From Research to the Applied Setting: Breaking Down the Three-Legged Stool of "Evidence Based Practice"

What Evidence-Based Practice Is Not: The Approved-List Myth

Many clinicians hear evidence-based practice (a way to choose treatment well) and picture a list. Pick from the list and you are safe. Dr. Jessica Osos says that idea is backwards. Lists of researched methods do exist. But working from a list is a compliance task, not a practice.

The second myth is just as common. A method has research behind it, so it must be the right call. That does not follow. A supported method still has to match the client, the goals, and the setting. Research support alone does not make your decision evidence based.

Two more myths round it out. The framework is not gut feel, even skilled gut feel. It is also not saying yes to every family request. Osos warns about buzz words too. Labels like affirming or natural do not prove that evidence exists. Someone still has to go look.

It's really about how you think and not just what you choose.

From the talk — Dr. Jessica Osos

The Three-Legged Stool: What Each Leg Holds Up

Picture a stool with three legs. The first leg is the best available research evidence. The second is clinical expertise (what you know from doing the work). The third is client values and context. The seat on top is your clinical decision.

The seat holds only when all three legs are the same length. Lean on research alone and it tips. Lean on your own history alone and it tips. Lean on family preference alone and it tips too. A short leg does the same damage as a missing one.

Osos gives four reasons this matters right now. Ethics comes first, since our code asks for effective, evidence-backed care. Families also swim in online noise about ABA, and some of it is wrong. The field is growing fast, and many clinicians are new to practice. And some methods get branded as new and innovative with thin support behind them.

And so a balanced evidence-based practice approach really keeps us grounded.

From the talk — Dr. Jessica Osos

Best Available Evidence: Weighing Relevance Against Certainty

Best available evidence is not one kind of study. It includes group studies and single case designs (research tracking one learner closely). It also includes systematic reviews (round-ups that combine many studies) and practice guidelines (formal recommendations from experts). Case studies from your own work count too. Each type adds something useful. Some also set limits: who a method works for, and who it does not.

Randomized controlled trials (studies that sort groups by chance) are the strongest design. They are also rare in our field. ABA has a long history of strong single case work. Replication across single case studies can build an evidence base. Group designs are not the only road to proof.

Judge quality on two lines at once. Relevance asks how closely a study matches your client and setting. Certainty asks how strong the method and findings are. A beautiful study that does not fit your case has limited relevance. A very relevant story with no data has low certainty. The best evidence sits where both lines cross.

Often the perfect study does not exist. You may have a new client profile, a rare behavior, or an emerging treatment area. Use the strongest and most relevant thing you have, and name its limits. Osos also flags research design as the weakest area for many supervisees. If reading methods feels shaky, go back to basics first.

It's important to note that the perfect study might not exist, right?

From the talk — Dr. Jessica Osos

Clinical Expertise Is Much More Than Past Experience

Expertise is not one skill. It starts with case conceptualization (why this behavior is happening). You pull together assessment findings, history, family input, and context. Everything after that rests on it. Next comes real command of behavioral principles. This means reinforcement and motivating operations (what makes a reward matter now). It also means stimulus control (what cues trigger a behavior) and shaping. Knowing the words is not the same as using them well.

From there, expertise means choosing and adapting procedures so they stay evidence based and still fit the case. It means training the people who run the plan. A strong plan dies without fidelity (running the plan as written). Think modeling, coaching, feedback, and troubleshooting. It also means data-based decisions, close work with families and teams, and honest self-reflection.

Osos points to interviews by Stuart and colleagues (2018) on how clinicians really decide. Many used unstructured assessments instead of validated tools. Many did not turn to the literature, saying they were too busy or too far from research. Many leaned on what had worked with past clients. Many judged success by a sense that the client was doing better.

That pattern has a name in the same work: therapist drift (sliding off evidence without noticing). Osos says ABA leans hard on data, so this is less common here. The pull is still real, and it is the fastest way to shorten this leg.

Without that objective data it becomes difficult to know whether progress is occurring, whether a program needs to be adjusted.

From the talk — Dr. Jessica Osos

Client Values and Context: Culture, Feasibility, and Gentle Correction

This leg decides whether a plan survives contact with real life. Start with family priorities: what they hope for and what they want changed. Add cultural considerations, since culture shapes routines, communication, and what counts as meaningful change. Osos uses a classic case: teaching eye contact when eye contact reads as disrespect in that family's culture. Add child preferences too. Preferences drive engagement and dignity, not just reinforcer choice. When a child seems unable to choose, teach choice making as a skill.

Then check what can actually be run. Feasibility asks whether the plan fits family or school routines and the skills of the people there. A beautiful written plan fails if nobody has the time or training for it. Organizational constraints matter just as much: staffing, training capacity, scheduling, resources, and what administrators expect.

Honoring values does not mean agreeing with everything. Some sincerely held beliefs come from missing information or from myths about ABA. Some requests trace back to pseudoscience (claims that only look like science). Osos says the move is gentle correction, not confrontation. Acknowledge the concern, teach, and point toward safe options that reach the same goal. That is where rapport earns its keep.

Client values really matter. It's super important, but it does not mean we have to automatically adopt every request or belief from a stakeholder.

From the talk — Dr. Jessica Osos

Three Ways the Stool Tips: Pitfalls From Applied Cases

First, the research-heavy tip. A clinician insists on PECS (a picture-based way to request) because the support is strong. The family has said clearly that they want vocal speech first. The plan is technically correct and practically dead, because buy-in never arrives. The fix is not to drop the evidence. Build vocal imitation and pair it with functional communication training (teaching a better way to ask). Add pictures only as a support.

Second, the expertise-heavy tip. A clinician treats aggression with a plan that worked for other clients. No structured assessment runs, so the function is never found. The behavior turns out to be escape maintained (behavior that ends a demand). The plan misses, the child escalates, and the adults lose confidence. Fidelity falls with it. The fix: run a functional analysis (a test of why behavior happens) and pull escape-specific research. Then check what staff can truly carry out.

Third, the values-heavy tip. Parents read online and ask for facilitated communication (an adult guides the person's hand). Osos notes that ASHA (the speech and hearing association) has a statement calling it pseudoscience. So does the BACB (the board that certifies behavior analysts). Adopting it would conflict with our duty to do no harm. It can also block real communication and build false beliefs about who is writing. The fix is to validate the wish behind the request, correct the claim gently, and offer validated options.

Osos also warns about slow scientific drift. Popular ideas can get adopted because they feel morally right, not because they work. She adds a clarification on trauma language. The DSM-5 (the manual that defines mental health diagnoses) sets a high bar for trauma. It means exposure to life-threatening events, serious injury, or sexual violence. Ordinary procedures like prompting, reinforcement, and demand fading (slowly increasing what's asked) do not meet that bar when used correctly. Misuse is a real risk. Mislabeling is also a risk, because scared clinicians may skip assessments that would have found the answer.

you can't just match an intervention to a topography of a behavior, it has to be function-based.

From the talk — Dr. Jessica Osos

An Eight-Step Decision Loop You Can Run on Monday

Start by naming the clinical need. What is the target, what is happening around it, what problem are you solving? Clear framing keeps you from jumping to a solution. Next, run a structured, validated assessment. Use interviews, direct observation, or ABC data (what happens before and after). A functional analysis may fit too. Then review the best available evidence for that behavior, that function, or that learning barrier. Then test contextual fit: the people, the routines, the materials.

The last four steps keep the plan alive. Integrate child and family values and goals. Select or adapt the intervention so it is supported, feasible, and wanted. Monitor progress and adjust with data. Then recheck the balance of the three legs on a schedule. Priorities shift, staffing shifts, and children change. This is a strong argument for steady caregiver meetings.

One worked case: a three-year-old learner who bites and has limited communication. The assessment shows biting escapes demands. The literature points to functional communication training. The parents want both sign and speech. The team has little time for training. The balanced plan teaches a request in both sign and voice, then prompts across both. It embeds practice in daily routines and reviews data weekly.

A second case: a nine-year-old learner who displays significant rigidity and task refusal, also maintained by avoiding demands. Research points to graduated exposure (slow, planned practice with hard tasks) and differential reinforcement (rewarding a better response instead). The family wants independence, not just compliance. The setting is a school with paraprofessionals who have little behavior analytic training. The plan is a simplified exposure procedure. Staff learn it through behavior skills training (teach, model, practice, feedback method). Coaching and a weekly data review back it up.

So you're not going to stop once the plan is in place, you're going to continuously monitor.

From the talk — Dr. Jessica Osos

Measuring Success and Teaching Balance in Supervision

Success often gets defined as fewer incidents. Fewer tantrums, less aggression, less refusal. That matters, but it is a thin slice. Osos asks for a wider lens. Look at daily functioning across school, home, and community. Look at social validity (does this change matter to them). Look at independence and choice, which she calls a cornerstone of ABA. Look at quality of life, where validated surveys already exist. Look at engagement from both the learner and the family.

Then build the habit early in supervision. Ask supervisees to explain why they chose a procedure, not just what they chose. They should be able to walk the assessment, the evidence, the values, and the context out loud. Teach them to test claims they find online. What is the source? Is there empirical support? Is the argument logical or just a story?

Teach the soft skills too. Supervisees need a way to say they hear a concern. They also need to say the evidence points elsewhere, without burning the relationship. And model the integration rather than telling people to consider values. Build hybrid plans, change teaching formats to fit preferences, adjust reinforcement systems to cultural norms. Osos closes with three questions worth asking yourself. Which leg do you lean on most? Where is the imbalance in your cases or your organization? What one step will you take this month?

And if the change isn't socially meaningful, it won't matter, right?

From the talk — Dr. Jessica Osos