy, minimal access to other services or treatment, less than ideal educational placement, etc., then really the #1 goal of treatment should always be parent training. When parents or caregivers are trained in behavior analytic methodology, they are empowered to help their child themselves. This is the equivalent of handing someone a fish, vs. teaching someone HOW to fish. When you teach parents how to fish, you give them the ability to teach their child for years to come, to advocate for their child's needs, and to recognize low-quality therapies and clinicians before precious time, energy, and money can be wasted.

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