Unrestricted Learning Opportunities for Trainees in Behavior Analysis: A Survey of Current Practices

The purpose of the current study was twofold: to collect information on how qualified BCBA supervisors are currently providing unrestricted learning opportunities for their trainees and to identify barriers they encounter when offering these experiences. An analysis of the results of this study demonstrate that an overwhelming majority of respondents offer unrestricted learning opportunities to their trainees, with over half reporting offering every unrestricted activity suggested within the BCBA Handbook (BACB, 2022b). Despite the reporting of these activities being offered, over three quarters of respondents experience at least one barrier to providing unrestricted learning opportunities to trainees. Given that these are the activities trainees will engage in once certified and the BACB requires unrestricted activities comprise a minimum of 60% of a trainee’s fieldwork, it is important that they are able to access a large number and wide variety of related learning opportunities. This necessitates a further evaluation into potential contributing factors of any limitations and how to avoid such limitations. Within the current study, we identified potential factors related to fewer barriers, such as nonprofit business models and salaried trainee employees, as well as potential factors related to increased barriers, such as for-profit business models and hourly trainee employees.

Supervisors that reported working in a nonprofit business model reported being able to offer more unrestricted learning opportunities to their trainees than those in for-profit business models. In addition, supervisors in nonprofit business models reported fewer barriers in offering these learning experiences than those in for-profit business models. In a similar pattern, supervisors whose trainees were salaried employees reported offering more unrestricted learning opportunities to trainees and reported fewer barriers to offering these activities than those with hourly employees. In general, for-profit business models operate with a single goal: to turn a profit. Nonprofit business models differ from for-profit models in that they are mission-driven, focused on public benefit, and only use profits to advance the organization (U.S. Chamber of Commerce, 2021). That is, profits made within this model ideally go towards funding continued service. Business practices that support continued service cannot guarantee good quality service delivery and related training. However, these findings suggest that the current practices within nonprofit service provision may be more conducive to meeting the training standards set forth by the BACB (2022b), providing, at minimum, the opportunity for supervisors to provide good quality supervision and unrestricted learning opportunities to trainees.

Employment status and profit model of your organization are both inextricably tied to financial contingencies; for example, a company’s profit model is focused on either profit or mission, and choosing to provide a salaried position rather than an hourly one means a company is choosing to provide a predetermined amount of pay on a regular basis, rather than as services are rendered (U.S. Chamber of Commerce, 2021; U.S. Department of Labor, 2019). The current findings are important particularly when considering two of the three most common reported barriers by supervisors were financial; in particular, restrictions on billing practices from funding sources. Furthermore, the most commonly coded undesirable consequence reported by supervisors was also financial, with responses mentioning billing, loss of revenue, cost to the organization, or other financial issues. Financial factors being reported by supervisors as a barrier to providing trainees unrestricted learning opportunities may be an example of the effects of ABA service delivery occurring largely within the capitalist health-care system in the United States. Garner et al. (2022) explores the contingencies ABA service delivery is subject to within this system. Their discussion focuses on “. . . contingencies that promote freedom, democracy, and cooperation as well as the contingencies that promote greater exploitation, less freedom, and more coercion” (p. 174). Within this, special focus is on for-profit business models, particularly those within private equity. Since 2004, the number of ABA service delivery companies operating within a private equity-backed, for-profit business model has grown considerably (for a full review, see Olson, 2022). According to Garner et al.’s findings, the effects of a private equity business model on applied behavior-analytic service delivery are as of yet unstudied. However, findings in other health-care disciplines such as nursing suggest the potential for negative effects, chiefly among them, poor clinical outcomes (e.g., Gupta et al., 2021). Fortunately, Garner et al. (2022) also propose actionable solutions to such issues. Some of these include support from our professional organizations in the form of tools which calculate an appropriate practitioner workload.

Although this recommendation was intended to help prevent poor clinical practices, it could also affect quality of supervision and training. If supervisors have an appropriate workload that is accounted for within the financial planning of the organization, trainees may be more likely to be exposed to better clinical practices and may be provided more unrestricted learning opportunities as a result. Future researchers should evaluate both the effect private equity business models have on provision of clinical services and quality of training provided to future practitioners.

The fields of psychology and medical education include guidelines for their supervised experiences similar to those provided by the BACB and have to operate within the same capitalist health-care system in the United States. One distinction that sets the requirements of these fields apart from the requirements of the BACB is that they include supervised training both during and following the completion of the trainee’s education. In the case of medical doctors, completing the majority of their supervised training upon the completion of their degree allows for the provision of a license to practice. Likewise, in some states, postdoctoral psychologists acquire a provisional license. Because these licenses are regulated by the states in which the trainees are completing their supervision experiences, the issues with third-party payers may be reduced compared to situations in which the trainee does not possess such a license, providing these practitioners with more opportunities for supervised experience. Future researchers should evaluate the extent to which a provisional credential (e.g., state license or national certification) and allowable billing could alleviate the financial barriers incurred while trainees acquire unrestricted learning opportunities.

Within the whole sample, supervisors who reported more opportunities for unrestricted activities reported fewer barriers to completing them. However, when we removed supervisors that reported no barriers to offering these opportunities, we see that the subsample of supervisors that offer more activities actually tend to experience more barriers. When more barriers are experienced, the likelihood for tasks to be left unfinished may increase; the trainee may not complete the task at all, or, if they do complete the task, the supervisor may not be able to provide them with necessary feedback required for repertoire shaping, etc. This could contribute to problems in the quality of a trainee’s experience; when learning opportunities are limited in scope, the ability to acquire the many different skills required by a BCBA also becomes limited. If contingencies select for supervisors to limit the number and quality of training experiences provided to trainees, the supervisor’s ability to adhere to the ECBA (BACB, 2022c) comes into question. In particular, section 4.06, “Providing Supervision and Training” of the ECBA covers a behavior analyst’s responsibility to provide positive reinforcement-focused, individualized, and evidence-based training within supervision. Provision of unrestricted learning opportunities is inherent in this section.

Previous literature on supervision practices offers potential solutions to this ethical challenge. For example, Hartley et al. (2016; 2023) proposes an apprenticeship model to meet the BACB’s supervision standards. Within this model, which was in place at the authors’ organization at the time of publication, trainees who have completed all of their restricted hours act as apprentices and are expected to shadow their BCBA supervisor and become fluent in the job responsibilities required of a BCBA, such as clinical case oversight, performance management of staff, client treatment planning, and clinical operations tasks. Trainees working as apprentices receive monthly performance evaluations and three forms of weekly or biweekly supervision: one focused on client interactions, one focused on review of the trainee’s client-related permanent products (e.g., designed data sheets), and one client team meeting focused on the trainee’s supervisory skills. These opportunities for skill-building align with the standards set forth by the ECBA, 5th edition Task list, and the 6th edition TCO (BACB, 2022c, 2017b, 2022a).

One may assume such a labor-intensive model is financially burdensome. Indeed, many of the tasks of the apprentice (and the BCBA) are not billable to third-party payers, based on the available CPT Codes (AMA, 2018), and therefore, cannot be directly tied to financial returns. However, Hartley et al. (2016) reported this model to be financially beneficial to their organization. In particular, an apprentice allows for increases to the caseload capacity for their BCBA supervisor. With an increased caseload, Hartley et al. reported “. . . a financial benefit to the organization of $475,000 to $500,000 annually” (p. 335). Given the specific learning opportunities for trainees and potential financial benefits to companies associated with this model, apprenticeships may provide an actionable solution to reducing barriers to offering unrestricted learning opportunities, regardless of the business model a BCBA supervisor works within. In addition to the financial and training solutions, the apprenticeship model may also help to combat recent trends in burnout in ABA clinicians (e.g., Plantiveau et al., 2018). In the current study’s qualitative analysis, the second-most reported negative consequence coded was performance-related, noting things such as supervisor burnout, stress, and taking on additional, uncompensated work. If additional support from a trainee and the trainee’s supervision are preplanned within the work performance standards of a supervising BCBA and their apprentice, there is potential for better work–life balance and less burnout.

Overall, a number of findings with future implications were identified in the current study. However, our analysis did not provide information for all factors investigated. Factors the current study investigated, but did not identify as potentially important for availability and barriers to unrestricted learning opportunities included: whether supervision was provided primarily remotely or primarily on site, whether trainees worked full time or part time, and whether the supervisor was employed by the same site as the trainee. Though additional research needs to be conducted before final conclusions can be made about these factors, promising hypotheses can be generated. For example, supervision provided remotely may be far more accessible than that which is conducted in-person. If unrestricted learning opportunities are not affected by the mode of supervision, and quality guidelines for remote supervision are followed, this could provide support for increased use of remote supervision; a more widely available alternative. Future researchers should evaluate the extent to which modality of supervision, employment status of the trainee, supervisor affiliation affect the provision of unrestricted learning opportunities using a-priori hypotheses and participants recruited to reflect the desired subgroups.

Future Directions and Limitations

The current study highlights opportunities for future research, given some limitations. First, this is the first study to explicitly study the unrestricted learning experiences offered to trainees in behavior analysis. Therefore, the study should be replicated. Second, although the focus of this article was on the unrestricted learning opportunities of trainees in behavior analysis, data were gathered from the supervisors of the trainees. Future research should expand the participant pool to include the trainees themselves, because they likely have specific information and insight that differs from their supervisors. Finally, the current study recruited supervisor participants based on their status as a qualified BCBA supervisor (BACB, 2022b), with the majority of respondents residing in the United States. Given that the unrestricted hours requirements to become a BCBA applies to the authorized countries of the United States, Canada, Australia, and the UK (BACB, 2023), the current study’s data may not represent the other three countries. Future researchers should seek respondent participation from all authorized countries to provide a more complete illustration of the current practices and barriers in accessing unrestricted learning opportunities. Furthermore, individuals seeking certification outside of these countries may do so as an international behavior analyst (IBA; International Behavior Analysis Organization [IBAO], 2021). Although the requirements to acquire the BCBA and the IBA credentials differ (e.g., number of practice hours, graduate degree necessity), experiences of supervisors with an IBA may be helpful in creating a well-rounded discussion of the training needs of the field at-large. Future research should survey the training practices and barriers of IBA supervisors as a means of starting a more global discussion on training in behavior analysis.

This study also provides future opportunities from a methodological perspective. In particular, our quantitative analyses were designed as supplemental rather than the focus of this study, and thus, we had no a priori directional hypotheses. The results are post-hoc and could be sample specific. Thus, our analyses need to be replicated with a priori directional predictions before more conclusive statements can be made.

Next, we did not recruit samples at the onset of the project to equally represent each subgroup analysis. This resulted in some subgroups having relatively different sample sizes in our independent groups t-test comparisons. It is important to note that equal subgroups are not an assumption of t-tests, and we did correct for unequal variances in our analyses when necessary. However, these analyses need to be replicated with intentionally recruited samples to produce more definitive conclusions.

Finally, the questions related to unrestricted activities available and barriers present treated all response options as unweighted. Thus, regardless of the impact of a single barrier, or the frequency of the activity’s availability, any response was weighted as equally important or available. For example, one respondent might report two unrestricted activity types available, but those activities are available to every trainee multiple times a week. Another respondent might report there are six different activity types available, but those activities are only available to a few trainees once a month. The former respondent’s “score” for the sum number of activities offered would appear lower than the latter, even though arguably the availability of unrestricted activities is higher in quality than the second respondent. For barriers, perhaps one respondent only reports one barrier present: unrestricted hours cannot count as billable time. There may be other barriers present, but to the respondent, this barrier supersedes all other barriers. As an alternative, perhaps a respondent reports five different barriers, but there is one primary barrier that is the most important. The other four, although present, do not really affect the day-to-day availability of unrestricted activities. Although both respondents may experience similar realities, their “scores” for barriers present are different. Future studies should either clarify that respondents are to select the most important barrier, or, allow respondents to rate the impact of each barrier. This would allow a more complete analysis of the potential effect of certain barriers on availability of unrestricted activities. Although limitations to our analyses are present, the results of these analyses do serve a hypothesis-producing function. We intend for these results to spur further discussion of the availability of unrestricted activities and barriers to completing them at present.

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