CLINICAL versus SCHOOL

Comparison of School and Clinical ABA Services

School

The focus is on providing free appropriate education (FAPE) in the least restrictive environment (LRE) as outlined in the individual education plan (IEP).
The goal is to increase educational opportunities and prepare children for post-school opportunities.
Services take place in the school and community.
Educational service placement and intensity are determined by the educational team. Students may receive services in a classroom without direct support or could be pulled out for one-to-one services during part of the day.
Services are drawn from research within the field of education.
Services are limited to school hours.
Services are limited by funding available. Funding comes from federal, state, and local education funds. Some districts are able to obtain grants.
A medical diagnosis may be considered, but ultimately a multidisciplinary team will determine educational necessity.
Services may be provided by licensed or certified teachers, psychologists, or other educational staff. Some schools hire Board Certified Behavior Analyst (BCBA)’s to provide guidance but this is not a requirement.
Providers must hold a minimum of a bachelor's degree, have completed an approved teacher preparation course sequence, and applied for licensure. Professional development requirements are limited to the field of education.
There are no rules regulating case sizes. Some are limited by classroom size and other professionals may work with children across the entire school district.
Goals focus on meeting state standards and preparing students to meet graduation requirements.
Students’ progress is monitored and reported quarterly. The multi-disciplinary team reevaluates qualifications for services every three years. Some students will participate in statewide testing every year.
If an inclusive setting is outlined in the IEP, students will be able to participate in educational activities alongside typically developed peers.
Falls under educational requirements and regulations.
Services are regulated by the Department of Education.
Access to typically developing peers which creates opportunities for learners to pick up on appropriate behaviors and social skills through observation..
IEP goals are annually revised with the learner’s educational team and family.

Clinical

The focus is on treating and reducing symptoms of neurological conditions.
The goal is to aid the participant in gaining access to the least restrictive environment possible and develop lifelong skills in order to increase independence.
Families are expected to participate and work with therapists to develop skills.
Each client receives 1 to 1 treatment. Some group treatment is provided to work on specific skills in this setting.
Treatment involves only evidence-based practices within the field of Applied Behavior Analysis.
Collaboration with other medical and educational providers will occur to ensure the best outcomes.
Services can take place in the clinic, home, and community
Your physician must provide a referral once medical necessity has been determined.
Services are provided by an individual certified by the Behavior Analyst Certification Board (BACB) with a minimum of a Master’s degree. They must undergo extensive training, and pass a board certification exam. Continuing education is a requirement limited within the field of behavior analysis.
Caseloads are limited by the BACB and take into consideration the intensity of services provided. It is recommended no more than 20 cases, although if the BCBA focuses on intensive treatment they may have less than 10 cases.
There are no federal limits on funding for services. Services are funded generally through private insurance and/or Medicaid.
Goals focus on remediating diagnostic criteria as identified in the DSM-5. Goals often focus on communication, executive functioning, daily living, and play skills. All developmental domains and skills are considered for treatment.
Providers are required to stick to a strict ethical code as outlined by the BACB, as well as those accepted by the medical community. Duty to the client is paramount.
The client’s progress is monitored weekly. Treatment is adjusted, and formal assessments occur at least twice per year.
Clients are treated individually, and within a larger group of individuals also receiving therapy.
Is overseen by the American Medical Association, US Bureau of Medicine, Centers for Medicaid/Medicare, and Health and Human Services.
Data is analyzed continuously in order to make program changes and ensure goals are updated with the learner's ongoing progress.

Gregory, P., Kuhn, L., Pratt, C., & Trivedi, M. (2020). Applied behavior analysis (aba) in schools and in clinics: Similarities and differences. Retrieved from https://www.iidc.indiana.edu/irca/articles/applied-behavior-analysis-in-schools-and-in-clinics.html.