Feasibility and safety of the practical functional assessment at scale: findings from a multi-state ABA organisation
Hillary Laney, Edward Sanabria, Cindi Kennedy, Cassi A. BreauxPurpose
Traditional functional analysis has proven difficult to implement at scale due to safety concerns, resource demands and the deliberate evocation of behaviours of concern. This study aims to examine whether the practical functional assessment (PFA), a trauma-informed alternative, could be delivered safely within a large, multi-state ABA organisation.
Design/methodology/approach
Data were drawn from 313 PFAs conducted by 251 clinicians and 23 coaches across 12 US states, spanning clinic, home and community settings. Coaching was delivered via telehealth (68.2%), in-person (24.8%) and on-site observation (7%), following a 10-h course or 2-h webinar.
Findings
Of the 313 PFAs, 96.17% demonstrated clear functional control and 98.72% met safety criteria in an average of 21.59 min. Precursor behaviours occurred at higher rates (M = 5.3) than high-intensity behaviours of concern (M = 0.23). Clinician social validity ratings improved substantially from pre- to post-training, with safety rated 9.65 out of 10.
Research limitations/implications
Interobserver agreement and procedural fidelity data were not collected, and no treatment outcome data were obtained. Social validity reflects clinician perspectives only; caregiver and client voices are absent. Generalisability beyond a US insurance-funded context requires further examination.
Practical implications
Organisations can implement function-based assessment at scale using a tiered coaching structure with blended telehealth and in-person delivery. The mentorship model offers a replicable infrastructure for compassionate, safety-first assessment within routine clinical service.
Originality/value
To the best of the authors’ knowledge, this is among the first systematic reports of large-scale PFA implementation, demonstrating that trauma-informed functional assessment can be embedded within routine clinical delivery without compromising safety or functional control.