Writing Your First Treatment Plan
Writing Your First Treatment Plan
As a brand new BCBA, it may be nerve-wracking to write your very first treatment plan for a client. Whether you're starting from scratch or picking up where another BCBA left off, there are many ways to get lost in the process.
Despite how difficult the task may be, there are a few things that can help get you through your first treatment plan.
1. Ask for a model
Most companies have treatment plan templates that you are required to use, so you probably won't be starting from scratch.
If there is no template (or if you still don't know where to start after getting a hold of a template), ask to see another BCBA's treatment plan. It's absolutely okay (and quite normal) to request help from more seasoned BCBAs. They are a resource available to you, so ask your coworkers for help!
2. Consider the needs of your client
The needs of your client should drive the decision making process for creating treatment plan goals.
Does your client have any skill deficits that are putting them behind their same-age peers? Do they engage in any challenging behaviors that are keeping them from being integrated into a less restrictive learning environment?
3. Consider the needs of the caregivers
All treatment plans will require parent/caregiver training goals. There needs to be a plan for generalization outside of therapy hours.
Some things to consider: Do the parents have any previous therapy experience? Do they have specific skill or behavior concerns? Have they even accepted their child's ASD diagnosis?
Sometimes the best place to start with parent training goals is to help caregivers understand the basics of ASD so that they don't feel as lost or alone. Examples may include understanding and recalling the differences between reinforcement and punishment, recalling the four functions of behavior, and being able to collect ABC data (which will help you as the BCBA later on when your client engages in novel behaviors outside of therapy).
Keep in mind that each parent and caregiver will respond to the diagnosis in different ways, so asking how you can support them as they navigate this turbulent time is a great way to brainstorm what your caregiver training goals will be.
4. Are the assessments you chose appropriate for your client?
Think about the needs of your client, mentioned earlier. Some assessments are for individuals of all ages, while other assessments are for specific age ranges.
You will also want to consider using a blend of norm-referenced and criterion-referenced assessments. Norm-referenced assessments will compare your client to others of the same age, whereas criterion-referenced assessments use a predetermined set of standards to analyze which skill sets your client has a deficit in. By including both norm-referenced and criterion-referenced assessments, you will be strengthening your treatment plan and setting yourself up for an easier battle later down the insurance road.
5. Consider the diagnostic report
Diagnostic reports are an amazing tool that will help prep you prior to meeting your client for the first time. Some are out-of-date and contain information about your client that is no longer relevant to them. Regardless, it's a great place to start as it gives you a snapshot of your client's history and helps you determine which assessments may be appropriate for your client.
Every BCBA practicing in ABA and working with insurance must receive a diagnostic report from the clinician who diagnosed the client with ASD prior to the initial assessment. If you are put in a position where you are expected to run an assessment without first receiving the diagnostic report to review, push back immediately and stand your ground. The diagnostic report gives you a heads up on what behaviors and skill deficits to prepare for, and you will need it prior to assessing the client directly.
6. Does your treatment plan paint a complete picture of your client?
If this is your client's very first assessment, you may only have their diagnostic report to go off of in terms of learner history. And, like we discussed earlier, diagnostic reports are sometimes out-of-date and don't properly reflect your client and where they are now.
Think about what you know of the client, their home life, their personal interests, and their fears. Consider their caregivers, how they've been doing since receiving the ASD diagnosis (again, assuming you're working with ASD clients in ABA). Think about all relevant information that may impact treatment, and include all that information somewhere in the treatment plan.
7. Request a review prior to submission
Ask your mentor or clinical director (or a fellow BCBA if you don't have a designated mentor or clinical director) to review and proofread your treatment plan prior to submitting it to insurance.
You may not agree with every piece of feedback you get, but having an extra set of eyes reading over your treatment plan is a huge help when deciding if your treatment plan is insurance-ready.
8. Be finished two weeks prior to the authorization end date
When should you submit a treatment plan? Ideally within two weeks of the insurance deadline. This can help prevent gaps in a client's therapy authorization, which is the approval required for insurance to reimburse for therapy services provided.
Your client's insurance may also require a pediatrician's signature before being submitted, which could take an additional 1-2 weeks to complete. Give yourself enough time to ensure everything gets submitted on time on your end to help other clinicians submit their parts in a timely manner if needed.
