ABA Shared Decision Options and Trade-Offs Worksheet for Families

Use one copy for one decision question. Write who owns the clinical recommendation, who holds the family or legal decision role, how the learner communicates preferences, and which separate payer or operational questions remain open. An option should not appear in the worksheet unless its responsible source identified it.

This ABA treatment decision worksheet for families is a conversation aid. It is not a treatment plan, clinical recommendation, risk assessment, evidence review, consent form, capacity determination, authorization request or direction to accept or refuse care.

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

What this worksheet can and cannot establish

The worksheet can preserve the exact decision question, options described by the responsible source, attributed benefits and burdens, uncertainties, learner and family priorities, access needs, unanswered questions and the next review. It can help reveal when a payer decision, staffing limit or schedule has been mistaken for a clinical recommendation.

Important boundary: This worksheet cannot create options, recommend or rank a choice, determine clinical appropriateness, medical necessity, evidence strength, risk, coverage, authorization, consent, assent or decisional capacity, or interpret a study, policy or treatment record. It cannot direct acceptance or refusal, establish that a decision was informed, or imply that documenting a preference creates a clinical or payer decision.

The BACB Ethics Code for Behavior Analysts addresses behavior-change programs, client and stakeholder involvement, informed consent, documentation and professional responsibilities within its scope. A family worksheet cannot determine compliance with the code or replace a qualified professional's responsibilities.

State the decision question precisely

Avoid beginning with a conclusion such as “Should we agree to more hours?” until the responsible team has confirmed what decision is actually being considered.

Decision frameEntryDecision question in neutral wordsWhy the question is being raised nowResponsible clinical source and roleFamily or legal decision roleLearner's communication and decision-support needsDate a decision or review is requestedWhat happens while the question remains open, attributed to sourceRecords or versions being discussedSeparate payer, staffing or scheduling issue

“Choose between Plan A and Plan B” may be premature if the options have not been defined, the current plan remains in effect, or another reasonable option has not been discussed. Record the open framing question rather than inventing an answer.

Separate six sources of information

Information layerResponsible sourceWhat the current record saysWhat remains unansweredClinical assessment or recommendationLearner goals, preferences and communicationFamily goals, preferences and circumstancesConsent or supported-decision processPayer coverage or authorizationProvider capacity, schedule and actual delivery

A covered service is not automatically clinically recommended. A provider's available schedule is not the full set of clinical options. A clinical recommendation does not establish payer authorization, family consent, learner assent or delivery. Keep each source, owner and date visible.

List only options identified by a responsible source

Copy the option in the source's words, including conditions and time limits. If “continue the current plan for now” or “seek more information before deciding” is discussed, record it only when the responsible source includes it.

OptionIdentified by whom and whenWhat would changeWhat would stay the sameConditions or limitsSource documentOption 1Option 2Option 3, if supplied

Do not add an intervention, reduce a service, change a goal or create a home program to make the table look complete. An empty row is not evidence that another option exists.

The AHRQ shared decision-making overview describes collaboration among a patient and care team that combines available evidence and professional knowledge with the person's goals, preferences and circumstances. It is a general health-care framework, not a clinical rule for ABA or proof that a particular set of options is complete.

Attribute benefits, burdens, risks and uncertainty

The worksheet should show who described each point. It should not translate a possibility into a probability or treat a family preference as a clinical effect.

Comparison fieldOption 1Option 2Option 3, if suppliedExpected purpose or benefit, attributedPossible burden or inconvenience, attributedRisk or concern stated by responsible sourceWhat is uncertain or not knownEvidence or record the source relied onTime to review the effect, if statedWhat could prompt reconsideration, if stated

Ask the responsible professional to explain numerical claims, evidence limits and relevant alternatives in accessible language. Do not calculate likelihood, compare study quality, infer causation or label a choice safer, better or more effective inside this worksheet.

Make goals, preferences and circumstances visible

The CMS person-centered care overview describes care that responds to a person's goals, values and preferences through communication and collaborative planning. The overview cannot decide which ABA option is appropriate or make the family's circumstances into clinical criteria.

TopicLearner communication or family entryWhy it matters to this decisionShared with whom and whenLearner's own goals or interestsPreferred communication method and supportAssent-related behavior, choice or request for a pauseFamily priorities and concernsCultural, language or accessibility needsSchool, work, childcare or other careSleep, meals, transportation and recovery timeRelationships, community activities and preferred routines

Use observable, attributed descriptions. “Touches the stop card and moves away when the tablet task begins” preserves communication better than “will not cooperate.” The entry can prompt discussion without proving assent, dissent, capacity, risk or treatment effect.

Prepare questions before a choice is recorded

• What exact decision is required now, and who is responsible for each part?
• Which options did the responsible clinical source identify, including the current course if applicable?
• What expected benefits, burdens, risks and uncertainties were explained for each option?
• Which information is based on this learner's current assessment and which is general information?
• How were the learner's goals, communication, choices and assent-related behavior included?
• How do family priorities, access needs and practical constraints affect the conversation?
• Which payer, authorization, staffing or scheduling questions remain separate?
• Can more information, communication support or time be provided before the decision?
• How will the decision be documented, reviewed and corrected if circumstances change?

The AHRQ SHARE Approach presents a five-step process for clinicians: seek participation, help compare options, assess values and preferences, reach a decision, and evaluate it. This worksheet borrows the organizational idea of keeping those parts visible. That use cannot certify a complete process or an informed and appropriate choice.

Record the conversation without converting it into consent

Conversation fieldEntryDate, participants and rolesCommunication support usedOptions actually discussedQuestions answered and sourceQuestions still open and ownerLearner communication observed or reportedFamily preference or concern statedClinical recommendation, attributedPayer or operational issue routed separatelyNext conversation or decision point

A meeting note, preference statement or checked box is not automatically valid consent. Preserve the organization's applicable consent process separately. Do not infer assent from attendance, silence, task performance or lack of objection.

Preserve the decision and follow-up as separate events

Follow-up layerDated entryDecision or provisional choice, attributed to decision makerConditions, limits or questions attachedConsent record location, if applicableTreatment-plan update and responsible sourcePayer decision or authorization recordProvider staffing and calendar confirmationFirst service actually deliveredLearner or family feedback after implementationReview date and decision owner

The decision, written treatment-plan change, payer authorization, scheduled appointment and delivered service may occur on different dates. Do not use one row as proof of another.

Correct the record when information changes

DateEarlier entryCorrection, new information or disagreementSourceEffect stated by responsible ownerNext review

A changed recommendation does not erase the earlier source. A new authorization does not retroactively establish coverage. Preserve versions and dates so the decision sequence remains understandable.

Fictional example: considering two session-setting options

This fictional example describes no real learner, family, provider, payer or recommendation.

Decision question. Cedar Compass Behavior Services asks Maya and her mother, Elena, to discuss where a newly proposed communication-focused session could occur. Rowan Patel, BCBA, identifies two options for conversation: one weekly clinic session or one weekly home session. Elena records that Rowan, not the worksheet, supplied both options.

Attributed comparison. Rowan says the clinic option would provide access to certain materials and peers, while the home option would allow observation in an ordinary evening routine. Rowan also explains that either setting may require adjustments and that the current information does not predict which setting Maya will prefer. Elena records these statements without ranking the options.

Goals and circumstances. Maya uses speech and a communication device. Elena reports that Maya selects the “home” icon when shown photos of both places, but also enjoys seeing one peer at the clinic. The family has transportation on Tuesdays but not Thursdays. These entries describe communication and logistics; they do not establish assent, capacity or clinical effectiveness.

Open questions. Elena asks how Maya's selection will be revisited, what support is available during transitions and whether the payer treats the settings differently. Rowan owns the clinical response; an authorization specialist owns the payer question. No one treats staffing availability as the clinical recommendation.

Follow-up. The family requests another conversation after receiving the payer answer and an accessible visual schedule. No choice, consent, treatment-plan update, calendar or delivered service is recorded yet.

The example does not establish medical necessity, appropriateness, evidence strength, coverage, authorization, consent, assent, capacity, risk or the best option. No direction to choose follows from it.