This month’s ASAT feature comes to us from Juliana Oliveira, PhD, BCBA-D, Munroe-Meyer Institute, University of Nebraska Medical Center. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!

Question: I’m a BCBA working in a home-based program for school-aged children. I know caregiver involvement is integral to a program’s success; however, I’m having a difficult time not only getting caregiver buy-in but also learning how to best support and coach the caregivers I work with. Any guidance would be helpful.

You raise an important question, and you are most certainly not the only provider to go through situations related to caregiver buy-in and support. Families play a central role in creating their children’s social world and have the most intimate knowledge of both their children and the environments in which they will thrive and grow. Therefore, considering how to effectively support and empower families through the intervention process is key to a successful collaboration.

Building a Strong Caregiver-Provider Rapport

One of the definitions of “buy-in” is the “agreement to support a decision” (Merriam-Webster, 2013). Supporting a decision, or engaging in behaviors aligned with a decision, implies that engaging in those behaviors might lead to short-, medium- or long-term reinforcement. If caregivers do not support a decision, the first thing to reflect on is “Do they believe their family will gain something from this treatment in the near- or long-term future?” This reflection may arise when you are starting a new relationship with a family or when a current relationship with a caregiver is not going as expected. In the first few meetings with caregivers, providers tend to focus on the client’s current skill level and the challenges the client might be facing. However, it is also important to consider skills, challenges, goals, and barriers related to the family (Taylor & Fisher, 2010). A strong relationship between a caregiver and a provider can be achieved through demonstrations of genuine interest in and empathy for the caregiver, respect for each family’s ethnic and cultural background, knowledge about the family’s strengths, routines and preferences, and effective communication (McGrath, 2005). Here are a few questions that can be asked when getting to know a family or when trying to reestablish rapport with a family that has been already receiving services:

• “What do you hope to gain from our time together?”
• “What went well in your relationship with prior providers? Can you share anything that could have made it better?”
• “What skills would you like to see your child develop over the next 6 months? What is your top priority or concern?”
• “What are the activities that you enjoy doing the most with your child? The least?”
• “What are some fun aspects of daily life with your child? The most frustrating?”
• “What worries do you have about beginning our work together?”
• “How much time do you usually spend with your child every day?”

The questions above and other questions related to the treatment plan, goals, or strategies being taught should be part of a continuous assessment of caregivers’ engagement throughout treatment (see Walkup, 2012) for a further discussion on encouraging parent participation in home-based services. Additionally, the caregiver should be encouraged to speak openly and honestly about issues and/or past experiences that are important to them. The service provider can facilitate an open dialogue on these topics by asking open-ended questions, listening attentively without interruption (making eye contact, nodding), reflecting on key aspects of what the caregiver says (e.g., “It sounds like you are worried that Maria can’t express herself”), and building on their responses (e.g., “It must feel hard. It seems like you are looking for alternatives on how to best help her”). See Rohrer et al. (2021) for a more comprehensive discussion on compassionate interactions.

Modify Your Role as an Authority Figure

As behavior analysts, we receive intensive training on selecting meaningful goals, designing procedures, and solving potential teaching procedure barriers. However, we receive less training on how to establish a collaborative relationship with caregivers and how to recognize the caregiver’s expertise in their family (LeBlanc et al., 2020). Barnett et al. (2014) conducted a study on types of therapist coaching and found that therapists’ responsive coaching (e.g., praise to parents) was a partial mediator of change in parenting behavior; whereas directive coaching (e.g., commands) did not relate to change. These results indicate that using a collaborative, rather than directive approach, may help facilitate meaningful caregiver behavior change.

Thus, instead of behaving as the authority figure with all the answers, or as the “provider-as-expert,” research suggests that it may be important to move towards a “shared-expertise” model, in which behavior analysts serve as collaboration partners. In other words, we are the “experts” in the intervention, but the caregiver is the “expert” on their child. See some differences between the authority figure and the collaboration partner in Table 1.

Table 1. Examples of an authority figure versus a collaboration partner

Authority figure/expert	Collaboration partner
Identify the child’s needs as you have defined them based on your assessment. Example: “One of the skills we will work on is imitation, as Maria did not demonstrate this skill during the initial assessment.”	Identify the family’s goals for their child and their assessment of their child’s strengths and needs, as well as strengths and recommended areas of intervention focused on in the individualized family assessment process. Example: “Based on the initial assessment and based on what we observed together while playing with Maria, it seems like imitation is an important skill for Maria to work on. Let’s work together on establishing imitation goals to work on at home.”
Direct caregivers on what do to at home and when to do it. Example: “Here are the imitation targets you will work on: clap hands, wave, and blow a kiss. You can work on these targets during bath time and when singing songs together.”	Discuss with the family what they could do at home, how the therapist can better support them, and what routines would work best for the targeted skills. Example: “What routines do you think you could use imitation in? Let’s discuss targets that would make sense at home. Let’s also discuss what materials we have available at home that we could use to work on this goal.”

As you can already probably tell based on the previous examples, integrating shared decision-making into your practice might help you move away from an authority figure role and better establish rapport with the family you are serving. Shared decision-making encourages the caregiver to play an active role in decisions about assessment and treatment.

Examples:

• The caregiver takes an active role in gathering information on the child’s current skills and selecting meaningful goals.
• The caregiver and service provider brainstorm on available activities and materials that will be part of the teaching set.
• The service provider and caregiver discuss how to break down long-term goals into short-term achievements.

By employing these strategies – aligning with the family’s values, treatment goals, and procedures – the service provider is setting the stage for successful treatment.

Supporting and Coaching Caregivers

At the beginning of each coaching session, the service provider should schedule a time to check in or conduct a brief reflection with the caregiver (Rogers et al., 2021). Check-ins can be relatively brief (e.g., 5 minutes). During this time, the provider should ask how the caregiver found the use of the strategies from the previous session. This check-in time is also a good opportunity to problem-solve potential challenges, such as limited time to implement the technique and potential difficulties in implementing the technique at home. An initial check-in is a good opportunity to recognize the caregiver’s and child’s strengths, efforts, and successes. Some examples of questions to ask caregivers during this time include:

• “How did you feel about using this strategy during these last few days?”
• “What do you think went well when trying to implement the strategy?”
• “Were there any barriers when trying to implement the strategy?”
• “I’m so impressed you were able to implement the strategy in this way [describe how they implemented it].”
• “I’m so glad to hear that Maria responded in this way [describe how Maria responded to it].”

Describe and Discuss the Technique

After the check-in, describe the technique the caregiver will be implementing, provide a rationale for using the technique, and describe examples of the technique, relating it to the family’s routine. It is important that the caregiver actively participates in this process and can ask questions and bring examples from their daily life.

Examples:

• “The technique we will be working on today is…”
• “The importance of this technique is that…”
• “Here are some ways we can implement this technique that align with your daily routine and resources…”
• “This technique will help Maria make progress on the following goals…”
• “Do you have any questions about it?”
• “Now it’s your turn to tell me what the technique is that we will be working on today. Would you be able to describe it?”
• “Can you tell me some examples of how we could use this technique with Maria?”
• “Does this technique align with your long-term goals for Maria and your family?”

Demonstrate or Model the Technique During Direct Work with the Child

The next step is to briefly demonstrate the technique with the child. While using the technique, narrate what you are doing and how the technique is affecting the child’s behavior in the moment. It is important to note that at this stage, the provider should not outshine the caregiver while modeling the technique with the child. The caregiver should feel empowered and motivated to employ the technique, instead of feeling frustrated or intimidated by the provider.

The provider works on mand training with Maria (i.e., teaching Maria to make requests). While creating mand opportunities, the provider provides an echoic prompt. Maria echoes, and the provider immediately delivers the preferred item to Maria. While modeling to the caregiver, the provider says, “It seems like Maria really wants to play with the puppy, so let me hold it for a few seconds out of her reach while she can still see it. Now she is looking at it and reaching for it. Let’s try this… ‘DOG.’ Wow! Did you see that? Maria repeated, ‘DOG!’” The provider immediately delivers the dog to her after that. “And that’s how we will practice requests together. She is a rock star!”

Live Coaching with Caregivers

When caregivers understand the technique by providing examples related to their child and identifying the technique when implemented by the provider, they can move on to practicing the techniques. If the caregiver seems initially hesitant to participate, you could conduct more role-plays or intersperse practice between you and the caregiver. It is important that the caregiver understands that their involvement and practice is an important part of each session’s routine.

• The caregiver says, “I still don’t think I’m ready. She responded so well to you. I’m not sure I can do it…” The provider says, “I understand the hesitation. I’ve been using this strategy with different kids, but please remember, you are the expert on your kid! I have a suggestion… What if we take turns? I will create one request opportunity, and you create another request opportunity. Does that sound good?”

Feedback

A crucial component of live coaching includes feedback. Several strategies for providing effective feedback are outlined in the literature (e.g., Ingersoll & Dvortcsak, 2010; Simonian & Brand, 2022). Parents are likely to require a higher level of direct feedback early in the implementation of treatment. However, it is important to remember that rapport plays an important role when receiving corrective feedback. Make sure to provide more positive feedback early in the treatment and wait to provide constructive comments until a rapport is established, so caregivers feel comfortable and safe during coaching sessions.

See Table 2 for examples of different types of feedback you could implement while live coaching the caregiver (Bruinsma et al. 2020).

Table 2. Types of feedback

Type of feedback	Definition	Example
Give behavior-specific feedback.	Feedback should be specific, clear, and related to the caregiver and child during that moment.	“When you held the duck, waited for the reaching response from Maria, and said ‘DUCK’, Maria immediately said ‘DUCK’. This was a great way to create a request opportunity”.
Give behavior-focused feedback.	Focus each session on a single or a small number of techniques.	“When you held the duck, waited for the reaching response from Maria, and said ‘DUCK’, Maria immediately said ‘DUCK’. I love how you were able to quickly identify the indicating response and provided an immediate prompt.”
Use positive examples of the correct application of techniques.	Provide caregivers with positive examples of the correct uses of the technique.	“Good job following her reaching response!” “You are being very immediate in providing positive reinforcement!” “Awesome holding the duck in front of her to assess motivation!”
Use corrective feedback when needed.	The use of corrective feedback is important to ensure integrity.	“Maria seems to have lost interest in the duck. Rather than continuing to try to play with the duck, let’s see what she shows interest in next.”

Sometimes you will have to provide succinct feedback while the caregiver is implementing the technique. However, the caregiver might benefit from more elaborate or reflective feedback. If that’s the case, make sure to provide more in-depth feedback after the practice is done.

Final Thoughts

Caregiver coaching is a process that certainly requires technical skills but also a variety of soft social skills (Rohrer et al., 2021). Each family has different values, preferences, abilities, goals, and obstacles. Getting to know the family and establishing a strong, trusting relationship with the caregiver are critical to a successful collaboration. Shared decision-making and switching from the provider as the “expert figure” to a collaborative partner will provide a strong foundation from which to start successful coaching sessions.

References

Barnett, M. L., Niec, L. N., & Acevedo-Polakovich, I. D. (2014). Assessing the key to effective coaching in caregiver-child interaction therapy: The therapist caregiver-interaction coding system. Journal of Psychopathology and Behavioral Assessment, 36(2), 211-223.

Bruinsma, Y. E., Minjarez, M. B., Schreibman, L., & Stahmer, A. C. (2020). Naturalistic developmental behavioral interventions for autism spectrum disorder. Brookes Publishing Company.

LeBlanc, L. A., Taylor, B. A. & Marchese, N. V. (2020). The training experiences of behavior analysts: Compassionate care and therapeutic relationships with caregivers. Behavior Analysis in Practice, 13, 387–393.

McGrath, J. M. (2005). Partnerships with families: A foundation to support them in difficult times. The Journal of Perinatal and Neonatal Nursing, 19(2), 94-96.

Merriam-Webster. (2003). Litmus test. In Merriam-Webster’s collegiate dictionary (11th ed., p. 727).

Rohrer, J. L., Marshall, K. B., Suzio, C., & Weiss, M. J. (2021). Soft skills: The case for compassionate approaches or how behavior analysis keeps finding its heart. Behavior Analysis in Practice, 14(4), 1135–1143. 10.1007/s40617-021-00563-x

Rogers, S. J., Vismara, L. A., & Dawson, G. (2021). Coaching caregivers of young children with autism: Promoting connection, communication, and learning. Guilford Publications.

Simonian, M. J., & Brand, D. (2022). Assessing the efficacy of and preference for positive and corrective feedback. Journal of Applied Behavior Analysis, 55(3), 727-745.

Taylor, B. A., & Fisher, J. (2010). Three important things to consider when starting intervention for a child diagnosed with autism. Behavior Analysis in Practice, 3, 52-53.

Reference for this article:

Oliveira, J. (2025). Clinical Corner: How can ABA providers empower caregivers for successful collaboration? Science in Autism Treatment, 22(3).

About the Author

Juliana Oliveira, PhD, BCBA-D, is an assistant professor at the Integrated Center for autism spectrum disorders (iCASD), at the University of Nebraska Medical Center (UNMC) Munroe-Meyer Institute (MMI). She obtained her bachelor’s degree in psychology at the Federal University of Para (UFPA) in Brazil, and her M.S. degree in Experimental Behavior Analysis also at UFPA. Juliana conducted research on conditional discriminations with Cebus apella monkeys, stimulus-stimulus pairing procedures to induce vocalization with children diagnosed with autism, and caregiver training for toddlers and children diagnosed with autism. Later, she moved to Texas and obtained her doctorate at Texas Christian University (TCU). During that time, Juliana worked on a series of studies that evaluated the efficiency and other potential benefits of equivalence-based instruction, while remotely consulting families back in Brazil. In her current position, Juliana is providing ABA services to dyads and small groups of children diagnosed with autism. She is also interested in assessing different teaching procedures to teach verbal behavior and to assess the emergence of different verbal operants. She loves eating shrimp (any kind of shrimp!) and loves to go to the beach.

By Alicia Marshall, MAT, BCBA LBS

One of the most appealing aspects of entering the field of Applied Behavior Analysis (ABA) is that analysts and technicians have the opportunity to work in a variety of settings. It is common for these ABA practitioners to accept jobs with organizations that allow their employees to work in multiple settings such as clinic-based therapy, school-based therapy, and in-home therapy.  Furthermore, clinicians have the opportunity to implement strategies and build skills among various settings during their sessions. BCBAs and behavior technicians working in schools may have the ability to work with clinicians in multiple settings, such as the special education classroom, general education classroom, cafeteria, music class, and recess all in one day.  Additionally, BCBAs and other clinicians working in a traditional clinical setting are often responsible for generalizing skills and training all key stakeholders.  This variability and flexibility often comes with challenges and increased responsibilities.

Understanding Behavior Contrast

An important concept to consider when entering the field is the concept of behavior contrast.  Behavior contrast is a side effect of reinforcement of punishment procedures implemented in one setting that causes a behavior change in another setting where the same contingencies are not in place.  For example, if a reinforcement procedure is used in the school setting to increase functional communication, but the same procedures and strategies are not used at home, the clinicians and family are likely to see an increase in the functional communication in school and a possible contrast of decreased functional communication at home.  In order to avoid the effects of behavior contrast, it is important that clinicians properly and thoroughly train all key stakeholders and implement treatment with fidelity. 

Best practice would suggest that all key stakeholders undergo Behavior Skills Training (BST).

What is BST?

The basics of BST include having the lead clinician, most likely a BCBA, provide thorough verbal and written instructions followed by modeling the behavior in a role play or re life scenario.  The trainee, key stakeholder, would then reverse roles with the trainer and demonstrate the skill being taught in a role play or real life scenario.  The trainer would then provide timely and effective feedback to the trainee.  The implementation of BST is essential to ensure that treatment fidelity is high.  The higher the treatment fidelity, the more likely there is likely to be progress with the student or client.

Preparing for Generalization

Another key component to assure that expectations are met in a variety of settings is to include plans for generalization as soon as treatment begins.  A common misstep of some practitioners is only discussing behavior plans for the treatment setting and forgetting to consider other settings until mastery criteria is obtained in that initial setting .  BCBAs should account for generalization into other settings on the onset of treatment.  When a BCBA begins to create a behavior, he/she should consider types of reinforcement available in all settings.  The behavior plan will not be effective if potential motivators are available in one setting, but not another.  During initial planning, it is also important to plan for fading of reinforcement.  When starting to develop a behavior plan, it may be necessary for the stakeholders to offer a dense schedule of reinforcement.  However, over time a BCBA should plan to teach learners to retain skills without the need of continuous reinforcement.  This strategy can include providing access to preferred activities and items less frequently, or generalizing reinforcement to other intrinsic, or “natural”, motivators.

The field of Applied Behavior Analysis has many challenges.  Clinicians, families, and other key stakeholders have to collaborate effectively in order to generalize reinforcers, skill acquisition, and assist with behavior reduction in all of the settings the learner will be a part of.  Many Behavior Analysts and other clinicians must also start planning for effective collaboration and transition of services amongst settings from the onset of beginning services.  While these challenges can be stressful, having the opportunity to work with learners in many different environments and measuring progress leads to a rewarding career and success for all stakeholders involved.

About the Author

Alicia Marshall, MAT, BCBA LBS, started out as a Special Education teacher and made the switch over to full-time BCBA 5 years ago. Alicia received her BCBA coursework at Rutgers and currently works as a Director of Behavioral Health in the Greater Philadelphia area. Alicia is passionate about making learning fun for all stakeholders and to encourage educators to focus on socially significant goals and compassionate care. 

When Alicia is not disseminating the science of ABA, she can be found on the beaches of the Jersey Shore (and occasionally Hawaii) with her husband and two dogs.

By Ashleigh Evans, MS, BCBA

Have you ever been in an uncomfortable situation? Were you able to freely leave or voice your concerns and have them respected? Imagine being unable to communicate your discomfort or disagreement with the situation while being forced to stay. That is the reality many autistic children experience in school, therapy, and other areas of their lives. Gaining assent is critical to allow our learners to have a voice in their treatment. Let’s explore what assent is and consider some strategies to establish assent-based care.

Assent Versus Consent: What is the Difference?

First up–what distinguishes assent from consent? Consent is a term that refers to a client (if legally capable) or their parent or legal guardian agreeing to a treatment based on a comprehensive understanding of the intervention’s purpose, benefits, and risks. To provide consent, one must be legally capable of making these decisions. Children (and many adults with special needs) cannot legally provide consent.

Assent, on the other hand, is not a legal term. Assent refers to the client demonstrating signs of agreement or willingness to participate in treatment. Even if they cannot legally approve or deny therapies, every learner can express their preferences and willingness to engage in therapeutic activities.

What is the Significance of Assent?

Acknowledging and respecting assent and assent withdrawal demonstrates an upholding of client dignity, one of the four core principles outlined in the Ethics Code for Behavior Analysts. Gaining client assent in ABA is one component of what many refer to as “Today’s ABA,” a more compassionate approach to behavioral treatment. In the most recent update to the Ethics Code, assent is included as an ethical requirement, under section 2.11. Therefore, behavior analysts should not only understand what assent is but also actively empower their learners through assent-based practices. By doing so, they can create an environment where clients feel safe, valued, and motivated to learn.

What are the Signs of Assent and Assent Withdrawal?

Behavior Technicians and Behavior Analysts should watch for indications of assent and assent withdrawal. Signs of assent may be vocal, such as the learner making affirmative statements (e.g., “I’m having fun!”). They may also be non-vocal, such as eagerly approaching the therapist and actively engaging in activities.

Signs that your learner is providing assent include:

• Smiling and/or laughing
• Cooperating with learning activities
• Making approval statements, such as “I want to keep doing X” and “I love this!”
• Actively engaging in therapy activities
• Eagerly approaching the therapist
• Requesting to repeat activities
• Staying in the therapy space

Assent can be withheld or withdrawn at any time. Assent withdrawal refers to the indications that the learner does not approve of the treatment methods being utilized or goals being targeted. Signs of assent withdrawal may be both vocal, such as protesting (e.g., “no!”) and non-vocal, such as running away.

Signs of assent withdrawal include:

• Turning away or pulling away from learning activities
• Pushing away teaching stimuli
• Eloping from the therapist or therapy space
• Aggression, self-injurious behavior, property destruction, or other harmful behaviors
• Crying, screaming, or vocally protesting
• Dropping or flopping to the floor
• Avoiding the therapist
• Frowning

How Can You Implement Assent-Based Learning in ABA Therapy?

Gaining and maintaining assent is a complex, ongoing process that requires careful observation, flexibility, and respect for the client’s autonomy. Here are a few key strategies you can use to promote assent-based ABA therapy with your learners.

1. Prioritize Choices
   
   Empower your learners with choices to foster engagement and promote autonomy. Offer choices in activities, reinforcers, stimuli, location of sessions, and even the structure and order of programs or activities. While the client may not be able to make choices regarding every aspect of therapy, prioritize offering choices whenever possible.
   
   
2. Teach & Reinforce Self-Advocacy

Encourage your learners to communicate their needs, preferences, and boundaries. Regardless of their communication abilities or mode of communication, support them in developing critical self-advocacy skills, such as requesting a break and expressing discomfort.

3. Make Therapy Fun
    
   Therapy doesn’t have to feel like work. While there are bound to be goals that are challenging and tasks that aren’t the most preferred, there are countless ways to ensure therapy remains enjoyable and motivating. Regularly conduct preference assessments to ensure you are continuously enriching the environment with preferred items and activities.
   
   
4. Honor Assent Withdrawal
   
   

Respect your learner’s right to withdraw assent. This is essential for fostering trust.

5. Analyze & Address the Reasons for Assent Withdrawal
   
   When a client withdraws assent, that doesn’t mean the therapy session simply ends or the therapist allows them to do what they want for the remainder of the session. The therapist must analyze the situation to identify the reason(s) for assent withdrawal. They may need to modify various aspects of the learning environment, treatment modality, or goals to regain their learner’s assent. Here are a few things to consider:

• Has the therapist and client successfully paired? Does the therapist continuously focus on maintaining a positive rapport?
• Is the teaching style aversive to the client? (e.g., overly structured and repetitive when the learner may prefer a more naturalistic approach)
• Are the tasks too difficult? Are prerequisite skills missing? Is additional prompting necessary?
• Are the tasks too easy and monotonous?
• Is prompting aversive? (e.g., full physical when the learner does not like to be touched)
• Are there sensory sensitivities that may be making the learner uncomfortable?
• Are the learner’s preferences being accounted for and prioritized?

Beyond Compliance: The Power of Assent

While compliance has historically been a central focus of ABA therapy, the shift toward “today’s ABA” has redefined the field. True progress is about more than simply complying. It’s about trust, active engagement, and meaningful participation. By embracing assent-based practices, behavior analysts can empower their learners to play an active part in their therapeutic journey.

About the Author

Ashleigh Evans, MS, BCBA, is a Board Certified Behavior Analyst. She has been practicing in the behavior analysis field for over 13 years and opened her own independent practice in early 2022. Her experience has been vast across different age groups, diagnoses, and needs. She is passionate about improving the field through education, reformative action, and better supervisory practices, leading her to create content and resources for families and ABA professionals which can be found on her website, www.abaresourcecenter.com