Bcba supervision form
- 1. BACB Fieldwork and Practicum Experience Supervision Form Supervisee:_____________________________ Supervisor:___________________________ Date:__________________________________ Time Start:___________ End:___________ This supervision session addresses the period from ____/____/____ to ____/____/____ Check appropriate characteristics of supervision session. (! if yes) Specific Client Group Individual Office On-Site Remote Video In Situ Client(s) privacy Supervision Supervision Supervision Supervision Supervision Observation Observation Discussed protected of of supervisee supervisee Readings suggested by supervisor: ________________________________________________________________ Readings discussed in supervision: ________________________________________________________________ Check BACB task list items discussed in this supervision session. __ 1: Ethical Considerations __ 6: Measurement of Behavior __ 2: Definition and Characteristics __ 7: Displaying and Interpreting Behavioral Data __ 3: Principles, Processes, and Concepts __ 8: Selecting Intervention Outcomes and Strategies __ 4: Behavioral Assessment __ 9: Behavior Change Procedures __ 5: Experimental Evaluation of Interventions __ 10: Systems Support Check measures of professional integrity. S – satisfactory NI - needs improvement U - unsatisfactory N/A – not applicable S NI U N/A Arriving on time for supervision Maintains professional and courteous interactions with: Clients/Consumers Other Colleagues 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 non-behavioral providers Supervisee self-detects personal limitations Supervisee self-detects professional limitations Overall evaluation of supervisee performance during this period (circle one): S NI U Supervisee signature: ____________________________ Supervisor signature: __________________________