A Conceptual Model of Treatment Adherence in a Behavior Analytic Framework

Talent of the practitioner is irrelevant if the person receiving support (or the person responsible for delivering support) does not follow through with the plan. This is true in applied behavior analysis (ABA), medicine, and allied health-care services. The cost of nonadherence and related nonoptimized interventions is a major contributor to the overall cost of health care, estimated at $290–528 billion annually in the United States (New England Healthcare Institute, 2009; Watanabe, McInnis, & Hirsch, 2018). Although a topic of research in medicine for over 60 years, no gold standard for the enhancement of adherence has been demonstrated in any single population, disease condition, or therapeutic approach (Nieuwlaat et al., 2014; Rudd, 1979). Given the broad applicability of behavior analysis as a framework for understanding human behavior, and the need to recognize and address the problem of nonadherence in ABA (Allen & Warzak, 2000) we propose a systematic behavioral model for adherence and the development of strategies to enhance follow-through with individualized support plans.