“Is This Working for My Child?” Deserves a Faster Answer

Every family asks us, in one form or another: Is this working for my child? It sounds simple. But the honest answer, for most of our field’s history, has been “we’ll know when we review the data.” Traditionally, the field has assessed at intake, reported at reauthorization, and summarized progress at scheduled evaluations. These measurement points are largely lagging indicators: they tell us what already happened.

That’s not a failure of effort or clinical skill on anyone’s part. It’s a feature of how measurement in our field developed. Reporting rhythms grew up around authorization cycles because the system required them, and they serve reimbursement well. They just weren’t designed for the pace of clinical decision-making. A child’s progress can change in a week or even a day. The reporting calendar doesn’t know that. And the gap between when something changes and when it gets reviewed is where therapy time quietly gets spent on an approach that may no longer be right.

For years, our team at Bierman Autism Centers has been focused on the question that comes out of that gap: what would it take to know whether treatment is working while there’s still time to adjust more proactively, rather than after the fact, reactively?

Changing the unit of measurement

For us, the answer started smaller than you might think: with what counts as a data point.

Every time a child masters an individual treatment target (or set of targets), we record it as a discrete, timestamped event. We call these Targets Mastered. A target mastered isn’t a note written after the fact or a general sense that a session went well. It’s a specific, auditable record that a child demonstrated a skill and is ready for the next one.

One target mastered doesn’t tell you much. The rate at which they accumulate tells you a lot. When we track how quickly a child is mastering targets over time, we get a measure we call Clinical Velocity™: a leading indicator of whether treatment is producing meaningful progress. We review it every three to five days.

The cadence is what makes it useful. A leading indicator only helps if someone looks while there’s still time to act. When a child’s velocity holds or climbs, this provides evidence that our current treatment approach is working. When it slows, we see it within days, and the team starts asking the questions that matter. Is the current goal or target being taught in the correct sequence, or are they missing prerequisite skills? Does the teaching approach need to change? Is something happening outside the session? We get to adjust while the adjustment can still make a difference.

What it changes in practice

The clinical impact is the most direct. Treatment decisions get made on measurable progress rather than impressions, and they can happen between authorization periods, not just at the ends of them. Plateaus become something we catch in days rather than discover when it is time to write a report.

Just as important is what this rhythm does for everyone around the child. That was part of the design from the beginning: when progress is reviewed every few days, clinicians can see whether this week’s decisions are producing results, clinical leaders can spot patterns early enough to send support where it’s needed, and families get a real answer to the question they’re actually asking. Not “what happened last quarter,” but “is this working for my child right now?”

It also shapes what we can study. Our practice-embedded research program, PEBBL, is testing whether teaching skills in a deliberate sequence drives faster overall progress. That’s an answerable question because progress at our centers exists as thousands of discrete, timestamped events instead of narrative summaries. When measurement lives inside practice, a research finding doesn’t sit in a journal for years. It can change how we teach next week.

The work ahead

Clinical Velocity isn’t the end of the measurement conversation. It’s our answer to one piece of it: how quickly a change in progress gets seen. What we do with what we see, and how the measure itself sharpens as PEBBL’s research matures, will keep evolving. But the time between a change in a child’s progress and the moment someone reviews it has become something I think about a lot, and my sense is that many of us in the field are thinking about versions of the same thing.

It’s a timely conversation. Payers are asking more detailed questions about outcomes. Families are asking what progress should look like and how soon to expect it. Those are reasonable questions, and the more our field can show progress as it happens, and show ourselves adjusting when it slows, the stronger the case we all make together for the value of this work.

The outcomes are why we keep investing in this approach. More than 400 children have graduated from our program, and 72 percent of children who completed clinically recommended comprehensive ABA transitioned to general education settings. Those results sit on top of nearly two decades of practice: more than 3 million therapy hours and more than 1 million individual goals mastered across our centers. Behind every graduation are hundreds of those targets and ultimately mastered goals, each one a moment the data confirmed a child was ready for what came next.

But the number I think about most isn’t a graduation count. It’s the time between a child’s progress changing and someone noticing. The ability to limit ineffective or stalled therapy. Shrinking that window is something we’re still working on ourselves, and I’d love to see it become part of how our field talks about quality.

AT A GLANCE

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