Bacb Experience Form PDF Details

The path to becoming a Board Certified Behavior Analyst® (BCBA®) or a Board Certified Assistant Behavior Analyst® (BCaBA®) is structured and rigorous, requiring candidates to meet specific Experience Standards outlined by the Behavior Analyst Certification Board (BACB). Effective from October 13, 2017, the current document delineates all necessary standards and includes essential forms aimed at documenting the qualifying experience. Prior to the commencement of the experience, a critical review of this document by both the supervisor and supervisee is mandatory, addressing any concerns and ensuring a frequent check for updates on the BACB's platforms to stay compliant. Including both the Experience Supervision Form, to be filled periodically throughout the experience, and the Experience Verification Form, for the culmination, the document stresses the significance of original, unaltered submissions. Importantly, the introduction of mandatory pre-experience training and continuing education underscores the emphasis on quality and competency in supervision. It outlines clear qualifications for supervisors, standards for supervision, and the necessity of a supervision contract setting forth responsibilities, activities, objectives, and the foundation for experience termination. Furthermore, it specifies documentation and retention policies for ongoing supervision, the possibility of multiple supervisors or settings, and the classification of experience categories to foster a comprehensive behavior-analytic skill set. Supervisees have a tableau of experience accrual options—Supervised Independent Fieldwork, Practicum, and Intensive Practicum—each with detailed requirements aiming at the development of a behavior analyst capable of delivering high-quality, ethical, and professional services. This multipart framework ensures that the supervision journey is not just a procedural hurdle but a pivotal developmental phase in the career of a behavior analyst.

QuestionAnswer
Form NameBacb Experience Form
Form Length9 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 15 sec
Other namesfinal verification form bacb, bacb monthly supervision form, bacb supervision forms, bacb standards

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BACB Experience Standards ver. 10/13/2017

EXPERIENCE STANDARDS

INTRODUCTION

This document contains all of the standards and forms for experience used to qualify for certification as a Board Certified Behavior Analyst® (BCBA®) or a Board Certified Assistant Behavior Analyst® (BCaBA®).

The BACB requires that the supervisor and supervisee review this entire document together and resolve any concerns before the experience begins. Both parties must also regularly review the BACB website, newsletters, and table of recent and upcoming changes to ensure that their experience complies with the version of the experience standards current at the time of completion of the experience requirement.

In addition to the standards, this document contains two forms for documenting experience used toward BACB certification.

1.The Experience Supervision Form: This form, or equivalent, must be completed at least once during each supervision period, throughout the duration of the experience. Both parties must retain a copy of every completed Experience Supervision Form.

2.The Experience Verification Form: This form should be completed at the conclusion of the experience.

If a supervisee has multiple experiences, one form for each experience must be completed. The original forms must bear the supervisor’s original signature and be unaltered (i.e., forms with white-out, other alterations, or photocopies will not be accepted). Note: The Experience Verification Form is updated periodically. Prior to submitting an application, supervisees must ensure that they are using the then- current version. Previous versions will not be accepted.

Initial exam applications should include Experience Verification Forms only. Do not submit the Experience

Supervision Forms unless specifically requested by the BACB.

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BACB Experience Standards ver. 10/13/2017

APPROPRIATE SUPERVISION

REQUIRED PRE-EXPERIENCE TRAINING: Supervisees and supervisors must pass an online, competency- based training module on BACB experience standards prior to the onset of experience. The module is available via the BACB Gateway at www.BACB.com. Additional supervisor qualifications include an 8-hour supervision training which must also be completed before providing any supervision. Any experience obtained after March 31, 2015 will not be acceptable if either party had not met these requirements. Supervisors are responsible for ensuring their supervisees have completed the online module prior to providing supervision.

SUPERVISOR QUALIFICATIONS: During the experience period, the supervisor must be a BCBA or BCBA- D in good standing, be a licensed or registered psychologist certified by the American Board of Professional Psychology in Behavioral and Cognitive Psychology who was tested in Applied Behavior Analysis, or be an authorized supervisor who is only providing supervision in a Verified Experience. All supervisors must meet all of the supervisor qualifications stated in the previous section. Supervisors who hold BACB certification must also meet an ongoing supervision CEU requirement in order to continue providing supervision after meeting the initial supervisor requirements.

The supervisor may not be related to, subordinate to, or employed by the supervisee during the experience period. Employment does not include compensation received by the supervisor from the supervisee for supervision services. Also, see sections 1.0 and 5.0 of the Compliance Code.

NATURE OF SUPERVISION: The purpose of supervision is to improve and maintain the behavior-analytic,

professional, and ethical repertoires of the supervisee and facilitate the delivery of high-quality services to the supervisee’s clients. Effective behavior-analytic supervision includes:

Development of performance expectations

Observation, behavioral skills training, and delivery of performance feedback

Modeling technical, professional, and ethical behavior

Guiding behavioral case conceptualization, problem-solving, and decision-making repertoires

Review of written materials (e.g., behavior programs, data sheets, reports)

Oversight and evaluation of the effects of behavioral service delivery

Ongoing evaluation of the effects of supervision

The supervisor must observe and provide feedback to the supervisee on his/her behavior-analytic activities with a client in the natural environment during each required supervisory period. In-person, on-site observation is preferred. However, this may be conducted via videoconferencing or similar means in lieu of the supervisor being physically present; synchronous (i.e., real-time) observation is strongly encouraged.

Structure. Supervision may be conducted in small groups for no more than half of the total supervised hours in each supervisory period. Small groups are interactive meetings in which 2-10 supervisees who share similar experiences participate in the supervision activities described above. The number of trainees in a group meeting may not exceed 10 at any time, regardless of the number of BCBAs in the meeting. If non-trainees are present, their presence must not inhibit discussion, and they may not participate. The amount of small-group supervision may not exceed the amount of individual supervision for any given supervisory period.

SUPERVISION CONTRACT: The supervisee and supervisor must develop and sign a written contract prior to the onset of the experience. The purpose of the contract is to protect all involved parties and align experience activities with the purpose of supervision.

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BACB Experience Standards ver. 10/13/2017

The contract should:

State the responsibilities of the supervisor and supervisee, including completion of the online experience training module by both the supervisor and supervisee as well as completion of the 8-hour supervision training by the supervisor; and

Include a description of the appropriate activities and instructional objectives; and

Include the objective and measurable circumstances under which the supervisor will sign the supervisee’s Experience Verification Form when the experience has ended; and

Delineate the consequences should the parties not adhere to their responsibilities (including proper termination of the relationship); and

Include a statement requiring the supervisee to obtain written permission from the supervisee’s on-site employer or manager when applicable; and

Include an attestation that both parties will adhere to the Compliance Code.

The supervisee and supervisor are responsible for retaining and providing to the BACB, if requested, a copy of the contractual agreement.

DOCUMENTATION OF ONGOING SUPERVISION: The supervisee and supervisor are responsible for collecting documentation on the Experience Supervision Form during each supervisory period. One form should

be completed within each supervisory period, ideally at each meeting. Backdated forms will not be accepted. The BACB reserves the right to request this documentation at any time following an individual’s application to

take the certification exam. This documentation should NOT be submitted with an exam application unless specifically requested by the BACB.

Supervisors are strongly encouraged to use the BACB Experience Supervision Form to document supervision. Alternate forms will be acceptable if they include all of the following elements:

Date of each supervisory meeting

Duration of each supervisory meeting

Type of experience for the supervisory period (i.e., supervised independent fieldwork, practicum, intensive practicum)

Format of each supervisory meeting (i.e., individual or small group)

An evaluation of supervisee performance

The total experience hours obtained during the supervisory period, with time spent in direct implementation of behavior-analytic programs separated from other activities

The total individual and small-group supervision hours obtained during the supervisory period

Date lines for supervisor and supervisee indicating when the form was completed & signed

Signature lines for supervisor and supervisee

The supervisee and supervisor are responsible for retaining and providing to the BACB, if requested, copies of supervision documentation. Supervision documentation should be retained for at least 7 years from the date of the last supervision meeting.

All applicants for certification must submit documentation of their experience using the then-current version of the Experience Verification Form.

MULTIPLE SUPERVISORS AND/OR SETTINGS: It is permissible to utilize multiple supervisors and settings within a given time frame in order to meet these experience requirements. In such cases, all parties must

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BACB Experience Standards ver. 10/13/2017

take great care to ensure that the supervision contract includes all relevant parties and clearly defines all roles and responsibilities. In cases where multiple supervisors share responsibility for a supervisee’s experience, they

may jointly sign a single Experience Verification Form attesting to the experience as a whole.

APPROPRIATE EXPERIENCE

EXPERIENCE CATEGORIES: There are three experience categories available: Supervised Independent Fieldwork, Practicum, and Intensive Practicum. In Supervised Independent Fieldwork, supervisees are typically responsible for securing an appropriate experience placement and obtaining the necessary supervision. By contrast, Verified Experience (i.e., Practicum and Intensive Practicum) requires explicit oversight and involvement by a Verified Course Sequence (VCS); these may only be offered by VCSs and only after BACB approval of an application to offer these categories of experience. The tables below outline additional critical details in each category.

Supervised Independent Fieldwork

Requirement

BCBA

BCaBA

Hours of Experience

1500 hours

1000 hours

Length of Supervisory Period

2 weeks

2 weeks

Minimum # of Contacts per Supervisory Period

1 contact

1 contact

Minimum Amount of Supervision per Supervisory Period

5% of total hours

5% of total hours

Practicum

 

 

Requirement

BCBA

BCaBA

Hours of Experience

1000 hours

670 hours

Length of Supervisory Period

1 week

1 week

Minimum # of Contacts per Supervisory Period

1 contact

1 contact

Minimum Amount of Supervision per Supervisory Period

7.5% of total hours

7.5% of total hours

Course Grade

Official

Official

 

documentation reflects

documentation reflects

 

a passing grade (C or

a passing grade (C or

 

better) in all

better) in all

 

experience courses

experience courses

Intensive Practicum

 

 

Requirement

BCBA

BCaBA

Hours of Experience

750 Hours

500 hours

Length of Supervisory Period

1 week

1 week

Minimum # of Contacts per Supervisory Period

2 contacts

2 contacts

Minimum Amount of Supervision per Supervisory Period

10% of total hours

10% of total hours

Course Grade

Official

Official

 

documentation reflects

documentation reflects

 

a passing grade (C or

a passing grade (C or

 

better) in all

better) in all

 

experience courses

experience courses

Accrual of Experience. For all categories, no fewer than 10 hours but no more than 30 hours, including supervision hours, may be accrued per week. Supervisees may accrue experience in only one category per supervisory period.

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BACB Experience Standards ver. 10/13/2017

Combination of Experience Categories. Supervisees may elect to accrue hours in a single category or may combine any 2 or 3 of the categories above to meet the experience requirement, with Practicum having 1½ times the temporal value of Supervised Independent Fieldwork, and Intensive Practicum having 2 times the temporal value of Supervised Independent Fieldwork.

ONSET OF EXPERIENCE: Supervisees may not start accumulating experience hours until they have completed all of the following:

Started qualifying coursework (may begin accruing hours after attending first class meeting)

Passed the Experience Standards Training Module

Secured a qualified supervisor

DURATION OF EXPERIENCE: The start and end dates of the experience may not be more than five years apart.

CLIENTS: Any person for whom behavior-analytic services are appropriate may be a client. However, the supervisee may not be the client’s primary caretaker or be related to the client or their primary caretaker.

Supervisees must work with multiple clients during the experience period. Also, see the following relevant sections of the BACB Professional and Ethical Compliance Code for Behavior Analysts (Compliance Code): 1.06, 1.07, 2.0, 3.01, 3.04, 3.05, 4.05, 4.0, and 8.06.

ACTIVITIES: The supervisee’s primary focus should be on acquiring the skills necessary to demonstrate competence on each of the tasks on the relevant BCBA/BCaBA Task List and the skills necessary to interact effectively with consumers, supervisors, families, and others.

Supervisees are strongly encouraged to have multiple experiences (e.g., sites, populations) with multiple supervisors and from each of the areas of activity below:

Conducting assessments related to the need for behavioral intervention (e.g., stimulus preference assessment, functional assessment, staff performance assessment) or for evaluating behavioral interventions.

Designing, implementing, and systematically monitoring skill-acquisition and behavior-reduction programs.

Writing behavior/treatment plans, progress summaries, clinical notes, transition summaries, and professional correspondence.

Overseeing the implementation of behavior-analytic programs by others.

Training others, designing behavioral systems, and performance management.

Communicating and collaborating effectively with caregivers and other professionals.

Other activities normally performed by a behavior analyst that are directly related to behavior analysis such as attending planning meetings regarding the behavior-analytic program and researching the literature that is relevant to current client programming.

Only behavior-analytic activities may be counted toward experience requirements. Non-behavior-analytic job duties may not be counted. Examples of activities that will not count as experience include:

Attending meetings with little or no behavior-analytic content;

Providing interventions that are not based in behavior analysis;

Performing nonbehavioral administrative activities;

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BACB Experience Standards ver. 10/13/2017

Service-delivery activities that are not behavior-analytic in nature (e.g., crisis management techniques, CPR);

Completing nonbehavioral assessments (e.g., diagnostic assessments, intellectual assessments), paperwork, documentation, billing, or any other activities that are not directly related to behavior analysis.

Attending professional conferences workshops, or university courses

Didactic coursework assignments

Although such activities might be part of any employment or experience scenario, supervisors and supervisees must be sure to count only acceptable behavior-analytic activities toward these experience requirements. The supervisor will be responsible for determining if experience activities qualify.

Restricted Activities. The delivery of therapeutic and instructional procedures is restricted. No more than 50% of the total accrued experience hours may be restricted activities. This limitation applies to the supervisee’s

entire experience; not to individual supervisory periods. Please note that this restriction does not refer to all time spent working with clients (see unrestricted activities below).

Unrestricted Activities. Activities that are unrestricted are those that best exemplify the work of a behavior analyst who develops programs and systems for others to implement. Examples of unrestricted activities that are not limited by the 50% restriction include (but are not limited to) the following:

Observation and data collection

Observation of others (e.g., implementers, staff, parents)

Training staff and caregivers on behavior-analytic programs or content

Conducting assessments related to the need for behavioral intervention

Meeting with clients about behavior-analytic programming and services

Performing behavior-analytic assessments (e.g., functional analysis, stimulus preference assessment)

Data graphing and analysis

Researching the literature related to a specific behavior-analytic program

Writing and revising behavior-analytic programs

CONTESTED EXPERIENCE

If a supervisee is unable to obtain the signature of a supervisor on the Experience Verification Form or disagrees with the information recorded on the form, the supervisee may submit a request for a Contested Experience by submitting a Contested Experience Form along with all of the following:

a.A copy of the supervisory contract; and

b.Copies of the signed Experience Supervision Forms completed during the experience; and

c.Emails, letters, or documentation of other correspondence between the supervisor and supervisee regarding the refusal to sign and/or from third parties who observed the supervisory relationship and are able to provide verifiable support of the contested experience; and

d.Documentation of any third-party actions related to the Contested Experience.

Supervisees also must provide the supervisor with copies of the documentation they are submitting to the BACB (unless the supervisor is unreachable) and must include proof of provision of this information to the supervisor (e.g., certified mail receipt along with a letter from the supervisee to the supervisor, forwarded e-mail correspondence). The BACB will attempt to contact the supervisor to confirm receipt of this information and to provide them with an opportunity to address this matter in writing. The supervisor will be asked to provide

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BACB Experience Standards ver. 10/13/2017

documentation of dissatisfaction/concerns regarding the experience previously provided to supervisees claiming a Contested Experience.

If the Contested Experience review results in a determination that is unfavorable to the supervisee, then the supervisee will have a right to appeal the determination. Information derived from the review of a Contested Experience may be used in an ethics review in the event that a Notice of Alleged Violation is filed related to the supervised experience. Appeals and disciplinary cases that may be characterized as Contested Experience may be subject to this process.

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BACB Experience Standards ver. 10/13/2017

BACB Experience Supervision Form

This form (or equivalent) must be completed at least once during each supervisory period.

Supervisee:____________________________

Supervisor(s):___________________________

Supervisory Meeting Date(s) & Duration(s):______________________________________________

Supervisory Meeting Format (check all that apply): _____ individual

_____ group

This document covers the supervisory period from ____/____/____ to ____/____/____

Type of Experience (check one): __Supervised Independent Fieldwork __ Practicum __ Intensive Practicum

Experience Hours Accumulated During This Supervisory Period (complete all lines)

A)Number of independent experience hours accumulated (excluding time spent with supervisor): _____

B)Number of individual supervision hours accumulated: _____

C)Number of small-group supervision hours accumulated: _____

D)Total experience hours accumulated (add lines A through C): _____

Of the hours listed above, state the number spent in direct implementation of behavior-analytic programs: _____

Characteristics of Supervision Conducted During This Supervisory Period (check all that apply)

_____ BACB Task List skills covered (list Task numbers): ________________________________

_____ Specific client(s) discussed

_____ Client privacy protected

_____ Observation of supervisee (video)

_____ Observation of supervisee (in-person)

_____ Supervisory discussion & feedback (in-person)

_____ Supervisory discussion & feedback (remote)

_____ Readings: ______________________________________________________________________

Evaluation of Supervisee Performance:

Ssatisfactory NI - needs improvement U - unsatisfactory N/A – not applicable

S NI U N/A

Arrives on time for supervision

Maintains professional and courteous interactions with:

Clients/consumers

Other service providers

Coworkers

Maintains appropriate attire & demeanor

Initiates professional self-improvement

Accepts supervisory feedback appropriately

Seeks supervision appropriately

Timely submission of written reports

Communicates effectively

Written

Oral

Demonstrates appropriate sensitivity to nonbehavioral providers

Supervisee self-detects personal limitations

Supervisee self-detects professional limitations

Acquisition of target behavior-analytic skills Overall evaluation of supervisee performance during this period (circle one): S NI U

Supervisee signature: ____________________________

Date: _______________________________

Supervisor signature: __________________________

Date: _______________________________

TO BE COMPLETED DURING EACH SUPERVISORY PERIOD BACKDATED FORMS ARE NOT ACCEPTABLE

DO NOT SUBMIT THIS FORM TO THE BACB WITH THE EXAM APPLICATION

SUPERVISOR AND SUPERVISEE MUST EACH RETAIN A COPY OF THIS FORM FOR AT LEAST 7 YEARS FROM THE DATE OF

THE LAST SUPERVISION MEETING

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BACB Experience Standards ver. 10/13/2017

BACB Experience Verification Form

SECTION A

Use one form per experience. Applicants may accrue only one type of experience at a time.

Applicant’s Name:

Date Applicant Completed the Experience Standards Training Module at www.BACB.com: _____________

Experience Hours Accumulated (complete all three lines):

A)Number of independent experience hours accumulated (excluding time spent with supervisor): _____

B)Number of supervision hours accumulated: _____

C)Total experience hours accumulated (add lines A and B): _____

Of the hours listed above, state the number spent in direct implementation of behavior-analytic programs: _____

Experience Type Obtained (check only one):

Supervised Independent Fieldwork

BACB Verified University Practicum (transcript must show passing grade in verified courses)

BACB Verified University Intensive Practicum (transcript must show passing grade in verified courses)

Experience Time-Frame:

Starting date (MM/DD/YYYY) ___ / ___ / _____ - Ending date (MM/DD/YYYY) ___ / ___ / _____

(Must NOT be prior to April 1, 2005) (Indicate specific date; do not write “present”)

Supervisor’s Name:

Date Supervisor Completed the Supervisor Training Requirements: ______________________

 

Supervisor’s Title:

 

 

 

 

Telephone:

 

 

 

 

 

Experience Setting:

 

City:

 

 

State/Country:

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION B

 

 

 

 

 

 

 

Must be completed by supervisor

 

 

 

 

By signing below, I hereby attest that:

The applicant completed the experience as specified in this policy document under my supervision and in compliance with all of the stated requirements.

I am the responsible supervisor designated in the supervision contract with this supervisee.

During the applicant’s experience I was:

O a Board Certified Behavior Analyst #

; OR

Oa BACB authorized supervisor for Practicum or Intensive Practicum experience within VCS #

____________. I was authorized by the BACB on ___________; OR

Oa licensed or registered psychologist certified by the American Board of Professional Psychology in Behavioral and Cognitive Psychology who was tested in Applied Behavior Analysis, license/registration # _________________

Supervisor: By signing below, you attest that ALL of the information contained on this Experience

Verification Form is true and correct to the best of your knowledge.

Printed Name of Supervisor:

Signature:Date:

This document must bear the original signature of the supervisor. Photocopies, faxed, or emailed copies of this document will not be accepted. Original documents that have been altered (white-out, strike-through, etc.) will not be accepted. Incomplete documents will not be accepted.

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Stage no. 1 for filling out bacb standards

2. Right after finishing this section, go to the next step and fill in the necessary details in all these blanks - Clientsconsumers Other service, S satisfactory NI needs, Arrives on time for supervision, Written Oral, and Overall evaluation of supervisee.

Part # 2 in filling out bacb standards

3. Completing Supervisee signature Date , Supervisor signature Date , TO BE COMPLETED DURING EACH, DO NOT SUBMIT THIS FORM TO THE, SUPERVISOR AND SUPERVISEE MUST, THE LAST SUPERVISION MEETING, and Page of is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

THE LAST SUPERVISION MEETING, Supervisor signature  Date , and Supervisee signature  Date  in bacb standards

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4. It is time to proceed to this next segment! Here you've got all these Use one form per experience, Applicants Name Date Applicant, A Number of independent experience, Experience Type Obtained check, Experience TimeFrame, Must NOT be prior to April , Starting date MMDDYYYY , Indicate specific date do not, Telephone, and Experience Setting form blanks to fill in.

Completing part 4 in bacb standards

5. Since you come near to the completion of the form, you will find several more things to complete. Specifically, Experience Setting, City, StateCountry, SECTION B, Must be completed by supervisor, By signing below I hereby attest, The applicant completed the, in compliance with all of the, During the applicants experience, o a Board Certified Behavior, OR, I was authorized by the BACB on , o a licensed or registered, in Behavioral and Cognitive, and Supervisor By signing below you must be filled in.

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