Describe either your best training experience, OR your worst training experience.? For your best training experience, what elements of BST were included? Wh

SPECIAL SECTION: SUPERVISION PRACTICES

Towards a Competency-Based, Ethical, and Socially Valid Approach to the Supervision of Applied Behavior Analytic Trainees

Laura B. Turner1 & Aaron J. Fischer2 & James K. Luiselli3

# Association for Behavior Analysis International 2016

Abstract Competency-based supervision of trainees has re- cently come to the forefront of behavior analytic practice; however, there are minimal data to support the effectiveness of various supervision practices on trainee outcomes. Accordingly, this paper is intended to spark further discussion and research activity regarding the supervision of those seek- ing to become Board Certified Behavior Analysts (BCBA). We present a practice model and considerations for supervis- ing applied behavior analytic trainees consistent with the Behavior Analyst Certification Board (BACB) Supervisor Training Curriculum Outline (Behavior Analyst Certification Board, 2012b), the Professional and Ethical Compliance Code for Behavior Analysts (Behavior Analyst Certification Board, 2014), and extant literature from behavior analysis and related fields. Inherent to the current model is a focus on bi- directional feedback and collaboration between the supervisor and trainee to frequently evaluate the acceptability of the pro- cedures, process, outcomes, and effectiveness of supervision. We present a Supervision Monitoring and Evaluation Form consistent with the current model and discuss the assumed

importance of objective and subjective self-assessment of su- pervisor competence to the ultimate advancement of the prac- tice of applied behavior analysis.

Keywords Applied behavior analysis . Competency-based supervision . Social validity . Supervision evaluation form .

Trainee

Supervision is a crucial activity of most Board Certified Behavior Analysts (BCBA) and is especially important given the growing number of applied behavior analytic trainees and the expanding demand for applied behavior analysis (ABA) services worldwide. It is generally assumed that quality super- vision will contribute to the development of effective and ethical practitioners, protection of clients, and advances in the field. Initial research also suggests that the intensity of supervision provided by applied behavior analysts is positive- ly related to clinically significant improvements in client per- formance (Eikeseth, Hayward, Gale, Gitlesen, & Eldevek, 2009). However, until recently, there were minimal standards on how to provide a valuable supervision experience for trainees. In 2011, the Behavior Analyst Certification Board (BACB) initiated a Supervision Task Force to develop defin- itive supervision guidelines and training standards for the field (Behavior Analyst Certification Board, 2011). Resulting from this task force were minimal competencies required of those providing supervision to individuals pursuing a BACB certi- fication or practicing as Board Certified Assistant Behavior Analysts (BCaBA) or Registered Behavior Technicians (RBT; Behavior Analyst Certification Board, 2012b). Relevant is- sues were designing a supervision contract, implementing be- havioral skills training (BST), and delivering frequent perfor- mance feedback.

Electronic supplementary material The online version of this article (doi:10.1007/s40617-016-0121-4) contains supplementary material, which is available to authorized users.

* Laura B. Turner [email protected]

1 University of Saint Joseph, 1678 Asylum Avenue, West Hartford, CT 06117, USA

2 University of Utah, 1721 Campus Center Drive, Salt Lake City, UT 84112, USA

3 Clinical Solutions, Inc. and North East Educational and Developmental Support Center, 1120 Main Street, Tewksbury, MA 01940, USA

DOI 10.1007/s40617-016-0121-4

Published online: 28March 2016

Behav Analysis Practice (2016) 9:287–298

Underlying this competency-based approach is the as- sumption that, rather than Bosmosis^ (Falender & Shafranske, 2012, p. 133), supervision is an independent area of practice and requires acquisition, refinement, and mainte- nance of skills; although strong clinical and research skills are essential to being a competent supervisor, these skills alone do not automatically equate to strong supervisory skills. Attention is now being given to the development of supervisor competencies and identification of effective components of supervision, a process mirrored by several other helping pro- fessions, such as social work (Kraemer-Tebes et al., 2011), psychology (American Psychological Association, 2015; Falender et al., 2004), and medicine (Frank et al., 2010).

The purpose of this paper is to present a practice model that integrates evidence-based training and supervision practices with the complex ethical and practical consider- ations regarding supervision. Because there are currently limited data on the effectiveness of supervision and specif- ic supervision practices in developing well-trained BCBAs, BCaBAs, and RBTs, the current model is guided by the supervisory experiences of the authors, extant liter- ature from behavior analysis and related fields, the BACB Supervision Training Curriculum Outline (Behavior Analyst Certification Board, 2012b), and the newly devel- oped Professional and Ethical Compliance Code for Behavior Analysts (Behavior Analyst Certification Board, 2014), which now more comprehensively reflects the pro- fessional responsibilities of supervisors. Some of these rec- ommendations may be time-consuming and go beyond the requirements of the BACB; however, these points of con- sideration on the application of existing supervisory and ethical guidelines may enhance supervisory practice. Note that we have adopted the term Btrainee^ throughout to refer to BCBA and BCaBA candidates, as well as prac- ticing BCaBAs and RBTs as they require ongoing super- vision and cannot practice independently.

Within this framework, we review the many competen- cies required of supervisors including fluency with the eth- ical guidelines regarding supervision, effective training techniques across basic and complex skill areas (e.g., clin- ical decision-making and professionalism), and perfor- mance feedback methods to support acquisition and main- tenance of skills. Our premise is that the implementation of an evidence-based approach within a positive, collabora- tive, and individualized environment fosters a well- rounded and effective trainee. We also provide examples and considerations for how to incorporate these competen- cy areas into a practice repertoire in which supervisor be- havior, in addition to trainee behavior, is frequently evalu- ated and modified based on trainee feedback and progress. Focus is placed on the use of social validity measures to aid in the ongoing adjustment of supervisory behavior and the ongoing self-assessment of the supervisor.

Practice Model for Behavior Analytic Supervision

Set the Occasion for Collaborative and Ethical Supervision

A strong and collaborative supervisory relationship is widely acknowledged as contributing to the quality and effectiveness of clinical supervision across several other disciplines (e.g., Bernard & Goodyear, 2014; Bordin, 1983; Falender et al., 2004). Although notoriously complex and difficult to objec- tively define and measure, the supervisory relationship is typ- ically defined in two parts. In behavior analytic terms, the first part can be described as the degree to which a supervisor and a trainee are mutual discriminative stimuli for generalized rein- forcement (i.e., Brapport^ as discussed by Carr and colleagues, 1997, p. 111). Carr and colleagues (1997; Magito, McLaughlin, & Carr, 2005) further discuss rapport as a setting event and demonstrate that the development of rapport is a key aspect to approaching skill development. Although their dis- cussion is specific to individuals with developmental disabil- ities, the basic behavioral principles behind their observations have clear implications for the supervisor-trainee relationship.

As an example, the relative rapport between a supervisor and trainee may impact the trainee’s approach behavior to- wards the supervisor. If a supervisor does not function as a cue for reinforcement (or the supervisor functions as a cue for punishment), it is likely that the trainee will avoid the super- visor and instead seek out others, including non-behavior an- alysts, for guidance and feedback. While the specific behav- iors required to develop rapport within the context of the su- pervisory relationship have not yet been systematically iden- tified, a few face valid examples that may assist supervisors in establishing themselves as reinforcers include being ap- proachable (e.g., visibility and nonverbal behaviors) and re- sponsive (e.g., to emails), using more positive statements rel- ative to negative (e.g., 4:1 ratio; Daniels & Bailey, 2014), and demonstrating undivided attention towards the trainee during meetings. Importantly, these behaviors certainly do not ensure that the supervisor will produce a competent trainee, and other variables are also likely to impact the degree to which the trainee approaches the supervisor with relevant issues and questions (e.g., supervisor competency).

The second component of the supervisory relationship can be described as the degree to which a supervisor and trainee generate mutually agreed upon expectations and goals for su- pervision and engage in behavior consistent with those expec- tations and goals. The supervision contract, a requirement of BACB approved supervision (Behavior Analyst Certification Board, 2015), can be used to guide the development of the supervisory relationship and the terms of supervision (see Guideline 5.05; Behavior Analyst Certification Board, 2014). The contract fosters an initial and collaborative discus- sion between a supervisor and trainee with regard to the nature

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of the professional relationship and the expectations and re- sponsibilities of each member. Supervisors can use this dis- cussion to model shared expectations and commitment to the supervision process.

Self-report data from related fields suggests that a poor supervisory relationship is related to a trainee’s decreased willingness to disclose relevant clinical information (Mehr, Ladany, & Caskie, 2015) and follow through with a supervi- sor’s recommendations (Ladany, Hill, Corbett, & Nutt, 1996), as well as increased likelihood of burnout (Gibson, Grey, & Hastings, 2009). However, to what extent the quality of the supervisory relationship influences the outcomes of supervi- sion is unknown and should be a focus of future research (see an extended discussion below). Until then, we hypothesize that the development of a technically skilled, ethical, and pro- fessional behavior analyst may potentially suffer without the presence of a strong supervisory relationship. Thus, an impor- tant first, and ongoing, step in the supervision process may be to build a strong supervisory relationship. As part of, or in addition to the supervision contract, we suggest supervisors participate in the following discussions with trainees to further establish mutual expectations for the supervision experience and ensure consideration of relevant ethical guidelines in an effort to avoid potential harm to trainees and the professional supervisory relationship.

Define the Relationship The first step in any professional relationship is to define basic and fundamental expectations between participating individuals. While there are clear exam- ples of inappropriate supervisory relationships that often do not necessitate a lengthy initial discussion (e.g., sexual relationships; see Guideline 1.07; Behavior Analyst Certification Board, 2014), subtle aspects of the supervisory relationship may be unclear to the trainee and should be clar- ified. The supervisory relationship can be confusing as the supervisor may serve as a teacher, mentor, evaluator, and fa- cilitator of self-assessment and growth, all of which are over- lapping roles and imply a slightly different style of profession- al interaction and power differential. For example, a supervi- sor is commonly defined as someone who oversees certain activities and holds evaluative power over the trainee, while a mentor is often described as a trusted advisor and confidant. Further, the everyday practice of behavior analysis can be stressful, often physically and mentally exhausting, making initial discussion of a supportive relationship beneficial.

While all these roles are supervisory in nature and holding these roles concurrently with a trainee does not necessarily constitute a multiple relationship as defined by the BACB (Behavior Analyst Certification Board, 2014), supervisors may find themselves differentially allocating their time across several of these roles depending on the current context of supervision and the trainee’s experiences. It may be beneficial to discuss these potentially changing roles at the outset of

supervision and to engage in self-assessment and monitoring, as well as peer consultation, to ensure the role fits the current needs of the trainee while still within the parameters of a professional relationship.

Further, trainees will already have negative and/or positive experiences working with people in these various roles and may have preconceived expectations about the nature of the current supervisory relationship. For example, trainees with past supervisors who did not encourage collaboration may be reticent to present contrasting ideas or raise concerns with their new supervisors. It may be fruitful for supervisors to ask trainees about their definition of supervision and their previ- ous experiences being supervised (whether or not in behavior analysis) and to discuss how their definition and experiences align with those of the supervisor and the most recent version of the BACB Experience Standards (i.e., Behavior Analyst Certification Board, 2015). Also important is the verbal rec- ognition of and sensitivity to the fact that the supervisory relationship can be impacted by beliefs, values, and interper- sonal biases shaped by previous experiences. Discussing such issues may reduce the likelihood of dissimilar views and ex- pectations regarding the supervision process.

Paying for supervision further complicates the role of the supervisor and trainee. Many individuals seeking a BACB credential do not have access to local or Bin-house^ BCBAs who are approved to provide supervision. This challenge re- quires those seeking supervision to identify approved BCBA supervisors in their community or even across great distances (through videoconferencing). When seeking supervision through this format, supervisors typically charge an hourly rate, which is determined by the supervisor and payment for supervision services must be discussed with the trainee at the onset of the supervisory relationship. Since trainees pay for services in this arrangement, the supervisor and trainee must consider any potential negative impact payment may have on the professional supervisory relationship.

Performance Expectations It is important to clearly define, outline, and agree upon the performance expectations and responsibilities of both the trainee and supervisor. Dual re- sponsibilities foster a give-and-take relationship and allow for shared accountability. To ensure a clear understanding of the expectations of the trainee and supervisor according to the BACB, we recommend reviewing the BACB Experience Standards (Behavior Analyst Certification Board, 2015) at the outset of supervision, even if the trainee has already ac- crued supervision hours with another supervisor. It is also important to identify any idiosyncratic expectations of the trainee and/or supervisor that, if not discussed, may place stress on the supervisory relationship. Such expectations may be that both parties must contact each other at least 24 h in advance to reschedule or that both parties will respond to email correspondence within 48 h.

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The degree to which either a trainee or supervisor can con- sistently complete the agreed-upon responsibilities is often impacted by an individual’s time and competing commit- ments. Conducting an analysis of time for both parties is one method for outlining reasonable responsibilities. With regard to the supervisor’s time, consider a supervisor supervising one trainee who is accruing 30 h/week of Supervised Independent Fieldwork. Per the Experience Standards (Behavior Analyst Certification Board, 2015), this equates to 3 h of supervision for every 2-week supervisory period (i.e., 5 % of total accrued hours); however, 3 h of supervision almost always requires more than 3 h of time. Often overlooked in the initial calcula- tion of time is (a) travel time to and from the trainee’s work- place for direct observations (i.e., if different from the super- visor’s workplace and if audio-video recording or videocon- ferencing is not viable), (b) travel time to and from supervision meetings (i.e., if videoconferencing is not an option), (c) time to search for appropriate articles and resources for the trainee, and (d) time to read (or re-read) those articles. Additional time is required in responding to trainee emails, reviewing trainee permanent products, giving detailed feedback during the su- pervision meeting, completing performance evaluations, documenting various aspects of the supervision process (e.g., remediation), and seeking peer feedback, and/or consul- tation with regard to the supervisory behaviors of the supervi- sor. Taken together, these activities can quickly increase those 3 h every 2 weeks to 6 h or more every 2 weeks! We encour- age supervisors and trainees to complete this activity together to establish appropriate workloads and expectations for both parties (see Guideline 5.02; Behavior Analyst Certification Board, 2014).

Evaluation of Performance Expectations One of the main responsibilities of supervisors is to consistently evaluate and document trainee performance. This matter is often an area of trainee distress and an area without strict guidelines, so it is crucial to gain initial agreement about the behaviors to be evaluated (e.g., technical, professional, and ethical), the eval- uation process, and the consequences of poor performance evaluations. Agreeing on the terms of a poor evaluation of the trainee beforehand may make execution of the set conse- quences more straightforward and perhaps have fewer nega- tive side effects. Include in the guidelines clear, objective and measureable circumstances for all consequences. For exam- ple, at what point will a remedial plan be developed (e.g., after 3 consistent supervisory periods of unsatisfactory perfor- mance), what will the remedial plan consist of (e.g., an addi- tional individual meeting with the supervisor, extra readings), and what is the consequence of performing poorly during, or not completing, the remediation (e.g., supervisor terminating the relationship)? Lastly, if the relationship is ultimately ter- minated, it will be important to pre-determine what, if any, hours the supervisor will approve.

Supervisors are highly encouraged to seek feedback from trainees concerning their performance as a supervisor and their ability to follow through with the agreed upon expecta- tions. We recommend communicating the value of this ap- proach to the trainee at the outset of supervision to further create a sense of shared accountability with respect to obtaining the goals of the supervisory relationship. Obtaining candid information from trainees can be difficult (Mehr, Ladany, & Caskie, 2010), and supervisors must con- sider the inherent power differential; however, a strong super- visory relationship between the supervisor and trainee and an expectation of the reciprocal nature of feedback is hypothe- sized to counteract this limitation.

Confidentiality The BACB Professional and Ethical Compliance Code (Behavior Analyst Certification Board, 2014) states that behavior analysts have a primary obligation to protect the confidentiality of the individuals they supervise (Guideline 2.06). Confidential information in a supervisory relationship predominantly includes performance evaluations, such as written reviews or ratings on evaluation forms. It may be beneficial to initially communicate to trainees that this in- formation will be kept out of public sight and only discussed with others that have a clear, professional reason for being concerned with such matters, such as a trainee’s on-sight su- pervisor. It may also be beneficial to let trainees know that individual corrective feedback will be given in private and not during group supervision sessions.

Given the sometimes close, professional relationships that can develop through supervision, the trainee may disclose personal information germane to his or her behavior analytic work. As an example, a trainee may acknowledge an interper- sonal conflict with a professional colleague. Direct conversa- tion about the confidentiality of such disclosures may increase the likelihood that a trainee approaches their supervisor con- fidently and without fear of disclosure so that the issue may be discussed and an appropriate solution determined.

Remote Supervision With the advent of contemporary vid- eoconferencing technology, behavior analytic supervision can occur remotely by interacting through live two-way audio- video communication across the Internet or cellular networks. Supervision through videoconferencing allows supervisors to engage in supervision sessions with trainees without having to be in the same physical location, which results in reduced travel time, increased savings associated with travel costs, and the potential to provide supervision for individuals in rural or hard to reach areas who may not have access to locally qualified behavior analysts.

Despite these benefits, supervision conducted through vid- eoconferencing also poses many potential challenges. These challenges include breaches of client confidentiality, technical difficulties, and lack of physical presence of a supervisor

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during high-risk situations (Florell, 2016). Supervision con- ducted via videoconferencing must ensure client confidential- ity by facilitating sessions through HIPAA and FERPA com- pliant videoconferencing software (e.g., Adobe Connect, Vidyo, VSee); however, due to perpetual changes to video- conferencing software, supervisors should thoroughly scruti- nize potential software before using it during remote supervi- sion. Readers are also encouraged to review Cavalari, Gillis, Kruser, and Romanczyk (2015) for an extended discussion regarding digital sharing and storage of audio-visual recordings.

Regarding technical difficulties, supervisors and trainees should be familiar with the videoconferencing software that is used, ensure that they have the required hardware for high- quality videoconferencing (e.g., 720p or higher resolution webcam, high bandwidth Internet connection, computer/lap- top/tablet with fast processing speed), and become familiar with the evidence-based practice guidelines for telemental health services (cf. Grady et al., 2011). To guarantee support for trainees during high-risk situations, the supervisor should develop a plan with the trainee so that an on-site supervisor is available or the supervisor can be reached by phone (Abbass et al., 2011; Panos, Panos, Cox, Roby, & Matheson, 2002).

Termination of the Relationship Just as expected with cli- ents, the parameters of planned or unplanned termination of the supervisory relationship should be discussed at the outset of supervision (Guideline 2.15; Behavior Analyst Certification Board, 2014). The BACB encourages trainees to accrue experience hours with different supervisors. Accordingly, an initial conversation about the number of su- pervisors trainees have already worked with and the number of experience hours trainees have accrued is warranted to de- termine a mutually agreed upon duration for the current su- pervisory relationship. Additionally, if the trainee is transfer- ring to another supervisor, we encourage the previous super- visor to speak with the new supervisor about the strengths and weaknesses of the trainee and current goals. This dialogue should be initiated with approval from the trainee. In the event of an unplanned termination such as the supervisor changing employers, development of a contingency plan will ensure the trainee continues to receive supervision.

Baseline Assessment of Trainee Skills

Although there are no standard procedures to initially assess trainee skills, we can incorporate strategies from the field of behavior analysis to guide our evaluation. We suggest the fol- lowing methods as strategies to evaluate trainee baseline per- formance across various skills: behavioral observation, infor- mal assessment, review of course syllabi, discussion with pre- vious supervisors, and review of the BACB Fourth Edition Task List (Behavior Analyst Certification Board, 2012a).

Using these indirect and direct methods, the supervisor and trainee are able to collaboratively develop goals that are objec- tive, measureable, and obtainable (Cooper, Heron, & Heward, 2007; Daniels & Bailey, 2014). We will discuss each of these strategies and their contribution to assessing trainee skills.

Behavioral observation, the basis of all behavior analytic work, requires a behavior analyst to operationally define be- haviors of interest and subsequently record the occurrence of those behaviors. In the context of supervision, a supervisor should observe and record specific trainee behavior such as the extent to which an intervention or behavioral support plan is implemented with integrity (Gresham, Gansle, & Noell, 1993), verbal behavior of a trainee as they interact with staff, colleagues, clients, or parents, and reliability of trainee behav- ioral observation through assessment of inter-observer agree- ment (Cooper et al., 2007).

Informal (formative) assessment, although not behavioral, is useful to gather information from a trainee. This type of assessment is frequently used in education (Dunn & Mulvenon, 2009) and is achieved through conversations with trainees about their previous experiences, completion of checklists, and review of writing samples or portfolios. Such assessment should combine records review, semi-structured interview, and discussion about the areas of practice as a be- havior analyst. The informal assessment should be used to gather information about past experience but also specific areas of strength and weakness. Additionally, as an ongoing skills assessment, supervisors should ask questions of the trainees to evaluate their knowledge of behavioral procedures (e.g., BWhat were the four test conditions of the Iwata, Dorsey, Slifer, Bauman, and Richman (1994) functional analysis [FA]?^). Depending on trainees’ understanding of the FA lit- erature and their prior implementation history, supervisors should ask follow-up questions (e.g., BWhat are pros and cons regarding the manymodifications to the original—Iwata et al., 1994—FA?^). These types of questions allow supervisors to gauge trainees’ skills and trainees’ responses provide a base- line assessment of their ability to think critically and discuss behavior analytic theory broadly or more acutely.

Review of course syllabi with the trainee is quite useful when assessing skills. In a collaborative format within super- vision sessions, the supervisor and trainee may benefit from discussing the topics covered in the trainee’s BACB-approved coursework. Independent of the supervision session, the super- visor is encouraged to review the syllabi to ensure that relevant readings have been assigned—this action provides the oppor- tunity to introduce readings to the trainee that might not have been assigned. The benefit of assigning readings within the supervision context is, as a supervisor, you can work individ- ually with your trainee and critically analyze and discuss the behavior analytic literature. Subsequently, reviewing articles is assumed to teach critical thinking that is essential for applied work and preparation for the upcoming BACB exam.

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Discussion with previous supervisors is a valuable way to assess a trainee’s skill set; however, the availability and ease of these options is variable depending on the practicum site. For example, if trainees receive their experience hours at a large human service provider with multiple schools within the or- ganization, trainees might change schools or classrooms. In this situation, the supervisors might change as well, leaving the opportunity for discourse between the prior and current supervisor.

Finally, it is recommended that the supervisor and trainee jointly review the BACB Fourth Edition Task List (Behavior Analyst Certification Board, 2012a) and use the document as a checklist of areas the trainee has already mastered and those that are still in need of instruction and practice.

Methods to Teach and Promote Skills

Acknowledging that trainees have varying levels of skills, supervisors can expect at some point that they will need to directly and systematically teach new skills. Importantly, the supervisor must attempt to match teaching techniques and performance expectations to the trainee’s current perfor- mance. For example, a novice trainee might not be fluent with all the different approaches to conducting preference assess- ments. In this case, the supervisor could indirectly discuss methods and provide relevant literature for the trainee to read about the topic and improve his or her knowledge. For the trainee who is familiar with the literature on preference assess- ments but has not actually conducted such an assessment with a client, the supervisor could model correct procedures. Lastly, for the trainee who has mastered designing and implementing preference assessments, the supervisor could speak with the trainee about possible modifications to implementing prefer- ence assessments and/or ask that the trainee uses behavioral approaches to teach the skill to another staff member or parent.

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