As the COVID-19 pandemic continues, applied behavior analysis (ABA) organizations across the country have overhauled their practice structures and systems to supervise telehealth services. Whether you’ve been offering telehealth services or are just getting started, BHCOE’s webinar, Telehealth: Strategies for Effective Supervision, offers practical considerations for behavior analysis practitioners.

Supervising direct care and middle tier staff looks very different when you’re physically removed from the supervisee,” says Ellie Kazemi, Ph.D., BCBA-D, Chief Science Officer with BHCOE. “Supervisors may be unsure what to provide feedback on and what to provide supervision for.”

For direct care staff supervision, supervisors can help supervisees meet the organization’s professional expectations, including completing paperwork and timely scheduling. You can also help your direct care staffing conduct risk assessments to determine whether the client, context, and resources are suitable for telehealth, in addition to behavior assessment and interventions, and collecting, interpreting, and graphing data.

Situational awareness is more important than ever. “When you’re unable to physically be in the environment with your direct care staff, you need your supervisee to become your eyes and ears to detect when key environmental variables or individuals have changed. Your supervisee needs to know when to report these issues to you and other colleagues.”

For middle tier staff, provide guidance about how to explain to clients and caregivers what telehealth service delivery will look like. Middle tier staff are likely to troubleshoot when an intervention isn’t working and develop assessment and intervention plans, and will need supervisory support in finding new ways to carry out treatment. They’ll also likely need guidance in developing written reports on the outcomes of any assessments and interventions.

Effective Supervision from a Distance

Although many of these principles of effective supervision apply when you’re physically available, some become especially important when employees are working remotely to ensure they’re productive, engaged, and thriving.

  • Set clear expectations: Explain how you will watch the supervisee deliver care and how you will provide feedback.
  • Review existing guidelines and protocols: Take the time to answer questions about the guidelines and protocols and ask them how they can apply the information to clients.
  • Adopt new technology: Consider technology that can support direct care staff in delivering services, such as a downloadable phone scanner application to make scanning billing and paperwork easy.
  • Use Behavior Skills Training: Use BST principles of modeling, instruction, rehearsal, and feedback to train staff to deliver care to clients.
  • Monitor performance: Observe and record supervisee performance using checklists.
  • Feedback: Provide helpful feedback that facilitates change. Feedback about professionalism, such as caregiver communication and bedside manner, can be uncomfortable to provide. Kazemi advises yielding into the discomfort, succinctly stating your observation, setting expectations for change, and demonstrating your confidence in the supervisee.
  • Remote supervision etiquette: Keep your camera off so the client doesn’t see too many people onscreen and communicate with the supervisee via Bluetooth using brief comments.
  • Building strong relationships: Demonstrating care for your supervisees’ growth and well-being is essential for a strong connection. Be dialed in during your supervisees’ sessions, providing differential reinforcements and in-the-moment support, such as music to play as a reinforcer.

Dr. Kazemi notes that delivering ABA services via telehealth is new territory for supervisors and supervisees alike. “Supervisors really need to be empathetic and put themselves in the shoes of supervisees who are providing services.”

Use BST to arm your team with new skills

In a telehealth environment, there are a number of skills that can be helpful to teach to supervisees, including how to:

  • mplement assessment protocols that a supervisor would usually do
  • mplement new procedures
  • Transfer stimulus control from in-person to telehealth
  • mplement less intrusive prompting
  • Use schedules of reinforcement, thinning, and self-management

To teach these new skills, Behavior Skills Training is the gold standard. Using a videoconferencing platform, you can review and instruct on a procedure, such as discrimination training or functional analysis. After the instruction, model or show videos before moving into rehearsal to practice the new skill while you observe and provide feedback. Using a simulated client, such as a spouse or partner, can help supervisees master the skill.

Technology Recommendations

Choosing the right technology to support your telehealth needs is important and the number of cameras, video conferencing platforms, and other tools can be overwhelming. To narrow your search, balance cost and quality considerations to obtain equipment and software that meets your needs and falls within your budget.

Here are some specific technology recommendations:

  • Cameras: Find a camera with pan, tilt, and zoom capabilities so that you can follow your staff members as they move to the floor to work with a client.
  • Bluetooth headset: Find a headset with noise-cancelling capabilities for better communication with your staff or a caregiver.
  • Staff loan agreement: Develop a simple loan agreement that outlines how to take care of the equipment and provides guidance if the equipment is lost, stolen, or damaged.
  • Tech support: Ideally, the equipment and software you purchase comes with tech support. If not, appoint one person on your team to be the technology coordinator.
  • HIPAA compliance: To ensure your client sessions are protected, contact the equipment or software company and ask for a Business Associates Agreement.

If you are looking for assistance with HIPAA compliance or ongoing virtual Chief Information Security Officer services, Pondurance can help you mature your security and compliance programs.

To learn more about effective supervision via telehealth, including video vignettes demonstrating how to provide remote feedback during a client session, watch the full BHCOE webinar.

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