Beyond 30 Hours: How to Make Ethical, Data-Driven ABA Dosage Decisions
You’re expected to recommend a number.
Not a range. Not a flexible model. A number that shapes a child’s life — and determines whether the plan gets approved, the case gets staffed, and the family gets the help they so desperately need.
Your agency pushes for more hours because it's easier to staff, reduces admin burden, and keeps the business profitable.
Insurance pushes for fewer hours to reduce costs — and if you don’t ask for enough up front, you may not get the chance to get more.
You’re the one in the middle.
The only one positioned to recommend what’s truly clinically necessary.
And yet, no one taught you how to make that decision — not with this much weight, not in this kind of system.
The Default Model BCBAs® Are Stuck In
For decades, 25 to 40 hours per week of ABA has been considered the “gold standard” for early intervention. It’s referenced in funding requests, baked into agency policies, and built into treatment plan templates.
But where did that number come from—and more importantly, should it still guide our decisions today?
The short answer: it came from one study. And the long answer is far more complicated.
The Enduring Influence of the Lovaas Study
In 1987, Ivar Lovaas published a now-famous study on early intensive behavioral intervention for autistic children. The findings were striking: of the 19 children who received 40 hours per week of one-to-one discrete trial training for two to three years, nearly half achieved what the study called "normal intellectual and educational functioning" (Lovaas, 1987).
The comparison group—children who received fewer than 10 hours per week—showed significantly lower gains.
That study became a cornerstone for ABA as a medically necessary intervention and continues to influence insurance policy today.
But there’s a problem: the model tested in that study isn’t the model most of us are delivering today.
Why Lovaas (1987) Doesn’t Translate to Today’s Practice
Let’s consider what that original intervention actually looked like:
Highly structured, clinic-based discrete trial training
Minimal focus on generalization or naturalistic instruction
Very limited parent involvement
One-to-one implementation with tightly controlled variables
A small sample (N=38) and no long-term replication
In contrast, today’s ABA services are often:
Home-based or delivered in more naturalistic settings
Focused on naturalistic developmental behavioral interventions (NDBIs) and routines-based learning
Implemented with significant parent involvement and coaching
Delivered under real-world constraints with variable staffing, fidelity, and environmental conditions
So if we’re no longer replicating the structure, setting, or methods of Lovaas (1987), we have to ask:
Why are we still replicating the dosage?
What the Modern Research Actually Shows
Recent large-scale reviews and meta-analyses have begun to untangle the assumption that more hours automatically lead to better outcomes—and the findings challenge long-held beliefs.
Sandbank et al. (2024) analyzed more than 150 studies of early intervention, including many that used ABA-based models. They found no consistent relationship between weekly treatment hours and child outcomes. Gains were seen across a wide range of intensities, and what mattered more was whether the intervention was sustained over time and adapted to the child’s context.
In fact, Linstead et al. (2017) came to a similar conclusion: duration of services—not weekly intensity—was the stronger predictor of progress in communication, adaptive behavior, and social functioning. Their findings suggest that a lower weekly dosage delivered consistently may outperform a higher dosage that leads to burnout, inconsistency, or early dropout.
More recently, Peterson et al. (2024) found that treatment outcomes are significantly influenced by learner characteristics, age, and contextual fit—not just the number of service hours. Their work adds further evidence that there is no universal optimal intensity for ABA.
And while dosage is often the focus, Choi et al. (2022) remind us that the treatment model itself—and how well it fits the child and family—is often more predictive of success than weekly hours.
Why This Matters for BCBAs® Today
We work in a system where insurance companies often expect BCBAs® to justify high hours upfront, or risk losing access to services altogether. At the same time, agencies are incentivized to recommend higher hours because it’s easier to staff, reduces administrative load, and increases profit margins.
But neither of those pressures prioritize what’s most important:
What does this learner actually need—clinically, functionally, and ethically?
When we default to 30–40 hours per week as the starting point, we risk delivering services that are more intensive than necessary, less sustainable, and less effective.
And when we don’t critically examine that default, we reinforce a system that values volume over fit—and compliance over outcomes.
So, What Should Guide Dosage Decisions?
The emerging research is clear:
High-intensity treatment can be effective—but it’s not always necessary.
Outcomes are influenced by consistency, contextual fit, and caregiver capacity, not just hours.
Dosage decisions must be individualized, data-informed, and responsive to real-world conditions.
As Ostrovsky et al. (2022) argue, we need models of ABA that are “client-centered and data-driven,” not dictated by default settings or reimbursement expectations.
Introducing the CLEAR Framework for Ethical Dosage Decisions
If you’ve ever sat down to write a treatment plan and felt uncertain about how many hours to recommend—you’re not missing knowledge.
You’re missing a structure.
That’s exactly why I created the CLEAR Framework.
CLEAR is a clinical reasoning tool I developed to help BCBAs® make ethical, efficient, and individualized ABA dosage decisions. It’s not a formula pulled from research. Instead, it’s grounded in:
What the research does tell us about dosage, duration, and context
Years of experience navigating insurance systems, caregiver dynamics, and service delivery constraints
And clinical tools like the Aetna medical necessity guidelines, which many of us are expected to use—without having the time to actually read them
In short, CLEAR gives you a way to think through complexity when the system wants you to oversimplify.
What CLEAR Stands For
Each part of the framework represents a step in the clinical reasoning process:
C — Collect and Score
Start by gathering relevant information across all key clinical domains: communication, behavior, adaptive functioning, safety, and family context. This step is about moving from gut feeling to structured reasoning.
But collecting information isn’t enough. You need a way to organize and interpret it.
That’s why I created the CLEAR Scorecard—a tool that helps you evaluate a learner’s profile across multiple dimensions and translate clinical complexity into a clear, defensible dosage recommendation.
The Scorecard is included as part of the CEU course,
Breaking the 30-Hour Myth: A Practical Framework for Ethical, Efficient ABA Dosage.
If you want to start using it in your own practice, that course is the next step.
You can learn more or enroll here.
L — Leverage Caregiver Capacity
Once you've collected and scored the learner’s needs, the next step is to assess caregiver capacity—because even the best-designed treatment plan won’t work without meaningful caregiver participation.
Consider how much time, emotional energy, and readiness the caregiver has to engage in services. This includes things like:
Availability for coaching or collaboration
Consistency in routines and follow-through
Stress levels and competing life demands
Willingness and ability to generalize skills outside of session
A well-supported, coachable caregiver may allow for lower-intensity, high-impact services, especially when parent-led or hybrid models are appropriate. On the other hand, a family under high stress may need more direct support or a modified service model that relieves—not increases—their load.
Caregiver capacity isn’t just a practical consideration. It’s a clinical variable that directly affects whether your plan will produce change.
E — Establish Least-Intrusive Recommendation
Ethically, your recommendation should always reflect the minimum effective dose—the lowest number of hours needed to meaningfully address treatment goals with a high likelihood of success.
This is where you synthesize the information gathered from the learner profile and family context, and ask:
What’s the least-intrusive, most sustainable intensity that’s still likely to be effective?
This doesn’t mean recommending fewer hours by default. In fact, for some learners—especially those with limited communication or unsafe behaviors—higher intensity may be clinically necessary.
But for others, a consultative or caregiver-led model might meet the same goals with fewer direct hours and greater long-term generalization.
The key is to anchor your recommendation in what the learner needs—not what’s easiest to staff, bill, or approve.
A — Adjust Based on Fidelity and Data
Dosage decisions shouldn’t be static. As services begin, you need to monitor two critical elements:
Implementation fidelity – Are behavior technicians or caregivers consistently delivering the intervention as designed?
Progress data – Is the learner making meaningful gains toward the stated goals?
If fidelity is low, adding more hours might not help—in some cases, it can even make things worse by spreading resources too thin. In other cases, strong fidelity but limited progress might indicate that goals need to be adjusted, or that a different intensity or instructional strategy is required.
This step reinforces that dosage is dynamic, not fixed. Just like medications are titrated based on response, ABA service hours should evolve with real-time data.
R — Recommend Ethically to Funders
This is where you translate your clinical reasoning into a clear, defensible treatment recommendation—one that communicates need effectively while staying aligned with ethical standards.
That includes:
Writing a rationale that reflects the learner’s unique needs and context
Avoiding generic justifications (“Research says 30–40 hours is best”)
Referencing assessment data and clinical decision-making tools
Anticipating payer expectations without letting them dictate your decision
It can be tempting to “round up” to protect against denial or administrative delays. But when you make a recommendation that doesn’t reflect clinical necessity, you risk setting expectations the family can’t sustain—and creating a service plan that’s ultimately ineffective.
Ethical recommendations are those you can stand behind clinically, explain confidently, and adjust transparently over time.
The CLEAR Framework doesn’t eliminate the pressure.
But it does give you a way to organize your judgment, so you’re not making high-stakes decisions based on habit, fear of denial, or what’s easiest to staff.
Because when we center our decisions around actual learner needs and caregiver context—not default numbers—we do better work, and the whole system becomes more sustainable.
Barriers BCBAs® Face When Recommending Less
Even when you know fewer hours are clinically appropriate, recommending less can feel risky. You're not just making a treatment decision—you’re navigating a web of competing demands, unclear policies, and unwritten rules.
In theory, we’re supposed to recommend the number of hours that best fits the learner’s needs.
In practice, we face real consequences for stepping outside the system’s comfort zone.
Let’s break down what’s getting in the way.
1. Fear of Insurance Denial
Many BCBAs® worry that if they don’t recommend a high enough number of hours—especially at the start of treatment—they won't be able to get more hours if the client demonstrates a need in the future. And in many cases, that fear is justified.
Most payers are far more willing to approve reductions in treatment hours than increases.
So the safest path often seems to be:
Ask for more now, adjust later.
But this logic reinforces a defensive approach to treatment planning. It shifts the focus from what the client actually needs to what’s most likely to get through utilization review. That’s not clinical reasoning—it’s system navigation.
And over time, it becomes the norm.
2. Pressure From Agencies to Recommend More
Many ABA agencies build their staffing, scheduling, and revenue models around high-hour cases. That doesn’t make them unethical—it makes them business-minded.
From a logistics standpoint, high-intensity cases are easier to:
Fill staff schedules (especially for full-time RBTs®)
Minimize drive time between clients
Increase billable hours per case
Reduce the number of clients per BCBA® caseload
So even when clinical need points toward a lower-intensity model, you may be nudged—subtly or explicitly—to round up.
Maybe it’s a supervisor asking, “Can we get closer to 25?”
Maybe it’s a scheduling team struggling to place a tech unless the case is worth 20 hours or more.
Or maybe it’s just the unspoken assumption that more hours = better services.
Over time, system pressure starts to look like clinical consensus—even when it’s not.
3. Lack of Training on How to Structure Low-Intensity Services Effectively
Most BCBAs® weren’t taught how to design effective ABA programs at lower intensities.
In graduate programs and fieldwork, the examples we saw were often built around 25–40 hour models. We learned how to run discrete trials, write measurable goals, and provide intensive services. But we weren’t trained to ask:
What does effective intervention look like at 5, 10, or 15 hours per week?
Which goals should be prioritized when time is limited?
How do I identify pivotal skills or behavioral cusps that create broad impact?
How can I integrate caregiver training to extend learning beyond sessions?
What if my RBT® is only with the client 10 hours a week—how do I make that time matter?
When BCBAs® aren’t confident designing low-dosage plans, the default becomes:
More hours = more impact.
5. System Expectations Are Sticky—Even When They’re Outdated
Even as research moves toward more flexible, individualized models, the structure of our system still leans on old defaults.
Insurance reviewers, funders, and even some colleagues may still ask:
Why aren’t you recommending 30 to 40 hours?
Don’t you know that’s what the research supports?
Are you sure the family understands the importance of intensity?
When you step outside the norm—even with evidence behind you—it can feel like you're creating more problems than you're solving.
But following the norm when it no longer fits?
That creates a different kind of problem: one that compromises clinical integrity.
Moving Beyond the Barriers
These pressures are real—and ignoring them won’t make them go away.
But the solution isn’t to default to the same number every time. It’s to build a structured, defensible process that helps you:
Collect the right information
Consider the full context
Make ethical recommendations
And communicate your reasoning clearly—no matter the dosage
That’s exactly what the CLEAR Framework is designed to do.
So you’re not just reacting to the system—you’re leading from your values, your data, and your clinical expertise.
The Ripple Effect of Thoughtful Dosage
Making an ethical, individualized dosage recommendation isn’t just about getting the plan approved or checking a box for medical necessity.
When you make the right recommendation for the right learner, the effects don’t stop with that one case.
Thoughtful dosage creates ripple effects—small changes that expand into bigger impact across your practice, your team, and even the family system.
Let’s break down what those ripples look like.
1. More Meaningful Progress for the Learner
When you recommend only the hours the learner actually needs—and structure those hours intentionally—you're not overwhelming them with filler time. You're creating space for focused, high-value instruction.
You’re prioritizing goals that matter:
Pivotal behaviors that unlock new learning
Skills that promote independence
Targets that generalize naturally into daily routines
And because the service model fits the learner’s capacity, you avoid therapy fatigue, overstimulation, or performance plateaus that come with “doing more” just for the sake of it.
In short: Fewer, better hours can create deeper impact.
2. Less Stress and More Follow-Through for Families
Families feel the difference between services that fit and services that flood.
When a treatment plan aligns with their real-life bandwidth, they’re more likely to:
Keep appointments consistently
Follow through on routines between sessions
Engage in caregiver coaching
See results they can attribute to their own participation
Thoughtful dosage builds trust, because families can see that your recommendations reflect their needs, not just the agency’s model. That trust increases collaboration—which is one of the strongest predictors of long-term success.
3. Higher Fidelity and Less Burnout for RBTs®
When RBTs® are assigned to cases that match their capacity—and when they have clear goals within a manageable scope—they’re more likely to:
Maintain higher treatment fidelity
Stay engaged and motivated
Build strong rapport with clients and caregivers
Feel confident in their role
Contrast that with over-prescribed cases where techs are stretched thin across too many hours, implementing goals that feel overwhelming or misaligned. The result? Turnover, low fidelity, and poor outcomes.
Thoughtful dosage protects your direct service providers from burnout—and improves the quality of the services they deliver.
4. More Precision, More Professional Growth
Recommending fewer hours — when that’s what’s clinically appropriate — challenges you to practice with clarity, precision, and creativity.
It pushes you to:
Prioritize the goals that matter most
Design lean, focused programs that deliver impact without excess
Leverage caregiver strengths, environmental supports, and naturally occurring opportunities
Think critically about what truly produces change — not just what fills a schedule
These aren’t shortcuts. They’re hallmarks of clinical maturity.
When you move beyond default hours and into truly individualized recommendations, you’re not just reducing intensity — you’re sharpening your skills as a behavior analyst.
You’re also building a reputation as someone who:
Writes thoughtful, well-reasoned plans
Respects family capacity and contextual fit
Operates from clinical integrity, not compliance with outdated norms
And in a field where quality is too often measured by quantity, that kind of practice stands out.
5. Better Use of Agency Resources
Thoughtful dosage helps agencies use staff, time, and billable hours more strategically.
It allows for:
Flexible service models that include both direct and indirect hours
Improved staffing efficiency (less scrambling to fill huge schedules)
Less reliance on high-hour cases to hit productivity targets
Greater retention of both staff and clients
When services are aligned with actual need—not just policy minimums—agencies reduce burnout and increase impact.
This doesn’t mean sacrificing revenue. It means building smarter systems where quality drives sustainability.
6. Stronger Alignment with Ethics and Evidence
Ultimately, thoughtful dosage moves your practice into closer alignment with both research and ethics.
You're no longer trapped between recommending what’s billable vs. what’s right.
You have a clear framework (like CLEAR) for thinking through dosage—and for articulating that reasoning to funders, families, and supervisors.
It’s not just about doing less.
It’s about doing what works, why it works, and for whom.
A More Sustainable Future—One Plan at a Time
Every time you pause and ask:
What does this learner actually need—and what intensity will make that work best?
You’re pushing the system forward.
You're modeling a way of practicing that’s:
Evidence-informed
Clinically honest
Logistically sustainable
And deeply centered on the human beings we serve
That’s how we change outcomes.
Not by writing 30 hours on every plan—but by writing the right hours on each one.
The Future of ABA Dosage Starts With Us
Recommending fewer hours—when it’s clinically appropriate—isn’t about doing less.
It’s about doing what’s needed, no more and no less.
It’s about breaking away from outdated defaults and shaping service models that are ethical, sustainable, and centered on the individual.
It’s also about stepping fully into your role as a clinical decision-maker. Because as a BCBA®, you weren’t trained just to deliver behavior-analytic services—you were trained to design them intentionally, with skill, nuance, and care.
But the system hasn’t always given you the tools to do that confidently—especially when recommending less.
That’s why I created the CLEAR Framework and the CEU course,
Breaking the 30-Hour Myth: A Practical Framework for Ethical, Efficient ABA Dosage.
Inside the course, you’ll get:
A deeper look at each step of the CLEAR Framework
Real-world examples of how to apply it across a range of client profiles
Specific guidance on designing low-to-moderate intensity plans that actually work
Tools to improve caregiver collaboration, goal selection, and documentation
Access to the CLEAR Scorecard — a structured decision-making tool you can use immediately in your own practice
Whether you're new to flexible service models or just looking to sharpen your reasoning and reduce your reliance on "safe" defaults, this course will walk you through the process step-by-step.
Because ethical, efficient ABA starts with clinicians who are willing to ask better questions—and bold enough to answer them differently.
Enroll in Breaking the 30-Hour Myth: A Practical Framework for Ethical, Efficient ABA Dosage
Start making confident, data-driven dosage decisions that reflect what your clients truly need.
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