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How occupational therapists and behavior analysts work together on the same client

When an occupational therapist (OT) and a behavior analyst serve the same autistic client, they often target the same skills. Working well together means learning each other's words, being clear about roles, deciding together with data, and agreeing in writing on shared goals and how to settle a disagreement.

Where the two fields overlap

A 2021 paper in Behavior Analysis in Practice by Gasiewski, Weiss, Leaf and Labowitz finds "some shared scope of practice in OT and ABA." Occupational therapists address activities of daily living such as feeding, dressing and grooming, and behavior analysts also build daily living and motor skills. Both fields focus on skill acquisition and behavioral regulation, both value change in the client's real-world, natural environment, and both address automatic or sensory-based behaviors, which the authors describe as a context for collaboration.

The Association for Science in Autism Treatment's review of that paper puts the stakes plainly: without coordination, "disjointed care could lead to inefficient, or worse, counterproductive service delivery, negatively impacting learners with ASD."

What gets in the way

The paper names three common barriers: misperceptions of the other discipline, differences in terminology, and unprofessional behavior. It calls the debate over sensory approaches possibly "the central point of contention between the professions," and notes that behavior analysts, although they often collaborate with other professions, are largely not trained on collaboration.

The words differ even when the work is similar. The paper pairs behavior-analytic terms with occupational therapy terms used for related ideas: "probe" with "screen" or "assess," "task analysis" with "activity analysis," "noncontingent" with "proactive strategies," and "model" with "demonstrates."

What helps

The paper's strategies include sharing basic information about each discipline, reading research from the other field, observing each other's sessions, cotreatment in which both clinicians jointly deliver treatment, and case conferences in which each discipline gives its perspective and the team then decides on a unified approach. When the team weighs an intervention one member questions, the paper describes devising an individualized trial and collecting data to decide whether to continue it. The ASAT review adds clarifying roles and staying in continuous communication about interventions and goals for shared clients.

Each professional also stays within their own limits. The Practice Board of the Association for Behavior Analysis International distinguishes scope of practice (the activities a professional is authorized to perform) from scope of competence (the clinical activities they can perform to a specified standard of excellence). Standard 2.10 of the Behavior Analyst Certification Board's Ethics Code for Behavior Analysts requires behavior analysts to collaborate with colleagues from their own and other professions in the best interest of clients and stakeholders, to address conflicts by compromising when possible and always prioritizing the client's best interest, and to document their actions and the eventual outcomes.

What to agree on, in writing

A short written plan keeps those agreements in one place. It records eight things: the team and how to reach each person; each professional's role; the shared goals and who leads each one; the methods and the words you both use for the same skill; what data each of you keeps and how often you share it; how and when you meet, with the client as appropriate and the family or guardians taking part; how you raise and resolve a disagreement; and the consent your setting requires, with a date to review the plan.

Our free collaboration plan walks an OT, an SLP or a psychologist and a behavior analyst through those eight parts and prints a plan for your next team meeting. For the speech side of the team, read how SLPs and behavior analysts work together, or explore our allied health collaboration guide.

Common questions

Do OTs and behavior analysts work on the same skills?

Often, yes. Gasiewski and colleagues (2021) describe some shared scope of practice: both fields build daily living and motor skills, focus on skill acquisition and behavioral regulation, and address automatic or sensory-based behaviors. Each professional still works within their own scope of practice and competence.

What if we disagree about a sensory-based intervention?

Agree in advance how the team decides. The paper describes devising an individualized trial of the approach and collecting data to decide whether to continue it. BACB Ethics Code standard 2.10 requires behavior analysts to address conflicts by compromising when possible, always prioritize the client's best interest, and document their actions and the eventual outcomes.

How do we avoid talking past each other?

Write down the words you will both use for each shared skill. The paper notes that terminology differs between the fields, for example "task analysis" in behavior analysis and "activity analysis" in occupational therapy, and recommends sharing basic information about each discipline.

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