ࡱ> hjg[ P:bjbj<< 4d^\^\R-/ vvFLH\\\8l <\@< < "^ ^ ^ 8%8%8%?@@@@@@$CET%@v8%$$^ &&H%@vv^ ^ |:@)))&6v^ v^ ?)8%?))<=^ 78(|=?P@0@'=&F(&F,==J&F2;>8%8%)8%8%8%8%8%%@%@)8%8%8%@8%8%8%8%&F8%8%8%8%8%8%8%8%8% > <: January 15, 2014 Supervision Contract for Independent Supervision The following sample contract describes a relationship between a supervisor and a supervisee who is acquiring Supervised Independent Fieldwork toward an eligibility requirement for a BACB credential. This contract pertains specifically to situations in which the supervisor and supervisee DO NOT work in the same service-delivery environment. The sample terms provided herein are for general reference and information purposes only. These terms are intended to comply with the requirements for supervised experience of applicants to the Behavior Analyst Certification Board (BACB). Nothing herein shall be construed as legal advice. The BACB does not warrant or guarantee the legal enforceability of any provision contained in this sample agreement. Contracts should be drafted by individuals familiar with local and state laws and requirements. Please note that it is the responsibility of the supervisor and supervisee to ensure that the contract meets all the requirements outlined by the BACB in the BACB Experience Standards policy. Please also note that this contract will need to be edited for supervisees pursuing the BCaBA credential. This Supervision agreement is made on the date indicated below by and between _____ (supervisor) and _____ (supervisee) for supervision of the delivery of applied behavior analysis services, including the following activities: Conducting assessment activities related to the need for behavioral interventions; Designing, implementing, and monitoring behavior analysis programs for clients; Overseeing the implementation of behavior analysis programs by others; Training, designing behavioral systems, and performance management; AND Other activities normally performed by a behavior analyst that are directly related to behavior analysis, such as attending planning meetings regarding the behavior analysis program, researching the literature related to the program, talking to individuals about the program; plus any additional activities related to oversight of behavioral programming such as behavior analyst supervision issues, or evaluation of behavior analysts' performance.The supervisor will determine if activities qualify. Direct implementation of behavioral programs may not count for more than 50% of accrued experience hours. RESPONSIBILITIES AND AGREEMENTS Supervisor and supervisee agree to work together to facilitate in-depth discussion/understanding of issues affecting practice both personally and professionally and developing a high level of behavior-analytic expertise. Supervisor agrees to provide specific feedback to supervisee on performance in Supervisee-client interaction; this may be conducted via web-camera, videotape, videoconferencing, or similar means in lieu of the supervisor being physically present. Both parties agree to protect the time and space for supervision, by keeping to agreed appointments and the time allotted. Privacy will be respected and interruptions avoided. Any party requiring a variance in schedule will notify the other party at the earliest possible time of variance to determine an appropriate time to reschedule. Supervision may be conducted in a small group for no more than half of the total supervised hours, per BACB standards. The rest of the hours of supervision must be conducted as direct one-to-one supervision. Supervisee and supervisor will meet at least once every 2 weeks for 5% of the total hours spent in Supervised Independent Fieldwork. A Supervision Documentation Form will be completed at each supervisory interaction. Supervisee agrees to accumulate the required minimum of 10 hours and maximum of 30 hours per week to meet the total 1500 hours needed to complete the BCBA Supervised Independent Fieldwork requirement approximately within one year. _____ agrees to provide supervisee with the work opportunities necessary to meet this requirement. In addition to supervision meetings, supervisee is required to attend additional professional meetings relevant to the case, such as school meetings, case conferences, and parent meetings, which may not count towards BACB eligible supervised experience. Supervisor is to be compensated at an hourly rate of $___ to be paid immediately upon conclusion of each supervision session or by a mutual agreement arranged at the onset of the supervisory relationship. Payment for supervision rendered is a necessary but insufficient condition for the submission of a signed Experience Verification Form to the BACB. Adequate progress and payment must be completed before such documentation is signed. Supervisor agrees to accept no remuneration from supervisee above the negotiated hourly consultant rate or salary. Supervisee agrees to begin Supervised Independent Fieldwork only after supervisee has started attending courses required to meet the BACB coursework requirements. Supervisee and supervisor both agree to maintain a copy of each signed supervision document including all feedback forms identified in Clause 13, below, and this signed contract for supervision. During the supervision period, there will be progress reviews conducted after every 100 hours of supervision have been acquired. At these reviews, the supervisor will provide feedback to the supervisee and document whether adequate progress is being made. After two progress reviews during which inadequate progress has been made, the supervisor must determine whether supervision should continue, and provide in writing the required steps to allow for continued supervision. If the determination is made that supervision should stop, the supervisor must provide in writing to the supervisee what areas were lacking adequate progress and determine if any of the hours during that period should be counted toward supervision. As such, there is no guarantee that the supervisor will sign off on hours accrued during the 100-hour period during which supervisee performance was inadequate. The Experience Verification Form will be signed by the supervisor when either of the following occur: All experience hours are completed satisfactorily. The supervisor-supervisee relationship is terminated under positive conditions (e.g.,). The following circumstances would justify a supervisor refusing to sign off on a supervisees accrued hours on the Experience Verification Form (i.e., even though those hours were tracked through individual Supervision Documentation Forms). Supervisee receives ___ unsatisfactory performance evaluations. Egregious violation of the BACBs Guidelines for Responsible Conduct for Behavior Analysts (see language below) and/or behavior that jeopardizes the well-being of clients or other team members. Supervisee fails to: It is strongly recommended that the supervisor and supervisee meet with relevant personnel (e.g., directors, supervisor, employer) in the supervisees practice settings to (a) ensure that all provisions in this contract can be faithfully executed in the setting, (b) familiarize the supervisor with setting-specific rules, regulations, and practices, (c) identify if and how the supervisors recommendations will be incorporated into the setting, and (d) identify potentially challenging dual relationship (e.g., supervision) issues and develop a plan to address them. It might be advantageous to incorporate some of this content into the supervision contract and include a section for setting personnel to formally agree to contract content via signature. RESPONSIBLE CONDUCT Both supervisor and supervisee herein referred to as both parties agree to adhere to high standards of professional behavior. This includes behavioral discussions grounded in scientific and professionally derived knowledge. The supervisor will provide supervision to the supervisee only within the boundaries of his/her competence. Both parties agree to maintain confidentiality in accordance with the guidelines for responsible conduct and all pertinent legal regulations. Both parties have read, understood, and will adhere to the BACBs Guidelines for Responsible Conduct for Behavior Analysts. Particular attention will be given to sections 1 through 6 as it relates to conduct, responsibility to clients, and assessing behavior. CONFIDENTIALITY Confidential Information. On and after the date of this agreement, supervisor and supervisee shall keep confidential all information relating to current or potential clients including, but not limited to, any medical or clinical information, in whatever form. Supervisor and supervisee shall be jointly responsible for ensuring that clients have consented to the observation of service delivery and sharing of confidential client information. Supervisor Records. All records related to the activities described in this contract are and shall remain the property of _____. Supervisee shall not, except in the ordinary and usual course of his/her duties and obligations under this agreement, remove from supervisors premises, copy, or retain any of _____s records. Upon termination of the agreement, supervisee agrees to return promptly to _____, any of _____s records, copies of records and all other property that are in supervisees possession or under supervisees control or custody. TERM AND TERMINATION Term. This agreement shall be effective on _____ and shall remain in effect until either party terminates this agreement by ___ days advance written notice to the other of the intention to terminate. In the event of termination Clause 14 shall survive and remain valid. MISCELLANEOUS PROVISIONS Entire agreement. This agreement contains the entire agreement between the Parties hereto with respect to the subject matter hereof. This section is reserved for selected miscellaneous provisions regarding topics important to contract interpretation and enforcement. Research into enforceable contracts in your state should help you select contract provisions to address the following provisions: Modifications Identify who may make changes to the agreement and whether they need to be in writing or via electronic format, if permitted by your state law. Identify the addresses where changes should be sent. Waiver - Do the parties have the right to waive a clause in the agreement? How should other clauses be treated? Severability If one clause is stricken by implication of law, may the remaining clauses of the contract be still considered valid? May a stricken clause be reconstrued so as to be enforceable? Governing law and venue Which law will govern the interpretation of the agreement? Do you desire arbitration or mediation prior to litigation? Are court costs and legal fees desired remedies? Notice under this agreement by one Party to another Party shall be in writing and considered effectively given if personally delivered or deposited via postal service, postage prepaid, certified or registered, return requested, and addressed to the recipient as follows: -------------------------------------------------------------------- The responsibilities described in this document will be carried out in accordance with the BACBs Guidelines for Responsible Conduct for Behavior Analysts and Professional Disciplinary and Ethical Standards.  All parties agree to the stipulations herein: Supervisee Name (printed): ____________________ Supervisee signature: ____________________ Date: _______ Supervisor Name & Credentials (printed): ____________________ Supervisor signature: ____________________ Date: __________       PAGE  PAGE 4  Be sure to include the supervisors credentials. It is the supervisor's responsibility to ensure that the supervisee's professional activities are consistent with the current BACB experioence standards. Edit for consistent with current BACB experience standards. Edit based on the circumstances. Company/agency name here Edit this to reflect which meetings will not be counted toward supervised experience. Edit to reflect current BACB standards pertaining to the onset of experience. Describe relevant conditions Specify the conditions under which the form will not be signed (e.g., consistently poor performance evaluations, failure to maintain adequate and timely documentation and reports, violation of the code of ethics, missing professional meetings, etc. Can be edited to specify emphasis if you wishe something different than emphasis on the first 6. Insert the appropriate entity here. Insert the appropriate entity here. Insert the appropriate entity here. Insert the appropriate entity here. Insert mailing address below You may edit this section to include any additional laws or regulations you wish to apply to this contract. 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