Site Content

Supervision of Board Certified Behavior Analysts (BCBA) and Board Certified Assistant Behavior Analysts (BCaBA)

BCBA certification is recognized under Section 393.17, Florida Statutes. 

The Behavior Analysis Certification Board has rigorous standards, training criteria, handbooks and tools for supervision of BCBAs, BCaBAs, and RBTs.

An 8–hour supervision training course is required for supervisors who oversee the work of (a) individuals acquiring fieldwork for BCBA or BCaBA certification and (b) current BCaBA or RBT certificants.
Click here to review the Behavior Analysis Certification Board’s standards for supervision.

No other agency in Florida requires supervision for BCBAs... not the Agency for Health Care Administration, not the Agency for Persons with Disabilities, not the Department of Children & Families, nor the Department of Education.

The bottom line: Supervision of BCBAs, BCaBAs, or RBTs by mental health professionals is unnecessary and adds extra costs to agency operation.

FABA recommends that BCBAs, BCaBAs, and RBTs work collaboratively with mental health clinicians and other professionals in problem solving teams. Click here for more information on problem solving teams.

Cost Benefit Analysis - Case Studies

Case Study 1: Severe Self Mutilation

• Six incidents resulting in hospitalization over two months

• ~$19,000 per incident

• Baker Act placement in psychiatric hospital after each incident

• $2,000-$9,000 per stay ~$5,000 average

• Psychiatric Medication Discontinued:

• $144,000 total costs

• ABA individual service intervention - no hospital stays

• 86.5 hours over two weeks - $8650 cost of intervention

• For every $1 spent on ABA services $16 saved in hospitalization costs

The medication that this individual received due to problem behavior was also discontinued. Finally, this Cost Benefit Analysis is only based on hospitalization and Baker Act costs over this limited time period. Prior information on the number and costs of previous Baker Acts and other failed interventions for this individual were not available for this calculation.

Case Study 2: Ingesting Dangerous Items

In this case study, specific hospitalization costs were not readily available. However, assuming similar costs over this 3 year period (~$19000 per hospital stay x 28 stays) the estimated costs would be $532,000.

Following ABA intervention by ATBx there was only 1 hospitalization for the second half of 2020 and no hospitalizations in 2021.

Estimated costs of hospitalizations in the first half of 2020 was already near $200,000 (10 incidents x ~$19000/incident). Assuming a similar number would have occurred the second half of 2020 this would have cost an additional $190,000. With only one incident for the rest of 2020 this would have saved an estimated $171,000. In 2021, assuming that if the intervention had not occurred we would have seen a similar pattern, this would have resulted in an additional $171,000 in hospital costs. Based on the cost of intervention in 2020-2021 and the cost savings associated with reductions in hospitalizations, for every $1 spent on ABA services almost $6 was saved in future hospital costs. In 2022 and 2023 there have also been no incidents. If we include these potential savings for every $1 spent on ABA services nearly $12 was saved in hospital costs. Additionally, medications were also discontinued for this individual, those costs as well as the costs of previously implemented failed interventions are not calculated into this analysis.

• 28 hospital stays over three years

• ~$532,000

• ABA - one incident

• 2021 savings ~$200,000

• For every $1 spent on ABA services almost $6 was saved in future hospital costs. In 2022 and 2023 there have also been no incidents. If we include these potential savings for every $1 spent on ABA services nearly $12 was saved in hospital costs.

Case Study 3: Baker Acts

In this case study, Costs for Baker Act hospitalization were estimated as described above. Five incidents in previous placements in 2020 would cost ~ $25,000. Following the ATBx ABA intervention, there were zero Baker Act incidents across 3 months.

Educational Strategies and Academic Gains

Issues:

- Many youth are significantly behind academically but don’t have access to coursework that fits their skill level

- Only High School level courses are offered.

- Vocational instruction is offered. But without basic math and reading skills, youth have difficulty meeting vocational goals or obtaining employment.

Example profile at one male residential program

- Average age of youth is 17.2 years old

- Mean ELA Grade Level: 3.7

- Mean Math Grade Level: 2.4

- Teachers are tasked with having to teach a classroom made up of youth with a variety of skill levels because they are grouped by dorm or behavior concerns rather than academic ability.

- Without the basic foundations of math and reading, subsequent coursework becomes more difficult

Solution: Data Driven Education Model

- Utilize precision teaching methods to increase the rate of learning for students who are behind.

- Use advanced data analytics (i.e., micro, meso, macro, meta analysis) to pinpoint deficiencies and create an environment that supports outcome-based learning.

- Train and coach teachers to utilize differentiated instruction techniques in programs where they are teaching large groups of students of all different abilities.

Student 1 Example:

- 18 year old male at residential program:

- Baseline rate = 25 math facts per minute x1.1 learning rate

- Fluency instruction 4-5xs per week: 70 math fact per minute.

- Accelerated learning rate by more than x2

Typical “good student’s” average rate of learning is 1.4

At this rate this student would make up 2 grade levels worth of learning with this intervention

Juvenile Justice - Staff Training and Coaching

Use Behavior Science-Informed Methods for Staff Training & Coaching

Issues:

Many staff training sessions are lecture-based. These sessions are not behavior science-informed and do not include follow up coaching. Research shows that without the use of follow up coaching, trainees are unlikely to be able to apply skills learned in a lecture style training in the real world. When follow up coaching is part of training, staff application of knowledge and skills increases to 80% which is much greater than other training methods. Please refer to the bottom line in the table below: .

Staff are frequently taught about mental health and behavioral disorders but not taught strategies to work with youth diagnosed with them.

After lecture-based training, staff can often verbally describe the facility operating procedures, but they do not actually implement correct procedures when they are on the job.

Solution:

Use evidence-based Behavior Skills Training (BST) methods: explanation, demonstration by instructor, practice by staff with feedback from instructor, and repeating these steps as needed until able to pass a competency checklist. When practical, extend from role-play practice to real life practice with youth.

Follow BST with the vital coaching component, led by BCBAs, to ensure staff are able to consistently apply the skills they have been trained on when they are on the job. Such coaching also presents positive reinforcement that motivates staff to continue correct procedure.

Behavior Skills Training and follow up coaching should be used to effectively train staff:

- facility operating procedures

- safety and security protocols (see Youth Search BST Training Procedure below)

- youth interactions/boundaries

Common Features of Intervention Plans Prepared by Behavior Analysts

Prevention – Reduce triggers that escalate problem behavior: Methods for staff to remove or avoid presenting triggers that may escalate problematic behavior. Such triggers may include the use of commands or coercive interactions or specific conditions that have been identified for individual youth (previous trauma, fears).
Prevention – Use triggers that improve cooperation: Methods for staff to use body language and words that will most likely result in cooperative behavior.
Functional communication: Strategies for staff to teach youth to communicate their wants and needs (functional replacement of problem behaviors).
Cognitive techniques: Strategies for staff to remind youth when and how to use cognitive techniques recommended by the youth's mental health professional such as coping skills, acceptance, thought stopping, awareness training, competing response training, muscle relaxation, deep breathing, attention-focusing (on neutral or pleasant stimuli to remove attention from anxiety-producing stimuli), and self-calming.
Positive consequences: to increase desired social skills and replacement behaviors that reduce the need for youth to engage in problem behaviors.
Behavior contracts: to identify goals and rewards, and to specify the related contingencies (what, how much, who, when, where)
Self-management procedures: that can gradually reduce youth over-dependence on direct care staff.
Group-oriented positive contingencies: to produce improved pro-social behaviors and learning skills.
Active participation strategies: to increase engagement and success in instructional settings, such as fluency-based learning, choral responding, and response cards.