Here is a pattern I see in a lot of clinics. The assessment is done, the BCBA writes a recommendation of 30 hours a week, and then the intake coordinator says, "Our openings are Monday through Friday, 9 to 3."
The family has been on a waitlist for months. So they pull their child out of school, and nobody ever really decided that. It just happened.
I want to be clear that I am not against intensive ABA. Full-time services are sometimes exactly what a child needs. I want us to make that call on purpose, with the whole picture in front of us.
Our job is to work ourselves out of a job
Every client we serve will eventually step down to a lower level of care. That might be school, a group home, a job, or just life back with their family. If our treatment is not preparing them for that next place, we have a problem, no matter how good the data looks in the clinic.
The question is not "can a clinic teach these skills?" A clinic absolutely can. The better question is: what developmental opportunities are lost when a child is removed from school?
What school gives a child that a clinic can't fully copy
For students with disabilities, school can provide:
Peer relationships and a social identity
Community inclusion and a sense of belonging
Group learning and collaboration
Exposure to real-world environments
Academic and vocational pathways that may not exist anywhere else
Self-advocacy practice
Preparation for adult systems and expectations
A clinic teaches skills. A school teaches participation in society. Even very good therapy has a hard time recreating authentic peer culture, natural social consequences, large groups, and community participation at scale.
Think about where this can lead. A child who could have graduated with a diploma or a GED is kept in clinic-based ABA because the team believed it could provide the same thing. Nobody meant harm, but that decision may have narrowed what that young adult can do later: work, contribute, live more independently.
And for a child with higher support needs, a clinic-only schedule may mean fewer chances for peer tutoring, friendships, or inclusion, even if those look different for that child.
A note on assent-based and instructor-led environments
As a field we have moved a long way from compliance-based services toward assent-based care. I support that.
But I have also worked with organizations that swung so far toward client-led services that they struggled to get a child back to the point where they could follow a group routine. Once a child leaves a highly individualized therapy setting, much of the world is not client-led. School, work, and community spaces have rules and instructor-led moments. We need to prepare for that without giving up dignity.
What the ethics code asks us to consider
I am not quoting code numbers here, but the BACB ethics code and its introduction point us toward the same questions:
Client welfare and doing no harm. Removing a child from school is a major developmental and environmental intervention. It should never be just a scheduling choice.
Naturalistic maintenance. We are asked to design interventions likely to maintain in natural conditions. For ages 3 to 18, school is one of the most important natural environments a child has.
Degree of restrictiveness. This one surprised me when I first looked at it closely. A clinic can feel like the less restrictive option if the child was spending the day in a small room with several adults in the school. But a clinic with limited peer access can also be more restrictive. It depends on the child. We rarely ask the question, because we see ourselves as providing medical care.
Collaboration. Schools should not be seen as obstacles to treatment. They are developmental partners, and they bring expertise we often do not have in academics, in some speech and OT-adjacent areas, and in how to teach skills outside of ABA research.
Appropriate service levels. Appropriate does not automatically mean the maximum hours in the most restrictive setting.
Six questions to ask before you recommend full-time ABA
Is removal from school truly necessary, or just convenient for our schedule?
Have less restrictive options been tried and documented?
Can some of the hours be delivered after school, with a mix of daytime and evening?
What developmental opportunities will be lost, and does the family understand them?
Will this recommendation increase long-term independence?
Are we treating behavior alone, or helping build a future adult?
Be honest with families
If I recommend full-time day treatment, I have been through this risk-benefit analysis myself, and I can walk parents through both sides. If I do not think it is the right fit, I tell them what the plan calls for and why I would suggest a different model.
There is no single right answer for every child. But there is a wrong one: the answer chosen without looking at the options.
If you remember one thing: pulling a child from school is a developmental decision, so make it on purpose.
If you want a structured way to do this, I built a free tool that walks through these questions. You can find it here: The ABA Educational Impact Analysis.
If your clinic needs help building service models that keep school access in view, learn about Clinical and Agency Consulting. I offer a free 15-minute consultation if you want to talk it through.
Casey Gressmen, MBA, MEd, BCBA, LBA, is a licensed special education teacher and board certified behavior analyst and the founder of Phoenix Rising Behavior and Academic Consulting.
