Faculty of Social Science Department of Applied Disability Studies ADST 5P76 SUPERVISED PRACTICUM IN APPLIED BEHAVIOUR ANALYSIS

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1 Faculty of Social Science Department of Applied Disability Studies Brock University Niagara Region 1812 Sir Isaac Brock Way St. Catharines ON L2S 3A1 T ads@brocku.ca brocku.ca/ads ADST 5P76 SUPERVISED PRACTICUM IN APPLIED BEHAVIOUR ANALYSIS LETTER OF AGREEMENT BETWEEN STUDENT, PRACTICUM BCBA SUPERVISOR & SITE SUPERVISOR (if applicable), PRACTICUM SITE DIRECTOR, AND THE BROCK UNIVERSITY CENTRE FOR APPLIED DISABILITY STUDIES General Description of Practicum: In order to qualify for BCBA certification, students are required to complete a qualifying degree, qualifying coursework, qualifying practical experience, and pass the BCBA examination. Students in the Masters of Applied Disability Studies (MADS) program (professional stream) and the Masters of Arts (MA) in Applied Disability Studies (academic stream) are in the process of completing a series of courses that will prepare them for certification with the Behaviour Analysis Certification Board (BACB). The practicum course is designed to provide students with qualifying practical experience, which may be counted toward their required supervised independent fieldwork hours. The primary goal of students during practicum is to acquire new behavior-analytic skills related to the BACB Fourth Edition Task List. Activities must be consistent with the dimensions of applied behavior analysis (ABA). Within the practicum course, students will complete150-hours of supervised practice in behavioural assessment and intervention with children, adolescents or adults with disabilities. As well, students will complete 24 hours of coursework related to ethics, jurisprudence, and professionalism issues. The details of this practicum are outlined in the ADST 5P76 course syllabus. Letter of Agreement: This letter of agreement is intended to provide clarity for the student, Practicum BCBA Supervisor, Practicum Site Supervisor (if a different person than the Practicum BCBA Supervisor), and the Practicum Site Director (or designate) about the roles and responsibilities for each party during this practicum placement. The following includes points of agreement between all those involved in the practicum placement. 1

2 Agreement Related to Supervision Qualifications: This Supervised Practicum in ABA (ADST 5P76) is an opportunity for students to apply what they have learned through Brock s Department of Applied Disability Studies BACB approved ABA course sequence. ( For these practicum hours (150 hours) to count toward the total hours required for certification as a Board Certified Behaviour Analyst (BCBA), each student must be supervised by a person who meets the requirements for supervision as outlined by the BACB ( For more information about the requirements and nature of BACB supervision, please refer to the BACB Experience Standards available online at I (Practicum BCBA Supervisor), of (practicum site) am a Board Certified Behaviour Analyst (BCBA) and meet the current criteria to provide BCBA supervision. (Certification # ) Work Mailing Address: Phone Number: Address: 2

3 ---TO BE COMPLETED BY THE PRACTICUM BACB SUPERVISOR--- Agreement of Hours and Requirements of Supervision: Details related to hours of supervision are covered in the course syllabus (minimum 5% of acquired field work hours, i.e., if 10 hours of field work, supervision = half hour weekly or one hour every two weeks). The Practicum BCBA Supervisor agrees to the following. 1. Provide individual and/or group supervision (maximum 50% group supervision) related to behavioural assessments and interventions specific to at least three clients, including the clients the student will use for their practicum related assignments (as outlined in the ADST 5P76 Syllabus), and ethical and professional issues related to the application of ABA in the practicum setting. Supervision should involve a combination of discussion of client cases, ethical and professional issues AND direct observation of the Practicum Student completing required practicum activities. 2. Review practical practicum assignments (as described in the ADST 5P76 Course Syllabus) in a timely fashion, with the Practicum Student and provide a Pass or Fail grade on the Generic Skills Supervisor Evaluation Form. 3. Review and provide general feedback on written components of course projects (involving practicum information). This feedback can be completed face-to-face, by phone, by , or in other written form. This feedback may count towards individual supervision time, but cannot be the sole form of supervision. 4. Complete and sign Supervisor Attestation Forms for each practicum assignment in order to verify the accuracy of the student s work and ensure client confidentiality. 5. Complete and sign the BACB Experience Form (or your own form that includes all components on the BACB form) following every supervision meeting (minimum once per two-week supervision period). The BACB Experience Form outlines what issues were discussed during supervision and what readings were assigned and discussed, and assesses the student s abilities related to clinical application of ABA, ethics and professionalism. 6. Complete and sign Experience Verification Form upon completion of the practicum. I (Practicum BCBA Supervisor) have read and understand the roles and responsibilities of the Practicum BCBA Supervisor as described above. As needed, I have had my questions and concerns addressed by the Clinical Coordinator, Dr. Julie Koudys (jkoudys@brocku.ca or phone x 6706). I am committed to providing the appropriate level of supervision required for this practicum student and to seeking timely support from the 5P76 Course Instructor or Clinical Coordinator around any issues that may impact upon the student s successful completion of the practicum within the course time frame (Insert practicum start and end dates here ). 3

4 ---TO BE COMPLETED BY THE PRACTICUM SITE SUPERVISOR (if applicable)--- NOTE: If the Practicum BCBA Supervisor is also the Site Supervisor they are also required to sign this agreement. Agreement of Practicum Requirements and Supervision: Details related to required practicum activities and supervision are covered in the course syllabus. The Practicum Site Supervisor agrees to the following. 1. Ensure the student is properly oriented to the practicum site, including participation in required trainings (e.g., policy and procedures, workplace safety, safe management, etc) 2. Assist in identifying appropriate clients and mediators (e.g., staff) for the student to work with to complete required practicum activities 3. Secure appropriate consents from involved clients, parents/guardians, and mediators 4. Provide onsite clinical and/or administrative supervision as appropriate 5. Liaise with the student and Practicum BCBA Supervisor to discuss course requirements and expectations, required learning opportunities, and student progress (if an alternate Practicum BCBA Supervisor is involved). I (Program Site Supervisor) have discussed the practicum course requirements with the student, including reviewing examples of course assignments and/or the draft course syllabus, and understand the expectations of this practicum for the student, the Practicum BCBA Supervisor, and the Practicum Site Supervisor. I agree to provide onsite supervision to the student during the course of their practicum. I understand that BCBA Supervision is also my responsibility OR is the responsibility of the Practicum BCBA Supervisor. As needed, I have had my questions and concerns addressed by the Clinical Coordinator, Dr. Julie Koudys (jkoudys@brocku.ca or phone x 6706). I am committed to providing the appropriate level of onsite supervision required for this practicum student and to seeking timely support from the 5P76 Course Instructor or Clinical Coordinator around any issues that may impact upon the student s successful completion of the practicum within the course time frame (Insert practicum start and end dates here ). 4

5 ---TO BE COMPLETED BY THE PRACTICUM STUDENT --- Agreement of Expectations of Practicum Students: Students are expected to work with a range of clients (at least three) during the 150 hours and to attend supervision meetings weekly or bi-weekly to discuss specific client cases, topics related to behavioural assessment and intervention, ethical and professional issues specific to this practicum site, and to update supervisors on their progress on practicum course assignments. All students, including MADS students (part-time or full-time) and MA students, should gain practical experience working with a minimum of three clients. Work with these clients will involve interventions related to developing skills, including functional replacement skills for interfering behaviour, and behavioural interventions to reduce interfering behaviour (as outlined in the course syllabus). A mediator (someone who actually implements the behaviour change program, e.g., staff, teacher, parent) may also be the focus of the practicum assessment and intervention assignment (e.g., improving mediator skills). For students completing their practicum within their place of employment, clients may be drawn from their current caseload. Student Name: Phone: Address: Anticipated days of the week on which practicum is to occur: I (student s name) have read and understand the roles and responsibilities of a supervisee, as well as the expectations for this practicum placement, as described above and outlined in the draft course syllabus. I agree to fulfill my responsibilities as a supervisee, including completion of all practicum projects, as agreed upon with my Practicum Supervisor. As needed, I have had all my questions and concerns related to the practicum addressed by the Clinical Coordinator, Dr. Julie Koudys. I am committed to being in timely communication with my practicum supervisor and the 5P76 course instructor around any issues that may interfere with my completion of the practicum course within the time frame of this course. (Insert practicum start and end dates here ). For unpaid practicum students: I (student s name) understand that this is an unpaid practicum placement. As such I will not be reimbursed for the practicum placement hours. 5

6 ---TO BE COMPLETED BY THE PRACTICUM SITE DIRECTOR --- Agreement to allow practicum placement on this site: I (Program Director or designate) of (Practicum Site) have discussed the practicum course requirements with the student, including reviewing examples of course assignments and/or the draft course syllabus, and understand the expectations of this practicum for the student in this site and for the Practicum BCBA Supervisor and/or Practicum Site Supervisor. I agree that the student can involve clients and/or mediators (e.g., staff) in this setting for their practicum placement, with appropriate consents from individual clients and/or their parents or guardians, and from the staff involved. 6

7 ---TO BE COMPLETED BY THE PRACTICUM SITE DIRECTOR IF ALTERNATIVE/ OFF- SITE PRACTICUM BCBA SUPERVISOR TO BE INVOLVED--- Agreement to allow an alternative Practicum BCBA Supervisor: Some students may have Practicum Site Supervisors who do not meet the requirements for providing supervision as per the BACB guidelines (i.e., BCBA certification, completion of the supervisory training), or who are unable to supervise the practicum due to other commitments. In these cases, the student is responsible for finding a qualified BCBA Supervisor within their practicum setting or outside this setting. 1. Supervision within the same agency (on-site): If the student finds a Practicum BCBA Supervisor who is not the student s Practicum Site Supervisor, but works within the same agency, the student will need to obtain the following: a) the Practicum Program Director s approval for this arrangement b) consent from the client and/or the client s parent or legal guardian for this arrangement, including consent to share information with the Practicum BCBA Supervisor If this is not applicable - please initial OR I (Program Director or designate) give permission for this student to be supervised by, an on-site alternative BCBA Practicum Supervisor, for the duration of the practicum and, with appropriate client and/or parent/guardian consents, allow the student to discuss client cases with this alternative Practicum BCBA Supervisor. This supervision will include some observations (live or through video) of the student demonstrating their behavioural assessment or intervention skills. I agree that the student will receive input on client-related and general ethical and professional issues form the BCBA Practicum Supervisor, but will continue to be accountable to his/her Practicum Site Supervisor for assessment and intervention planning and implementation. 7

8 2. Supervision from outside the agency (off-site): If the student cannot find a qualified Practicum BCBA Supervisor within the agency who is able to provide practicum supervision, the student will need to look outside the practicum site for a qualified Practicum BCBA Supervisor. In this case, the Program Director of the practicum site will need to give permission for the student to discuss clinical cases and ethical and professional issues with an outside supervisor, while maintaining appropriate confidentiality. However, it will be necessary for the off-site Practicum BCBA Supervisor to observe the student implementing ABA assessment and/or intervention with a client, through either live or video observation. In this situation the student will need to obtain the following: a) the Practicum Program Director s approval for this arrangement b) consent from the client and/or the client s parent or legal guardian for this arrangement, including consent to share information, including video or live observation, with the Practicum BCBA Supervisor. If this is not applicable - please initial OR I (Program Director or designate) give permission for this student to be supervised by an off-site Practicum BCBA Supervisor,, who is not an employee of our agency/organization, for the duration of the practicum and, with appropriate client and/or parent/guardian consents, allow the student to discuss client cases and view the implementation of behavioural assessment and/or intervention for at least one client with this alternative off-site BCBA Practicum Supervisor using non-identifying information about the client and his/her family or staff. The student will continue to be accountable to his/her Practicum Site Supervisor for assessment and intervention planning and implementation for all agency clients. 8

9 Any concerns regarding the students involvement in this practicum that could impact on the student s successful completion of the practicum will be immediately brought to the attention of the practicum site Program Director (or designate) and the student s ADST 5P76 Course Instructor (as listed on the attached syllabus). Student Print name & Date Signature Practicum BCBA Supervisor Print name & Date Signature Practicum Site Supervisor (if applicable) Print name & Date Signature Program Director Print name & Date Signature Brock University Applied Disability Studies Clinical Coordinator: Julie Koudys, Ph.D., C.Psych., BCBA-D cc: Student Practicum BCBA Supervisor Practicum Site Supervisor (if applicable) Program Director Brock s ADS Clinical Coordinator NOTE: Client, parent and/or guardian or staff consents (as appropriate) will be completed on separate consent forms. 9