Peer review

Peer review has a defined question and authority

A useful review names the work, period, criteria, reviewer, evidence, decision sought, and permitted outcome. The CASP ABA Practice Guidelines Version 3.0 public summary places assessment, treatment planning, implementation, and evaluation within standards of care for autistic people. CASP licenses the detailed guidelines; its public page neither requires this process nor supplies the criteria below.

Practices may also call this case review or clinical peer review.

Separate nearby functions before opening a case:

A peer can advise, recommend, or decide only within the chartered authority. Review does not transfer the treating clinician's accountability, create payer approval, or give an owner permission to alter clinical reasoning.

A charter makes the process repeatable

Define:

• scope, period, cohort, triggers, exclusions, and sampling or referral rule
• reviewer competence, independence, conflicts, recusals, and backup
• criteria and version, rating scale, required evidence, and missing-data rule
• accessible client, representative, family, clinician, and supervisee input when authorized
• lawful access, secure workspace, recording, retention, legal holds, and permitted destruction
• finding, disagreement, response, escalation, and appeal rules
• who may advise, approve, hold, disclose, or close
• action owner, deadline, verification, remeasurement, and closure test

Emergency response, medical care, mandated reporting, and other controlling deadlines proceed through their authorized routes without waiting for peer review. A later review may examine reasoning and system learning.

Reviewers need competence and fair distance

Match expertise to the question. Functional analysis, augmentative and alternative communication (AAC), feeding, severe behavior, billing, and state scope may require different qualifications. Use another team, site, or external reviewer when practical. Otherwise disclose relationships and use recusal, second review, or a narrower question.

The current BACB Ethics Code applies to BCBA and BCaBA certificants and people who completed an application for either credential, including their peer-review and management work. It addresses competence, confidentiality, conflicts, documentation, assessment, intervention, risk, client involvement, and truthful communication. BACB has no separate jurisdiction over the organization.

Give the reviewed professional the question, criteria, evidence set, deadline, and available response route unless an authorized investigation requires another process. Preserve original ratings, corrections, response, dissent, and final disposition. A finding should state its evidence and limits rather than turning reviewer seniority into proof.

Evidence should include the person's experience

Use the smallest authorized set that answers the question; label each source and version. Include only relevant clinical, safety, service, and incident evidence.

When the review concerns care, offer accessible input on priorities, benefit, burden, discomfort, assent, dissent, and desired change. The BACB Ethics Code defines assent as willingness when a person cannot provide informed consent and requires it when applicable; assent does not replace required informed consent. ASHA says AAC users should always have their tools or devices. Keep the usual AAC and any approved backup accessible.

Family or representative involvement depends on preference, authority, consent, confidentiality, and relevance. Record access alone does not authorize assessment, recording, contact, or treatment change; route those actions to the authorized role.

Privacy and legal protection require separate analysis

For a HIPAA covered entity or business associate, current 45 CFR 164.502(b) and 164.514(d) require reasonable efforts to limit covered uses, disclosures, and requests for protected health information to the minimum necessary; treatment disclosures and requests are excepted. Classify the review as treatment, health care operations, or another activity before setting access and safeguards.

A label or confidential footer does not establish privilege. Current 42 CFR Part 3 protects only patient safety work product, subject to exceptions. It can cover specified information developed in a documented patient safety evaluation system for reporting to a listed Patient Safety Organization; it excludes original medical, billing, discharge, and separately existing information. Ordinary internal review is not automatically protected. Counsel should map federal and state protections, required records, reporting, and retention before promising confidentiality.

Findings should lead to proportionate action

Possible dispositions include meets criteria, needs clarification, improvement opportunity, critical concern, outside reviewer scope, or insufficient evidence. Define each before scoring. Route a critical safety or legal concern to the role authorized to order a hold or start an external process. Documentation ambiguity may require correction; a competence gap may require training, rehearsal, and direct observation.

Keep clinical, employment, credentialing, payer, privacy, and compliance decisions separate even when they share evidence. Record the authorized owner and basis for each. Closure needs proof that the action occurred and the selected measure was repeated under the approved rule.

A fictional review preserves disagreement and open work

At a fixed cutoff, a fictional practice locks 10 treatment-plan reviews that reached a predeclared maturity date; missing packets remain. Two reviewers score eight criteria per case, creating 10 × 8 = 80 criterion-case pairs and 160 individual ratings. They agree on 72/80 pairs, or 90% raw agreement. Raw agreement is descriptive, not chance-adjusted reliability. Retain both ratings and all eight disagreements through disposition.

Three cases lack evidence showing how the person's priorities informed a goal. The sample rate is 3/10, or 30%; it does not show that the plans were inappropriate or estimate a rate outside this cohort. One case has an urgent communication-access concern and uses the clinical escalation route immediately.

At the next-cycle cutoff, four actions are due. Three meet closure by deadline: 3/4, or 75%. The fourth remains in the denominator and stays open with risk, age, owner, next step, and escalation date. A later predeclared sample may assess recurrence; this review cannot establish causal improvement.

Measure reach, reliability, timeliness, and closure

Use these denominators:

• review reach: locked mature cases reviewed divided by all mature cases due; retain missing packets
• raw agreement: agreed criterion-case pairs divided by all scorable pairs; report missing ratings
• response access: professionals offered the response route divided by all entitled to respond
• urgent timeliness: items escalated within target divided by all urgent items; retain late and open items
• on-time closure: actions closed by deadline divided by all actions due; retain open actions

Report recusals, disagreements, critical findings, open age, accessible input offers, reviewer time, and remeasurement. Define cutoff, cohort, unit, clock and time zone, exclusions, missing-data rule, source, and criteria version before interpreting a percentage.