ABA Choice, Assent and Dissent Check-In Worksheet for Families

Use the ABA assent check-in worksheet for one interaction at a time. Record direct words or observable actions before interpretation. Keep the person's expression, the family's question, and the provider's clinical or administrative response in separate fields.

Repeat the check-in when the choice, context, access, or response changes.

Families and Caregivers / Progress, Quality, Rights and Ethical Care.

The BACB ethics-codes page identifies the current Ethics Code and includes a glossary definition of assent. The code applies to certificants and applicants. A family's worksheet does not establish an organization's assent parameters, informed consent, decisional authority, capacity, or legal rights.

Important boundary: This is a family-owned communication check-in. It cannot define or score assent or dissent, infer willingness, determine capacity or authority, or provide or revoke informed consent. It also cannot authorize services, direct staff, create or change a treatment plan, decide clinical risk, establish a legal conclusion, or replace urgent safety and emergency processes.

Name the one choice or interaction being checked

Avoid writing about an entire program at once. A specific interaction makes the person's expression easier to preserve accurately.

Check-in fieldEntryPersonDate, time, and settingActivity, goal, meeting, or decision discussedWho presented itWhat was being asked or offeredWhy the family is recording this check-inImmediate safety or urgent issue routed elsewhere

Name the interaction without labeling it accepted or refused. Record the source of the description. If an urgent safety issue exists, use the current safety or emergency process and keep this worksheet secondary.

Use one row set per interaction. Copy the actual wording when possible. State who was present. Note changes in setting or health only when known. Keep the family's purpose specific.

List accessible options and the information provided

The AHRQ shared decision-making overview describes a collaborative process informed by evidence, clinical knowledge, and the patient's values, goals, preferences, and circumstances. It is not an ABA assent protocol.

Option or informationHow it was presentedAccessible to the person?Person asked for more information?SourceUncertainty

Do not invent options or clinical tradeoffs. Record what the responsible team actually offered or explained. If the person did not receive accessible information, preserve that fact separately from any later selection.

Use plain source labels. Note whether pictures, objects, written text, demonstration, AAC, interpretation, or additional processing time were available. Ask who can explain clinical risks and benefits. Do not treat incomplete information as a decision.

Preserve the person's communication method and direct expression

The ASHA communication access resource emphasizes asking about communication preferences, communicating directly, confirming understanding, allowing time, and supporting multiple methods. The ASHA AAC portal describes aided and unaided communication forms and person-centered participation.

Communication fieldEntryMethod availableMethod the person usedDirect words, selection, gesture, movement, or other observable actionContext immediately before the expressionChange, pause, or withdrawal observed laterWhat remains unknown

Describe only what was directly communicated or observed. Do not translate silence, stillness, task completion, distress, avoidance, proximity, eye contact, or another action into assent or dissent. Interpretation belongs within the responsible clinical process and the person's communication context.

Wait for the person's response. Preserve their method. Use quotation marks only for exact words. Separate observation from interpretation. Record a later change as a new entry instead of overwriting the first one.

Separate choice, preference, assent, dissent, and consent questions

These terms are not interchangeable. The worksheet keeps questions separate so the qualified people can answer within their roles.

Question categoryExact family questionPerson or role askedResponse source and dateAnswer recordedFollow-upAvailable choicePreferenceAssent or willingnessDissent, disagreement, or withdrawalInformed consent or authorizationClinical plan or safety

The BACB Ethics Code provides professional standards and definitions for covered certificants. It does not make a family member the assessor of assent or the decision-maker for clinical, legal, or organizational requirements.

Ask one question at a time. Record the respondent's role. Keep a clinical answer distinct from a legal or organizational answer. Do not collapse assent into consent. Preserve disagreement between sources for follow-up.

Record how the responsible team responded

Response fieldEntryPerson's expression shared withDate and channelDirect acknowledgment receivedImmediate response or pauseClarification requestedResponsible decision owner namedNext check-in date

An acknowledgment is not proof that the expression was clinically interpreted, that a plan changed, or that consent was given or withdrawn. Ask the responsible team to explain its process in accessible language.

Save the direct response. Note whether the person was included. Record any pause without assuming its reason. Ask who owns the next decision. Keep plan changes in the provider's official record.

Check whether participation remained person-centered

The CMS person-centered care overview describes care guided by a person's goals, preferences, and values and collaborative care planning. It does not define assent for ABA.

Participation promptFamily observation or direct statementSourceQuestion for teamPerson had a way to receive informationPerson had a way to communicateMore than one meaningful option was discussed, if applicablePerson could ask for time, a pause, or a changeBasic communication and access remained availablePerson's own priorities were represented

This is a prompt list, not a compliance score. Some choices may be limited by safety, law, clinical judgment, resources, or another decision-maker. Those limits require source-specific explanation and review.

Ask rather than assume. Record who explained a limit. Keep basic access separate from earned items or treatment procedures. Route clinical plan questions to the qualified clinician. Preserve the person's direct feedback.

Compare expressions across time without declaring a pattern

Check-in dateSame interaction or changed context?Accessible optionsDirect expressionTeam responseWhat changedOpen question

Do not call repeated task completion assent or repeated distress dissent. A qualified team must interpret information within the person's communication, clinical, ethical, organizational, and legal context.

Use comparable descriptions. Note changes in access and options. Keep a new expression visible. Do not average away disagreement. Ask when the next direct check-in will occur.

Close the family check-in without closing the underlying issue

Closeout fieldEntryPerson's latest direct expressionAccess method usedLast responsible responseOfficial record or plan location, if providedUnresolved questionNext owner and date

Close this worksheet entry when the interaction and follow-up are accurately recorded. Do not treat closure as proof of agreement, consent, clinical resolution, safety, or legal compliance.

Summarize only the latest sourced state. Preserve earlier expressions. Ask how the person can revisit the choice. Keep sensitive notes secure. Start a new check-in when circumstances change.

Fictional example: Morgan asks to pause a planning discussion

This example is fictional and demonstrates wording only.

FieldFictional entryInteractionProvider presented two possible times for a caregiver coaching meetingAccessMorgan used a speech-generating device and had both times shown in writingDirect expressionMorgan selected “not now” on the device and moved the paper awayFamily actionParent repeated “not now” and asked the provider how Morgan could revisit the choice laterProvider responseCoordinator acknowledged the message and offered to pause the scheduling discussionOpen questionWho will ask Morgan again, with the same communication access, and when?

The example cannot establish assent, dissent, refusal, capacity, consent, clinical meaning, a required provider response, or a legal result. A real family would preserve the direct expression and ask the responsible team to apply its current process.