What Does "Supervision" Mean?

In the ABA field, the term “supervision” is used by different people to mean different things, sometimes leading to confusion. Some people use “supervision” to mean the behavior analyst’s oversight of a Registered Behavior Technician (RBT).  Some people use the word “supervision” to refer to the oversight a behavior analyst provides over an individual client’s case. Some people use “supervision” to mean either or both interchangeably, which leads to lack of clarity in the field.

I have long argued that the field should choose two different terms to describe the distinct concepts, and several resources in fact do so. Let’s review, starting with the ABA Coding Coalition, which brings together several of the country’s most prominent autism and behavior analytic bodies: APBA, BACB, Autism Speaks—and CASP. The Coalition plays a crucial role in the field by promoting understanding of ABA coding principles among providers and payers, so its term definitions have quite a broad reach.

In the Coalition’s 2020 Model Coverage Policy, the term “supervision” is defined as follows:

“Supervision” of a technician or other employee by a qualified health care provider (QHP) generally refers to processes through which the QHP ensures that the supervisee (a) practices in a competent, professional, and ethical manner in accordance with the standards of the profession; (b) engages with and follows the employer’s policies and procedures; (c) continues to develop their knowledge and skills; and (d) receives the personal support needed to cope with the stressors and demands of their position. “Supervision” may also involve activities to enable the supervisor and supervisee to comply with specific requirements for obtaining or maintaining a paraprofessional or professional credential, such as a certification or license, or to fulfill ethical responsibilities.

In contrast, the ABA Coding Coalition uses the term “case supervision” in its Model Coverage Policy to mean “the work conducted by the behavior analyst to develop, deliver, and oversee implementation of a patient’s treatment plan. It encompasses both direct contact with the patient or caregivers and indirect services.” This definition originally appeared in the first edition of the ABA ASD treatment guidelines published by the BACB in 2012 and was adapted in subsequent versions of those guidelines.

In 2024, CASP carried forward the Coalition’s terminology with this prefatory note in our ABA Practice Guidelines:

The term ‘case supervision’ is used to refer to activities that the professional behavior analyst engages in to support treatment (including but not limited to assessment, development and modification of the treatment plan, monitoring and reporting progress, summarizing and analyzing data, and developing and overseeing a discharge plan), whereas the term ‘supervision’ is reserved for activities that are relevant to training staff, certification, or re-certification purposes.

Therefore, some helpful key words for understanding the term “supervision” would include training, performance, support, and certification. As an example of one type of supervision, per the Behavior Analyst Certification Board, an RBT must obtain ongoing supervision for a minimum of 5 percent of the hours spent providing behavior analytic services each calendar month. This supervision is primarily for the professional benefit of the RBT. (There are also supervision rules and requirements in various licensure laws in the states that have behavior analyst licensure laws.)

Key words for understanding the term “case supervision” would include treatment, implementation, patient monitoring, and data analysis. A behavior analyst should be providing case supervision for 10 to 20 percent of the direct service hours a client receives. The exact percentage depends on the individual’s programming and support needs. When providing case oversight, a behavior analyst’s overarching goal is to ensure conditions are ideal for the individual to achieve maximum meaningful progress in a safe, supportive environment. Thus, this case supervision is primarily for the benefit of the patient.

Sloppy use of the word “supervision”— particularly using it while billing where “direction of technician” should be used—has led to coding and policy problems, which will be the subject of next month’s column.

For now, the key to clarity when it comes to the word “supervision” in the above-described contexts is to be specific and consistent. A good rule of thumb might be using this tricky word within longer descriptive phrases such as “supervision of an RBT” or “case supervision for Client A.”