Bcaba Annual Supervision Verification Form – Fill Out and Use This PDF

Behavior Analyst Certification Board®

BCaBA Annual Supervision Verification Form

This form must be submitted to the BACB annually at the time of renewal or recertification of your BCaBA certification. Please use multiple forms if you have had multiple supervisors.

BCaBA’s Name: _______________________________________________________

BCaBA’s certificate number: ________________________________

BCBA Supervisor’s Name: _______________________________________________

BCBA Supervisor’s certificate number: ________________________________

I confirm that I supervised __________________________, BCaBA, for at least one

hour per month from ________________________ until _______________________.

(Beginning Date)(Ending Date)

Number of supervision hours accumulated: ________

(Since last renewal/recertification)

By signing below, I affirm that I provided supervision to the above-named BCaBA and that supervision was in compliance with all of the BACB’s requirements for supervision

of BCaBAs. I also acknowledge that, as with any documentation required by the BACB, submission of inaccurate information on this form may be grounds for sanctions against my certification status, as provided in the BACB Professional Disciplinary Standards.

_____________________________________________________________________

BCBA Supervisor’s Signature

____________________________

Date

Policy on Supervision of Board Certified Assistant Behavior Analysts

Amount of Supervision for BCaBA: 1 hour per month (12 hours per year)

Type of Supervision: 2 of the 1 hour sessions per year must be in-person Verified on your annual renewal or recertification form

Each Board Certified Assistant Behavior Analyst™ (“BCaBA®”) must be supervised by a Board Certified Behavior Analyst® (“BCBA®”). This applies to all BCaBAs, including those previously

certified as Board Certified Associate Behavior Analyst.®*

Supervision shall occur at least once each month for one hour. Annually, at least two of these monthly supervision sessions shall be conducted in-person, to include direct observation of actual service provision with individuals. Type 3 CE may be earned for this supervision (up to 9

total Type 3 hours for the BCBA and 6 hours for the BCaBA), if properly documented (see the

“Maintain Certification” section of www.BACB.com). For group supervisory sessions, normally not more than half may qualify towards the monthly requirements (e.g., not more than 6 sessions per year). (In rare cases of extreme hardship and/or temporary/unexpected breaks in supervision the BACB will consider alternative proposals pre-approved by the BACB.)

Qualifying supervision shall: (a) occur only through two-way interactions involving real time visual and auditory contact (i.e., face-to-face meetings or electronic video chat sessions); (b) involve prior and follow-up submission of materials by the BCaBA concerning his or her

professional work, as requested by the BCBA supervisor; (c) depending on the nature of the BCaBA’s work, include some observation of appropriate professional skills; (d) ensure that the

quality of the services provided by the BCaBA to his or her employer and to consumers meets the minimum standards of the profession as defined by the current BACB Task List, the BACB Professional Disciplinary Standards, the BACB Guidelines for Responsible Conduct for Behavior Analysts, current BACB rules and regulations, and the professional literature in the

field (including textbooks and peer-reviewed journals); and (e) guide the professional development of the BCaBA in ways that improve the practitioner’s knowledge and skills.

Supervisory interactions should generally include review, discussion, and recommendations focusing on the following topics: (a) case background information, (b) planned behavioral assessment procedures, (c) assessment outcomes, (d) data collection procedures, (e) possible intervention procedures and materials, (f) intervention outcome data, (g) modifications of intervention procedures, (h) ethical issues associated with behavior change services or employment, and (i) professional development needs and opportunities. When needed or desired, the supervision relationship may include informal contacts via telephonic, e-mail, and postal communication. These exchanges, however, do not qualify towards the once per month requirements.

All BCaBAs must meet these supervision requirements, even if they are not currently providing

behavior analysis services. If not currently providing behavior analysis services, supervision may focus on guiding the development and maintenance of the BCaBA’s professional

knowledge and skills and remaining current with the professional literature in the field.

*As of January 1, 2009, the certification mark Board Certified Associate Behavior

Analyst, is replaced with the mark “Board Certified Assistant Behavior Analyst.”