Getting a Second Opinion on Your Child's ABA Treatment Plan

Doctors get second opinions all the time, and ABA is no different. If your child's treatment plan does not feel right, or the recommendation surprised you, an outside review by another qualified professional can either reassure you or point to changes worth making. This guide explains when a second opinion makes sense, who can give one, what records to gather (and your right to them in Florida), and how to use what you learn without disrupting your child's services.

When does a second opinion on an ABA plan make sense?

You do not need a crisis to ask for another view. Common reasons families seek one:

• The hours recommendation surprised you. A plan recommends far more or far fewer hours than you expected, and the reasons are not clear. See focused vs comprehensive ABA hours.
• Progress has stalled. The graphs have been flat for several months, or the same goals keep rolling over into each new plan.
• The goals do not match your family's priorities. The plan focuses on skills you care less about, while the things that make daily life hard (communication, safety, sleep, toileting) are missing.
• You are uneasy about a procedure. The plan includes restrictive or punishment-based procedures, or your child seems distressed in sessions.
• Your child's needs changed. A new diagnosis, a move to a new school, puberty or a big life change may call for a fresh look.
• The insurer cut hours. An outside review can help you decide whether to appeal. See why ABA authorizations get cut.
• Parents disagree. Co-parents may want an independent view before agreeing to a plan.

If what worries you is that therapy is not working, our guide to what to try when ABA is not working covers steps to take with your current team first.

Who can give a second opinion?

The right reviewer depends on the question you are asking.

Before you book, check the reviewer's credentials. Florida does not issue its own license for behavior analysts, so look up the BCBA on the BACB's free certificant registry. Our guide to verifying BCBA and RBT credentials walks you through it.

What should I bring to a second-opinion review?

A reviewer can only judge what they can see. Gather these documents:

• the initial assessment report and any reassessments, including standardized test results;
• the current treatment plan with goals, targets and mastery criteria;
• any behavior intervention plan, including how challenging behavior is handled;
• recent progress reports and data graphs (the last two or three authorization periods if possible);
• a few recent session notes, so the reviewer can see what a session actually looks like;
• authorization letters showing the hours requested and approved;
• the diagnostic report, plus any IEP or 504 plan and recent doctor or therapist reports; and
• your own notes: what you see at home, what you want for your child, and what worries you.

Short phone videos of a typical session or a hard moment at home (with your current provider's knowledge, and without recording other children) can also help.

Do I have a right to my child's ABA records in Florida?

In most cases, yes. Florida's Parents' Bill of Rights gives parents the right "to access and review all medical records" of their minor child, with narrow exceptions such as when the law prohibits it or a parent is the subject of a criminal investigation of a crime against the child and law enforcement asks that records be withheld (s. 1014.04(1)).

For records held by Department of Health licensed practitioners, such as an LCSW or psychologist, s. 456.057 requires copies to be provided "in a timely manner" and says copies cannot be conditioned on paying for services. For psychotherapy records, the practitioner may provide a report instead of full copies.

Providers that bill health insurance electronically are generally covered by HIPAA as well. Under the HIPAA access rule (45 CFR 164.524), a provider must act on a request for access no later than 30 days after receiving it, with one extension of up to 30 more days if it explains the delay in writing. It may charge only a "reasonable, cost-based fee" for copies. The BACB's ethics code also requires behavior analysts to explain assessment and intervention results in understandable language.

For divorced or separated parents, either parent generally has access to the child's medical records unless a court order says otherwise (s. 61.13(2)(c)7). Our guide to your right to your child's ABA records covers requests, fees and timelines in more detail.

A simple written request is enough: "I am requesting a copy of my child's complete ABA record, including assessments, treatment plans, behavior plans, progress reports, data graphs and session notes from [date] to the present, in electronic format if available."

Do I have to tell my current provider?

You do not need permission to get another opinion, but being open usually works better. The BACB's ethics code asks behavior analysts to involve families in selecting goals and monitoring progress, to collaborate with other professionals "in the best interest of clients," and to consult with other providers with appropriate consent. A good BCBA should not be offended. You will need to sign a release if you want the two professionals to talk to each other directly.

A script you can adapt: "We value the work you are doing. Because this is a big decision for our family, we would like another BCBA to review the plan. Could you help us by sharing records, and would you be open to a call with them if we sign a release?"

Will insurance pay for a second opinion?

Do not assume it will. Many plans authorize ABA assessments for one provider at a time, and an outside review may not be billed as a covered service. Before booking, ask your insurer whether a second-opinion assessment is covered, whether it needs prior authorization, and whether it would affect your current provider's authorization. If you pay yourself, you have a federal right to a good faith estimate of the cost when you schedule care at least three business days ahead or ask for one. See our insurance call script.

Second opinion checklist: what should the reviewer look at?

Use this list to make sure the review covers what matters:

1. Do the goals reflect your family's priorities and your child's age, strengths and communication style?
2. Are goals measurable, with clear mastery criteria?
3. Do the data show progress, and does the plan change when progress stalls?
4. Is the recommended number of hours explained and linked to specific goals?
5. Does the plan prioritize positive reinforcement and the least intrusive strategies?
6. Is your child's assent (willingness to take part) respected and tracked?
7. Is parent training built in, with goals of its own?
8. Is there a plan for generalizing skills to home, school and community, and for eventually fading services?
9. Is BCBA supervision of the RBT frequent enough to keep the plan on track?

What happens after the second opinion?

Most reviews end in one of three places:

• The plan is sound. You can continue with more confidence, and maybe a few questions to raise.
• The plan needs adjustments. Bring the written feedback to your current BCBA and ask for a team meeting. Many issues can be fixed without switching.
• You decide to switch. If you change providers, plan the handoff so your child does not lose services. See how to switch ABA providers without losing your authorization.

Whatever you decide, the choice is yours as the parent, together with your child's doctors and therapists.

How can Hope Center help?

At Hope Center, BCBAs write each program and the clinical director reviews every plan before it goes to insurance. Parents are trained weekly and goals are discussed in those sessions, so you always know why each goal is there. If you are considering a change of provider, our BCBAs can complete an initial assessment (2 to 4 hours, at home or at a center) and write a new plan. Contact us or call 561-337-8865 for a free consultation and a free benefits check.