csun m of sci ence i n applied behavior a sis (ms-aba...
TRANSCRIPT
*Adopted fro**Adopted fr***Adopted f
CS
om CSUN Purcharom CSUN Officefrom CSUN CIEL
SUN M
A
asing & Contracte of Insurance & LO Documents
Master
Analys
P
t Administration Risk Manageme
r of Sci
sis (MS
ractica
Documents ent Documents
ience i
S-ABA
a Hand
in App
A) Prog
dbook
L
plied B
gram
Last Revised Jun
ehavio
e 2017
or
* Adopted fr**Adopted fr***Adopted f
I. In Pu G Ev
II. S BA Un Un O DIII. InIV. S Pr M St W
V. InVI. S MVII. In In M
VIII. E Ev BA Ev Ev EvIX. S Fo Sa
SaX. O
Co Co
O Or Ou
Sa Sa Sa Sa
XI. A FB
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ntroductionurpose of Unioals of Univevaluation of Itudents PraACB Requirniversity-Basniversity-Basff-Site Practicifferences amnternship Ltudent Interacticum Opti
MS-ABA Intertudent Interns
Waiver of Liabnternship Site Supervis
MS-ABA Site nternship S
nternship Site MS-ABA InterEvaluation Fvaluation of IACB Experivaluation of Svaluation of Ivaluation of Cample Formolder Index: Lample Tab: T
ample PerformOther Relateonsent to Listonflict of Inteffsite Practicarientation Coutline of the Tample Supervample Syllabiample Syllabiample Syllabi
Appendix BA Rubric…
hasing & Contrace of Insurance & LO Documents
n to CSUN Uiversity-Basedersity-Based PInterns………actica Optiorements………sed Practica wsed Off-Site Pca (Independe
mong the threeLearning Pla
rnship Appion I – Lab Arnship Studenship Guidelinebility and Holite & Supersor ApplicaSupervisor Aite ApplicatSelf-Assessm
rnship Site AgForms Intern………ience SuperviSite SupervisoInternship SiteCSUN………ms From StrList of Compeask Analysis
mance Monitoed Universitt Name & Creerest Documea Supervisionnfirmation FoTwo-Day Wovisor-Supervisi Option I……i Option II……i Option III…
………………
ct Administration Risk Manageme
Table
University-Bd Practica......Practica………
………………ons and Elig………………
with Tenure -TPractica………ent Fieldworke Options……an*…………plication……Applications…nt Agreement…es**…………d Harmless A
rvisor Appliation ………Agreement……tion ………ment and Ackgreement……
………………ision Form…or……………e……………
………………ructured Suetencies………for Each Com
oring Sheet…ty Forms oredentials……ent……………n Verification orm…………orkshop for Asee Contract…
……………………..………
…….…………
………………
Documents ent Documents
e of Conten
Based Pract.....................………………………………
gibility Crite………………Track Faculty………………k Model)……
………………………………………………………………
………………………………Agreement**…ication Info
……………………………………...……
knowledgemen………………
…………………………..…
………………………………
………………upervision F………………mpetency……
………………r Samples
………………………………
Form………………………Approved Site ………………
………………………………………………
………………
nts
tica………….....................
………………………………eria…………
…...................y ……………………………………………………………
…………………………………………
………………………………………………
ormation……………………………………
……………nt of Risks*…
………………
………………………………………………
………………………………Folder ………………………………
…………..…
………………………………
……………………………Supervisors…
………………………………
………………………………
………………
L
MS in Appl
College of
……………….....................
……………………………………………......................
………………………………
………………………………………………………………………
…………………………………………………………………………
……………………………..………..……………………
………………………………
……………………………………………
…………………………..……
………………
………………………………
……………………………
………..…....……..…………
………………………………………………
………………
Last Revised Jun
lied Behavior ADepartm
Social and Beh
…………............................
…………………….……..…
…………........................……………………………………....……………
…………………………..……………..
……………...…………….
……………...…………...….................………….....…………..…………….……………..
…………………………….…………….
……………..……………...
…...………….……………..
………….…...
……………..………………
……………..…………......
......................……………...……………..……………..……………..
…………….
1
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
2 . . 3
3 4 5 6 7 8 9 13 14
. 17 19
20
. 23
. 27 30
35 . 36
. 40 42 . 43 . 45
47
. 48 51
52
53 54
. 56 57 . 58 . 60 . 65 . 71 80
. 89
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
The Pur The MasteNorthridgbased pracsupervisiostudents a Goals of To complcompetencompeten
I. II.
III. IV. V.
VI. VII.
VIII. IX. X.
Evaluati All Practirequiremeinternship(assessed
om CSUN Purchrom CSUN Officefrom CSUN CIEL
In
pose of Uni
er of Science ge (CSUN) is ctica. The puron from CSUNapply the skill
f University-
ete Universityncies (see the ncy) in their 2
Use the prDevelop anConduct bDevelop evDesign andimplementDesign andProgram aConduct oTrain anotDevelop ananalysis
ion of Intern
ca grades areents for accrup hours. Insteaon the superv
hasing & Contrace of Insurance & LO Documents
ntroduction
versity-Bas
in Applied Bapproved, byrpose of the CN MS-ABA fls acquired in
-Based Prac
y-Based PracCSUN Struct-year graduatofessional annd use behaviehavior measvidence-basedd implement t a language ad implement bnd probe for ngoing assessher individuand present a t
ns
competency-ing their supead, students’ gvision evaluat
ct Administration Risk Manageme
n to CSUN
ed Practica
Behavior Analy Behavior AnCSUN Univerfaculty and a
n their educati
ctica
tica, studentstured Supervite program d ethical guidior measurem
surement methd interventionskill acquisitiacquisition prbehavior redugeneralizationsment of interal to conduct atraining modu
-based. Althoervised experigrades are bation forms), a
Documents ent Documents
N Universi
a
lysis (MS-ABnalyst Certificrsity-Based Pvariety of hig
ional course-w
s are expectedsion Folder fo
delines with cment methodshods and recon plans basedion procedurerogram based uction procedn and maintenrventions a procedure ule to individu
ough students ience hours, t
ased on their pand their achie
ity-Based
BA) program cation Board
Practica is to ogh quality in-vwork.
d to meet the ffor a detailed t
colleagues andand record an
ord and analyd on assessmees based on inon VB-MAP
dures nance
uals who are
are advised tthey are not eparticipation, evements on
L
MS in Appl
College of
Practica
at California (BACB), to
offer MS-ABAvivo experien
following mintask analysis
d clients nd analyze da
yze data ent results andnitial assessmPP results)
not familiar w
to adhere to Bevaluated base
clinical profethe competen
Last Revised Jun
lied Behavior ADepartm
Social and Beh
State Univero offer a univeA students nces, during w
nimum for each
ata
d baseline datment (e.g.,
with behavior
BACB® ed on their essionalism ncies
2
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
sity, ersity-
which
a
r
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Studen
As a gradu(options sexperiencCSUN Myear progr
BACB As a BACfollowing Distributi
1. St2. T
w3. A
pa4. St
spth
Distributi1. St
Pr2. T
w3. A
pa4. St
Pr
Individuathe supervmodule on
Supervisedefines “C
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ts' Practic
uate student, shown below)ce). The followS-ABA graduram.
Requireme
CB® universityg BACB guid
ion of Hours ftudents must
The distributioweek. All approved u
assing grade (tudents must pend in Univehe supervisory
ion of Hours ftudents must ractica
The distributioweek. All approved u
assing grade (tudents must racticum. Tot
ls pursuing cevision registran BACB exp
ees may accruCombining Ex
Superviseecategoriesthe experieSupervisedvalue of Su
hasing & Contrace of Insurance & LO Documents
ca Options
in the Master) to obtain supwing practicauate program
nts
y approved Pdelines (see.b
for Option I &complete 1,0
on of hours m
university exp(i.e., XBEH 9be supervised
ersity Practicuy period is on
for Option IIIcomplete 1,5
on of hours m
university exp(i.e., XBEH 9be supervisedtal supervisio
ertification atation process perience hour
ue experience xperience Cat
es may elect to listed, Superence requiremd Independentupervised Ind
ct Administration Risk Manageme
s and Elig
r’s program ypervision (see
a options, a prat this time. S
racticum Sitebacb.com).
& II is as follo000 hours of U
must be no few
perience must903). d at least weeum. Total sup
ne week.
I is as follows00 hours of S
must be no few
perience must903). d at least ween must be at
t the Board Cewith the BAC
rs prior to on
in only one stegories” in th
o accrue hourrvised Indepenment, with Prat Fieldwork, a
dependent Fie
Documents ent Documents
ibility Cri
you are eligible www.bacb.crofessional reqStudents enro
e, all of the CS
ows: University-Bawer than 10 hr
t be complete
ekly for 10% pervision mus
s: Supervised In
wer than 10 hr
t be complete
ekly for 5% oleast 75 hour
ertified BehavCB by taking
nset of experi
supervision exhe following
rs in a single ndent Fieldwoacticum havinand Intensive
eldwork.
iteria
le to apply focom under caquirement of
oll in Practica
SUN Practica
ased Practicars per week bu
d for graduat
(7.5% minimst be at least 1
ndependent Fi
rs per week bu
d for graduat
of the total hours, and the sup
vior Analyst g an online, cience.
xperience cateway:
category or mork, Practicung 1 ½ times e Practicum h
L
MS in Appl
College of
r University‐Bategories of suf the program,a for each sem
a Options mu
ut no more th
te academic cr
um) of the tot100 hours (75
ieldwork for O
ut no more th
te academic cr
urs they spenpervisory peri
(BCBA) levecompetency-b
egory at a tim
may combineum, Intensive Pthe temporal
having 2 times
Last Revised Jun
lied Behavior ADepartm
Social and Beh
Based Practicupervised , are offered b
mester of the tw
st adhere to th
han 30 hrs per
redit with a
tal hours they5 minimum), a
Option III Off
han 30 hrs per
redit with a
nd in Universiiod is bi-week
el must complbased training
me. The BACB
e any 2 or 3 ofPracticum, tovalue of
s the tempora
3
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ca
by the wo
he
r
y and
ff-Site
r
ity kly.
lete g
B
f the o meet
al
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
I. U
This pTheseMeetiprovidperformemb
A. F
W
Rbede
Se
C
B. F
W
Randeefretein
Se
Cpa
C. F
W
Rcahu
SeP
CtrofM
om CSUN Purchrom CSUN Officefrom CSUN CIEL
University‐practica optioe positions areing times andded by each Mrmance is evabers conductin
Faculty membe
Website: https
esearch & Clehavioral inteevelopment o
etting: Autism
Clients: Young
Faculty membe
Website: www
esearch & Clnd treatment oevelopmentalfficiency of skesearch is coneachers, parenndividuals wit
etting: Pacoim
Clients: Indiviarents, guardi
Faculty membe
Website: www
esearch & Claregivers (parumanoid robo
etting: Trainiartners.
Clients: In thisranslational reff-site practic
MS-ABA stud
hasing & Contrace of Insurance & LO Documents
‐Based Pr
on provides die competitive
d supervised eMS-ABA facualuated by tenng clinical wo
er: Dr. Debra
://www.csun.
linical Intereserventions andof children wi
m Clinic at CS
g children wit
er: Dr. Tara F
w.csun.edu/~tf
linical Interesof behavior dl, physical). Inkill (social, ac
nducted in a cnts, and caregth special nee
ma Charter Sc
duals (ages 3ians, teachers
er: Dr. Ellie K
w.csun.edu/~k
linical Interesrents, teacherot that simula
ng & Supervi
s lab, studentsesearch. To acca option in addents intereste
ct Administration Risk Manageme
actica wit
irect supervise, and studentsexperience varulty in their synure-track facork and behav
a Berry-Malm
.edu/wellbein
sts: The Autisd parent educith autism.
SUN
th Autism Sp
Fahmie
fahmie/
sts: Dr. Fahmdisorders in chn addition, Drcademic, self
clinical contexgivers, and ulteds.
chool and Au
-15) with ands).
Kazemi
klab/
sts: Dr. Kazems, and behavi
ates a client.
ision Laborat
s provide trainccrue superviddition to theed in pursuing
Documents ent Documents
h Tenure-
ion by MS-As must apply ry based on thyllabi and supulty. Below, vior analytic r
mberg
ng/csun-autism
sm Research cation program
ectrum Disor
mie's research hildren and adr. Fahmie con
f-care, etc.) acxt and the resutimately, to im
utism Behavio
d without disa
mi's research oral staff). Cu
tory at CSUN
nings in a pyrsed experiencir work in lab
g doctoral trai
-Track Fa
ABA tenure-trand be selecthe research lapervision conis a list of ouresearch:
m-clinic
Lab focuses oms to promote
rders and thei
interests includults with disnducts researccquisition proults of her res
mprove the in
or Intervention
abilities as we
interests invourrently, she
N and off-site w
ramidal modece hours, studb. Therefore, tining in ABA
L
MS in Appl
College of
aculty
ack faculty wted by the facaboratory (spentract). Each iur three tenure
on developinge socio-comm
r caregivers.
ude the assesabilities (intech to enhance
ograms. Most search are use
ndependent fu
n, Inc.
ell as their car
olve training conducts rese
with Commu
el and sometimdents are requthis lab is onl
A.
Last Revised Jun
lied Behavior ADepartm
Social and Beh
with research lulty membersecific informaintern’s e-track faculty
g and evaluatmunicative sk
sment, prevenellectual, e the efficacy of Dr. Fahmi
ed to help infounctioning of
regivers (i.e,
and supervisiearch with a
unity Research
mes conduct uired to selectly appropriate
4
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
labs. s. ation
y
ting ill
ntion,
and ie's
form
ion of
h
t the e for
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
II. Univ
A. Stof
B. B
C. Pr
om CSUN Purchrom CSUN Officefrom CSUN CIEL
versity‐Ba
tudents work f a CSUN‐app
A. CSUNCSUNapprovApplic
BACB® GuideA. Purpos
improvsuperv
B. AccordA.B.
C.
D.E. F.
G.
H.I.
racticum InstA. The pu
repertoB. The Pr
A.B.C.
D.E.
F.
G.
H.I. J.
hasing & Contrace of Insurance & LO Documents
ased Off‐si
directly at onproved site su
N‐approved inN Internship val process is cations are rev
elines for Fielse of Field Suve and maintavisee, and faciding to BACB. Developing Providing s
is likely tha Observing t
corrective f. Using Beha
Modeling tGuiding ansolving, pro
. Reviewing reports)
. MonitoringConductingsupervision
tructor Responurpose of pracoires of the suracticum Instr. Execute a w Develop pe Use Behavi
setting . Model tech
Guide and gprogram deReview datand provide
. Meet with fexperience,approved su
. Observe suProvide speProtect the the time all
ct Administration Risk Manageme
ite Practic
ne of our CSUupervisor.
nternship sitesSite approvainitiated by t
viewed and ap
d Supervisorsupervision (thain the behaviilitate the deliB®, effective g performancesupervisee wiat some compthe supervisefeedback avior Skills Technical, prof
nd providing fogram develodata and writ
g and evaluatig weekly evaln
nsibility cticum is to imupervisee, andructors’ will:written contraerformance goior Skills Tra
hnical, professgive feedback
evelopment, ata and writtene specific feedfield supervis, performanceupervisors, O
upervisee in-fiecific feedbactime and spac
lotted.
Documents ent Documents
ca
UN‐approved
s are local ABal as well as Sthe local agenpproved/deni
s he majority ofior analytic, pivery of high-behavior-anae goals with sth opportunit
petences will ne in the field
Training to teafessional, andfeedback on bopment, and dtten materials
ng the effectsluation of sup
mprove behavd monitor sup
act prior to onoals with supeining to teach
sional, and ethk on behaviorand decision-mn materials (e.dback sors to conduce, and effects
Option II Practield a minimuck to supervisce for superv
internship sit
BA service proSite‐ Supervincy or a currenied by the MS
f which is in-pprofessional, -quality servi
alytic supervissupervisee ties to performnot be met).and use perfo
ach and improd ethical behabehavioral casdecision-makis (e.g., behavi
s of behaviorapervisee’s per
vior analytic, pervisee’s per
nset of experieervisees h and improve
hical behavioral case concemaking repert.g. behavior p
ct monthly evof supervisiotica) um of once easee on performvision by keep
L
MS in Appl
College of
tes under the
oviders who oisor approvant MS-ABA
S-ABA review
person, onsiteand ethical re
ices to his/hersion should in
m listed comp
ormance feed
ove superviseavior se conceptualing repertoireior programs,
al service delirformance and
professional,rformance in t
ence
e supervisees
or eptualization,toires in grou
programs, dat
valuation of suon (this only a
ach semester mance in grouping to agreed
Last Revised Jun
lied Behavior ADepartm
Social and Beh
direct superv
obtain formaal status. Thestudent. w committee.
e observation)epertoires of tr clients. nclude:
petences (Not
dback to give
e’s skills
lization, probles , data sheets,
ivery d effects of
, and ethical the field.
’ skills in gro
problem-solvup setting a sheets, repo
upervisee’s applies to CSU
up supervisiond appointment
5
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
vision
al
) is to the
te* it
lem-
oup
ving,
orts)
UN
n ts and
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
III. Off
A. Sta
B. B
C. Pr
om CSUN Purchrom CSUN Officefrom CSUN CIEL
K.
f‐site Prac
tudents must site superviso
1. For thisuperv
2. CSUNCSUNcurrenABA r
BACB® Guide1. Purpos
improvsuperv
2. AccordA.B.
C.
D.E. F.
G.
H.I.
racticum Inst1. The pu
reperto2. The Pr
A.B.C.
D.E.
F.
G.H.
hasing & Contrace of Insurance & LO Documents
. Notify supemay result
tica (Inde
work at one oor who is a Bis practica op
visor (see wwN‐approved inN Internship Snt MS-ABA streview comm
elines for Fielse of Field Suve and maintavisee, and faciding to BACB. Developing Providing s
is likely tha Observing t
corrective f. Using Beha
Modeling tGuiding ansolving, pro
. Reviewing reports)
. MonitoringConductingsupervision
tructor Responurpose of pracoires of the suracticum Instr. Execute a w Develop pe Use Behavi
setting . Model tech
Guide and gprogram deReview datand provide
. Provide sup
. Provide spe
ct Administration Risk Manageme
ervisee, at thein reschedulin
pendent F
of our CSUNACB approvtion, it is the w.bacb.com)
nternship sitesSite approval. tudent. Appli
mittee.
d Supervisorsupervision (thain the behaviilitate the deliB®, effective g performancesupervisee wiat some compthe supervisefeedback avior Skills Technical, prof
nd providing fogram develodata and writ
g and evaluatig bi-weekly evn
nsibility cticum is to imupervisee, andructors’ will:written contraerformance goior Skills Tra
hnical, professgive feedback
evelopment, ata and writtene specific feedpervisee with ecific feedbac
Documents ent Documents
e earliest possng a meeting.
Fieldwork ‐approved intved supervisointern's respo.
s are local ABThe approvalcations are re
s he majority ofior analytic, pivery of high-behavior-anae goals with sth opportunit
petences will ne in the field
Training to teafessional, andfeedback on bopment, and dtten materials
ng the effectsvaluation of s
mprove behavd monitor sup
act prior to onoals with supeining to teach
sional, and ethk on behaviorand decision-mn materials (e.dback individual su
ck to supervis
sible time, of .
Model)
ternship sites or. onsibility to s
BA service prol process is in
eviewed and a
f which is in-pprofessional, -quality servi
alytic supervissupervisee ties to performnot be met).and use perfo
ach and improd ethical behabehavioral casdecision-makis (e.g., behavi
s of behaviorasupervisee’s p
vior analytic, pervisee’s per
nset of experieervisees h and improve
hical behavioral case concemaking repert.g., behavior p
upervision a msee on perform
L
MS in Appl
College of
any changes
under the dir
eek and secur
oviders who onitiated by theapproved/den
person, onsiteand ethical re
ices to his/hersion should in
m listed comp
ormance feed
ove superviseavior se conceptualing repertoireior programs,
al service deliperformance a
professional,rformance in t
ence
e supervisees
or eptualization,toires in grouprograms, dat
minimum of omance in grou
Last Revised Jun
lied Behavior ADepartm
Social and Beh
to schedule th
rect supervisi
re a qualified
obtain formale local agency
nied by the MS
e observation)epertoires of tr clients. nclude:
petences (Not
dback to give
e’s skills
lization, probles , data sheets,
ivery and effects of
, and ethical the field.
’ skills in gro
problem-solvup setting ta sheets, repo
once each semup supervision
6
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
hat
on of
site‐l y or a S-
) is to the
te* it
lem-
f
oup
ving,
orts)
mester n
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Differe
Direct Su
Practica G
Students units of Xcourse ea
Students meeting
Students course sylInternship
Total reqexperiencstandards
Commitm
To be eligfollowing
1. B2. Su3. In4. B5. E
om CSUN Purchrom CSUN Officefrom CSUN CIEL
I.
J.
nces amon
pervisor
Group Superv
must enroll inXBEH 903 pra
ch semester
must attend s
must adhere tllabus & "MSp Student Agr
uired supervisce by BCBA fos
ment to Intern
gible for CSUg criteria.
Be in good acaubmit "MS-Anterview for o
Be matched orEnroll in 3‐CE
hasing & Contrace of Insurance & LO Documents
Protect the and the timNotify supemay result
ng the thre
vision
n 3-CE acticum
upervision
to the S-ABA reement"
sed or BACB®
ship
UN‐approved U
ademic standiABA Internshon‐site or off‐r selected for tE units of the X
ct Administration Risk Manageme
time and spacme allotted.
ervisee, at thein reschedulin
ee options
UNIVERSITON-SITE P
OPTI
Dr. Fahmie, DDr. Kazemi
Dr. Fahmie, DDr. Kazemi
X
Weekly - Specfaculty
X
1000 hours (Ahours per wee
2 years to Fac
University-B
ing (i.e., a 3.0ip Applicatio‐site position(the UniversityXBEH 903 Pr
Documents ent Documents
ce for superv
e earliest possng a meeting
s:
TY-BASED RACTICA: ON 1
Dr. Malmberg,
Dr. Malmberg,
cific to each
About 15 ek for 2 years)
ulty
ased Practica
0 or above cumn & Agreeme
(s). y‐Based Pracracticum Cou
vision, by keep
sible time, of
UNIVERSISITE PRAC
CSUN ApprSupervisor
CSUN Pract
X
Bi-weekly PWeekly Fiel
X
1000 hours (per week for
1 AcademicSite
a experience, t
mulative GPAent" by specif
ctica experienurse each sem
L
MS in Appl
College of
ping to agreed
any changes
ITY-BASED OCTICA: OPTIO
roved Off-Site
ticum Supervis
Practica Meetinld Supervision
(About 15 hour 2 years)
c year to Intern
the student m
A). fied deadlines
nce. mester.
Last Revised Jun
lied Behavior ADepartm
Social and Beh
d appointmen
to schedule th
OFF-ON 2
OFF-S
BCBA
sor CSUN Superv
X
ngs
Bi-weeMeetinBi-WeSuperv
X
urs 1500 hhours pyears)
ship 1 AcadInterns
must meet the
s.
7
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
nts
hat
SITE PRACTICOPTION 3
A in good stand
Practicum visor
ekly Practica ngs ekly Field
vision
hours (About 20per week for 2
demic year to ship Site
ABA)ology es & llege
CA:
ding
0
* Adopted fr**Adopted fr***Adopted f
Learning
in the Struto accrue
1. I leSPrth
2. I
3. I
reaschminmfum
4. I
Inin
5. I
ob
Print Inter
Intern’s S
Print Site
Site Super
Internship
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Internsh
g Objectives:
uctured Supersupervised ex
will devote _east 1 academite), and agreracticum Sup
his internship.
will use the C
understand anesponsibility) ssigned tasks haracteristics
materials at or nternship, (f) t
mental, behaviurther underst
my acting resp
agree to act innternship Sitenterning.
understand thbjectives to b
rn’s Name __
Signature ____
Supervisor’s
rvisor’s Signa
p Site’s Clinic
hasing & Contrace of Insurance & LO Documents
hip Learni
To meet the
rvision Folderxperience hou
____________mic year to the
e to completepervisor, the a.
CSUN Structu
nd acknowledassociated wand responsibof the Internsnear the locathe time of daioral, and soctand and acknponsibly to pro
n a responsibe and abide by
he connectionbe fulfilled at t
____________
___________
Name _____
ature _______
cal/Executive
ct Administration Risk Manageme
ing Plan*-
supervision c
r (which are burs to become
_ hours (basede Internship Se all paperworapproved Site
ured Supervis
dge that therewith my select
bilities, (b) thship Site, (d)
ation of the Inay when I wilial backgroun
nowledge thatotect myself f
le manner why all the rules
n between the the Internship
___________
____________
____________
___________
Director Sign
Documents ent Documents
- Filled ou
competencies
based on the Be eligible to si
d on the off-site (or followrk required bySupervisor (i
sion Folder to
are potentialted internshiphe location of the amount a
nternship Site,ll be present ands of the indt my safety anfrom persona
hile representiand regulatio
course (i.e., Xp Site.
___________
___________
___________
___________
nature _____
ut by Stud
outlined by t
BACB’s lateit for the Boa
site internshipw the guideline
y the MS-ABif applicable)
o meet the com
l risks (for whp, some of whf the Internshiand type of cr, (e) any traveat the Internshdividuals I wilnd well-beingal injury, bodi
ing the MS-Aons that gover
XBEH practi
____________
___________
___________
____________
____________
L
MS in Appl
College of
ent in Pra
the CSUN MS
est edition of ard Certificatio
p options) peres laid out by
BA Program, t), and Internsh
mpetencies lis
hich CSUN ishich may ariseip Site, (c) theriminal activitel associated hip Site, and (ll be workingg are primarilyily injury, or p
ABA Programrn the site in w
cum course)
___________
_________Da
____________
_________Da
___________
Da
Last Revised Jun
lied Behavior ADepartm
Social and Beh
actica
S-ABA Progr
f the Task Liston Exam.
r week, commy the Internshithe CSUN hip Site as pa
sted.
s absolved of e from (a) mye physical ty or hazardouwith the (g) the crimin
g with or serviy dependent uproperty dam
m at CSUN at which I am
and the learni
____________
ate _________
___________
ate ________
____________
ate_________
8
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ram
t) and
mit at ip
art of
y
us
nal, ing. I upon
mage.
the
ing
____
____
____
_____
____
_____
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
CSUN
1. N
2. G
3. S
4. C
5. C
6. C
7. E
8. E
9. B
10. O
11. C
12. C
13. Wyo
Rank
* 1.2.3.
14. A
15. F Y
16. W
om CSUN Purchrom CSUN Officefrom CSUN CIEL
N Master o
Please c
Name
a. Last n
Gender:
treet address
City, state, zip
Cell phone nu
CSUN E-mail
Emergency co
Emergency co
Bachelor’s in
Other degrees
Cumulative G
Citizen of the
Which practicour choices,
k 1-3 -
For Option . __________. __________. __________
Agency preferSites on yAcknowleread, undepreferred s _________
For Option II
Yes □ No □ –
What languaga. Could Yes □
hasing & Contrace of Insurance & LO Documents
of Science Stu
complete the
ame________
Fe
s _________
p _________
umber ______
l address ___
ontact ______
ontact phone
___________
s __________
GPA, bachelo
United State
ca option (Seyou will be c
Option I –
I – please lis_________________________________
rences/Internyour Practicadgement of Rerstand, and site)
___________
II Internship
– Please prov
ge other thanyou provide No □
ct Administration Risk Manageme
in Applieudent Inte
following inf
___________
emale______
____________
____________
___________
____________
___________
e number ___
______ Fro
_______ From
ors_________
es? Yes □ N
ee Practica Hcontacted bas
________ O
t faculty in o__ __ __
nship Site (*a Moodle BoRisk. By sele
acknowledg
____________
Sites: Please
vide the name
n English do assessment o
Documents ent Documents
d Behavioernship Apformation in
___ First nam
___________
___________
___________
___________
___________
___________
m _________
m _________
_____ Cumu
No □
Handbook pased on the in
ption II ____
order of pref
Review the lioard and readcting a partic
ge the potent
___________
e indicate if y
of your agen
you speak frr deliver serv
or Analysipplication
preparation
me_________
Male ___
___________
___________
____________
___________
____________
____________
___________
___________
ulative GPA,
age 4-7) do ynformation yo
_____ Option
ference
ist of CSUN-d the Internscular Internsh
ntial risks inv
___________
your agency n
ncy ________
requently? __vices in that la
L
MS in Appl
College of
is (MS-AB
of an intervi
__________ M
___
____________
____________
___________
____________
___________
___________
________ Ye
________ Ye
, other _____
you wish to sou provide)?
n III _______
-MS-ABA Apship Site Selhip Site, you volved with
____________
name is on our
____________
___________anguage?
Last Revised Jun
lied Behavior ADepartm
Social and Beh
BA) Progra
iew:
Middle initial_
______
_______
_______
___________
_______
___________
ear ________
ear ________
___________
elect (please ?
__
pproved Interlf-Assessmenare indicatinworking at
___________
r approved lis
________
_______
9
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
am
____
___
____
_
_
rank
rnship nt and g you
your
_____
st.
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
17. W(c□
□
□
□
□
□
□
□
18. In□
□
□
□(
19. Wpa
*I
20. Wo
om CSUN Purchrom CSUN Officefrom CSUN CIEL
What populatcheck all that□ Infants
□ Toddlers
□ Pre-school
□ Elementary
□ Middle sch
□ High schoo
□ Adults
□ Seniors
n what clinic□ Homes
□ Schools
□ Camp settin
□ Other ____(specify)
What is your age 15 for fu
a. Day______
b. Tim______
Internships ty
What is youccur in the m
hasing & Contrace of Insurance & LO Documents
tions have yot apply)
l age
y school age
hool age
ol age
cal settings ha
ngs
___________
schedule of rther informa
ys available (e___________
mes available (___________
ypically occur
r schedule mornings or
ct Administration Risk Manageme
ou worked w
ave you work
_________
availability ation)?
e.g., M-F, Sat___________
(e.g., morning___________
r Monday-Fri
of availabilevenings M-
Documents ent Documents
with in a clini
□ Deve
□ Emo
□ Typi
□ None
□ Othe
ked for at lea□ Clini
□ Grou
□ After
□ None
for internshi
turday) ____________
gs until 2pm) ____________
iday, in the m
lity for Prac-Sat. Please
ical setting f
elopmental di
otional disturb
ically develop
e
er__________
ast 3 monthsics
up homes
r- school prog
e
ip (Please lis
___________
______
mornings, after
ctica groupprovide all a
L
MS in Appl
College of
for at least 3
isabilities
bance/mental
ping
______ (spec
s (check all th
grams
st all availab
__________
rnoons, or ev
p meetings? availability.
Last Revised Jun
lied Behavior ADepartm
Social and Beh
months - 1 y
illness
ify)
hat apply)?
ility. See bul
enings
These typi
10
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
year?
llet H,
ically
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
21. H □
22. In
23. D
24. Bin
25. Bin
26. B
om CSUN Purchrom CSUN Officefrom CSUN CIEL
How many ho
15 hours a w
n what geogr
Do you have a
Briefly describnternship(s) y
Briefly describnternship(s) e
Briefly describ
hasing & Contrace of Insurance & LO Documents
ours a week
week
raphical loca
a reliable for
be your acadyou selected:
be your cliniexperience y
be why you a
ct Administration Risk Manageme
would you b
□ Up to 20
ations do you
rm of transpo
demic backgr:
ical experienou selected:
are interested
Documents ent Documents
be able to com
0 hours a week
hope to inte
ortation?
round and co
ces and any
d in the inter
mmit to this i
k □ A
ern?
Yes □ No □
oursework th
positions hel
rnship(s) exp
L
MS in Appl
College of
internship? (
Above 20 hou
□
hat is relevan
ld that relate
perience(s) yo
Last Revised Jun
lied Behavior ADepartm
Social and Beh
(please check
urs a week
nt to the
e to the
ou selected:
11
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
k one)
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
27. Inyo
28. W
29. Inan
30. TIn
om CSUN Purchrom CSUN Officefrom CSUN CIEL
n a few sentou selected w
What are som
n addition tonticipate to h
Tell us other nternship:
hasing & Contrace of Insurance & LO Documents
ences, indicawill help you
me skills that
o your gradhave this nex
information
ct Administration Risk Manageme
ate your longattain these
you feel you
duate curricuxt year:
n that would
Documents ent Documents
g range profgoals:
would bring
ulum, what
d facilitate a
fessional pla
g to the Inter
additional c
assessment o
L
MS in Appl
College of
ans and how
rnship Site(s)
commitments
of your quali
Last Revised Jun
lied Behavior ADepartm
Social and Beh
w the internsh
) you selected
s do you ha
ifications for
12
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
hip(s)
d:
ave or
r this
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
If you arethe form bmember’smakes you
Dr. MalmRank: ___Paragraph
Dr. FahmRank: ___Paragraph
Dr. KazemRank: ___Paragraph
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Prac
e interested in below. For eas lab and provu a good fit fo
mberg (Autism____ h:
ie (Taking St____ h:
mi (Training &____ h:
hasing & Contrace of Insurance & LO Documents
cticum Opti
being considach faculty mevide one paragfor the lab.
m Clinic/Autis
teps Together
& Supervision
ct Administration Risk Manageme
ion I - Lab A
dered for a facember’s lab thgraph describ
sm Research L
, Community
n Laboratory
Documents ent Documents
Application
culty memberhat you would
bing a) why y
Lab)
y Partnerships
)
ns – Student
r’s research lad like to applou are interes
s)
L
MS in Appl
College of
t to Fill-Out
ab (Practicumly for, rank thsted in the lab
Last Revised Jun
lied Behavior ADepartm
Social and Beh
t
m Option I), fihe faculty b and b) what
13
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ill out
t
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
A. I AminM
B. I an
C. I
Cvefoet
prprap
D. I
LroIn
E. I chvaIntimIn 1
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Please read
hereby certifyApplication Fomisrepresentatnternship eval
MS-ABA Aca
am responsibnd CSUN Pra
hereby give pCSUN Practicu
erify any and ormer employtc. Please be arofessional strogram shall ppropriate pa
understand thLearning Plan ole can be disnstructor, and
understand thhecks, randomalid Driver’s nternship Siteme during thenternational S
. I am willinany resultsand CSUNconfirmed and therefothat if I faiable to inteAcademic I am eligibsite. In addrelationshiunderstancompletio
hasing & Contrace of Insurance & LO Documents
MS-AB
d the followin
y that the statorm & Learnition or omissiluation, separdemic Directo
ble for meetinacticum Instru
permission to um Instructorall informati
yers, clinical i
advised that iftudent status abe authorized
arties.
hat any informand/or any pecussed betwe
d the approved
hat most Interm drug screenLicense, etc.
e confirmatione year. If you
Students and t
ng to participas that affect m
N Practicum Inat the specifi
ore not intervil a screening erview for anDirector or C
ble to continudition, I underip with the intnd that my grn of the inter
ct Administration Risk Manageme
BA Interns
ng statements
tements containg Plan are trion of any maration from thor or the CSU
ng all the requuctor.
the CSUN Mr, and any of ton contained internship/pra
if any informaand/or internd to assess an
mation containertinent informeen the MS-Ad Site Superv
rnship Sites rens, physical exas requireme
n. Internship Su are an Internthe MS-ABA
ate in these admy internship nstructor. I alied Internship
viewed for an during the yeother internsh
CSUN Practice the programrstand that entern site can rrade in the prnship comp
Documents ent Documents
ship Stude
s carefully an
ained in this crue and correcaterial facts onhe internship, UN Practicum
uirements agre
MS-ABA Progthe approved within this ap
acticum sites,
ation should cship role, and
nd discuss the
ned in this Stumation relatin
ABA Academiisors and Inte
equest securitxaminations,
ents for their pSites may alsonational studeInternship Co
dditional screstatus to be p
lso understandp Site, can becinternship for
ear, I will be rhip for the remcum Instructorm, and if so, thngaging in actresult in a fail
practicum coupetencies in th
ent Agreem
nd sign at the
completed MSct. I agree than my part mayand/or can in
m Instructor.
eed upon with
gram, the MSSite Supervispplication. Th and/or review
come to our ad thus the intee significant i
udent Internsng to my profic Director, thernship Sites.
ty backgroundTB tests, imm
placement into require randent, please cooordinator fo
eenings/evaluaprovided to thd that if I fail come ineligibr an entire acremoved frommainder of thr will review he timeline fotivities that reling grade in murse is continhe internship
L
MS in Appl
College of
ment
bottom of th
S-ABA Studeat and understay be cause fonitiate immedi
h my Internsh
-ABA Acadesors and Interhis can includwing graduate
attention that ernship experinformation w
ship Applicatifessional studhe CSUN Pra
d investigatiomunization veterview procedom drug scr
onsult with theor further assis
ations and givhe MS-ABA A these screeni
ble for schoolademic year.
m the internshhe academic y
my case to dor returning toesult in severimy practicumngent on my p practicum.
Last Revised Jun
lied Behavior ADepartm
Social and Beh
e page:
ent Internship tand that any
or delay in iate review by
hip Site Super
emic Directorrnship Sites tode contacting e school reco
can affect yorience, the
with the
ion & dent acticum
ons, fingerprinerification, an
ess and for reening(s) at ae CSUN Officstance.
ve permissionAcademic Dirings, I will no-based internI also unders
hip site and noyear. The MS-determine wheo the internshing my m course. I
successful
14
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
y the
rvisor
, the o
rds,
our
nt nd a
any ce of
n for rector ot be ships,
stand ot -ABA ether hip
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
F. I tr
G. A
sthe
H. Cis(ObeapA
I. I un
J. I PrBandefuth
K. IfcoscAle
I Apn
om CSUN Purchrom CSUN Officefrom CSUN CIEL
understand thrainings (e.g.,
At all times, I tandards, the Bealth provider
CSUN is not res my responsibOption III). I e flexible witpproved sites
ASAP for cons
1. I undeon myconducperformSamplhighly
am aware thanits of XBEH
understand thracticum (see
BACB examind 1, 500 houepending on mulfill all 1,000hose hours are
f the situationommitment, Ichool and ass
ABA Academieast 30 days’ n
1. Commspecifi
i.
2. Meet wresult i
understand thABA Academi
rematurely, eed to reapp
hasing & Contrace of Insurance & LO Documents
hat I may be fCPR) if the I
shall maintainBACB Coders.
esponsible fobility to seekunderstand thh my internshdo not meet y
sult.
rstand my sity practicum opct (e.g., on timmance assessle Performancy influenced b
at as an internH 903 each sem
hat I am optine www.bacb.cination, a minurs is requiredmy hours of c0 hours. I recoe sufficient to
n arises and I nI shall terminaigned Internsic Director, thnotice). Steps
municate with ic concerns/si
Be preparedregarding y
with MS-ABAin a resolution
hat any such tic Director, thI am aware tly for intern
ct Administration Risk Manageme
financially resInternship Sit
n professionae of Ethics, pr
r my internsh, interview, an
hat dependinghip service hoyour internsh
e supervisor eption. My evame and consisments, and ra
ce Assessmenby these evalu
n at a CSUN-amester and ad
ng to obtain mcom) or indepnimum of 1,00d for Option Icommitment aognize that it o sit for the BA
need to terminate in an apprhip Site and p
he CSUN Pras to follow pr
CSUN Practiituations d to talk with
your concernsA Academic Dn.
termination whe CSUN Prathat I may nship and disc
Documents ent Documents
sponsible to pte does not co
al conduct in arofessional w
hip placementnd secure an
g on the type oours and geoghip needs, plea
evaluates me aluations inclustent attendanating scales (snt form). I unduations (see X
approved Intedhere to the p
my experiencependent fieldw00 hours of exII; therefore, and duration ois my responACB examin
nate the internropriate and pprovide writte
acticum Instruior to termina
icum Instruct
h the internshis as recommenDirector and y
will be done onacticum Instruot be accepteclose my pre
pay for clearaover the cost.
accordance wwork values, a
t. To enroll aInternship Siof internship
graphical locaase contact yo
on a weekly ude direct obnce to meetingsee Evaluationderstand my g
XBEH 903 cou
ernship Site, Ipracticum cou
e hours througwork. To becoxperience is rI acknowledgof services, m
nsibility to keenation.
rnship before professional men and verbaluctor, and the ating:
tor, verbally a
ip site and younded by the Byour Practicu
nly with the wuctor, and the ed in the samemature disco
L
MS in Appl
College of
ances, health s
with the schooand laws regu
and pass practte and a BCBI seek, it is m
ation. If the cour internship
or bi-weekly servations of gs or appointmn of Student Igrade in my purse syllabus)
I am required urse syllabus.
gh a Universitome eligible trequired for Oge that my int
may not be suep track of my
fulfilling my manner as desl notice as reqInternship Si
and in written
ur internship BACB code um Instructor
written approvInternship Si
me internshipontinuation o
Last Revised Jun
lied Behavior ADepartm
Social and Beh
screenings, an
ol’s academic lating behavi
tica, I understBA Supervisormy responsibilcurrent CSUNp coordinator
basis dependf my professioments), in-vivIntern form a
practicum cou).
to enroll in 3
ty-Based to sit for the Options I and ternship hourfficient for my hours and e
internship signated by thquired by the ite (e.g., prov
n format, abou
site supervisoof ethics. if Step 1 did
val of the MSite. If I termip setting; I mor terminatio
15
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
nd
oral
tand it r lity to
N
dent onal vo nd
urse is
3-CE
II rs,
me to ensure
he MS-
vide at
ut the
or
not
S-inate
may on
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
db
L. I an(psi
I have revan intern policies auniversity
Student N
Student S
om CSUN Purchrom CSUN Officefrom CSUN CIEL
uring the intased practicu
shall fulfill thnd proceduresp.9-16), Studeite).
viewed and uand I agree tnd procedure
y-based pract
Name (Print) _
Signature ___
hasing & Contrace of Insurance & LO Documents
terview proceum to accrue
he responsibils as outlined ient Internship
nderstand thto comply wites, I understaticum to accru
___________
____________
ct Administration Risk Manageme
ess of the newe my experie
lities of the stin the Interns
p Guidelines (
e MS-ABA Sth all of the aand that I canue my experi
___________
___________
Documents ent Documents
w internshipnce hours.
tudent intern rhip Learning
(pg.17-18), an
Student Internabove. If I amn be considerience hours.
____________
_________
p in order to p
role and be inPlan (pg.8),
nd Supervisio
nship Agreemm not in compred ineligible
___________
D
L
MS in Appl
College of
participate in
n compliance Student Inter
on Contract (f
ment which sppliance with tto participate
___________
Date: _______
Last Revised Jun
lied Behavior ADepartm
Social and Beh
n the univers
with all policrnship Applicafrom internshi
pecifies my rothe school’s e in the
____________
____
16
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
sity-
cies ation ip
ole as
____
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
The stud
GUIDEL• Ask for and you ayou in detyour CSU • Be puncorganizatithe personhours/proj
• Call if yor if you a
• Respect with whomyou treat icould idepseudony
• Show rean educaticommunit
• Be approcourtesy aotherwiseprograms.
• Be flexibto changinfor everyo
MAXIMI
DO partic
DO makeemergenc
DO make
DO ask foin doubt.
om CSUN Purchrom CSUN Officefrom CSUN CIEL
dent agrees to
LINES: help when in
are encouragetermining the
UN Practicum
ctual and respion as a reliabn whom you sject througho
you anticipate anticipate bei
the privacy om you are woit as privilegentify the clie
yms.
espect for the ional opportuty is serving y
opriate: You and kindness.e. Set a positiv.
ble: The levelng situations one involved.
IZE THE EX
cipate in orien
e sure you knoy.
e sure you kno
or help from y
hasing & Contrace of Insurance & LO Documents
Stu
abide by the
doubt: Your d to approach best way to rInstructor wi
onsible: Althoble, trustworthserve rely on
out your partn
lateness or abng late. Be m
of all clients: Iorking (i.e., ored informationent, superviso
partnership ounity and a priyou by invest
are in a work Dress comfove standard fo
l or intensity can assist the
XPERIENCE
ntation for you
ow who to co
ow how to ex
your internshi
ct Administration Risk Manageme
dent Inter
following Gu
internship sith him/her withrespond to difith questions
ough you are hy, and contriyour punctua
nership.
bsence: Call tmindful of you
If you are privrganizational n. Wheneveror, or colleag
organization yivilege. Keepting valuable
k situation andortably, neatlyor other stude
of activity at e partnership i
E:
ur internship
ntact at the in
it your intern
ip site superv
Documents ent Documents
rnship Gu
uidelines and
te supervisor h problems orfficult or uncoconcerning y
volunteeringibuting memb
ality and comm
the internshipur commitmen
vy to confidefiles, diagnos
r you are refegues, in class
you work for: p in mind, not resources in y
d are expectedy, and appropents to follow
a service sitein working sm
experience.
nternship site
ship site in ca
visor or anothe
uidelines**
d Limitations
understands tr questions asomfortable si
your placemen
g your time, yber of the teammitment to co
p site supervisnt; people are
ential informastics, personaerring to youor outside c
Placement wt only are youyour learning
d to treat yourriately. Use fas part of CS
e is not alwaymoothly and p
and at the un
ase of an eme
er staff memb
L
MS in Appl
College of
*
s:
the issues at ys they arise. Hituations. Feent.
you are particim. Both the aompleting you
sor if you are e counting on
ation with regal stories, etc.ur clients or ilass, you sho
within commuu serving the cg.
r supervisor aformal names SU's ongoing
ys predictableproducing a p
niversity in ca
ergency.
ber at your in
Last Revised Jun
lied Behavior ADepartm
Social and Beh
your internshiHe/she can assl free to conta
ipating in the administratorsur service
unable to comyou.
gard to the per), it is vital thinformation
ould use
unity programcommunity, th
and others witunless instruinternship
. Your flexibipositive outco
ase of an
nternship site w
17
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ip site sist act
s and
me in
rsons hat that
ms is he
th ucted
ility me
when
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
DO call y
DO show
DO be aw
DO knowmember/P
DO sign-iservice lo
DO knowinternship
LIMITAT
DON'T re
DON'T g
DON'T m
DON'T g
DON'T toan individ
DON'T tosexual wit
DON'T e
DON'T eterm of yo
TRANSPStudent unresponsibresponsib If you feebeen viola
I have revabove. If Iconsidere
Student NDate: ___
om CSUN Purchrom CSUN Officefrom CSUN CIEL
your internship
respect for y
ware that you
w that if you arPracticum Ins
in at your integ. This will e
w that you canp site. Please f
TIONS:
eport to your
give or loan a
make promise
give a client o
olerate verbaldual on the ba
olerate verbalth a client or
ngage in any
nter into persour service.
PORTATIONnderstands anility of each pility or liabili
el that your rigated, please c
viewed and uI am not in c
ed ineligible t
Name (Print) _________
hasing & Contrace of Insurance & LO Documents
p site supervi
your internship
are representi
re having troutructor about
ernship site evensure you rec
n request an alfollow proced
internship sit
client money
s or commitm
r agency repr
l exchange orasis of his/her
l exchange ofcommunity o
type of busin
sonal relations
N: nd agrees thatparticipating sity for student
ghts have beeontact the CS
nderstand thcompliance wto participate
___________
ct Administration Risk Manageme
isor if you kn
p site, its staf
ing your univ
uble at your init.
very time youceive credit fo
lternative intedures outline
te under the in
y or other pers
ments you can
resentative a r
r engage in ber age, race, ge
f a sexual natuorganization r
ness with clien
ships with a c
t transportatiostudent. Neitht transportatio
en or may be vSUN Practicum
e Student Intwith the schoo
in the univer
___________
Documents ent Documents
ow you will b
ff, and its clien
versity.
nternship site
u are there, anor the hours y
ernship site if in Student Int
nfluence of dr
sonal belongin
nnot keep to a
ride in a perso
ehavior that mender, sexual o
ure or engagerepresentative
nts during the
client or comm
on to and fromher the Univeon.
violated, or thm Instructor a
ternship Guidol’s policies arsity-based pr
____ Student
be late or not
nts.
e, you can talk
nd record youyou have serv
f you are not cternship Agre
rugs or alcoh
ngs.
a client.
onal vehicle.
might be perceorientation, a
e in behavior te.
e term of your
munity partne
m the internshersity nor the I
hat any of theand/or the MS
delines and Iand procedureracticum to a
Signature___
L
MS in Appl
College of
able to come
k with your fa
ur service houved.
comfortable weement.
hol.
eived as discrability, or ethn
that might be
r service.
er representat
hip site shall bInternship sit
e above-statedS-ABA Acad
I agree to comes, I understa
accrue my exp
___________
Last Revised Jun
lied Behavior ADepartm
Social and Beh
e in at all.
aculty
urs on your stu
with your curr
riminating aganicity.
perceived as
tive during the
be the sole te shall assum
d limitations hdemic Directo
mply with all oand that I canperience hou
___________
18
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
udent
rent
ainst
e
me
have or.
of the n be
urs.
_____
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Wa
I, the und Name of Social and Activity: that begin In consideheirs and Trustees oofficers, dclaims of paralysis participati I am voluand particpain, suffeor emotioother’s aclocation(sparticipa I agree to my personfrom and the Univeresult of s I am 18 yreleasing all risks o I understaCaliforniaremaining I have reaof this doc ________Participant
________
Print Partic
om CSUN Purchrom CSUN Officefrom CSUN CIEL
aiver of Li
ersigned parti
department d Behavioral
Practica Expe
ns on: ______
eration for berepresentativ
of The Califordirectors, voluf the Universiand death), ilion in this Ac
ntarily particicipating in thifering, illness,nal loss, and/
ctions, inactios). Nonetheleation in this A
hold the Uninal property tduring the Ac
ersity. If I neesuch treatmen
ears or older.the Universi
of participati
and that this da. I agree that g terms.
ad this documcument have
__________t’s Signature
__________
cipants Name
hasing & Contrace of Insurance & LO Documents
iability an
icipant, am re
and College:Sciences, Dep
erience
___________
ing allowed tes, I release frnia State Ununteers and agity’s negligenlness, damage
ctivity, includ
ipating in thisis Activity, wh, disfiguremen/or death. I unn, or negligenss, I assume
Activity, inclu
iversity harmthat may occuctivity. If the d medical tre
nt. I am aware
I understanity from all ling in this Ac
document is wif any portion
ment, and I ambeen made to
___________
___________
ct Administration Risk Manageme
nd Hold H
equesting part
: Applied Behpartment of P
___________
to participate from all liab
niversity; Caligents (collectnce, resultinges, or econom
ding travel to,
s Activity. I ahich include bnt, temporarynderstand thatnce; conditionall related riuding travel
mless from anyur as a result oUniversity in
eatment, I agree and understa
d the legal coliability, (b) pctivity, includ
written to be an is held inva
m signing it freo me.
__________
__________
Documents ent Documents
armless A
ticipation in t
havior AnalysPsychology
___ and ends
in this Activiility and proifornia State Uively “Univer
g in any physimic or emotion
from and dur
am aware of thbut are not lim
y or permanent these injuriens related to tisks, both knto, from and
y and all claimof my participncurs any of thee to be finanand that I shou
onsequences promising noding travel to
as broad and ialid or unenfo
eely. No other
___________
___________
Agreement
the CSU, Nor
sis Graduate P
on: _______
ity, on behalf omise not to sUniversity, Nrsity”) from acal or psychonal loss I mayring the Activ
he risks assocmited to physnt disability (ies or outcometravel; or the
nown or unknd during the
ms, includingpation in this hese types of
ncially responuld carry my
of signing thot to sue the Uo, from, and
inclusive as leorceable, I wil
r representati
_______
________ _
L
MS in Appl
College of
t**- Stude
rthridge,
Program with
____________
f of myself ansue the State
Northridge andany and all claological injuryy suffer becauvity.
ciated with trasical or psychincluding paraes may arise frcondition of tnown to me, Activity.
g attorney’s feActivity, incl
f expenses, I ansible for any
own health in
his documentUniversity, ( during the A
egally permittll continue to
ions concernin
__________ Date
__________Phone Numbe
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ent fill out
h the College
__
nd my next of of California
d their employaims, includiy (including use of my
aveling to/frohological injuralysis), econo
from my own the Activity of my
ees or damageluding travel agree to reimbcosts incurrensurance.
t, including ((c) and assumActivity.
ted by the Sta be bound by
ng the legal e
______
______ er
19
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
of
f kin, ; the yees, ing
om ry, omic or
e to to, burse ed as a
(a) ming
ate of y the
effect
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
CSUN
Thank you
offering Mto docume
in accordaapproval/dinternship
1. Aonthouabth
2. Mpr
om CSUN Purchrom CSUN Officefrom CSUN CIEL
N Master oInter
u for your int
MS-ABA student that stude
ance with BAdenial of you
p site/site supe
All submissionn msaba.csunhrough electrur MS-ABA rbout 60 dayshe MS-ABA r
a. We withe Suother tbasis.
MS-ABA Comrocess:
a. Applicb. Applicc. Reviewd. Letterse. A spec
This isi.
hasing & Contrace of Insurance & LO Documents
of Science rnship Site
terest in becom
dents internshnts accruing e
ACB Code ofr application.ervisor applic
ns for considen.edu (Go toronic submisreview comms. You will recreview commill only review
ummer prior totimes, those w
mmittee Revi
cations are reccations are senwed applicatis are sent to acific review ps not an exhau
Internship1. Loo
2. Loo
ct Administration Risk Manageme
in Appliee & Super
ming a CSUN
hip opportunitexperience at
f Conduct (se Below we h
cations and th
eration for the Practicum t
ssion to csunbmittee, they wi
ceive a letter mittee. w internship so their start. I
will be approv
iew Process –
ceived and rent to MS-ABAons are sent t
applicants witprocess for intustive list but
p Site Applicaok at internsh
a. Evidencb. Testimo
whom yc. Does yo
analyticAnalysiBehavio
d. Personni.
e. Organizi.
ok at the appl
Documents ent Documents
d Behaviorvisor App
N Approved I
ties. As an appt a CSUN Uni
ee www.bacb.have providedhe review proc
e Fall cohort mtab – then Gebcba.info@cill review andregarding the
sites/site supeIf there are spved by the MS
– Below is inf
viewed for coA review comto the MS-ABth decision ternship site at provides a geation Reviewhip site websitce-Based Treaonials from clyou no longerour website &c terminologys” is incorrec
or Analysis”.
nel that are apIf personnel list of individapplication s
zation Chart If one is not your applicat
lication to see
or Analysiplication I
Internship Site
proved BACBiversity-Base
.com). You wd some detailecess.
must be receeneral Timel
csun.edu. Oncd provide feee approval/de
ervisors for eapecial circumsS-ABA review
formation reg
ompletenessmmittee BA Academic
and/or site supeneral guidel
w Process: te and reviewatments adverlients; Are ther provide serv
& job descriptiy? For exampct; the name o
pproved by BAare not listedduals, with cosubmission.
listed on yoution submissie if fully com
L
MS in Appl
College of
is (MS-ABnformatio
e and/or Site
B program, ed Practica rec
will receive a led informatio
eived by the dline for Incomce submission
edback and fienial of your a
ach incomingstances requirw committee
garding the ge
c Director for
pervisor appline:
w for: rtised ey ONLY fro
vices? ion use correc
ple “Applied Bof the disciplin
ACB® to offed on website, pontact inform
ur website, pleion
mplete
Last Revised Jun
lied Behavior ADepartm
Social and Beh
BA) Prograon
Supervisor
we are obligaceive supervis
letter regardinn regarding
deadline postming Studenns are receive
final decisionapplication fro
Fall cohort dring reviews aon a case by
eneral review
final approva
ication is belo
m clients for
ct behavior Behavioral ne is “Applie
er supervisionplease provid
mation, with yo
ease provide w
20
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
am
ated sion
ng the
ted nts) ed by
ns in om
during at case
w
al
ow.
d
n de a our
with
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
3. InCapyowpasu
4. Ssiyo
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ii.
nternship Sit
Clinical/Execupproval/deniaour applicatio
with informatiartners to not ubmission to
i.
ite Supervisoite supervisorou are approv
hasing & Contrace of Insurance & LO Documents
3. Looage
Site Superv
1. Co
2. Mi
3. Me
4. FB
te Applicantsutive Directoral of your appon on our CSUon regarding prematurely protect the re
To be approeligible to ssupervisor process be intended foIf you are sinformation
or Applicantr, using the coved as a site s
ct Administration Risk Manageme
a. Specificand that
ok at missionency or organ
visor Applicmpleted appla. Supervib. Cover L
offeringc. Curricul
with supd. De-iden
Assessme. De-iden
supervisnimum of on
eet BACB R
a. Compleb. Comple
Supervic. Obtain 3
during eA and BIP ada. Please s
s - We will prr of the internplication confiUN MS-ABAapproved intetell prospecti
eview processoved as Optiosupervise expapplications foptional for y
or any purposeseeking to becn below regar
s - We will prontact informaupervisor, we
Documents ent Documents
cally ‘Self-Ast items indican statement annization uses o
ation Reviewication whichsor Applicati
Letter stating ig structured sulum Vitae detpervision ntified samplment and Interntified Permasees e year of clin
Requirements
etion of BACBetion of Compsion Worksho3 hours of Coeach certificatdhere to the dsee sample rub
rovide detailsship site and
fidential. HowA Practica Couernship sites eive or incomins and confidenon II, you mayperience hoursfor MS-ABAyour supervisoe other than scome an Optiording site supe
rovide detailsation you proe will notify y
ssessment andated as “no” ond website to only scientific
w Process: h includes theion & Contracinterest in supupervision tailing clinica
le of a writtenrvention Plan
anent Product
nical experien
for Supervisi
B Modules opetency-Basedop
ontinuing Edution cycle
dimensions ofbric used to r
s of the reviewwe will keep
wever, if you urse Websiteeach year. Thng MS-ABAntiality of they request thats of MS-ABACommittee rors as it is an
selection of Con II practicaervisor review
s of the reviewvided in your
you of the MS
L
MS in Appl
College of
d Acknowledgoffer further ex
show evidenccally proven i
e following: ct pervising CSU
al experience
n Functional Bn t that reflects
ce
ion
on Experienced Post-Certifi
ucation related
f ABA review FBA/B
w and decisioninformation are approvedto provide M
herefore, we astudents abou
e outcome of tt your site sup
A students, sureview. We adn exhaustive reCSUN approvea provider, plews.
w and decisior site supervisS-ABA review
Last Revised Jun
lied Behavior ADepartm
Social and Beh
gement of Rixplanations.ce that your interventions
UN interns an
and experien
Behavior
feedback give
e Standards ication
d to Supervis
BIP (page 88)
n only to the regarding the
d, we will posMS-ABA studeadvise commuut their applicthe review. pervisors, wh
ubmit site dvise that thiseview and noed site supervease see the
on only to yousor applicatiow committee’
21
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
sk’
.
nd
nce
en to
ion
)
e t ents unity cation
ho are
s ot visors.
u, the on. If ’s
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
dewsc
5. Mofof
6. Tsu
7. RsievthaveaPCcu
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ecision and itwhich you worcope of the M
i.
ii.
MS-ABA Rev
f your internsf the MS-ABA
There is no appupervisors is a
Renewal procites and site suvaluations of heir applicatiovailable to proach approvedlease note, if
CSUN MS-ABurrently expir
hasing & Contrace of Insurance & LO Documents
t will be your rk. The MS-A
MS-ABA Inter We will alNames & CWebsite We will alswill be revi
iew Committship site and/oA Internship
peal process fa blind review
cess for Apprupervisors onsite superviso
ons, if internsovide supervi
d internship sityou have not
BA Practica Cred.
ct Administration Risk Manageme
responsibilityABA site supernship Prograso ask you to
Credentials (se
so ask you to iewed by the
tee is releasedor site supervProgram alon
for internshipw process. If
roved Internsn a yearly basors, review sihip sites are bision. A letterte and site supt had a placemCourse Websit
Documents ent Documents
y to notify theervisor reviewm. disclose the ee page 53) fo
sign a ConfliMS-ABA Ac
d of any liabilisor applicatione.
p site and/or sif you are denie
ship Site andis. We look ate applicationbeing selectedr from the MSpervisor with
ment within thte with an “*”
e Clinical/Exw process sho
information ifor our CSUN
ct of Interest cademic Direc
lity for the feeon. Reviews
ite supervisored, you may r
d Site Supervat Intern and Pns and determd by students,S-ABA reviewh information he last two ye” indicating y
L
MS in Appl
College of
ecutive Direcould not be us
indicated on tN MS_ABA P
Document (sctor
edback and reare conducted
r applicationsreapply the fo
visor – We rePracticum Sup
mine if they ha, and if site suw committee about their re
ears, you will you have been
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ctor of the siteed beyond th
the Consent toractica Cours
see page 54)th
eview conducd for the purp
s. Review of sollowing year
eview internshpervisors’ ave adhered toupervisors arewill be sent t
enewal statusbe listed on o
n approved bu
22
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
e for e
o List se
hat
cted pose
site r.
hip
o e to . our ut are
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
CSUN
1. N
2. G
3. S
4. C
5. W
6. C
7. E
8. E
9. M
10. B
11. O
12. C
13. BE
14. O
__
15. InS
16. C
17. Y
18. W
om CSUN Purchrom CSUN Officefrom CSUN CIEL
N Master o
To be cName
a. Last n
Gender:
treet address
City, state, zip
Work phone n
Cell phone nu
E-mail addres
E-mail addres
Master’s in __
Bachelor’s in
Other degrees
Citizen of the
BACB certifExpiration Da
Other profess
___________
nternship SitSite applicatio
Current posit
Years of expe
What languag
a. Could
Yes □ No
hasing & Contrace of Insurance & LO Documents
of Science Site Su
onsidered for
ame________
Fe
s _________
p _________
number____
umber ______
ss (work) ___
ss (alternativ
___________
___________
s __________
United State
fication numate_________
sional license
___________
te at which yons must be co
tion title ____
rience as a b
ge other than
you provide
o □
ct Administration Risk Manageme
in Appliepervisor Ar CSUN appr
___________
emale______
____________
____________
____________
___________
___________
ve) _________
_________ F
_________ F
_________ F
es? Yes □ N
mber __________________
es, certificati
____________
ou will proviompleted and
___________
behavior anal
n English do
assessment o
Documents ent Documents
d BehavioApplicatioroval, please c
___ First nam
___________
___________
___________
___________
____________
____________
From ______
From ______
From ______
No □
______ Issue_________
ions, and num
___________
ide supervisid approved) _
____________
lyst ________
you speak fr
r deliver serv
or Analysion & Contcomplete the
me__________
Male ___
___________
___________
____________
____________
___________
___________
____________
____________
____________
e date______
mbers
____________
ion. (please b___________
___________
________
requently? _
vices in that la
L
MS in Appl
College of
is (MS-ABtract
following fo
__________ M
___
____________
____________
___________
___________
___________
____________
__________
___________
__________
___________
___________
be reminded t___________
__________
____________
anguage?
Last Revised Jun
lied Behavior ADepartm
Social and Beh
BA) Progra
rm:
Middle initial
___________
___________
___________
___________
____________
___________
Year ______
Year ______
Year _____
_____
___________
that Internsh____________
_______
23
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
am
l____
_____
_____
_____
_____
____
_____
____
____
_____
__
ip ____
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
19. Wal □
□
□
□
□
□
□
□
20. In
□
□
□
21. W
22. W
23. W
om CSUN Purchrom CSUN Officefrom CSUN CIEL
What populatll that apply)
□ Infants
□ Toddlers
□ Pre-school
□ Elementary
□ Middle sch
□ High schoo
□ Adults
□ Seniors
n what clinic□ Homes
□ Schools
□ Other ____
What types of
What is your
a. Days a
b. Times
What geograp
hasing & Contrace of Insurance & LO Documents
tion(s) have y
l age
y school age
hool age
ol age
cal settings ha
_______ (spe
f clinical sett
schedule of a
available (e.g
available (e.g
phical area d
ct Administration Risk Manageme
you worked
ave you work
ecify)
ings do you c
availability f
., M-F) _____
g., mornings
do you superv
Documents ent Documents
with in a cli
□ Deve
□ Emo
□ Typi
□ None
□ Othe
ked for at lea□ Clini
□ Grou
□ None
currently pro
for providing
___________
until 2pm) __
vise in?
inical setting
elopmental di
otional disturb
ically develop
e
er__________
ast 6 monthsics
up homes
e
ovide superv
g internship s
___________
___________
L
MS in Appl
College of
g for at least
isabilities
bance/mental
ping
______ (spec
s - 1 year? (ch
vision in?
supervision?
____________
____________
Last Revised Jun
lied Behavior ADepartm
Social and Beh
6 months? (c
illness
ify)
heck all the a
?
__
_
24
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
check
apply)
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
24. Dst
25. B
26. B
27. P
28. Tsu
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Describe the tructured sup
Briefly describ
Briefly describ
Please provid
Tell us other iupervision po
hasing & Contrace of Insurance & LO Documents
reasons youpervision to
be your clini
be your expe
e your areas
information osition.
ct Administration Risk Manageme
u are intereCSUN Unive
ical experien
erience with
of expertise
that would f
Documents ent Documents
ested in becersity-Based
ces:
supervision:
within ABA
facilitate asse
coming a SiPracticum s
A:
essment of yo
L
MS in Appl
College of
ite Supervisstudents:
our qualifica
Last Revised Jun
lied Behavior ADepartm
Social and Beh
or who pro
ations for this
25
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ovides
s
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
29. **
YCommitte
* in
om CSUN Purchrom CSUN Officefrom CSUN CIEL
*Please attaca. A Cov
supervb. A Currc. A De-I
Plan d. A De-I
Your applicatiee.
De-identifiedndividual, com
hasing & Contrace of Insurance & LO Documents
ch the followver Letter - stavision riculum VitaeIdentified* s
Identified* pon and supple
d is defined ampany name,
ct Administration Risk Manageme
wing items: ating interest
e - detailing csample of a w
permanent proemental mate
as removal of, applicant na
Documents ent Documents
in supervisin
clinical experiwritten Functio
oduct that reflrials will be r
f anything thaame, client na
ng CSUN inte
ience and exponal Behavior
flects feedbackreviewed by t
at would idename, etc.
L
MS in Appl
College of
erns and offeri
perience with r Assessment
k given to supthe MS-ABA
ntify associati
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ing structured
supervisiont and Interven
pervisees Review
ion to an
26
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
d
ntion
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
A. I AmapCin
B. I
thap
C. I
B
D. I of
E. I
toSu
F. I
foPrfere
G. I
mInsisubepl
H. I
evinInm
I. I
qucrtim
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Please read
hereby certifyApplication Fomisrepresentatpplication and
CSUN Practicunternship/prac
hereby give phe CSUN Pracpplication.
agree to supeBACB and to
agree to seekf my scope of
agree to allowo probe some upervisor and
agree that as or the assessmracticum Insteedback, or reesponsibility t
understand thmonitor the qunstructor deteite, the site suupervisor ande resolved, thlace the intern
recognize thavery 2 weeks nterpretation, nterns may pr
meetings.
agree to take uestions/concrises related cmes.
hasing & Contrace of Insurance & LO Documents
MS-Ad the followin
y that the statorm & Contration or omissid/or can initiaum Instructorcticum sites, a
permission to cticum Instru
ervise accordio work with m
k consultation/f expertise.
w the CSUN Psupervision m
d be determin
a Site Supervment, recommtructor does necommendatioto approve an
hat the Internsuality of superrmine that the
upervisor, or td the agency che CSUN MS-n at a differen
at the CSUN Pfor 2 hours tocase formula
resent cases u
the supervisicerns that arisconsumers ser
ct Administration Risk Manageme
ABA Site Sng statements
tements contaact are true anion of any maate immediater. This can incand/or review
the CSUN Muctor to verify
ng to high ethmy intern(s) to
/support on b
Practicum Insmeetings. Suc
ned on a case-
visor, I, and nmendations, annot serve as a ons provided
nd monitor an
ship Site agrervision offeree intern is notthe intern); thcontact person-ABA Progrant approved si
Practicum Inso discuss ethi
ations, evidencnder my supe
ion time seriose during the srved by the in
Documents ent Documents
Supervisors carefully an
ained in this cnd correct. I aaterial facts one review by thclude contacti
wing graduate
MS-ABA Progy any and all i
hical, legal, anoward profess
est practices
structor to shach sessions anby-case basis
ot the CSUN nd treatment pclinical consuto interns and
ny services pro
ees that the CSed to CSUN int meeting the e CSUN Pracn to resolve tham holds the rite.
structorwill mics and profesce-based interervision for co
ously, be on tisupervision pnterns under m
r Agreemend sign at the
completed MSagree and undn my part mayhe MS-ABA Aing former emschool record
gram, the MSinformation c
nd professionsional growth
in supervision
adow me whend probes wous.
Practicum Inprovided to thultant and is nd site superviovided to the
SUN Practicunterns. Shoulddesired comp
cticum Instruche determinedright to termin
meet a group ossionalism, darventions, anonsultation an
ime, and be prprocess. I agremy supervisio
L
MS in Appl
College of
ent bottom of th
S-ABA Site Sderstand that aay be cause foAcademic Dimployers, clinds, etc.
-ABA Acadeontained with
nal standards h and compete
n and on topi
en supervisinguld be discus
nstructor, am he site’s consunot liable for isor. It is ultimapproved site
um Instructord the CSUN Ppetencies (reactor will meetd barriers. If tnate the stude
of interns (i.eata collection
nd other case cnd review dur
repared to adee to be availaon during non
Last Revised Jun
lied Behavior ADepartm
Social and Beh
e page:
Supervisor any or removal of irector or the nical
emic Directorhin this
as outlined byence.
ics/issues outs
g CSUN intersed with the S
solely responumers. The Cany suggestio
mately my e’s consumer
’s main role iPracticum asons related t with the sitethe barriers caents’ internsh
., 8-9 interns), data consultations.ring these
ddress able to addresn-supervisory
27
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
my
, and
y the
side
rns or Site
nsible CSUN ons,
rs.
is to
to the e annot
hip or
) once
.
ss
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
J. I in
K. I re
L. I
in
M. I prmevwIn
N. I coth
O. I sufe
P. I recl
Q. I
pr
R. IfSurepl
S. IfcoanS
T. I
SuneleSune
U. I R
om CSUN Purchrom CSUN Officefrom CSUN CIEL
agree to supentern working
agree that at lequirement.
recognize than-field observ
agree to condrocedures, an
my intern’s wovaluation of h
with the internnstructor whe
acknowledgeompleting an hat I will supe
agree to adheupervision foleedback based
agree to compequirements (linical record
shall fulfill throcedures as o
f our students upervision Coeserves the riglacement at a
f the situationommitment, Ind assigned Inite (e.g., prov
understand thupervisor, aneed to be appeaves the Inteupervisor wilew site as we
agree to provReview Comm
hasing & Contrace of Insurance & LO Documents
ervise 10% of g 15 hours a w
least 50% of t
at my supervivations, mode
duct any/all Innd observationork with direchis/her performn directly, andn necessary.
e that my interevaluation fo
ervise.
ere to CSUN’lder which ind on performa
ply with all dspecified by Bs and externa
he responsibiloutlined in th
report that thontract, BACght to contactdifferent site
n arises and I nI shall terminanternship Site
vide at least 30
hat approval od both the Introved BEFORrnship Site, thll need to submll as inquire i
vide, to my sitmittee.
ct Administration Risk Manageme
f the experiencweek would b
the interns ho
sion will consling, and offe
nternship Siten of my internct verbal and wmance. I agre
d with the MS
rn(s) will be aorm and resul
s competencycludes conduance assessm
documentationBACB), inc
al corresponde
lities of the suhe Site Superv
hey are not reCB standardst you for moree if a resolutio
need to terminate in an appre, and provide0 days’ notice
of the Internshternship Site ARE a CSUN she Internship mit another aif the site is ap
te, if I am app
Documents ent Documents
ce hours of the provided w
ours will be in
sist of weeklyering feedback
e-related trainn’s first attemwritten feedb
ee to discuss aS-ABA Acade
asked to rate tts from such
y-based structucting in-vivo ent results.
n and correspluding documences.
upervision rolvisor Applicat
ceiving super, and/or the Ce informationon cannot be r
nate the internropriate, profee written and e).
hip Site does AND the Sitestudent can scSite can cont
application bepproved by C
proved as a su
he intern per Bwith supervisio
ndirect and 50
y direct in-fiek.
ning, modelingmpts at any behback and to suany concerns emic Director
their satisfactevaluations w
tured supervisperformance
ondence/extementing super
le and be in ction.
rvision experiCSUN MS-ABn, seek a resolreached.
rnship before essional mannverbal notice
not result in ae Supervisor wchedule an inttinue to be ap
efore supervisCSUN.
upervisor afte
L
MS in Appl
College of
BACB requion for 1.5 hou
0% direct as p
eld supervisio
g of assessmehavioral work
ubmit a brief mabout the inte
r and CSUN P
tion with supewill be shared
sion model bye assessment a
ernal communrvision and sig
compliance w
ience accordiBA Practica Hlution, and rec
fulfilling my ner as designae to CSUN an
automatic appworking at thterview. If th
pproved; howesing CSUN stu
er hearing from
Last Revised Jun
lied Behavior ADepartm
Social and Beh
irements (e.gurs a week.)
per the BACB
n, which incl
ent and k. I agree to gmonthly and fern’s performPracticum
ervision by d with other in
y using the and providing
nication gning off on
ith all policie
ng to their Handbook, Ccommend
supervision ated by the sc
nd the Internsh
proval of the he Internship Se Site Supervever, the Siteudents at thei
m the MS-AB
28
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
.,
B
udes
guide final
mance
nterns
g
es and
SUN
chool hip
Site Site visor ir
BA
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
V. Sbeagadteco
W. I anofA
X. I toSu
Y. I
I have rev
Site Supe
Site Supe
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ite Supervisoelow and shalgreement. Thdvance writteermination takomplete their
understand thnd review conf the MS-ABA
ABA Internshi
consent to myo appear on thupervisor” if
read and agre
viewed and I
ervisor Name
ervisor Signat
hasing & Contrace of Insurance & LO Documents
r acknowledgll remain in eis Agreement
en notice by oke effect withtraining for a
hat the MS-ABnducted of myA Internship ip Program.
y name, credehe CSUN MSI am approve
ee with the “In
agree with al
(Print) _____
ture _____
ct Administration Risk Manageme
ges that this Affect for 1 act may be term
one party to thh respect to cuany semester
BA Review Cy supervisor aProgram alon
entials, area(s-ABA Practic
ed.
nternship Lea
ll of the abov
___________
___________
Documents ent Documents
Agreement shaademic year.
minated at anyhe other, PROurrently enrollin which term
Committee is application. Tne and should
s) of expertiseca Course We
arning Plan” (
ve statements.
__________
__________
all be effectivThis Agreem
y time by writOVIDED, HO
led students, mination wou
released of anTheir reviews d not be used b
e, and geograpebsite, as an “
(page 8 of thi
.
Date: _____
L
MS in Appl
College of
ve as of the dament may be rtten agreemen
OWEVER, thawho shall be ld otherwise o
any liability foare conducte
beyond the sc
phical locatio“Option II CS
is document).
______
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ate first writterenewed by mnt or upon 30 at in no event permitted to occur.
or the feedbaced for the purpcope of the M
on (or specificSUN Approve
29
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
en mutual
days shall
ck pose
MS-
c site) ed
ABA)ology es & llege
Y
N A
P A A
C
P
W
If
M
A(
* Adopted fr**Adopted fr***Adopted f
CSUN
ou are seekin
Name and PoApplying for
Phone:
Agency Nam
Address:
City:
Phone:
Website: If you will nofor Internshi
Main Contac
Auspice of ag(check all tha
1. P(ew
2. Lw
om CSUN Purchrom CSUN Officefrom CSUN CIEL
N Master o
ng to become
osition of ther Site Approv
e:
ot serve as thps:
ct phone:
gency at apply):
Please provide.g., send a co
will coordinate
List the locatiwhere intern(
hasing & Contrace of Insurance & LO Documents
of Science Interns
e an approve□ Practica O
e Person val:
e main conta
□
e instructionover letter ane with interns
ions where in(s) work will
ct Administration Risk Manageme
in Applieship Site A
ed site for (ChOption II
act, please pr
PublicOrganization
ns for how intnd CV to conship coordina
nterns will bebe located (e
Documents ent Documents
d BehavioApplicatio
heck One) □ Practica O
E-mail:
State:
Hours o
rovide the na
Main C
n
terested studntact person tor for intern
e able to recee.g., Northrid
or Analysin & Contr
Option III
:
of operation
ame & title o
Contact Ema
□ Non‐ProfOrganizatio
dents may apfor interview
nship placeme
eive on-site sudge, Torranc
L
MS in Appl
College of
is (MS-ABract
□ Both
Zip
: f the main co
ail:
fiton
pply for interw). Note: Optent.
upervision ace):
Last Revised Jun
lied Behavior ADepartm
Social and Beh
BA) Progra
p:
ontact person
□ For‐ProOrganizat
rnships with tion II Studen
and/or locatio
30
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
am
n
ofit tion
you ts
ons
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
3. T□ In
□ To
□ Pr
□ El
□ M
□ Hi
□ Ad
□ Se
4. S□ Ho
□ Sc
□ Ot
5. La) Ab � ImplBeha
b) In
in
Pleas____c) M
d) Af
om CSUN Purchrom CSUN Officefrom CSUN CIEL
To which popufants
oddlers
re-school age
lementary sch
Middle school a
igh school ag
dults
eniors
ettings in whomes
chools
ther ________
Logistics: ble to provid
Direct lementation oavioral Proce
nternship Site
Paid nternships
se specify Oth____________orning hours
Optional
fternoon hou
Optional
hasing & Contrace of Insurance & LO Documents
ulations will stu
hool age
age
e
hich student(
___ (specify)
de supervised
of edures
R
e provides (c
Unpaidinternships
her: ___________s are (check a
Possible
urs are (check
Possible
ct Administration Risk Manageme
udents be prov
(s) will be pro
)
d experiences
Indirect Report Writin
check all that
d
Mreimb
____________all that apply
e Re
k all that app
Re
Documents ent Documents
viding services□ Developm
□ Emotiona
□ Typically
□ Other___
oviding servi□ Clinics
□ Group h
s for (check o
Services (Asng, Treatmen
apply):
Mileage bursements
___________y):
equired
ply):
equired
s? (check all tmental disabil
al disturbance
y developing
____________
ices (check al
homes
one):
ssessment, nt Planning,
Other schola
___________
Available
Available
L
MS in Appl
College of
that apply): lities
e/mental illne
__ (specify)
ll that apply)
etc.) B
(e.g. stipendsarships)
____________
N
N
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ess
:
Both
s, academic
___________
Not Available
Not Available
31
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
_
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
e) Ev
f) We
g) Ho
6. W
h) Inte
□
□ Improcestude
□ DaMeas
□ GrData
□ Ininterpquest
□ SkABL
□ Fu
om CSUN Purchrom CSUN Officefrom CSUN CIEL
vening hours
Optional
eekend hour
Optional
ome visits ar
Required
What are the
ernship Site
Orientations
Citizenship
CPR training
Fingerprintin
TB tests
Other: _____
mplementationedures (approents)
ata Collectionsurement
raphing and V
direct Assesspret findings tionnaires, &
kills AssessmeLLS)
unctional Ana
hasing & Contrace of Insurance & LO Documents
are (check a
Possible
rs are (check
Possible
re (check one
Not Requ
e opportuni
requires the
□
□
g □
ng □
□
____________
n of behavior opriate for firs
n and Behavio
Visual Inspect
ment (e.g., usfrom checklisinterviews)
ent (e.g., VB-
alysis
ct Administration Risk Manageme
all that apply)
Re
all that apply
Re
e):
uired
ities our inte
following be
□ Yes □ N
□ Yes □ N
□ Yes □ N
□ Yes □ N
□ Yes □ N
____________
change st year MS
or
tion of
se and sts,
-MAPP,
Documents ent Documents
):
equired
y):
equired
erns will ha
efore internsh
No
No
No
No
No
___________
□ Monitorinbased decisi
□ Training
□ Training parent, aide,
□ Monitorindirect staff
□ Staff train
□ Use groupschool wide
Available
Available
ave at your s
hip placemen
Paid
___ (specify)
ng interventioions
staff using ev
and consultat, teacher, etc.
ng, managem
ning
p contingenciee plans)
L
MS in Appl
College of
N
N
site (check a
nt:
d for by Intern □ Yes □
□ Yes □
□ Yes □
□ Yes □
□ Yes □
□ Yes □
on plans and m
vidence-based
tions with oth)
ment, and supe
es (e.g., class
Last Revised Jun
lied Behavior ADepartm
Social and Beh
Not Available
Not Available
all that apply
nship Site □ No
□ No
□ No
□ No
□ No
□ No
making data-
d procedures
hers (e.g.,
ervision of
s wide or
32
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ly)?
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
□ Oth 7. D
*I
8. L
9. L
10. D
11. Dn
12. Pac
□ Wrepor
om CSUN Purchrom CSUN Officefrom CSUN CIEL
her_________
Describe the g
If you have a j
List the skills
List the prima
Describe the t
Describe yourew employee
Please list the ccruing hour
Writing comprerts
hasing & Contrace of Insurance & LO Documents
___________
general demo
job descripti
necessary fo
ary responsib
training oppo
r new employe orientation)
process yours (e.g., tests
ehensive asse
ct Administration Risk Manageme
____________
ographics of
on, please pr
or this intern
bilities of the
ortunities av
yee orientatio):**
r agency reqto complete,
essment
Documents ent Documents
___________
the Internsh
ovide a copy
nship:
e student inte
vailable to stu
on process (p
quires for stu, timelines wi
□ Writing plans
____________
hip Site’s con
with the appl
ern at the Int
udents includ
please note, i
udents to becith company
comprehensi
L
MS in Appl
College of
___________
nsumers:
lication
ternship Site
ding staff dev
interns must
ome interns y, etc.):
ive behavior i
Last Revised Jun
lied Behavior ADepartm
Social and Beh
______ (speci
e:
velopment:
complete yo
and begin
intervention
33
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ify)
our
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
13. MS
14. OPan(e
15. A
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Mission Stateite described
Often, studenPlease describ
nd wish to ace.g., pay chan
As you compla. Are tr
based
b. If youfrom c
c. Do yoexamp“Appl
d. Look i.
e. Look organ
hasing & Contrace of Insurance & LO Documents
ment: Pleased to our grad
ts are currenbe your termccrue experienges, hour re
ete your Sitereatments ad?
□ Yes
r website or clients for wh
□ Yes
ur website &ple, “Appliedlied Behavior
□ Yes
at the applicSpecificallyand do item
□ Y
at mission stization uses o
□ Yes
ct Administration Risk Manageme
e provide a bduate student
nt employeesms and condit
ence hours aequirements,
e Applicationdvertised on y
other adverthom you no l
& job descripd Behavioralr Analysis”.
cation to see iy the ‘Self-As
ms indicated a
Yes
tatement andonly scientifi
Documents ent Documents
brief descriptts*.
s at the site thions for indiv
as CSUN inte, reimbursem
n, please condyour website
□ No
tising includelonger provi
□ No
tions use corAnalysis” is
□ No
if fully compssessment andas “no” offer f
□ No
d website. Doically proven
□ No
tion about ho
hey wish to oviduals who
erns. Please bment clauses,
duct the folloe or other for
es testimoniade services?
rrect behavios incorrect, th
plete d Acknowledfurther explan
o
oes it show evn intervention
L
MS in Appl
College of
ow you want
obtain BCBAare employe
be specific ab etc.)
owing self-asrms of advert
als from clien
or analytic tehe name of th
dgement of Rinations?
vidence that yns?
Last Revised Jun
lied Behavior ADepartm
Social and Beh
your Interns
A supervisionees of your agbout each ste
ssessment: tising eviden
nts, are they
erminology?he discipline
isk’ Form (pg
your agency
34
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ship
n. gency
ep
nce-
only
For is
g.35)
or
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
I(W
1. Inyo
2. P
Yes □ □ □ □ □ □ □ □ □ □ □ □ □ □ □
3. P(e&
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Internshipe will provide
nherent Risksour organizat
lease self-ass
No N/A□ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □
lease providee.g. If you pro
& interns)
hasing & Contrace of Insurance & LO Documents
p Site Self-e interns with
ac
: Please list ation (facility h
ess the follow
A Is the site Are emer Are hazar Are all m Are intern Will inter Are work Is there ad Are parki Is site acc Will inter Is manage Driving is Interns’ d Is the site
will work
e further detaiovide training
ct Administration Risk Manageme
-Assessmeh this informacknowledge th
all known riskhazards, locat
wing:
e considered argency plans crdous materia
manufacturing ns provided wrns wear persoking conditiondequate empling areas wellcessible by purns be restrictement and sus not required
duties do not ie location youk?
iled informatig, such as cris
Documents ent Documents
ent and Acation and ask the risks repor
ks inherent to tion concerns,
an “office expcurrent? als or hazardotools and equ
with safety traonal protectivns and generaloyee parkingl lit as necessublic transported from inter
upervisory oved as a part of iinclude heavyu indicated on
on for any iteis manageme
cknowledgthem to sign arted below)
the internship, personal issu
posure” only s
ous chemicalsuipment guardaining prior tove equipmental environmeng on site? ary? rtation? racting with persight adequintern’s respoy manual labon this applicat
ems above forent, or how yo
L
MS in Appl
College of
gement of an agreement
p environmenues, etc.)*
site?
s controlled? ded? o starting wort, if necessarynt safe?
potentially viouate? onsibilities. or. tion the only p
r which you iou mitigate ha
Last Revised Jun
lied Behavior ADepartm
Social and Beh
f Risks* t stating they
nt associated w
rk? y?
olent clients?
place the inte
indicated “Noarm to person
35
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
with
ern
o”. nnel
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
A. InAomm
B. Thfoin
C. In“wbetosa
D. Inthsube
E. Inth
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Please read
nternship SiteApplication &
mission of anmy application
1. I hDico
he Internship Sollowing befonvolved partie
1) Cle
2) Inclinternscompe
3) Inclperformconcep
4) Spe
5) Spebe prov
6) Inclthe sup
7) De (includ
nternship Site workforce,” ae subject to Ino ensure that same training t
nternship Sitehe Site Supervupervision mee determined
nternship Sitehat the intern
hasing & Contrace of Insurance & LO Documents
MS-Ad the followin
e certifies thatContract are
ny material facn by the MS-A
hereby give peirector, and th
ontained withi
Site agrees toore onset of thes and align e
arly stipulate
lude a descrips to use the Cetencies)
lude a descripmance in-fielptualization)
ecify expecta
ecify how thevided
lude objectivepervisee’s Ex
lineate the coding appropri
agrees that aas that term isnternship Sitestudents compthat is provide
e agrees, for Pvisor at the Ineetings. Such on a case-by
e agrees that, fis not meetin
ct Administration Risk Manageme
ABA Interng statements
t the statementrue and corrcts on my parABA Program
ermission to the CSUN Prain this applica
o provide the ihe internship. experience act
what the sup
ption of the acSUN Structur
ption of the nald, review of w
ations of the su
e direct/indire
e and measuraxperience Ver
onsequences siate methods t
s interns, studs defined by the’s policies reply with suched to regular
Practica Optionternship Site
sessions and-case basis.
for Practica Og the desired
Documents ent Documents
nship Sites carefully an
nts contained rect. I agree anrt can initiate
m.
the CSUN Mcticum Instruation.
intern with anThe purpose
tivities with th
pervisor and su
ctivities and inred Supervisi
ature of superwritten mater
upervisee
ect supervised
able circumstification form
should either pto terminate t
dents shall behe HIPAA re
especting confh policies, Inteemployees.
on II, to allowwhen superv probes woul
Option II, if thcompetencie
e Agreemend sign at the
in this compland understand
immediate re
S-ABA Progructor to verify
n explicit writof the writtenhe purpose of
upervisee rela
nstructional oion Folder and
rvision (e.g., drial, case mee
d experience h
tances under wm when the ex
party not adhthe relationsh
e considered mgulations at 4fidentiality ofernship Site s
w the CSUN Pvising CSUN d be discusse
he CSUN Pras (reasons rel
L
MS in Appl
College of
ent bottom of th
leted MS-ABAd that any mieview and po
ram, the MS-y any and all i
tten agreemenn contract is tf supervision.
ationship will
objectives (wd meet the pr
direct observtings to discu
hours (see ww
which the supxperience has
here to their reip)
members of In45 C.F.R. § 16f medical infoshall provide
Practicum Instinterns or pro
ed with the Sit
acticum Instrulated to the si
Last Revised Jun
lied Behavior ADepartm
Social and Beh
e page:
A Internship isrepresentatiossible rejectio
-ABA Academinformation
nt outlining thto protect all .
l entail
e expect all oractica
ations of uss case
ww.bacb.com
pervisor will s ended
esponsibilities
nternship Site60.103, and sormation. In ostudents with
tructor to shaobe some te Supervisor
uctor determinte, the site
36
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
Site on or on of
mic
he
of our
) will
sign
s
e’s shall order h the
adow
r and
nes
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
suthCat
F. Intobedipr
G. InreFcoinm
H. Intuan
I. Inre
J. In
reSuscS“Mre
K. InwIIle
L. Inen
M. Inaldi
N. Inex
O. InPr
om CSUN Purchrom CSUN Officefrom CSUN CIEL
upervisor, or the agency con
CSUN MS-ABt a different a
nternship Siteo provide suppe asked to disiscussions. Drivacy by de-
nternship Siteesponsible foror Practica Oonsultant andnterns and site
monitor any se
nternship Siteuberculosis tend maintain th
nternship Siteesponsibilities
nternship Siteesult in automupervisor wochedule an intite can continMS-ABA Siteeview commit
nternship Site
without the actII. There is spetters to the in
nternship Sitenrolled in a U
nternship Sitell inquiries wiifferent than d
nternship Sitexperience at t
nternship Siteracticum Inst
hasing & Contrace of Insurance & LO Documents
the intern); thntact person toBA program happroved site.
e agrees that fplemental supscuss current uring these diidentifying th
e agrees that Sr the assessme
Options II & IId is not liable e supervisor. ervices provid
e must informst; obtain the he confidenti
e must provides.
e understands matic approval
rking at the Internship inter
nue to be a CSe Supervisor Attee.
e acknowledgetive approval
pecific terminnternship site.
e understands University-Bas
e agrees that aithin 24-hourdesignee on a
e understands the Internship
e acknowledgetructor (within
ct Administration Risk Manageme
he CSUN Praco resolve the holds the righ
for Practica Opervision to Ccaseloads, intiscussions int
he case inform
Site Supervisoent, recommeII, the CSUN for any suggeIt is ultimatel
ded to the app
m students of thstudent’s bac
ality of any re
e student with
that, for Pracl of the Site Snternship Site
rview. If the SSUN approveApplication &
es that it cannof the Site Suology to be u.
that they havsed Practicum
a contact perss. Please prov
application.
that CSUN sp Site and that
es that they mn 30 days) of
Documents ent Documents
cticum Superdetermined bt to terminate
Option III, the CSUN internstervention platerns will respmation.
or, and not theendations, andPracticum In
estions, feedbly the site supproved site’s c
he need for a ckground cheesults as requ
h a written de
ctica Option ISupervisor, ane must be appSite Supervisod site and hav
& Agreement
not advertise iupervisor for
used. CSUN w
ve the right to m deemed app
on must be avvide this infor
tudents will bt this informa
must notify thany changes
rvisor will mebarriers. If thee the students
CSUN Practis. During Pracans, and otherpect internshi
e CSUN Pracd treatment prnstructor doesback, or recompervisor’s respconsumers.
background eck, fingerprinuired by feder
escription of t
II, approval ofnd both the Inproved BEFOor leaves the Ive another qut” form to be r
itself as a CSOption II and
will provide th
interview anpropriate for t
vailable to CSrmation to M
be asked to evation will be a
e MS-ABA Ato the Interns
L
MS in Appl
College of
eet with the sie barriers cann’ internship o
icum Instructctica meetingr related activip site, superv
cticum Instrucrovided to thes not serve as mmendations ponsibility to
check, fingernts, and/or tubral and state la
the student’s t
f the Internshnternship Site ORE a CSUN
Internship Situalified supervreviewed by t
SUN-approvedd/or CSUN aphis terminolog
nd accept CSUtheir site.
SUN studentsS-ABA progr
valuate their savailable to al
Academic Dirship Site whic
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ite supervisornot be resolve
or place the in
tor’s main rols the interns m
vities for pracvisor, and clie
ctor, is solely e site’s consua clinical provided to
o approve and
rprinting and/berculosis tesaw.
tasks and
hip Site does nAND the Sitstudent can te, the Internsvisor submit athe MS-ABA
d Internship Spproval for Ogy on approv
UN students
s and will ansram coordina
supervision ll CSUN inter
rector and CSch may affect
37
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
r and ed,
ntern
le is may
ctical ent
umers.
d
/or a st;
not te
ship an
A
Site Option val
swer ator if
rns.
SUN t the
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Cch
P. Inbeagadteco
Q. Tmcoprre
R. Ttola
S. Tfothwm
T. In
U. Inm
V. Athhane
W. I anMIn
X. I si
om CSUN Purchrom CSUN Officefrom CSUN CIEL
CSUN studenthange from O
nternship Siteelow and shalgreement. Thdvance writteermination takomplete their
The Internshipmeetings, that ontact the Interoblem. Howefer the studen
This written ago follow all apaws prohibitin
The parties expor educationalhe Internship
welfare and pemembers of In
nternship Site
nternship Sitemost recent ch
Although we dhat the internsave agreed toeed to,
1) Havsuperv 2) Hav 3) Obtcycle
understand thnd review con
MS-ABA Internternship Prog
consent to myite.
hasing & Contrace of Insurance & LO Documents
t internship. FOption II to Op
e acknowledgell remain in eis Agreement
en notice by oke effect withtraining for a
p Site agrees ttheir contracternship Site cever, if no resnt to another
greement maypplicable fedeng discrimina
pressly underl purposes, anSite for any p
ension benefitnternship Site’
e read and agr
e agrees to adhhanges please
do not formallship site has Bo supervise CS
ve passed an 8vision worksh
ve completed
tain 3 hours o
hat the MS-ABnducted of thernship Progragram.
y company na
ct Administration Risk Manageme
For example, cption III, etc.
es that this Affect for 1 act may be term
one party to thh respect to cuany semester
that if the studt is not being contact personsolution can binternship sit
y not be altereeral, state, andtion and hara
rstand and agrnd such studepurpose, incluts, or workers’s “internship
rees with the “
here to the BAgo to http://b
ly review or aBCBAs, in goSUN interns.
8-hr-post certhop
the training m
of continuing
BA Review Ce site applicatam alone and
ame being dis
Documents ent Documents
change in con
greement shaademic year.
minated at anyhe other, PROurrently enrollin which term
dent intern repfulfilled, the
n and work wbe reached, thte to accrue th
ed unless bothd local laws a
assment.
ree that MS-Ants are not co
uding, but nots’ compensatip program” fo
“Internship L
ACB® Experibacb.com/upco
approve the siood standing, As of Decem
tification, com
module on BA
education rela
Committee is tion. Their revshould not be
sclosed to CS
ntact, change
all be effectivThis Agreem
y time by writOVIDED, HO
led students, mination wou
ports, during MS-ABA int
with them and he MS-ABA pheir supervise
h parties agreand regulation
ABA student ionsidered empt limited to, coion insuranceor purposes of
Learning Plan”
ience and Supoming-chang
ite supervisorwhich meet t
mber 31, 2014
mpetency-bas
ACB® experie
ated to superv
released of anviews are cone used beyond
SUN students
L
MS in Appl
College of
in policy for
e as of the dament may be rtten agreemen
OWEVER, thawho shall be ld otherwise o
practicum suternship coordthe supervise
program resered experience
ee in writing. ns, including
interns providployees of theompensation . Students aref HIPAA com
” (page 8).
pervision Stanges/
rs for Option the BACB® re, all potential
ed, BACB® a
ence standard
vision during
any liability fonducted for thd the scope of
as a CSUN a
Last Revised Jun
lied Behavior ADepartm
Social and Beh
accruing hou
ate first writterenewed by mnt or upon 30 at in no event permitted to occur.
upervision dinator will ee to address rves the right hours.
The parties agbut not limite
de clinical sere university ofor services,
e considered mpliance.
ndards. For th
III, it is expeequirements al supervisors w
approved
ds
g each certific
or the feedbache purpose of f the MS-ABA
approved Prac
38
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
urs,
en mutual
days shall
the t to
gree ed to
rvices or of
he
cted and will
ation
ck f the A
ctica
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
I have rev
In
Ap
Ap
C
C
*Please nClinical Pformal ag
om CSUN Purchrom CSUN Officefrom CSUN CIEL
viewed and I
nternship Site
Applicant Nam
Applicant Sign
Clinical/Execu
Clinical/Execu
note these docPracticum Agrgreement with
hasing & Contrace of Insurance & LO Documents
agree with al
e Name ____
me _________
nature ______
utive Director
utive Director
cuments will breement to re
h the MS-ABA
ct Administration Risk Manageme
ll of the abov
____________
___________
___________
r Name (Prin
r Signature _
be sent to CSUead and sign. program.
Documents ent Documents
ve statements.
___________
____________
___________
nt) _________
____________
UN PurchasinThis will be a
.
____________
____________
____________
___________
___________
ng and Contraa formal CSU
L
MS in Appl
College of
___________
___________
___________
____________
__________ D
racts. They wUN agreement
Last Revised Jun
lied Behavior ADepartm
Social and Beh
___________
____________
___________
___________
Date: ______
will send you at in addition t
39
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
_____
____
_____
____
_____
a to the
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Thsup
Intern
Supervise
Site Supe
Hours of
On which________
S – satisfa
om CSUN Purchrom CSUN Officefrom CSUN CIEL
his is a monpervisor, w
ns turn in to
ee: ________
ervisor: ____
Direct Supe
h Competenc____________
Please rate t
factory NI -
1. Adheresof intere
2. Seeks susituationprior to
3. Is recep
4. Modifie
5. Remain
6. Comes
7. Compli
8. Looks f
9. Takes in
10. Arrives
11. Maintai
12. Maintai
13. Maintai
hasing & Contrace of Insurance & LO Documents
Evaluanthly summ
which will bo their Pra
____________
____________
rvision: ____
cy (from the ___________
the following
- needs impro
s to BACB® est)
upervision whn, they will cimplementat
ptive to correc
es behavior ba
ns within his/h
prepared for
es with comp
for opportunit
nitiative in im
on time for s
ins profession
ins profession
ins profession
ct Administration Risk Manageme
ation of Inmary of pebe taken in
acticum Sup
___________
___________
___________
CSUN Super___________
g in regards t
ovement- but
Ethical Guid
hen appropriaontact you wition) ctive feedback
ased on perfo
her scope of p
supervision (
pany policies
ties to advanc
mproving exis
sessions
nal communic
nal communic
nal communic
Documents ent Documents
tern (MS-erformancnto accounpervisor =
____ Site
____ Dat
____ Hou
rvision Folde____________
to the superv
acceptable
delines (e.g., c
ate (e.g., wheith ideas and
k
ormance feedb
practice
e.g., brings fo
& procedures
ce behavior an
sting program
cation with co
cation with cl
cation with su
-ABA; CSUce, completnt in stude1st Practic
of Practicum
te: _________
urs of Indirec
er) are you c___________
visee’s perfor
U – unsatisf
confidentiality
n supervisee obtain your a
back
orms, HW)
s
nalytic experi
ms
o-workers
lients/consum
upervisor
L
MS in Appl
College of
UN) ted by Optient’s practica Meeting
m: _________
___________
ct Supervisio
urrently wor____________
rmance:
factory N/A
y or conflict
faces novel approval
ience
mers
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ion II site ica grade.of the Mon
___________
____________
on: ________
rking? ____________
A – not appli
S NI
40
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
nth
_____
____
_____
_____
cable
U N/A
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Candidat
(circle on
Other no
________________________
Signature
Signature
Official P
Contact I
******P
om CSUN Purchrom CSUN Officefrom CSUN CIEL
14. Maintai
15. Commu
16. Arrives
17. Submits
18. Takes in
te continues t
ne): S N
tes or comm
____________________________________
e of Supervis
e of Site Sup
Position/Title
Information
Please attach
hasing & Contrace of Insurance & LO Documents
ins profession
unicates effec
on time for s
s work on tim
nitiative in ad
to meet crite
NI U
ents:
_________________________________
see: ________
ervisor: ____
e of Site Supe
of Site Super
h completed
ct Administration Risk Manageme
nal communic
ctively both in
supervision an
me (e.g., repor
dvancing supe
eria as stated
_________________________________
___________
___________
ervisor: ____
rvisor: _____
d performan
Documents ent Documents
cation with ot
n written and
nd training
rts, time sheet
ervised experi
d in the CSUN
____________________________________
___________
____________
____________
___________
nce monitor
ther service p
oral methods
ts)
rience
N Supervisio
_________________________________
____________
___________
____________
____________
ring forms f
L
MS in Appl
College of
roviders
s
on Competen
____________________________________
__
___
________
________
for this evalu
Last Revised Jun
lied Behavior ADepartm
Social and Beh
S NI
ncy Folder
____________________________________
uation perio
41
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
U N/A
_______________
od
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
The followcompleted
BACB E2 weeks).
om CSUN Purchrom CSUN Officefrom CSUN CIEL
wing is the fod alongside th
Experience Su
hasing & Contrace of Insurance & LO Documents
orm provided he MS-ABA E
upervision Fo
ct Administration Risk Manageme
by BACB. TEvaluation of
orm should be
Documents ent Documents
The BACB Ef Intern Form.
e completed fo
Experience S. The form ca
or each super
L
MS in Appl
College of
Supervision Foan be found at
rvisory period
Last Revised Jun
lied Behavior ADepartm
Social and Beh
orm is to be t www.bacb.c
d (i.e., once ev
42
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
com.
very
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Supervise
Site Supe
Duration
S – satisfa
1. Am
2. Is
3. Prex
4. L
5. D
6. P
7. Dde
8. Rac
9. C
10. Pran
11. Upe
12. Asu
13. Km
14. Suho
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ETo
ee: ________
ervisor: ____
n of Supervisi
Please ra
factory NI - n
Adheres to BAminimizes cons a knowledge
repares me foxpectations, a
Looks for oppo
Defines tasks c
lans and orga
Determines apecisive mann
Recognizes whccommodates
Can be reached
rovides timelnd written fee
Uses a variety erformance (e
Allows me to wupervision wh
Keeps appointmmissed appoint
upervises at lours
hasing & Contrace of Insurance & LO Documents
valuation be comple
____________
____________
ion: _______
ate the follow
needs improv
ACB® Ethicanflicts of intereable and com
or supervisionand methods oortunities to a
clearly
anizes work (e
propriate actier hen I do not us to my level o
d in case of em
y informationedback
of ways of pre.g., videotap
work indepenhen necessary
ments with mtments within
least 10% (7.5
ct Administration Risk Manageme
of Site Sueted each s
___________
___________
____________
wing in regar
ement- but ac
al Guidelines rest, remains wmpetent behav
n by explaininof evaluationsadvance my b
e.g., establish
ion and follow
understand infof experience
mergencies
n on my perfo
roviding feede of the sessi
ndently, yet pry
me and arrivesn 24 hours)
5% minimum
Documents ent Documents
upervisor (semester by
__ Site
__ Dat
__
rds to the Sit
cceptable U –
(e.g., keeps cwithin his/hervior analyst
ng our roles, hs
behavior analy
hes appropriat
ws through in
formation beie and style of
ormance and f
dback to me abon, modeling
rovides adequ
s on time (or r
m) of my week
(MS-ABA;by intern vi
e of Practicum
te: _________
te Supervisor
– unsatisfacto
confidentialityr scope of pra
his/her
ytic experienc
te priorities)
n a timely and
ing presented f learning
frequent verb
bout my g, etc.)
uate support a
re-schedules
kly experience
L
MS in Appl
College of
; CSUN) ia Moodle
m: ________
___________
r’s Performa
ory N/A – n
S
y, actice)
ce
d
d and
bal
and
e
Last Revised Jun
lied Behavior ADepartm
Social and Beh
____________
_
ance:
not applicable
NI U N
43
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
____
e
N/A
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
What did
What did
Would yo
□ Y
On which
________
Other no
________________________
Signature
Tco
15. Is
16. Is
17. C
18. R
19. In
om CSUN Purchrom CSUN Officefrom CSUN CIEL
d you like MO
d you like LE
ou recommen
Yes □
h competency
____________
tes or comm
____________________________________
e of Supervise
This evaluationonfidential.
s professional
s genuinely in
Considers my
Recognizes my
ncludes me in
hasing & Contrace of Insurance & LO Documents
OST about y
EAST about y
nd this Site S
□ No
y from the C
___________
ents:
_________________________________
ee: ________
n will only be
l and approach
nterested in m
needs, interes
y efforts
n his/her decis
ct Administration Risk Manageme
your Site Sup
your Site Sup
Supervisor to
CSUN Superv
___________
_________________________________
____________
e used for MS
hable
my learning an
sts, goals
sion making
Documents ent Documents
pervisor?
pervisor?
o another int
vision Folder
____________
____________________________________
________
S-ABA CSUN p
nd performanc
tern?
r are you cur
___________
_________________________________
purposes. Th
ce
L
MS in Appl
College of
rrently worki
____________
____________________________________
is informatio
S
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ing?
_______
____________________________________
n will remain
NI U N
44
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
_______________
n
N/A
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Supervise
Option II
Date: ___
Please raabout you S – satisf
1. S
2. Pr
3. A
4. R
5. N
6. Pr
7. Prcl
8. H
9. T
10. E
11. Prditim
12. R
13. Prin
14. Prw
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ET
ee: ________
I Site Superv
___________
te the followur site superv
factory NI -
ite’s staff are
rovides adequ
Assigns opport
Recognizes my
Nurtures adher
rovides oppor
rovides opporlasses
Has a professio
Treats interns w
Experiences m
rovides me wirect experienmeframe
Requires a ma
rovides me wnternship setti
rovide behavwith science of
hasing & Contrace of Insurance & LO Documents
EvaluationTo be comp
____________
visor or BCB
______ Hou
wing in regardvisor elsewh
needs improv
helpful (e.g.,
uate orientatio
tunities to per
y efforts
rence to BAC
rtunities to ac
rtunities for m
onal atmosph
with respect a
meet my trainin
with opportunince hours requ
anageable wo
with materials ing and resou
ior analytic sef behavior
ct Administration Risk Manageme
of Internpleted once
______ Sit
BA Superviso
urs interned
ds to the Inteere:
vement- but a
, human resou
on and trainin
rform meanin
CB® ethical gu
cquire compet
me to apply w
here
and in a profe
ng goals and
ities to accrueuired by BAC
rkload
so that I can urces to meet m
ervices that a
Documents ent Documents
ship Site (e a year by
te of Practicu
r Option III
per week: __
ernship Site,
acceptable U
urces, admini
ng
ngful tasks
uidelines
tencies and sk
what I am lear
essional mann
interests
e the minimumCB® within a
be successfulmy learning o
re conceptual
(MS-ABA;y intern via
um: _______
: __________
___________
you will hav
– unsatisfact
istrative staff)
kills
rning in my
ner
m number of a specified
l in my objectives
lly systematic
L
MS in Appl
College of
; CSUN) a Moodle
____________
___________
______
ve the opport
tory N/A –
S )
c
Last Revised Jun
lied Behavior ADepartm
Social and Beh
___________
____________
tunity to resp
not applicabl
NI U
45
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
_____
_____
pond
le
N/A
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
What did
What did
What tra
Would yo
□ Y
Do you p
□ Y
Given youfuture stu
Other no
__________________________________
Signature
Tco
15. Couop
om CSUN Purchrom CSUN Officefrom CSUN CIEL
d you like MO
d you like LE
aining/experi
ou recommen
Yes □
lan on worki
Yes □
ur experiencudents consid
tes or comm
________________________________________________
e of Supervise
This evaluationonfidential.
Company is awutside of direpportunities,
hasing & Contrace of Insurance & LO Documents
OST about y
EAST about y
ence opportu
nd this Intern
□ No
ing at this In
□ No
ce at this site,dering a prac
ents:
____________________________________________
ee: ________
n will only be
ware that at lect implementfor such expe
ct Administration Risk Manageme
your Internsh
your Interns
unities could
nship Site to
nternship Site
, what additicticum at thi
____________________________________________
____________
e used for MS
east 50% of sutation and proeriences
Documents ent Documents
hip Site?
hip Site?
the Internsh
another inte
e after comp
ional informais site?
________________________________________________
___________
S-ABA CSUN p
upervisee houovides, or will
hip Site impr
ern?
leting the M
ation do you
____________________________________________
____
purposes. Th
urs must be l provide
L
MS in Appl
College of
rove upon?
MS-ABA Prog
u think would
________________________________________________
is informatio
S
Last Revised Jun
lied Behavior ADepartm
Social and Beh
gram?
d be beneficia
________________________________________________
n will remain
NI U
46
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
al to
____________________
n
N/A
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Practicum
Site Supe
Date: ___
S – satisfa
Other no
________________________
Signature
OR
Signature
om CSUN Purchrom CSUN Officefrom CSUN CIEL
To be co
m Site: _____
ervisor Name
___________
Please rate t
factory NI -
1. Nurtureconfide
2. Explain
3. Can be
4. CSUN i
5. CSUN s
6. CSUN pskills w
tes or comm
____________________________________
e of Practicu
e of Site Sup
hasing & Contrace of Insurance & LO Documents
mpleted ye
___________
e (if applicab
____________
the following
- needs impro
es and adheresntiality or con
ns roles and ex
reached in ca
is professiona
staff is helpfu
provides oppowithin laborato
ents:
_________________________________
um Site Repre
ervisor: ____
ct Administration Risk Manageme
Evaluaearly by th
____________
ble): _______
__________
g in regards t
ovement- but
s to BACB®
nflict of inter
xpectations o
ase of emerge
al and approa
ul
ortunities for ories, practicu
_________________________________
esentative: _
___________
Documents ent Documents
ation of CSe practicu
___________
____________
to the CSUN
acceptable
Ethical Guidest)
f CSUN partn
ncies and/or c
chable
students to acum, speaker s
____________________________________
____________
____________
SUN um site and
___________
___________
N’s partnersh
U – unsatisf
delines (e.g.,
nership effect
concerns with
cquire compeeries, guest le
_________________________________
___________
___________
L
MS in Appl
College of
d site super
____________
___________
hip with you:
factory N/A
tively
h interns
etency and ectures, etc.
____________________________________
___________
___
Last Revised Jun
lied Behavior ADepartm
Social and Beh
rvisor
___________
____________
A – not appli
S NI
____________________________________
_________
47
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
_____
_____
cable
U N/A
_______________
ABA)ology es & llege
Mate
C
B
I. Use
II. D
III. CAsses
IV. D
* Adopted fr**Adopted fr***Adopted f
erials/Docum
Contracts & Im
BACB® Docu
e the profess
Demonstrate
Demonstrate
Develop and
Select & def
Measure tarbaseline datAssess quali
Graph & an
Conduct behassment, Rein
Conduct com
Conduct pre
Conduct rein
Design & co
Develop evide
Obtain, sumof interventiRecommendscientific ev
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ments
mportant Form
uments & Gu
sional and eth
e knowledge
e knowledge
use behavio
fine target beh
get behaviorsa ity of behavi
alyze gathere
avior assessmnforcer Asses
mprehensive
eference asses
nforcer assess
onduct param
ence-based in
mmarize, and eion plans d interventionvidence
hasing & Contrace of Insurance & LO Documents
STRUCT
ms
uidelines
hical guidelin
of ethical, res
of HIPPA an
or measurem
havior for cha
s using variou
ioral measurem
ed information
ments (e.g., Fssment)
functional be
ssments (I-07
sments
metric analyses
ntervention p
evaluate resea
n strategies ba
ct Administration Risk Manageme
SAMPTURED SU
CSUN M
FOLD
nes with colle
sponsible, pro
d confidentia
ment metho
ange
us direct obser
ment (e.g., A
n
Functional Be
ehavior assess
)
s (B-12)
plans based o
arch articles a
ased on the as
Documents ent Documents
PLE FOUPERVIS
MS-ABA Prog
DER IND
eagues and c
ofessional and
ality rules
ods, record
rvation measu
Accuracy & Re
ehavior Asse
sments
on assessmen
as part of reco
ssessment resu
RM SION FOLgram
DEX
clients
d disciplinary
and analyze
urement meth
eliability)
essment, Pref
nt results and
ommendation
ults and the b
L
MS in Appl
College of
LDER
y guidelines
e data
hods to collec
ference
d baseline da
ns & developm
best available
Last Revised Jun
lied Behavior ADepartm
Social and Beh
D
M
ct
A
ata In
ment
48
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
Tabs
Important Documents
BACB® Guidelines Ethics & Professionalism
Tab 1*
Tab 2*
Behavior Measurement
Tab 3*
Tab 4*
Tab 5*
Tab 6*
Behavior Assessment
Tab 7*
Tab 8*
Tab 9*
Tab 10
ntervention Planning
Tab 11*
Tab 12*
ABA)ology es & llege
m
V. De
VI. D
* Adopted fr**Adopted fr***Adopted f
esign and im
Conduct for
Skill Acquis
Implemdiscrimienvironm
Developusing dienvironm
Daily Living
Implem
Develop
Social and P
Implem
Develop
Design and im
Antecedent-
Implem
Develop
Consequent
Implem
Develop
Group Cont
Implem
Develop
Self-Manag
Implem
Develop
om CSUN Purchrom CSUN Officefrom CSUN CIEL
mplement skil
rmal assessm
sition Program
ent skills acqination using ment/incidentp skills acquisirect instructioment/incidentg Skills
ent daily livin
p daily living
Play Skills
ent social and
p social and p
mplement beh
-Based Interv
ent anteceden
p antecedent-b
-Based Interv
ent consequen
p consequenc
tingencies
ent group con
p group contin
ement
ent self-mana
p self-manage
hasing & Contrace of Insurance & LO Documents
ll acquisition
ment using VB
ms
quisition progrdirect instructal teaching sition programon (e.g. DTT)tal teaching
ng skills prog
skills program
d play skills p
play skill prog
havior reduc
entions
nt-based inter
based interve
ventions
nce-based int
e-based interv
ntingences
ngences
agement strate
ement strategi
ct Administration Risk Manageme
procedures
B-MAPP or A
rams to teachction (e.g. DT
ms to teach ve), precision te
grams based o
ms based on f
programs base
grams
ction procedu
rventions
ntions
terventions
ventions
egies and con
ies and contin
Documents ent Documents
based on ini
ABLLS-R
h verbal behavTT), precision
erbal behavioeaching, and/o
on formal asse
formal assess
ed on formal
ures
ntingency con
ngency contra
itial assessme
vior, imitationn teaching, and
or, imitation aor natural
essment resul
sment results
assessment re
ntracts
acts
L
MS in Appl
College of
ent
n and d/or natural
and discrimina
lts
esults
Last Revised Jun
lied Behavior ADepartm
Social and Beh
Ski
ation
49
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ill Acquisitio
Tab 13*
Tab 14*
14A*
14B*
Tab 15*
15A*
15B*
Tab 16*
16A*
16B*
Behavior Reduction
Tab 17*
17A*
17B*
Tab 18*
18A*
18B*
Tab 19
19A
19B
Tab 20
20A
20B
ABA)ology es & llege
n
VII.
VIII.
IX. T
X. Danaly
Supp
S
* Adopted fr**Adopted fr***Adopted f
Program an
Program and
Program and
. Conduct on
Evaluate the
Conduct trea
Evaluate eff
Compare eff
Train another
Design and behavior cha
evelop and ysis
Develop and
Explain beh
plemental Ma
Supplementa
*compete
om CSUN Purchrom CSUN Officefrom CSUN CIEL
nd probe fo
d probe for st
d probe for m
ngoing assessm
e effectivenes
atment fidelit
fectiveness of
ffectiveness of
r individual
use competenange procedu
present a tr
d present a tra
havioral conce
aterials
al Document
encies must be
hasing & Contrace of Insurance & LO Documents
or generaliza
timulus and re
maintenance
ment of inter
ss of the behav
ty checks
f components
f different tre
to conduct a
ncy based traiures
raining mod
aining module
epts using non
s (e.g. Perfo
e met to pass
ct Administration Risk Manageme
ation and m
esponse gener
rventions
vioral program
of an interve
eatments
procedure
ining for pers
dule to indiv
e to individua
n-technical la
rmance Mon
CSUN practi
Documents ent Documents
maintenance
ralization
ms (K-07)
ention packag
sons who are r
viduals unfa
als unfamiliar
anguage
nitoring Too
ica coursewor
e
ge
responsible fo
amiliar with
r with behavio
ols, Contract
rk
L
MS in Appl
College of
for carrying ou
h behavior
or analysis
s etc.)
Last Revised Jun
lied Behavior ADepartm
Social and Beh
Ge& M
A
ut
Di
S
SuD
50
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
eneralizationMaintenance
Tab 21*
Tab 22*
Ongoing Assessment
Tab 23*
Tab 24*
Tab 25
Tab 26
Training
Tab 27*
issemination
Tab 28*
Tab 29*
Supplement Materials
upplemental Documents
ABA)ology es & llege
n e
* Adopted fr**Adopted fr***Adopted f
Sample T
II. Dr
Tab 3:
(Click
I. R A. Re
II. D A. E B. PIII. D A. D
b
B. D
b
C. D
b S
BR
CU
O(P
UAE
WA1
om CSUN Purchrom CSUN Officefrom CSUN CIEL
STRTab: Task A
Develop record a: Select &
k to see samp
Review BACeview and dis
Ethictarge
Develop andEvaluating thPrioritizing pDefine targetDefine behavbehaviors) in
1. Discuchang
2. IncluDefine behavbehaviors) in
1. Discuchang
2. IncluDescribe andbehavior-anauggested Re
Bailey, J., & Routledge. Cooper J.O, HUpper SaddleO’Neil, R. E1997). Func
Practical HanUmbreit, J., FAssessment aEnglewood CWolf M.M., Applied Beh11, 203-214.
hasing & Contrace of Insurance & LO Documents
SARUCTUR
Analysis for
and useand anal& define t
ple of a Perfo
CB® ethical gscuss with supcal practiceset behaviors use workshhe social signpotential targt behaviors vior topograpn measurableuss definitionges de the final wvior functionn measurableuss definitionges de the final w
d explain behalytic (non-meadings Burch, M. (
Heron T.E, He River, NJ: ., Horner, R
ctional Assesndbook. PacFerro, J., Liaand FunctionCliffs, NJ: Pr(1978). Sociavior Analy
ct Administration Risk Manageme
AMPLE RED SUr Each Com
e behavilyze datatarget beh
ormance Mo
guidelines pervisor s in selecting
heets to prionificance of get behaviorsin observab
phically (defe and observns with supe
written opernally (definee and observns with supe
written operhavior, inclumentalistic) t
(2011). Ethic
Heward W.LPearson.
. H., Albin, Rssment and Pific Grove, Caupsin, C. J.,n‐Based Interentice Hall.ial Validity: sis is Findin
Documents ent Documents
FORMUPERVImpetency
ior measa
havior for
nitoring Too
g and assessi
oritize targef potential tars ble and meafine at least
vable terms ervisor and m
rational definat least 10 d
vable terms ervisor and m
rational definuding privateterms (G-05)
cs in Behavi
L. (2007). Ap
R. W., SpragProgram DevCa.: Brooks/, & Lane, K.ervention: An. The Case fo
ng its Heart. J
M FROMISION F
suremen
r change
ol)
ing potential
et behaviorsrget behavio
asurable ter10 different
make necessa
nitions in thidifferent
make necessa
nitions in thie events, in )
or Analysis
pplied Beha
gue, J. R., Sovelopment fo/Cole Publis. L. (2006). Fn Effective,
or SubjectiveJournal of A
L
MS in Appl
College of
M FOLDE
nt meth
1st YStud
l
s ors
rms (I-01)
ary
is tab
ary
is tab
(2nd ed). Ne
avior Analys
orey, K., Neor Problem Bhers Functional BPractical Ap
e MeasuremApplied Beha
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ER
ods,
Year dents
2nd YStud
ew York, NY
is (2nd ed.).
ewton, J. S. Behavior: A
Behavioral pproach.
ment or How avior Analys
51
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
Year dents
Y:
A
sis,
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Sample P
om CSUN Purchrom CSUN Officefrom CSUN CIEL
STRPerformanc
hasing & Contrace of Insurance & LO Documents
SARUCTUR
ce Monitori
ct Administration Risk Manageme
AMPLE RED SUng Sheet
Documents ent Documents
FORMUPERVI
M FROMISION F
L
MS in Appl
College of
M FOLDE
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ER
52
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
The interPractica Cyour namappear w
□ I con
specific sCSUN A
□ I decl
Course wthis optio
________Approved
________Credentia
________Areas of
________Specific S
Approved
_______
om CSUN Purchrom CSUN Officefrom CSUN CIEL
rnship site, aCourse webs
me and locatiwith a list of o
sent to my n
site) appearApproved Si
line to have
website as aon, we will n
____________d Site Superv
____________als (e.g., degr
____________Expertise (as
____________Site/Geograp
d Site Superv
_________
hasing & Contrace of Insurance & LO Documents
Conse
at which yousite as a CSUion to MS-Aother approv
name, crede
ring on the Cite Supervis
my name a
an Option IInot be able
___________visor’s Name
___________rees, certifica
___________s it is to appe
___________phic Supervis
visor’s Signa
__________
ct Administration Risk Manageme
ent to List
u will provideUN-Approve
ABA studentsved superviso
entials, area
CSUN MS-Aor. Please c
and credent
I CSUN Appto inform o
___________e (as it is to a
___________ations, and/o
___________ear on our co
___________sion Area (as
ature
__________
Documents ent Documents
t Name &
e supervisioned Internships, your nameors.
a(s) of exper
ABA Practicomplete the
ials appear
proved Site our students
____________appear on ou
____________or licenses; a
____________ourse website
____________s it is to appe
______
Credentia
n, will be lisp Site. If youe, approval s
rtise, and ge
ica Course we informatio
on the CSU
Supervisors of your ap
___________ur course web
___________s it is to appe
___________e)
___________ear on our co
Date
____
L
MS in Appl
College of
als
sted on the Cu consent forstatus, and cr
eographical
website as aon below.
UN MS-ABA
r. Please notpproval statu
___ bsite)
___ ear on our co
___
___ ourse website
e
_________
Last Revised Jun
lied Behavior ADepartm
Social and Beh
CSUN MS-Ar us to releasredentials w
l location (o
an Option II
A Practica
te if you seleus.
ourse websit
e)
__________
53
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ABA se
will
r
I
ect
e)
____
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Faculty/
CSUN P
Departm
AT THI
Conflict
obligatio
other ma
is reques
field of B
include th
househol
Nam
1
2
3
4
5
Are you
above?
Do you h
Do you r
Do you h
above?
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Site Superv
Position/Title
ment/College
S TIME, I H
of Interest is
ns outside o
terial interes
ting faculty
Behavior An
he Faculty/S
ld for whom
e of Non-CS
a director,
have a finan
receive inco
have an inte
hasing & Contrace of Insurance & LO Documents
CalifornConflict
visor Name:
e:_________
e: ________
HAVE NOT
s defined as
ne entity are
sts, or relatio
and site sup
alysis, and/o
Site Supervis
this is relev
SUN Entity
officer, par
ncial investm
me from an
erest in any
ct Administration Risk Manageme
nia State Ut of Inter
_________
__________
___________
THING TO
a potential o
e likely to be
onships. The
ervisors to d
or other relat
sor, his/her s
vant.
Address
rtner, truste
ment in any
ny of the ent
intellectual
Documents ent Documents
Universitrest Discl
___________
___________
__________
DISCLOSE
or actual situ
e compromis
e CSUN M.S
disclose any
ted entities o
spouse, and a
s of Entity
ee, or emplo
Yes
of the entit
Yes
tities listed a
Yes
l property r
Yes
ty, Northlosure Fo
__________
__________
___________
E
uation where
sed by the Fa
S. in Applied
work being
outside of CS
any depende
oyee of the a
No
ties listed ab
No
above?
No
rights belong
No
L
MS in Appl
College of
hridge orm*
___________
___________
__________
e commitmen
aculty/Site S
d Behavior A
done that is
SUN. Respo
ent children i
Principal Ty
any of the en
bove?
ging to the e
Last Revised Jun
lied Behavior ADepartm
Social and Beh
___________
__________
___________
nts and
Supervisor’s
Analysis Pro
related to th
onses should
in their
ype of Busin
ntities listed
entities liste
54
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
_____
____
____
gram
he
ness
d
ed
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Faculty/
I ack
I agr
I agr
poten
I agr
I agr
redu
Signed: _
*Adopted fro
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Site Superv
knowledge th
ree to updat
ree to coope
ntial conflic
ree to adher
ree to comp
ce, or elimin
__________
om the CSUN Conf
hasing & Contrace of Insurance & LO Documents
visor Certif
hat the info
e this disclo
erate in the
ct of interest
e to the BA
ply with an
nate actual
___________
flict of Interest Dis
ct Administration Risk Manageme
fication:
ormation list
osure as new
developme
t identified i
CB Code of
ny condition
or potentia
__________
sclosure Form for
Documents ent Documents
ted above is
w, reportabl
ent of a Res
in this Discl
f Ethics.
ns or restri
l conflicts o
_____
r the Office of Rese
s true and c
le informati
solution Pla
losure.
ictions impo
of interest.
Date: __
earch and Sponsor
L
MS in Appl
College of
orrect.
ion is obtain
an to addre
osed by CS
___________
red Projects
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ned.
ss any actu
SUN to man
___________
55
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ual or
nage,
____
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
As a studeresponsibsupervisio
Please see
A
If you andguidelines
________
Practica S
________
Practica S
________
Practica S
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ent enrolled inility to obtainon at your inte
e the clause b
According to B Develo Provid
that so Observ
feedba Use B Model Guide
develo Review Monito Condu
d your BCBAs, please sign
____________
Student Signa
____________
Student Printe
____________
Student Date
hasing & Contrace of Insurance & LO Documents
Off Sit
n practica andn a signature fernship site.
elow pasted f
BACB®, effecop performande supervisee ome competenve the supervack ehavior Skillsl technical, prand give feed
opment, and dw data and wror and evalua
uct bi-weekly
A supervisor cbelow.
___________
ture
___________
ed Name
___________
Signed
ct Administration Risk Manageme
te Practica Su
d working at afrom your BC
from your pra
ctive behaviornce goals with
with opportunces will not bisee in the fie
s Training to rofessional, andback on behdecision-makiritten materia
ate the effectsevaluation of
onfirm you ar
___________
___________
___________
Documents ent Documents
upervision Ve
a CSUN apprCBA supervis
actica syllabi:
r-analytic suph supervisee unities to perfobe met). eld and use pe
teach and impnd ethical behavioral case cing repertoireals (e.g., behav of behavioraf supervisee’s
re receiving B
_ ____
BCB
_ ____
BCB
_ ____
BCB
erification For
roved Option or to confirm
pervision shou
form listed com
erformance fe
prove supervhavior conceptualizaes vior program
al service delis performance
BCBA superv
___________
BA Option III
___________
BA Option III
___________
BA Option III
L
MS in Appl
College of
rm
III Internshipm that you are
uld include:
mpetences (N
eedback to giv
isee’s skills
ation, problem
ms, data sheetsivery e and effects
vision that adh
____________
I Supervisor S
____________
I Supervisor P
____________
I Supervisor D
Last Revised Jun
lied Behavior ADepartm
Social and Beh
p site, it is youreceiving BC
Note* it is like
ve corrective
m-solving, pro
s, reports)
of supervisio
heres to BAC
___________
Signature
___________
Printed Name
___________
Date Signed
56
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ur CBA
ely
ogram
n
CB®
_____
_____
e
_____
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
This formorientatioThe MS-Astudent's f ________Name (Ple Address _ Telephone The interthese issuexpectati □ Know□ The st autom□ If you□ If driv□ In cashome. □ Famil emerg□ Abide□ Make□ Keep □ Know□ You s□ You s□ You s□ Do no sexual□ Do nagainst an□ Avoid□ Avoid□ You abeing, and□ Use chas its owFamiliariz I have disinternship
__St
om CSUN Purchrom CSUN Officefrom CSUN CIEL
is to be compon. This is a cABA Internshipfile.
____________ease print)
____________
e No._______
rnship studenues with the sons associate
w that you (thetudent intern
mobile liabilitu take public tving your perse of a breakd
liarize yoursegency (i.e., kne by any othere sure you kno
all informatiow that you canshould not repshould not givshould not givot tolerate verl with a clientot tolerate ve
n individual od any type of d any personaare reminded d you are respommon sense
wn rules, policze yourself w
scussed the abp. ___________tudent Signat
hasing & Contrace of Insurance & LO Documents
ORpleted as soononfidential inip Coordinato
___________
___________
___________
nt should chestudent and ted with inter
e intern) can is responsible
ty insurance atransportationsonal car, be
down or a mix
lf with peoplenow the locatir terms of emow how to exion about clienn request an alport to the Intve or loan a clve a client or rbal exchanget or site reprerbal exchangen the basis ofbusiness arra
al relationshipthat your own
ponsible for the and conductcies, procedurith the workin
bove items wi
___________ture
ct Administration Risk Manageme
To be comRIENTATIONn as possible
nternal documor will proces
___________
___________
____________
eck these itemthat the stud
rnship partic
contact the Ine for transporas required byn, select the sasure to park c
x up with tran
e, places and ion of phones
mployment andit the Internshnts you work lternative siteternship Site wlient money osite represent
e of a sexual nsentative. e or engage inf his/her age, angement withps with a clienn personal chhose choices.t yourself in ares, protocol angs of the Int
ith my Superv
_________
Documents ent Documents
mpleted by StN CONFIRMonce the stud
ment and shouss, follow-up
____
____________
___________
ms as confirmdent understa
ipation.
nternship Coortation to and y state law. afest route to close to the sinsportation, ca
things in the s, 24-hour stord regulations hip Site in caswith confiden
e if you are nowhile under thor other persotative a ride innature or enga
n behavior tharace, gender, h clients durinnt or site repreoices in any s
a professionaland expectatioternship Site.
visor and und
tudent MATION**dent has partiuld not be givep, and maintai
_
___________
______
mation that tands and acc
ordinator whefrom the inte
the Internshiite in a safe, warry enough m
area that can res, police starequired by tse of an emerntial. ot comfortablhe influence o
onal belongingn a personal vage in behavi
at might be psexual orient
ng your internesentative dursituation can
l manner at alons, for whic
derstand the ri
____ D
L
MS in Appl
College of
icipated in anen to unauthoin this docum
___________ Student ID N
___________
the departmecepts the gene
enever you neernship site an
ip Site. well- lighted amoney for an
be of assistanation, etc.). the Internshiprgency.
le with your cof alcohol or gs. vehicle. or that might
perceived as dtation, abilitynship period.
uring the internaffect your sa
ll times. Everh you are resp
isks associate
___________Date
Last Revised Jun
lied Behavior ADepartm
Social and Beh
n internship orized person
ment in the
___________No.
___________
ent has discueral risks an
eed help. nd should carr
area. alternate ride
nce in times o
p Site.
current site. drugs.
be perceived
discriminatingy, or ethnicity
nship. afety and wel
ry Internship ponsible.
d with my
_____
57
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ns.
_
ussed d
ry
e
of
d as
g .
l-
Site
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
This two-accruing sbased on ContinuBoard CerApprovedthis worksboth days WorkshoThe formaeffective aresearch-contractuaprovidingby the atte Day 1 (Pr8:30 – 9:09:00 – 10
10:30 – 1010:45 – 12
12:00 – 11:00 – 3:0
3:00 – 3:3
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Ethical CA Tw
day workshopsupervised exthe BACB®
ed Educatiortified Behav
d Continuing Eshop will accr to receive ce
op Format at of the workand ineffectiveevidence for eal agreements
g performanceendees.
resentations)00 Reg:30
0:45 2:00
:00 00
30
hasing & Contrace of Insurance & LO Documents
ompetency-wo-Day Wo
C
p is appropriaxperience houSupervisor Tr
on Credits ior Analysts: Education (Arue 10 CE cre
ertificate of co
kshop will ince supervisioneffective supes, setting and e feedback. Th
) istration Evaluating yosupervision BACB® NeBACB® SupCurriculum Ethical ConsiPurpose of thBreak Important Fesupervision Evidence-bas
o Clearo Como Exam
Lunch on youDevelop and checklists Assessing iniMonitor perfoProvide perfofeedback
Sign-out/ObtObtain
ct Administration Risk Manageme
-Based Supeorkshop for CSUN Unive
ate for experieurs to become Training Curri
CSUN ColleACE) provideredits [Type 2]ompletion of
clude presenta, rationale fo
ervision. Therevaluating pehe workshop
our own
w Requiremepervisor Train
iderations he supervision
atures of
sed supervisior Expectation
mpetency-basemple Contractur own use performa
itial skills formance ormance
tain Homewor
Documents ent Documents
ervision of ECSUN-App
ersity-Based
enced BCBAeligible to sit
iculum Outlin
ege of Social &r with Dr. Kaz]; we will notCE credits.
ation on the pr and the use
re will be grouerformance exwill also incl
Day 2 8:30 –
ents ning
n
9:00 –
10:30
on ns ed ts
10:45
12:00 ance 1:00 –
rk 3:00 –
Emerging Bproved Site d Practica
As involved int for the BCBne but is offer
& Behavioralzemi as the At issue partial
purpose of thee of structuredup exercises ixpectations, blude discussio
(Group wor– 9:00 – 10:30
– 10:45 – 12:00
– 1:00 – 3:00
– 3:30
L
MS in Appl
College of
Behavior AnSupervisor
n the supervisiBA Exam. Thired independe
l Sciences is aACE instructo
credit. Atten
e supervision,d supervision in developingbehavior skillons of specific
rk) Sign-in Behavior
(BST) Develop
Break Develop Collect d Give per
Lunch on Give per Evaluate
effective Ongoing
develop Sign-out Complet Pick-up c
Last Revised Jun
lied Behavior ADepartm
Social and Beh
nalysts s
ion of individis workshop ient of the BA
a BACB or. Attendees ndees must att
, outcomes offolder, and
g and using ls training, anc concerns sh
ral Skills Trai
and use BST
and use BSTdata on perforrformance fee
n your own rformance feee supervisory eness g professionment
t te evaluation fcertificate
58
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
duals is
ACB®.
of tend
f
nd hared
ining
T
T rmance edback
edback
nal
form
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
WorkshAfter the w� Explain� Describ� Describ� Describ� Describ� Describ� Demon� Explain� Describ� Develo� Explain� Set per� Use per� Describ� Identify� Identify� Describ� Describ Payment: Graduate However,CSUN FocontinuedBCBA. Fustudent tulaw. Dona18111 NoBehaviorawrite “BC
om CSUN Purchrom CSUN Officefrom CSUN CIEL
hop Objecworkshop, thn the BACB®
be the BACB®
be reasons forbe potential obe important fbe how to estanstrate how ton what is meabe the purposop and use pern how to asseformance goarformance chbe effective my the commony key componbe methods tobe methods fo
The two-dayProgram for
, donations tooundation in thd education wunds will be u
uition, confereations can be ordhoff St, Caal Sciences at
CP” in the not
hasing & Contrace of Insurance & LO Documents
ctives: e participants New Require® Experience r effective, evutcomes of infeatures of suablish clear p
o develop conant by compete of using perrformance chess initial skillals based on t
hecklists to givmethods to pron training pronents of Behao evaluate supor ongoing pr
y 10-hr worksfree to candid the MS-ABAhe suggested orkshops andused for advaence travel, ansent to BCP P
alifornia Statet 18111 Nordhtes line on the
ct Administration Risk Manageme
s will be able ements Standards
vidence-basedneffective supupervision erformance etractual agreetency-based srformance checklists ls of supervisthe results obtve constructivovide feedbacocedures usedavior Skills Trpervisory effeofessional de
shop is offeredates approveA program areamount of $5
d materials, anancement of end research exProgram direc
e University, Nhoff St, Califoe check.
Documents ent Documents
to:
d supervision pervision
expectations fements for supsupervision anecklists durin
ee tained from pve feedback ck d in evidence-braining (BST)
ectiveness velopment
ed by the Apped as site supee much appre500 for the strnd on-going inmerging behaxpenses. Conctly at DepartNorthridge 91
fornia State U
for both the supervision nd training ng supervision
performance c
based effectiv) and how the
plied Behaviorervisors for Ceciated and neructured supendividualizedavior analysts
ntributions aretment of Psyc1330-8255 or
University, No
L
MS in Appl
College of
upervisor and
n
checklists
ve training paey are used in
r Analysis (MCSUN Practicaeeded! Checkervision folded support froms by coveringe tax deductibchology (376 r to the Collegorthridge 9133
Last Revised Jun
lied Behavior ADepartm
Social and Beh
d supervisee
ackages n training
MS-ABA) a Option II. ks can be mader, both days om a doctoral lg costs such asble as permitte
Sierra Hall) ge of Social a30-8255. Plea
59
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
de to of level s ed by
and ase
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
S
The followThe sampleintended toCertificatioguarantee by individusupervisor ExperienceBCaBA cre
This samplfound in a separate sy
This Supe_____ (susupervisee
1. Condu2. Desig3. Overs4. Traini5. Other
analythe litactivior eva
RESPON
1. Superissuesbehav
2. Superinteralieu o
3. Both pand thvarianan app
4. Superper BAsuperv
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Sample S
wing sample cone terms provido comply with ton Board® (“Bthe legal enfor
uals familiar wr and supervisee Standards poedential.
le agreement issyllabus, such yllabus docume
ervision agreeupervisee) for e’s Practicum
ucting assessmgning, implemseeing the imping, designingr activities norsis, such as atterature relateties related toaluation of be
NSIBILITIES
rvisor and sups affecting pravior-analytic ervisor agrees taction; this maf the supervisparties agree he time allottence in schedupropriate timervision may bACB standarvision.
hasing & Contrace of Insurance & LO Documents
SAMPL
Supervisi
ntract pertainsed herein are fthe requiremen
BACB®”). Nothrceability of an
with local and see to ensure thaolicy. Please als
s not designed as grading, ac
ent and may be
ement is madesupervision o
m experience t
ment activitiementing, and mplementation g behavioral srmally perforttending planned to the progo oversight ofehavior analys
S AND AGR
pervisee agreeactice – both expertise. to provide spay be conductsor being phyto protect the
ed. Privacy wule will notify e to reschedu
be conducted ids. The rest o
ct Administration Risk Manageme
E BACB
ion Cont
s to supervisionfor general refents for supervishing herein shany provision costate laws and rat the contract lso note that th
to serve as a ccademic dishone attached to th
e on the date of the deliverthrough _____
es related to thmonitoring beof behavior a
systems, and rmed by a behning meetingram, talking t
f behavioral psts' performan
REEMENTS
e to work togepersonally an
ecific feedbacted via web-c
ysically presene time and spa
will be respectthe other par
le. in a small gro
of the hours o
Documents ent Documents
B Supervi
ract for a
n conducted or ference and infosed experience all be construedontained in thisrequirements. Pmeets all the ris contract wil
course syllabusnesty, student dhis sample agr
indicated belory of applied b_, including t
he need for behavior analysanalysis progrperformance
havior analysts regarding thto individuals
programming nce. The supe
ether to facilind professiona
ck to superviscamera, videont. ace for superved and interrurty at the earli
oup for no mof supervision
ision Con
a Univer
r coordinated thformation purpe of applicants d as legal advis sample agreePlease note tha
requirements oll need to be ed
s. University podisability policyreement as an a
ow by and bebehavior analthe following
ehavioral intesis programs rams by othermanagement
t that are direhe behavior as about the prsuch as behav
ervisor will de
itate in-depth ally – and dev
see on performotape, videoco
vision, by keeuptions avoidiest possible t
ore than half omust be cond
L
MS in Appl
College of
ntract
rsity Prac
hrough a univeposes only. Theto the Behavioice. The BACB ement. Contracat it is the resp
outlined by the Bdited for superv
olicies and procy, etc. should bappendix.
etween _____lysis services activities:
erventions; for clients; rs; t; AND
ectly related toanalysis progrrogram; plus avior analyst setermine if ac
discussion/unveloping a hig
mance in Suponferencing, o
eping to agreeded. Any partytime of varian
of the total suducted as dire
Last Revised Jun
lied Behavior ADepartm
Social and Beh
November
cticum
ersity practicumese terms are or Analyst
does not warrcts should be drponsibility of thBACB in the Bvisees pursuing
ovisions typicalbe covered in a
_ (supervisor) in the
o behavior ram, researchiany additionasupervision isctivities quali
nderstanding gh level of
pervisee-clienor similar me
ed appointmey requiring a nce to determ
upervised houect one-to-one
60
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
6, 2013
m.
rant or rafted he BACB g the
lly a
and
ing al ssues, fy.
of
nt ans in
ents
mine
urs, e
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
5. SuperSuper
6. A Sup7. Super
week appro
8. In addrelevacount
9. Supermeet t
10. Superinclud
11. Durinsupervsupervduringshouldetermsupervperiodsign oinadeq
12. The Eoccur
a.b
13. The fohoursindivi
a.bc.
d
If Practicumeet with rensure thasetting-speincorporatdevelop a pcontract an
om CSUN Purchrom CSUN Officefrom CSUN CIEL
rvisee and suprvised Indepepervision Docrvisee agrees to meet the to
oximately withdition to supeant to the caset towards BACrvisee agrees the BACB corvisee and supding all feedbng the supervivision have bvisee and docg which inaded continue, anmination is mvisee what ard should be cooff on hours aquate.
Experience Ver: . All experie. The superv
following circ on the Experidual Supervi. Supervisee. Supervisee. Egregious
Analysts (sother team
. Supervisee
um services arerelevant persont all provisions
ecific rules, regted into the settplan to addressnd include a se
hasing & Contrace of Insurance & LO Documents
pervisor will mndent Fieldwcumentation Fto accumulateotal 1000 houhin one year.
ervision meetie, such as schCB eligible suto begin Prac
oursework reqpervisor both back forms ideision period, tbeen acquiredcument whethequate progrend provide in
made that supereas were lackounted towar
accrued during
erification Fo
ence hours arvisor-supervisumstances worience Verificsion Documee does not rece receives ___violation of t
see language m members. e fails to:
e to be deliverennel (e.g., dires in this contragulations, and pting, and (d) ids them. It mighection for settin
ct Administration Risk Manageme
meet at least work. Form will be e the requiredurs needed to
ings, supervishool meetingsupervised expcticum only afquirements. agree to main
entified in Clathere will be p. At these rev
her adequate pess has been mn writing the rervision shoulking adequated supervisiong the 100-hou
orm will be sig
re completed ssee relationshould justify acation Form (ientation Formceive a passin_ unsatisfactothe BACB’s Gbelow) and/o
ed off-campus, ectors, supervisact can be faithfpractices, (c) i
dentify potentiaht be advantageng personnel to
Documents ent Documents
once every w
completed at d minimum ofcomplete the
see is required, case confere
perience. fter supervise
ntain a copy oause 11, belowprogress revie
views, the supprogress is bemade, the suprequired stepsld stop, the sue progress andn. As such, theur period duri
gned by the su
satisfactorily.hip is terminata supervisor rei.e., even thou
ms). ng grade. ory performanGuidelines for
or behavior tha
it is strongly rsor, employer) hfully executed dentify if and h
ally challengingeous to incorpoo formally agre
week for 7.5%
each supervif 10 hours an
e BACB Pract
d to attend adences, and pa
ee has started
of each signedw, and this siews conducte
pervisor will peing made. Afervisor must
s to allow for upervisor musd determine ifere is no guaring which sup
upervisor wh
. ted under posefusing to sigugh those hou
nce evaluationr Responsibleat jeopardizes
recommended tin the supervisin the setting,
how the supervg dual relationorate some of tee to contract c
L
MS in Appl
College of
% of the total h
isory interactind maximum oticum require
dditional profearent meetings
attending cou
d supervisionigned contraced after everyprovide feedbfter two progrdetermine whcontinued sup
st provide in wf any of the hrantee that thepervisee perfo
hen either of th
sitive conditiogn off on a supurs were track
ns. e Conduct fors the well-bei
that the supervsee’s practice s(b) familiarize
visor’s recommnship (e.g., supthis content intcontent via sig
Last Revised Jun
lied Behavior ADepartm
Social and Beh
hours spent in
ion. of 30 hours p
ement
essional meets, which may
urses required
n document ct for supervisy 100 hours ofback to the ress reviews hether supervpervision. If twriting to theours during the supervisor wormance was
he following
ons (e.g.,). pervisee’s accked through
r Behavior ing of clients
visor and supersettings to (a) e the supervisomendations willpervision) issueto the supervis
gnature.
61
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
n
er
tings not
d to
sion. f
vision the
e hat will
crued
or
rvisee
r with l be es and ion
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
RESPON
1. Both of proprofes
2. The sucomp
3. Both pcondu
4. Both pConduto con
RELEAS
Superviseemployeefees, arisinservices rebreach of with supe
CONFID
Confidentconfidentimedical o
Supervisothereof, arcourse of or retain ato _____ apossession
Supervisoobservatio
TERM A
Term. Thithis agreeof termina
om CSUN Purchrom CSUN Officefrom CSUN CIEL
NSIBLE CON
supervisor anofessional behssionally deriupervisor wiletence. parties agree
uct and all perparties have ruct for Behavnduct, respons
SE AND IND
ee agrees to rees, from and ang from or alendered by orany term set rvisee’s busin
DENTIALITY
tial Informatiial all informa
or clinical info
or Records. Are and shall rehis/her duties
any of _____’any of _____n or under sup
or and supervion of services
AND TERMI
is agreement ment by ___ ation Clause 1
hasing & Contrace of Insurance & LO Documents
NDUCT
nd supervisee havior. This inived knowledll provide sup
to maintain crtinent legal rread, understovior Analysts. sibility to clie
DEMNIFICA
elease, defendagainst any anleged to ariser to be renderforth in this aness operation
Y
on. On and afation relatingormation, in w
All _____ recoemain the pros and obligati’s records. Up
_’s records, copervisee’s co
isee shall be js delivery and
NATION
shall be effecday’s advanc12 shall survi
ct Administration Risk Manageme
herein referrencludes behavge.
pervision to th
confidentialityregulations. ood, and will Particular att
ents, and asse
ATION
d, indemnify, nd all claims, e from (a) anyred by the supagreement; ANns and the beh
fter the date og to current orwhatever form
ords includingoperty of ____ions under thipon terminatioopies of recordntrol or custo
jointly respond sharing of co
ctive on _____ce written notiive and remai
Documents ent Documents
ed to as “bothvioral discuss
he supervisee
y in accordan
adhere to thetention will b
essing behavio
and hold harmdamages and
y asserted defpervisee in accND (c) any ahavior analys
of this agreemr potential cliem.
g, but not limi__. Superviseis agreement, on of the agreds and all oth
ody.
nsible for ensuonfidential cl
_ and shall reice to the othen valid.
h parties” agresions grounde
only within t
nce with the gu
e BACB’s Gube given to secor.
mless _____,d expenses, inficiencies or dcordance with
act or omissiosis services pr
ment, supervisents including
ited to the infee shall not, eremove from
eement, superher property th
uring that clielient informat
emain in effecer of the inten
L
MS in Appl
College of
ee to adhere ted in scientifi
the boundarie
uidelines for
uidelines for Rctions 1 throu
its officers, ancluding costsdefects in the h this agreemn of supervisrovided by su
sor and supervg, but not lim
formation desexcept in the om supervisor’srvisee agrees hat are in sup
ents have contion.
ct until either ntion to termi
Last Revised Jun
lied Behavior ADepartm
Social and Beh
to high standac and
es of his/her
responsible
Responsible ugh 6 as it rela
agents, and s and attorneybehavior ana
ment; (b) any ee in connect
upervisee.
visee shall kemited to, any
scribed and coordinary and us premises, coto return prom
pervisee’s
nsented to the
party terminainate. In the e
62
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ards
ates
ys’ alysis
tion
eep
opies usual opy, mptly
ates event
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
REMEDI
Injunctivecontainedsubsidiariaffiliates orights or rbreach, suor permanprohibitedto specific
Supervisein the jurielection o
Costs andentitled tobrings to e
MISCEL
Entire agrthe subjec
This sectiinterpretatcontract p
Mwch
Wcl
Seco
Gdere
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ES
e Relief. The d in this agreemies for which or its subsidiaremedies, bothupervisor shalnent injunctiod by this agrecally enforce
ee hereby agreisdiction in wof supervisor.
d Attorneys’ Fo recover fromenforce this a
LLANEOUS
reement. Thisct matter here
on is reservedtion and enfo
provisions to a
Modifications writing or via ehanges should
Waiver - Do thlauses be trea
everability – ontract be stil
Governing lawesire arbitratiemedies?
hasing & Contrace of Insurance & LO Documents
supervisee acment may resthere is no adaries resultingh legal and eqll be entitled t
on against supement, or to sany of the co
ees and consehich the viola
Fees. In additim supervisee tagreement in w
PROVISION
s agreement cof.
d for selectedorcement. Resaddress the fo
– Identify whelectronic ford be sent.
he parties havated?
If one clause ll considered
w and venue –on or mediati
ct Administration Risk Manageme
cknowledges tsult in materiadequate remedg from a breacquitable, avaito seek and ob
pervisee that sseek and obta
ovenants or ob
ents that injunation occurs, o
ion to any oththe costs and which it prev
NS
ontains the en
d miscellaneousearch into enollowing prov
ho may make rmat, if permi
ve the right to
is stricken byvalid? May a
– Which law wion prior to lit
Documents ent Documents
that a breach al and irreparady at law and ch will be immlable to superbtain a tempo
shall prevent sain such otherbligations con
nctive relief mor any other c
her relief to wreasonable atails.
ntire agreeme
us provisions nforceable convisions:
changes to thitted by your s
waive a clau
y implication a stricken clau
will govern thtigation? Are
of any of theable injury to
d that injury anmeasurable. Wrvisor in the eorary restrainisupervisee fror relief againsntained in this
may be soughtcourt of comp
which it may bttorneys’ fees
ent between th
regarding topntracts in you
he agreement state law. Ide
se in the agre
of law, may tuse be recons
he interpretatie court costs a
L
MS in Appl
College of
e covenant or o _____, or itsnd damages tWithout limitevent of an acing order andom engaging st supervisee as agreement.
t ex parte in apetent jurisdic
be entitled, __s it may incur
he Parties her
pics importanur state should
and whether entify the addr
eement? How
the remainingstrued so as to
ion of the agreand legal fees
Last Revised Jun
lied Behavior ADepartm
Social and Beh
obligations s affiliates or to _____, its ting any otherctual or threatd/or a prelimin
in any activitas may be req
any court of rection, at the
____ shall be r in any action
reto with resp
nt to contract d help you sel
they need to resses where
w should other
g clauses of tho be enforceab
eement? Do s desired
63
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
r tened nary ties quired
ecord
n it
pect to
lect
be in
r
he ble?
you
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Notice ungiven if preturn req
The respoBACB’s Disciplin
All partie
Supervise
Supervise
Superviso
Superviso
om CSUN Purchrom CSUN Officefrom CSUN CIEL
nder this agreeersonally deli
quested, and a
-
onsibilities dGuidelines f
nary and Eth
s agree to the
ee Name (prin
ee signature: _
or Name & Cr
or signature: _
hasing & Contrace of Insurance & LO Documents
ement by one ivered or dep
addressed to th
---------------
described in for Responsi
hical Standar
e stipulations h
nted): ______
___________
redentials (pri
___________
ct Administration Risk Manageme
Party to anotosited via poshe recipient a
---------------
this documeible Conducrds.
herein:
____________
__________
inted): _____
__________
Documents ent Documents
ther Party shastal service, p
as follows:
---------------
ent will be cact for Behavi
____
____________
all be in writinpostage prepa
---------------
arried out inior Analysts
Date: ___
_____
Date: ___
L
MS in Appl
College of
ng and considaid, certified o
-----------
n accordanceand Profess
_____
________
Last Revised Jun
lied Behavior ADepartm
Social and Beh
dered effectivor registered,
e with the ional
64
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
vely
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
INSTRUCT
CLASS MEMAIL AOFFICE H
PracticuStudents(BCBAs)once weeStudentsstudents practicumpracticumsupervisirole-play The purpstructurewhich beand intelgeneralizhow to sebehaviorfaculty apin which performasemestesupervisosetting. S(Fall, Sprto sit for requirem
Student
In this co
Id U U D
om CSUN Purchrom CSUN Officefrom CSUN CIEL
S
TOR/SUPERV
MEETINGS: ADDRESS: HOURS:
um Course s will work w. Students inekly for 10%
s will collabowill be requ
m goals and m supervisioion on site, ds, and regul
pose of practed supervisioehavioral asslectual disabzation of coneek, receiveal observatiopproval, studthey are Ma
ance will be rr; at this poinor(s) is possStudents muring, & Summthe BCBA e
ment.
Learning O
ourse, studen
dentify profeUnderstand aUse and interDevelop and
hasing & Contrace of Insurance & LO Documents
SAMCOU
SUPERVISE
VISOR:
SH By
Descriptionith agency un the practic
% of the total rate with supired to a) doobjectives a
on. Methods direct feedbaar review of
ticum is to eon and qualitsessment anbilities. The mncepts learnee, and grow fon, data colldents may re
aster’s in Appreviewed at nt at the end
sible if a supst be enrollemer semestexam as a ca
Objectives
nts will learn
ssional and and use currrpret indirectuse data co
ct Administration Risk Manageme
MPLE OPRSE SYLLA
ED PRACTIC
H 320, Tues
appointmen
n under the sucum course r
hours in thepervisor(s) t
ocument the and b) maintof supervisioack inside anprogress on
nhance studty feedback nd treatmentmain objectied in graduafrom feedbaclection methegister for thplied Behavithe end of e
d of each terervisee is noed in practicers for the eandidate who
n to:
ethical stanrent researcht, direct, and
ollection syst
Documents ent Documents
PTION I ABUS: XBE
CUM IN BEH
sday 4:00-5
nt
pervision of receive supee practicum (o identify proactivities of
tain documeon may inclund outside (vn goals and
dents’ traininregarding ex
t is provided ve of practic
ate coursewock, assessmods and inte
his course asior Analysis each semestrm, terminatiot upholdingum for six (6ntire 2 yearso has fulfilled
dards of clinh on behaviod experimenttems.
SYLLABEH902/90
HAVIOR AN
5:00pm + fie
Board Certiervision by th(group and i
rofessional gf the practicuentation for aude bug-in-tvia email) ofassignments
ng as scientixperiences ito children w
cum is to offeork. Profess
ment methoderpretation ws many timestudents at
ter for registion of the su
g their respon6) consecutivs of the Masd university-
nicians and boral technolotal behaviora
L
MS in Appl
College of
BI 03
NALYSIS:
eldwork ho
fied Behaviohe supervisoindividual su
goals for the um as relateall individual he-ear, indivf meetings, rs.
st-practitionin a clinical ewith variouser multiple e
sional and etds, treatmentwill be emphes as needed
CSUN. Eacration for the
upervision rensibilities in ve semester
ster’s progra-based pract
behavior anaogy with chilal assessme
Last Revised Jun
lied Behavior ADepartm
Social and Beh
urs
or Analysts or(s) at leastupervision). practicum, ad to the and group
vidual review of vid
ers by provienvironment
s developmeexemplars fothical conduct proceduresasized. Withd during the
ch student’s e following
elationship bthe practicu
rs for 2 yearm) to be eligticum
alysts. dren with au
ents.
65
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
t
and
deos,
ding t in
ental or ct, s, h time
y the um rs gible
utism
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
D M C G U
a A
A more cattached
From the
In this corelated toapplied bDimensioAnalysis.superviso
Appropria
C D
re O T O
bpapa
The purpethical reclients. E
D O M G
re R O O
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Develop and Monitor behaCollect interoGraph and reUse appropria
ssistants. Apply feedba
comprehensCompetenc
e BACB:
ourse, the stuo the BACB behavior anaons of Applie. Students aors.
ate experien
Conducting aDesigning, imeduction pro
Overseeing thTraining, desOther activitie
ehavior anarogram, resebout the prorogrammingnalysts' perf
pose of supeepertoires ofEffective beh
DevelopmentObservation, Modeling techGuiding behaepertoires
Review of wrOversight andOngoing eval
hasing & Contrace of Insurance & LO Documents
implement bavior supportobserver reliaeview data wate methods
ack to show g
ive list of leacies docume
udent’s primFourth Editi
alysis identified Behavior re encourag
nce activities
assessmentsmplementingograms; he implemenigning behaves normally lysis such asearching the
ogram plus ag such as beformance. Th
ervision is to f the supervihavior analyt
t of performabehavioral shnical, profe
avioral case
itten materiad evaluationluation of the
ct Administration Risk Manageme
behavior intet plans and sability and pr
weekly and ms to offer fee
growth as a
arning objectent for the AB
mary focus shon Task Listied by Baer,
r Analysis puged to have e
s include:
s related to �, and system
ntation of bevioral systemperformed bs attending
e literature reany additionahavior analyhe superviso
improve andsee and factic supervisio
ance expectaskills training
essional, andconceptualiz
als (e.g., behn of the effece effects of s
Documents ent Documents
ervention plaskill acquisitirocedural int
monitor and medback to tea
behavior an
tives for thisBI Practicum
hould be on t. Activities m Wolf, and R
ublished in thexperiences
�the need fomatically mo
ehavior-analyms, and perfby a behavioplanning meelated to theal activities ryst supervisior will determ
d maintain thilitate the deon includes:
ations g, and delived ethical behzation, probl
havior progracts of behavisupervision
ans. ion programtegrity data.modify intervachers, staff
nalyst in train
s practicum sm.
learning newmust adhereRisley (1968he Journal os in multiple s
or behavioranitoring skill
ytic programformance ma
or analyst thaeetings regae program, arelated to ovon issues, omine if activi
he behavior elivery of hig
ery of perforhavior lem-solving,
ams, data shoral service
L
MS in Appl
College of
ms. vention planf, paraprofes
ning.
site is includ
w behavior ae to the dime) in the artic
of Applied Besites and wi
al interventio-acquisition
ms by othersanagement;at are directlrding the bend talking to
versight of beor evaluationities qualify.
analytic, proh-quality se
mance feed
and decisio
heets, repordelivery
Last Revised Jun
lied Behavior ADepartm
Social and Beh
s. ssionals, and
ed in the
analytic skillsensions of cle Some Cuehavior th multiple
n and behavio
; ly related to
ehavior analyo individuals ehavioral n of behavior
ofessional, arvices to his
back
on-making
rts)
66
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
d
s
urrent
or-
ytic
r
and s/her
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Expecta
StudentspracticumparticipatprofessioStudents
Grades
StudentscompletioStudents“Unsatisfgrowth) waccording
93-100%C; 70-73
Success
Successfthe supeuniversitysuccessfcourse. Sthe BCBAexperiencourse reexcused conferen
Absence
A studensupervisiper semeshould becomplete
Nature o
This contpracticuminstructoand stud
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ations of Stu
s are expectem, complete te in discuss
onalism and s also are ex
s will have thon of assign
s will be gradfactory” marwill result in g to the follo
% = A; 90-93%% = C-; 66-7
sful Comple
ful completiorvisor (see ay graduate-leful completioStudents whA exam; a gce requiremequires attenwith the instce.
es:
nt who is absion. Studentester will rece pre-arrang
ed in a timely
of the Contr
tract is to esm course (sur(s)/supervisents are inv
hasing & Contrace of Insurance & LO Documents
udents
ed to attend homework (
sion regularlyto work as a
xpected to ad
he opportunitments, parti
ded accordinks, or consislower final p
owing breakd
% = A-; 86-870% = D+; 6
etion of the
on of this praattached Comevel rigor an
on of this couo receive anrade is requent to qualifndance at altructor, and
sent from schs who are a
ceive a perceged with the y manner up
ract:
stablish a suupervisee) asor(s) reevalited to re-en
ct Administration Risk Manageme
practicum w(e.g., role-ply. Students a collaborativdhere to ABI
ty to earn a icipation, anng to performstent “Needspercentages down:
89% = B+, 863-66% = D;
Course:
acticum courmpetency lisnd will mainturse is definn “Incompletuired in all 6 fy to sit for thl ABA Speamake up as
heduled supbsent from pentage deduinstructor an
pon return to
pervisor-supnd the supeuate whethe
nroll only whe
Documents ent Documents
with consisteays, developare expecteve partner inI policies, as
grade for thid meeting th
mance feedbs Improvemefor this cour
3-86% = B; 60-63% = D
rse involvesst). Becauseain graduateed as earnine” in this prasemesters ohe exam. In ker Series e
ssignments w
pervision willpracticum anuction in theind alternativ
o practicum.
pervisee relarvisor(s) namer students cen given per
ent punctualipment of ma
ed to maintain a team of os described i
is course bahe competenback on the Bent” marks (wrse. Grades
80-83% = BD-; <60.0% =
meeting thee this coursee-level expeng a letter gracticum courof the courseaddition, su
events (any awill be requir
l not be ablend/or supervr final practi
ve (make up
ationship betmed above. can continuermission for
L
MS in Appl
College of
ity, be prepaaterials) andin the highesother profesin new empl
ased on succncies for theBACB superwith no notewill be dete
B-; 76-80% == F
e competence will be facilctations of srade of B or rse are not ee to fulfill theccessful comabsences shred) and the
e to make upvision more tcum grade. ) activities s
tween the stEach semes
e in the praccontinuation
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ared for readings, ast level of sionals. loyee orienta
cessful e practicum. rvision formsed performanrmined
= C+; 73-76%
ces specifieditated with
students, better in the
eligible to site fieldwork mpletion of thould be pre CalABA an
p that than three timAbsences hould be
tudents in thster, the
cticum settingn. Should eit
67
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
and
ation.
s. nce
% =
d by
e t for
his e-nual
mes
he
g, ther
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
party notwritten nopracticumthe supeb) specifacting in for improor policiedocumenand gene(supervis
If a studeis terminaa clear dviolation)the superelationsAnalysts
Experien
Field expof compleare not redocumenperson; texperienfieldworkunless thThe maxthe table
om CSUN Purchrom CSUN Officefrom CSUN CIEL
t adhere to thotice, immedm site for onervisor (studeic incident(sthe role of a
ovement or bes, for exampnting work ateral demeansors, client fa
ent does notated in the mdescription o) will be provervisor untilhip agree toand the BA
nce Forms
perience/supetion of the seceived in hnted on the fthe supervisece weeks on
k supervisedhere is contaximum numb
below:
hasing & Contrace of Insurance & LO Documents
heir responsdiately. Stude of four reaents are exp) of unaccep
a superviseebelow acceptple but not lit the site; ina
nor; displayinamilies, colle
t complete tmiddle of a pof requiremevided by thel all requireo adhere toCB Disciplin
pervision formsupervisory ard copy priform. Forms ee maintainsnly count wh. The superv
act with the sber of superv
Se
ct Administration Risk Manageme
sibilities, thisdents may beasons: a) inaected to resptable, unproe, c) performtable performimited to: faiappropriate ong inappropreagues, teac
the requirempracticum coents to come instructor(sements are
o the BACB nary and Eth
ms must be period. The or to end of may not be
s responsibihen the supevisor is not asupervisor atvised hours c
emester M1 2 3 4 5 6
Documents ent Documents
s contract mae placed on adequate resspond to verbofessional bance feedbamance, or d)ling to compor unprofessriate behaviochers or staf
ments for a pourse, an inc
mplete that ps). The BAC
e met. BothGuidelines
ical Standar
signed by thforms will nthe week fosent over elity for havin
ervisee receiauthorized tot least one ticompleted a
Max supervis101215151820
ay be terminprobation or
sponse to subal and writtehavior at thack that con) noncompliaplete assignmsional behavors that coulff, etc.); exce
practicum cocomplete in practicum seCB verificatioh parties in for Responrds.
he supervisonot be signedollowing the smail for sign
ng forms signives at least o sign off onime that wee
as a part of th
sed hours
L
MS in Appl
College of
nated by eithr terminated
upervision, inten feedbackhe practicumsistently demance with sitments, clinicvior regardind impact othessive abse
ourse, is putthe course w
ection (if poon form will n the supernsible Cond
or within oned by the supsupervision nature and mned by the s7.5% of the field experieek (either onhis practicum
Last Revised Jun
lied Behavior ADepartm
Social and Beh
her party upo from the n the judgmek immediate
m site or whilmonstrates nte requiremecal work, or ng appearanhers nces
t on probatiowill be given
ossible, givenot be signervisor-super
duct for Beh
e week (7 dapervisor if theperiod
must be signsupervisor. Fe total hours ence hours
n site or remm are outline
68
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
on
ent of ely), le need ents
ce
on, or n, and n the ed by rvisee havior
ays) ey
ed in Field of
ote). ed in
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Experien
The supeyears of higher in semestecontact asupervisiTo obtainto providthe numb
(From BAstandardPracticumand takesupervisewithin a usupervisoperiod, sthe total 1.5 supe
No fewer
DOCUME
As part o
D D F
At the cocompile: total indivbe providpreferencthe supe
These dathe right the certifsupervisiexaminat
om CSUN Purchrom CSUN Officefrom CSUN CIEL
nce Verifica
ervisor will spracticum if practicum fo
rs for the enand relationsion experienn the superve an electrober of hours
ACB): PRAC at the BCBA
m in behavion for graduaees must couniversity prory period isupervisees mhours spentrvised hours
r than 10 ho
ENTATION OF
of this contra
Date and durDate and dur
ormat of eac
onclusion of eevaluationsvidual and gded to the suce). A gradervisor within
ata should bto request th
fication examion on the Etion.
hasing & Contrace of Insurance & LO Documents
ation Form
ign the supeeach of the or six (6) cotire 2 years
ships with thnce; and the visor’s signatnic folder wireported on
CTICUM (100A level, supeor analysis wate academicomplete, withracticum progs one week. must be sup in Practicum
s.
urs but no m
F EXPERIEN
act, each stu
ration of eacration of eacch superviso
each practic of superviseroup superv
upervisor (e.e of “Incompl one week (
e retained fohis documen
m. In additionxperience V
ct Administration Risk Manageme
ervisee’s Expfollowing consecutive seof the Mastee work site astudent comture on the Eith scans of
n the Experie
00 hours BCervisees mu
within a univec credit. To qh a passing ggram approvIn order to c
pervised at lem. For exam
more than 30
CE
udent should
h experienceh supervisorory meeting
cum course (ee performa
vision hours g., on Dropblete” will be 7 days) of th
or 7 years frontation at ann, the superv
Verification F
Documents ent Documents
perience Veonditions havemesters forer’s programand supervis
mpleted all aExperience Vall signed ex
ence Verifica
CBA, 670 houst completeersity practicqualify undegrade, 670 hved by the Bcount experieeast once du
mple, 20 hour
0 hours may
d maintain re
e activity ry meeting (i.e., individu
(i.e., 6 timesance, the totaobtained. Elbox or a flasgiven if matehe conclusio
om completiy time followvisor(s) will borm that is p
erification Fove been metr 2 years (Fa
m); the studesor until the
assignments Verification Fxperience foation Form.
ours BCaBA)e, with a passcum programer this standahours of PraBACB and taence hours wuring that pers of experie
be accrued
ecords of:
ual; group)
s over the 2 yal experienclectronic file
sh drive, deperials are no
on of the cou
ion of supervwing an indivbe required provided wit
L
MS in Appl
College of
rm at the cot: the studenall, Spring, &ent maintaine
conclusion orequired for
Form, the storms that cor
): To qualify sing grade,
m approved ard at the BCcticum in be
aken for acadwithin any g
eriod for no leence would i
per week.
years), the sce hours obtaes of these mpending on sot submitted urse.
vision. The Bvidual’s applto verify thehin the appl
Last Revised Jun
lied Behavior ADepartm
Social and Beh
onclusion of nt received a& Summer ed professioof the r the practicutudent is reqrrespond wit
under this 1000 hours by the BACBCaBA level, ehavior analydemic credit
given supervess than 7.5include at le
student shouained, and t
materials shosupervisor
electronical
BACB reservlication to ta
e applicant’s ication for
69
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
2 a B or
onal
um. uired th
of B
ysis t. A isory
5% of ast
uld he
ould
lly to
rves ke
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
I have syllabus ______________Supervis ______________Supervis ______________Supervis
om CSUN Purchrom CSUN Officefrom CSUN CIEL
read ths/contract.
_______________ see’s Name
_______________ sor’s Name
_______________ sor’s Name
hasing & Contrace of Insurance & LO Documents
e above .
__________
e
__________
e
__________
e
ct Administration Risk Manageme
and agre
_____ ___
Super
_____ ___
Super
_____ ___
Super
Documents ent Documents
ee to the
__________
rvisee’s Sig
__________
rvisor’s Sign
__________
rvisor’s Sign
e provisio
_________
gnature
_________
nature
_________
nature
L
MS in Appl
College of
ons set
__________
__________
__________
Last Revised Jun
lied Behavior ADepartm
Social and Beh
forth in
____
Date
____
Date
____
Date
70
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
this
ABA)ology es & llege
Days/Time:PlaceProfes OfficeE-mai
* Adopted fr**Adopted fr***Adopted f
CourseThe MasteNorthridgbased pracABA studexperienc(BCBA),
StudenTo complminimumfor a detai
I. UII. D
III. CIV. DV. D
imVI. D
VII. PVIII. C
IX. TX. D
an
BACB®
Individuathe supervbased traicertificati
/Time: ssor:
e Hrs: il:
om CSUN Purchrom CSUN Officefrom CSUN CIEL
e Descriptier of Science
ge (CSUN) is cticum progra
dents supervisces, under the during which
t Learningete university
m competencieiled task anal
Use the profeDevelop and Conduct behaDevelop evidDesign and Immplement a l
Design and imrogram and
Conduct ongoTrain anotherDevelop and nalysis
® Requiremls pursuing cevision registraning module on, the BACB
Syllabus
ThursdayBiweeklySH304 By appoi
hasing & Contrace of Insurance & LO Documents
ion Applied Behapproved, byam. The purpsion from CSUdirect superv
h students app
g Objectivy-based practies in their 2-yysis for each
essional and use behavio
avior measurdence-based mplement sklanguage acqmplement beprobe for ge
oing assessmr individual tpresent a tra
ments ertification atation process on BACB® ex
B® has the fol
Fi for Off-sit
y, 7-9:30pmy Group Sup
ntment
ct Administration Risk Manageme
havior Analysy Behavior Anpose of the CSUN MS-ABA
vision of a CSply the skills a
ves ica with a pas
year graduate pcompetency)
ethical guidr measuremerement methintervention
kill acquisitioquisition proehavior redueneralizationment of intervto conduct aaining modul
t the Board Cewith the BACxperience houllowing requir
irst Year Fte Option
pervision M
Documents ent Documents
is (MS-ABA)nalyst CertificSUN Univers
A faculty and SUN-Approveacquired in th
ssing grade, stprogram (see).
elines with cent methods
hods and recon plans basedon procedureogram basedction proced
n and mainteventions
a procedure le to individ
ertified BehavCB® in whichurs prior to onrements:
Fall XBEH II CSUN U
eetings; Mi
) program at cation Board sity-Based Praa variety of h
ed Board Certhe course-wor
tudents are exe the CSUN S
colleagues ans and record ord and anal
d on assessmes based on
d on VB-MAdures enance
duals who are
vior Analyst h they must tanset of experi
903; 3 unUniversity-
inimum one
L
MS in Appl
College of
California Sta(BACB®), toactica is to ofhigh quality intified Behaviork.
xpected to meStructured Sup
and clients and analyzelyze data
ment results ainitial assess
APP results)
e not familia
(BCBA) leveake an online, ience. For tho
nits -Based Pra
e site visit p
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ate University offer a unive
ffer CSUN Mn-vivo or Analyst
eet the followpervision Fold
e data
and baseline sment (e.g.,
ar with behav
el must complcompetency-
ose pursuing
actica
per semeste
71
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
y, ersity-
MS-
wing der
data
vior
lete -
er
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Aa
A T
w S
thm
S“C
Individuatake the esupervisee(note, thesto sit for t
Studen R P
Sap
A A C M P
ti D M
ac
om CSUN Purchrom CSUN Officefrom CSUN CIEL
All approved passing grad
A minimum oThe distributiweek.
tudents mushey spend in
minimum) andupervisees mCombining E
o Superor 3 ofIntens1½ timPractiFieldw
ls pursuing cexam at the ene has completse are not couthe certificatio
t ResponsRegister for 3
rint out and o Keep o Keep
recordto pro
elect a site bpproved site
o If youinternintern
Attend all groAdhere to theCommit at leaMeet weekly
rotect the timime allotted
Document theMaintain docctivities
hasing & Contrace of Insurance & LO Documents
university ede. of 1,000 houion of hours
st be supervin University Pd supervisormay accrue eExperience C
rvisees may eof the categosive Practicumes the tempicum havingwork.
ertification atnd of the first ted 670 hoursurse requiremon exams).
ibility 3 units of XBdevelop the copies of sigrecords of a
ds for 7-yearovide the sigby applying aes u are employnship site, plenship applicaoup meetinge course syllaast one year with field su
me and spac
e activities oumentation
ct Administration Risk Manageme
experience m
urs of supervmust be no
sed at least wPracticum. Try period is oexperience inCategories” elect to accrries above (Sum) to meet tporal value og 2 times the
t the Board Ceyear of the gr
s of supervisements, but the
BEH-903 eacCSUN Supe
gned superviall experiencers. If you or gned copiesand interview
yed and wishease discuss ation. s prepared foabus and “Mto the appro
upervisor fore for superv
of the practicfor all indivi
Documents ent Documents
must be comp
vised experiefewer than 1
weekly for 1Total supervone week. n only one cin the followue hours in a
(Supervised Ithe experienof Supervisedtemporal va
ertified Assisraduate progr
ed experience BACB® requ
ch semesterervision foldision forms ie hours accryour super. wing for inte
h to obtain inthe requirem
for group supMS-ABA Inteoved clinicalr supervisionision by kee
cum as relateidual and gro
pleted for gr
ence in behav10 hrs but no
10% (7.5% mvision must b
category at a wing way: a single cateIndependentnce requiremd Independealue of Super
stant Behaviorram. The BACwith all othe
uirement for
der in the folder
rued. BACB®
rvisor is aud
ernship posi
nternship at yments with th
pervision ernship Studl site n meetings
eping to agre
ed to the praoup practicu
L
MS in Appl
College of
raduate acad
vior analysiso more than
minimum) ofbe at least 10
time. The B
egory or mayt Fieldwork,
ment, with Prent Fieldworrvised Indep
r Analyst (BCCB® requireser requiremensupervisees to
r ® asks that y
dited, you w
itions with un
your CSUN he contact p
dent Agreem
eed appointm
acticum goalum supervisi
Last Revised Jun
lied Behavior ADepartm
Social and Beh
emic credit w
s. 30 hours per
f the total ho00 hours (75
BACB® defi
y combine aPracticum,
racticum havrk, and Intenpendent
CaBA) level cs that the ts stated abovo become elig
you keep thewill be expec
niversity
approved erson on the
ment”
ments and the
s and objection hours an
72
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
with
r
ours 5
fines
any 2
ving sive
can
ve gible
se cted
e site
e
tives d
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Nm
P S N
ch C A
BACB®
Infowprqu
A
Practic T
resure
T
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Notify practicmay result in
rovide the suubmit, to the
Notify the prahanges at the
Comply with Adhere to BA
® Guidelinnformation round in the C
which is in-perofessional, uality servic
According to Develo Provid
that so Observ
feedba Use B Model Guide
develo Review Monito Condu
um InstruThe purpose oepertoires ofupervision meceives in a o
The practicumo Execu Develo Use B Model Guide
develo Review
provid Meet w
hasing & Contrace of Insurance & LO Documents
ca instructorreschedulin
upervisor coe CSUN praactica instruce clinical sitall requirem
ACB® guide
nes for Fielregarding theCSUN Practerson, onsiteand ethical r
ces to his/her
BACB®, effop performande supervisee ome competenve the supervack ehavior Skillsl technical, prand give feed
opment, and dw data and wror and evalua
uct weekly ev
uctor Respof practicumf the supervimay count foone week pe
m instructor ute a written op performanehavior Skillsl technical, prand give feed
opment, and dw data and wrde specific feewith field sup
ct Administration Risk Manageme
r, at the earlig a meeting
ompleted supactica supervctor and the e that may im
ments of the alines with re
ld Superve role and reica Handbooe observationrepertoires or clients.
ffective behance goals with
with opportunces will not bisee in the fie
s Training to rofessional, andback on behdecision-makiritten materia
ate the effectsaluation of su
ponsibilitym is to impro
see, and monor no more theriod.
will: contract pri
nce goals withs Training to rofessional, andback on behdecision-makiritten materiaedback pervisors to co
Documents ent Documents
est possible
pervision forvisor, monthl
CSUN Pracmpact superapproved cliegards to exp
visors sponsibilitieok. The purpn) is to improf the superv
avior-analytich supervisee unities to perfobe met). eld and use pe
teach and impnd ethical behavioral case cing repertoireals (e.g., behav of behaviora
upervisee’s pe
y ove behavior nitor supervihan half of th
or to on-set h superviseesteach and impnd ethical behavioral case cing repertoireals (e.g., behav
onduct month
time, of any
rms after eacly evaluationctica Adminirvised experiinical site perience hou
es of approvepose of field rove and maivisee, and fac
c supervision
form listed com
erformance fe
prove supervhavior conceptualizaes vior program
al service delierformance an
r analytic, prisee’s perforhe total supe
of experienc prove supervhavior conceptualizaes in group setvior program
hly evaluation
L
MS in Appl
College of
y changes to
ch supervisions from the sistrative Cooience
urs
ed site supersupervision
intain the becilitate the d
n should inc
mpetences (N
eedback to giv
isee’s skills
ation, problem
ms, data sheetsivery nd effects of
rofessional, armance in thervised hours
ce (that is th
isees’ skills in
ation, problemtting
ms, data sheets
n of supervise
Last Revised Jun
lied Behavior ADepartm
Social and Beh
schedule tha
on meeting site-supervisordinator of a
rvisors can bn (the majoritehavior analydelivery of h
clude:
Note* it is like
ve corrective
m-solving, pro
s, reports)
supervision
and ethical he field. Gros each super
is syllabus)
n group settin
m-solving, pro
s, reports) and
ee’s experienc
73
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
at
sor any
be ty of ytic, igh-
ely
ogram
oup rvisee
ng
ogram
d
ce,
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Req
Cour
The class contain anhelpful re
Clas
The followor email f
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
om CSUN Purchrom CSUN Officefrom CSUN CIEL
performOption
Observ Provid Protec
the tim Notify
may r
quired Tex
Bailey, J. SRoutledgeBailey, J. SBehavior ARoutledgeCooper, J.OUpper Sad
rse Websi
web site can nnouncementsources. You
s Meeting
wing is a schefrom the CSU
, September 3
, September 1
, October 1st
, October 15th
, October 29th
, November 1
, November 2
, December 1
hasing & Contrace of Insurance & LO Documents
mance, and en II Practica) ve superviseede specific feect the time anme allotted. y superviseeesult in resc
xts:
S., & Burch, M. S., & Burch, MAnalyst: Expe. O., Heron, T.
ddle River, NJ
te:
be found whes, links, hand
u will be expec
g Times:
edule of meetUN Practica In
3rd
17th
h
h
12th
26th – off for T
0th
ct Administration Risk Manageme
ffects of supe
e in-field a miedback to supnd space for
, at the earliheduling a m
M. R. (2011)
M. R. (2009)ert Tips for M
E., & HewardJ: Pearson Pre
en you log intd-outs, researccted to check
tings for the snstructor.
Thanksgiving
Documents ent Documents
ervision (this
inimum of onpervisee on per supervision
est possible meeting.
. Ethics for B
. 25 EssentialMaximizing Co
d, W.L . (200entice Hall.
to Moodle (hch informationk the board for
semester, any
g
only applies t
nce each semeerformance inn, by keeping
time, of any
Behavior Analy
l Skills and Stonsulting Effe
07). Applied B
http://moodlen, readings anr announceme
changes will
L
MS in Appl
College of
to CSUN app
ester n group supervg to agreed a
y changes to
lysts (2nd Ed.).
trategies for tectiveness. Ne
Behavior Ana
e.csun.edu). Tnd a discussioents daily.
l be communi
Last Revised Jun
lied Behavior ADepartm
Social and Beh
proved superv
vision appointment
schedule tha
. New York:
the Professionew York: NY
lysis (2nd Ed
This site will on board, and
icated via mo
74
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
visors,
ts and
at
NY,
nal ,
d.).
d
odle
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Students arequired f
Wednesda
Com
Eteis
Ycob
S
G
om CSUN Purchrom CSUN Officefrom CSUN CIEL
are required tfor the semest
ay, October 4
If you havPractica Ilearning o
position o
Each student’ermination os not upholdi
Your grade iompetenciey your site-
upervised EEach (see thaboveto meeevent duringrequeshttp://conditof theCharg
Group Partico This i
sciencintereengaga partiby atteMissibeing
hasing & Contrace of Insurance & LO Documents
o attend specter:
4th – ABA Spe
ve a valid exnstructor an
opportunity.
of Course G
’s performanof the superving their resp
in XBEH 90s, group att
-supervisor:
Experience Csemester youhe Selected Ce the assigneet the designthat there is
g the semestst for a grade/www.csun.etions by whi Incomplete
ged (“IC”), w
cipation ands a graduate
ce and practisting group
ge in discussiicular groupending a grong two or m
g limited to a
ct Administration Risk Manageme
ific CSUN M
eaker Series 4
xcuse for misd complete a
Grade
nce will be reision relationponsibilities
03 will be batendance an:
Competencu will work Competencid competencnated compe a reasonabler (e.g., site e of Incompedu/anr/soc/gich the compcontract bef
which is equi
d attendanc course on aice. To gain dynamic, yoions. If you meeting, yo
oup meeting more group a maximum
Documents ent Documents
MS-ABA Spon
4-5:15pm in W
ssing the evean alternativ
eviewed at thnship by the
s in the pract
ased on yound participa
ies ( 40% ofon specific ces below). Ycies to obtain
etencies will e excuse forsupervisor tlete (“I”) byguides/incompetencies wilfore the deadivalent to an
ce (25% of yapplication othe most fro
ou are requirmiss a group
ou are requirheld by onemeetings fo
m of “C“.
nsored Events
Whitsett Room
ent, you mayve assignmen
he end of eae supervisor(ticum setting
ur completioation, and pr
f your gradcompetencie
You are expen a passing gresult in a g
r not meetingturnover), thy completingmplete.htmlll be met. Fadline will resn “F”.
your grade)of principles om the practired to attend p meeting, ored to make-e of the otheror any reaso
L
MS in Appl
College of
s. The follow
m
y send an emnt to make up
ach semester(s) is possiblg.
on of the desrofessionali
de) es in the Supected to comgrade in XB
grade of C- og certain com
he student mag an Incompand specifyi
ailure to comsult in a grad
) of applied bica, and to crgroup meeti
or arrive later-up the misser Practica suon will resul
Last Revised Jun
lied Behavior ADepartm
Social and Beh
wing dates are
mail to your p for the mis
r at which pole if a superv
signated ism as repor
pervision foldmplete 80% o
EH 903. Faior below. In tmpetencies ay initiate a
plete Contracing the term
mplete the terde of Incomp
behavior anareate a rich aings on timer than 30 mied group me
upervisors. lt in your gr
75
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
e
ssed
oint visee
rted
der or ilure the
ct ms and
rms plete
lysis, and e and in for eeting
rade
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
P
P
Table 1:
No msatisfformsNo msatisfformsNo mOnly superNo mone usuperTwo osuper
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Professional o You a
Supertop pothe suconduperforUnsatdetermsigned
Professional o Your
are reqwhen FormThe evprofesappeaprofesrelatio
Relationship
Suore than one
factory overals for given semore than two
factory overals for given semore than two one unsatisfarvision forms ore than 3 NI
unsatisfactoryrvision forms or more Unsarvision forms
hasing & Contrace of Insurance & LO Documents
and ethicalare expected rvision form ortion of the upervisory peucted during rmance in patisfactory (Umine this pord by your pra
and ethicalsite supervisquired to preasked, durin
m”). You willvaluation is ssional and earance, attendssional relationship betwe
p between y
Monthlupervisor ENI working tol performancemester NI working tol performancemester NI working to
actory overall for given semI working toway overall perfofor given sem
atisfactory oveduring a sem
ct Administration Risk Manageme
l behavior ato provide yat the end oform (includ
eriod, and chthe period. O
articular areaU), or Not Ap
rtion of youractica instru
l behavior asor will evaluesent the weng group mel also submitconducted n
ethical behavdance, askinionships witheen weekly s
our performa
y Site Evaluationsowards compe on all month
owards compee on all month
owards compeperformance
mester ards compete
ormance on amester erall performa
mester
Documents ent Documents
at practica myour practicaf each practiding the dateheck mark thOn the formas was Satisfpplicable (NAr grade based
uctor.
at practicumuate your peekly evaluatetings (See “t monthly ev
not only on yvior. Some o
ng for and rech clients andsite evaluatio
ance evalua
s etences and hly supervisio
etences and hly supervisio
etences and on all month
ences and onll monthly
ance on mont
meetings (15a instructor wica meeting.e and duratiohe characteri
m, the instructfactory (S), NA). Table 1, d on the Exp
m sites (20 %erformance otions to the C“BACB® Exvaluations toyour skill acqof the skills eceiving suped colleaguesons and mar
ation and cou
Ma
on
on
hly
ly
thly
L
MS in Appl
College of
5% of your with a BACB. You shouldon of the groistics of supetor will noteNeeds Impro below, will
perience Sup
% of your gron a weekly CSUN practixperience So CSUN pracquisition butevaluated incervision and . The table b
rks for in-fie
urse grade
ark for ProfeEthical B
100
90
80
70
Fa
Last Revised Jun
lied Behavior ADepartm
Social and Beh
grade) B® Experiend complete thoup superviservision e if your ovement (NIbe used to
pervision for
rade) basis and yoica instructoupervision ctica instructt also your clude feedback, an
below showsld work.
essional anBehavior 0 %
%
%
%
ail
76
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
nce he sion),
I),
rms
ou or,
tor.
nd s the
nd
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Grade BrAs noted profession84-86 % i
AcadYou MAown worexpectedstandardsfor the unresult in Academi
StudeIf you haEducatiooffice is office is 2611. If yset up an
om CSUN Purchrom CSUN Officefrom CSUN CIEL
reakdown above, your cnal behavior. is B) will be u
demic InteAY NOT plag
k (this applid to adhere tos will be hanniversity polacademic saic Affairs Of
ents with Dave a disabilinal Serviceslocated in Blocated on Byou would li
n appointmen
hasing & Contrace of Insurance & LO Documents
course grade wA plus-minus
used with cou
Percent Ran93-100%90-92% 87-89% 84-86% 80-83% 77-79% 74-76% 70-73%
69%
grity giarize; meanes to work o
o the Univerndled in accolicy on acadeanctions, sucffice or the D
Disabilitieity and need s (DRES) offayramian Ha
Bertrand Streike to discusnt.
ct Administration Risk Manageme
will be based s grading syst
urse grades.
nge %
ning presentof peers as wsity’s Acadeord with the emic dishonh as a failing
Dean.
es accommoda
fice or the Nall, room 11eet in Jeanness your need
Documents ent Documents
on your cumtem (e.g., 93-
t ideas, opiniwell as expertemic DishonUniversity’sesty). Failurg grade in th
ations, pleasNational Cent
0 and can bee Chisholm H
for accomm
mulative score -100 % is A, 9
Letter GrA A- B+ B B- C+ C C- F
ions, or the wts and resear
nesty standars policies (sere to complyhe course and
se register witer on Deafne reached at Hall and can
modations wi
L
MS in Appl
College of
on participat90-92 % is A
rade
writing of otrchers). All srds, and violaee the curren
y with these sd a referral t
ith Disabilityness (NCOD(818) 677-2
n be reached ith me, pleas
Last Revised Jun
lied Behavior ADepartm
Social and Beh
tion and A -, 87-89 % is
thers as yourstudents are ations of thent CSUN catstandards wito the Studen
y ResourcesD). The DRE2684. The NCat (818) 677
se contact m
77
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
s B+,
r
ese talog ill nt
s and ES COD 7-
me to
ABA)ology es & llege
Selec
I. Use
II. F
III. D
* Adopted fr**Adopted fr***Adopted f
cted Compete
e the profess
Demonstrate
Demonstrate
Demonstrate
Dev App Bail
FoundationGive examp
FK-Develop and
Sele
Use
Asse
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ences for the
sional and eth
e knowledge
e knowledge
e professiona
velop resume ply and securely & Burch, 2nal Knowleples of and exp
-01 to FK-46 d use behavi
ect & define tar
various direct o A-01 Meao A-02 Meao A-03 Meao A-04 Meao A-05 Meao A-06 Meao A-07 Meao A-12 Des
recordingo A-13 Des
whole into H-01 Sele
of the beho H-02 Seleo H-05 Eva
sessions, o FK-47 Ide
inter-respo FK-48 Sta
procedurerecording
ess quality of bo A-08 Asso A-09 Eva
hasing & Contrace of Insurance & LO Documents
Fall semeste
hical guidelin
of ethical, res
of HIPPA an
al conduct
and letter of e internship p2010 edge plain philosop
ior measure
rget behavior f
observation masure frequencasure rate (i.e.,asure duration.asure latency. asure interrespasure percent oasure trials to csign and implemg). sign and implemterval, momentect a measuremhavior and the ect a schedule aluate temporaltime series). entify the meas
ponse time). ate the advantaes and discontig, momentary tibehavioral mea
sess and interpraluate the accur
ct Administration Risk Manageme
er – 1st year
nes with colle
sponsible, pro
d Confidentia
intent by end positions no la
phical assump
ement meth
for change
methods to colley (i.e., count)., count per unit.
onse time (IRTof occurrence.criterion. ment continuou
ment discontintary time sampment system to logistics of obsof observationl relations betw
surable dimens
ages and disadvnuous measureime sampling)asurement (Acret interobserveracy and reliab
Documents ent Documents
eagues and c
ofessional and
ality rules
of Septembeater than end
ptions of beh
hods, record
ect baseline dat
t time).
T).
us measuremen
nuous measuremling). obtain represeserving and recand recording
ween observed
sions of behavi
vantages of usiement procedu.
ccuracy & Relier agreement.
bility of measur
clients
d disciplinary
er of October
havior analysi
d and analyz
ta
nt procedures (
ment procedure
entative data gicording.
g periods. variables (with
ior (e.g., rate, d
ing continuousures (e.g., partia
ability)
rement procedu
L
MS in Appl
College of
y guidelines
s and concept
ze data
(e.g., event
es (e.g., partial
iven the dimen
hin & between
duration, latenc
s measurement al- and whole-i
ures.
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ts
M
l &
sions
n
cy,
t interval
78
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
Ethics & Professionalism
1
2
2.1
3
Behavior Measurement
4
5
6
ABA)ology es & llege
m
IX. C
* Adopted fr**Adopted fr***Adopted f
If you, thebe signed your Prac
The hoursthe superv
O M A
Tofho
The respoGuidelineStandards All partieI have car
________Practica In________Practica S
Grap
Conduct ongo
Eva
Com
om CSUN Purchrom CSUN Officefrom CSUN CIEL
e practica studwithin 2 weetica Instructo
s included on visee:
Obtained a graMet 80% or mAND either of
o All expo The su
instrucfaculty
The following ff on a supervours were trac
Superv Egregi
Analysmemb
Supervto the
onsibilities dees for Responss.
s agree to therefully review
____________nstructor Sign
____________Student Signa
ph & analyze go A-10 Deso A-11 Deso A-14 Deso H-03 Seleo H-04 Eva
oing assessm
aluate effectivo K-01 Provo K-07 Eva
mpare effectiv
hasing & Contrace of Insurance & LO Documents
dent, meet theeks of the semor.
the BACB® E
ade of C or higmore of all supf the followingperience hour
upervisor-supctor recommey member’s sucircumstance
visee’s accruecked through visee does noious violationsts and/or behers visor-supervisinternship agr
scribed in thisible Conduct
e stipulations hwed this syllab
___________nature ___________ture
gathered informsign, plot, and isign, plot, and isign, implemenect a data displaluate changes ent of interv
veness of intervide for ongoin
aluate the effecveness of diff
ct Administration Risk Manageme
e requirementmester ending
Experience V
gher pervised experg occur: rs were compervisee relatio
ends that the supervision) es would justied hours on th
Individual Sut receive a pa
n of the BACBhavior that jeo
see relationshreement or po
s document wt for Behavior
herein: bus and agree
___ _______ Date
_ _______Date
mation interpret data uinterpret data u
nt and graph chlay that effectivin level, trend,
ventions
rventions ng documentat
ctiveness of theferent treatme
Documents ent Documents
ts listed belowunless otherw
Verification Fo
rience compe
pleted satisfaconship was tesupervisee acc
ify a practica he Experienceupervision Do
assing grade inB® Guidelinesopardizes the
hip is terminatolicies of the
will be carriedr Analysts an
e to the items
_________
_________
using equal-intusing a cumulahoice measuresvely communic, and variability
tion of behavioe behavioral proents
w, your Expewise explicitly
orm are ONL
etencies
ctorily erminated undcrue experien
instructor (ore Verificationocumentationn XBEH 903s for Responswell-being o
ted as a resultinternship/cli
d out in accord Professiona
listed.
terval graphs. ative record to s. cates relevant qy.
oral services. ogram.
L
MS in Appl
College of
rience Verificy specified be
LY those for s
der positive cnce hours und
r supervisor) n Form (i.e., en Form). sible Conduct
of clients or ot
t of the superinical site.
rdance with thal Disciplinar
display data.
quantitative re
Last Revised Jun
lied Behavior ADepartm
Social and Beh
cation Form wetween you a
semesters in w
onditions (e.gder a different
refusing to seven though th
t for Behaviother team
rvisee not adh
he BACB® ry and Ethica
lations.
A
79
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
will nd
which
g., the t
sign he
r
hering
al
7
Ongoing Assessment
20
21
ABA)ology es & llege
Days/FormaPlaceProfes OfficeE-mai
* Adopted fr**Adopted fr***Adopted f
Course
The MasteUniversitya universiCSUN Mexperienc(BCBA),
Studen
To complminimumfor a detai
XI. UXII. D
XIII. CXIV. DXV. D
imXVI. D
XVII. PXVIII. C
XIX. TXX. D
an
BACB®
Individuathe supervbased traicertificati
/Times: at: ssor:
e Hrs: il:
om CSUN Purchrom CSUN Officefrom CSUN CIEL
e Descripti
er of Science y, Northridgeity-based pracS-ABA stude
ces, under the during which
t Learning
ete universitym competencie
iled task anal
Use the profeDevelop and Conduct behaDevelop evidDesign and Immplement a l
Design and imrogram and
Conduct ongoTrain anotherDevelop and nalysis
® Requirem
ls pursuing cevision registraning module on, the BACB
Syllabus
ThursdayBiweeklySH320 By appoi
hasing & Contrace of Insurance & LO Documents
ion
in Applied Be (CSUN) is acticum prograents supervisio
direct supervh students app
g Objectiv
y-based practies in their 2-yysis for each
essional and use behavio
avior measurdence-based mplement sklanguage acqmplement beprobe for ge
oing assessmr individual tpresent a tra
ments
ertification atation process on BACB® ex
B® has the fol
Firstfor Off-sit
y 7-9:30pm y Group Sup
ntment
ct Administration Risk Manageme
Behavior Analapproved, by Bam. The purpon from CSU
vision of a CSply the skills a
ves
ica with a pasyear graduate p
competency)
ethical guidr measuremerement methintervention
kill acquisitioquisition proehavior redueneralizationment of intervto conduct aaining modul
t the Board Cewith the BACxperience houllowing requir
t Year Fale Option I
pervision m
Documents ent Documents
lysis (ABA) gBehavior Ana
pose of the CSUN MS-ABASUN-Approveacquired in th
ssing grade, stprogram (see).
elines with cent methods
hods and recon plans basedon procedureogram basedction proced
n and mainteventions
a procedure le to individ
ertified BehavCB® in whichurs prior to onrements:
ll XBEH 90III CSUN U
meetings; Ind
graduate progalyst CertificaSUN Universifaculty and a
ed Board Certhe course-wor
tudents are exe the CSUN S
colleagues ans and record ord and anal
d on assessmes based on
d on VB-MAdures enance
duals who are
vior Analyst h they must tanset of experi
03; 3 unitsUniversity-
dividual Su
L
MS in Appl
College of
gram at Califoation Board (Bity-Based Pra
a variety of hitified Behaviork.
xpected to meStructured Sup
and clients and analyzelyze data
ment results ainitial assess
APP results)
e not familia
(BCBA) leveake an online, ience. For tho
s -Based Pra
upervision o
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ornia State BACB®), to oactica is to offgh quality in-or Analyst
eet the followpervision Fold
e data
and baseline sment (e.g.,
ar with behav
el must complcompetency-
ose pursuing
actica
once per Se
80
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
offer ffer -vivo
wing der
data
vior
lete -
emester
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Aa
A T
w S
spsu
S“C
Individuatake the esupervisee(note, thesto sit for t Studen R P
S
P A C M P
ti A E D M
ac
om CSUN Purchrom CSUN Officefrom CSUN CIEL
All approved passing grad
A minimum oThe distributiweek.
tudents muspend in Univupervisory pupervisees mCombining E
o Superor 3 ofIntens1½ timPractiFieldw
ls pursuing cexam at the ene has completse are not couthe certificatio
t ResponsRegister for 3
rint out and o Keep o Keep
recordto pro
eek and securo If you
internintern
rovide a copAdhere to theCommit at leaMeet bi-week
rotect the timime allotted
Attend all groEngage with PDocument theMaintain docctivities
hasing & Contrace of Insurance & LO Documents
university ede. of 1,500 houion of hours
st be superviversity Practperiod is twomay accrue eExperience C
rvisees may eof the categosive Practicumes the tempicum havingwork.
ertification atnd of the first ted 670 hoursurse requiremon exams).
ibility 3 units of XBdevelop the copies of sigrecords of a
ds for 7-yearovide the sigre a qualified
u are employnship site, plenship applicapy of your sie course syllaast one year kly with fieldme and spac
oup meetingPractica Supe activities oumentation
ct Administration Risk Manageme
experience m
urs of supervmust be no
sed at least oticum. Total o weeks. experience inCategories” elect to accrries above (Sum) to meet tporal value og 2 times the
t the Board Ceyear of the gr
s of supervisements, but the
BEH-903 eacCSUN Supe
gned superviall experiencers. If you or gned copiessite‐supervis
yed and wishease discuss ation. gned supervabus and “Mto the appro
d supervisor e for superv
s prepared fopervisor onceof the practicfor all indivi
Documents ent Documents
must be comp
vised experiefewer than 1
once every tsupervision
n only one cin the followue hours in a
(Supervised Ithe experienof Supervisedtemporal va
ertified Assisraduate progr
ed experience BACB® requ
ch semesterervision foldision forms ie hours accryour super.
sor at a univerh to obtain in
the requirem
vision contraMS-ABA Inteoved clinical
for supervisision by kee
for group supe during semcum as relateidual and gro
pleted for gr
ence in behav10 hrs but no
two weeks fon must be at l
category at a wing way: a single cateIndependentnce requiremd Independealue of Super
stant Behaviorram. The BACwith all othe
uirement for
der in the folder
rued. BACB®
rvisor is aud
rsity approvednternship at yments with th
act to CSUN ernship Studl site sion meetingeping to agre
pervision mester for inded to the praoup practicu
L
MS in Appl
College of
raduate acad
vior analysiso more than
or 5% of theleast 75 hou
time. The B
egory or mayt Fieldwork,
ment, with Prent Fieldworrvised Indep
r Analyst (BCCB® requireser requiremensupervisees to
r ® asks that y
dited, you w
d site (see wwyour CSUN he contact p
supervisor dent Agreem
gs eed appointm
dividual supacticum goalum supervisi
Last Revised Jun
lied Behavior ADepartm
Social and Beh
emic credit w
s. 30 hours per
e total hours urs and
BACB® defi
y combine aPracticum,
racticum havrk, and Intenpendent
CaBA) level cs that the ts stated abovo become elig
you keep thewill be expec
ww.bacb.comapproved erson on the
ment”
ments and the
pervision s and objection hours an
81
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
with
r
they
fines
any 2
ving sive
can
ve gible
se cted
m).
e site
e
tives d
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Nm
P N
ch C A
BACB®
InCpprqu
A
Practic T
refeth
T
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Notify practicmay result in
rovide the suNotify the prahanges at the
Comply with Adhere to BA
® Guidelinnformation r
CSUN Practicerson, onsiterofessional, uality servic
According to Develo Provid
that so Observ
feedba Use B Model Guide
develo Review Monito Condu
um InstruThe purpose oepertoires ofeedback provhe total supe
The practicumo Execu Develo Use B Model Guide
develo Review
provid Provid Provid
hasing & Contrace of Insurance & LO Documents
ca instructorreschedulin
upervisor coactica instruce clinical sitall requirem
ACB® guide
nes for Fielregarding theca Handbooke observationand ethical r
ces to his/her
BACB®, effop performande supervisee ome competenve the supervack ehavior Skillsl technical, prand give feed
opment, and dw data and wror and evalua
uct bi-weekly
uctor Respof practicumf the supervivided to suprvised hours
m instructor ute a written op performanehavior Skillsl technical, prand give feed
opment, and dw data and wrde specific feede supervisee de specific fee
ct Administration Risk Manageme
r, at the earlig a meeting
ompleted supctor and the e that may im
ments of the alines with re
ld Superve role and rek. The purpon) is to imprrepertoires or clients.
ffective behance goals with
with opportunces will not bisee in the fie
s Training to rofessional, andback on behdecision-makiritten materia
ate the effectsevaluation of
ponsibilitym is to impro
see, and monervisee. Gros each superv
will: contract pri
nce goals withs Training to rofessional, andback on behdecision-makiritten materiaedback with individu
edback to sup
Documents ent Documents
est possible
pervision forCSUN Pracmpact superapproved cliegards to exp
visors sponsibilitieose of field srove and maiof the superv
avior-analytich supervisee unities to perfobe met). eld and use pe
teach and impnd ethical behavioral case cing repertoireals (e.g., behav of behavioraf supervisee’s
y ove behavior nitor supervioup supervisvisee receive
or to on-set h superviseesteach and impnd ethical behavioral case cing repertoireals (e.g., behav
ual supervisiopervisee on pe
time, of any
rms after eacctica Adminirvised experiinical site perience hou
es of site supsupervision (intain the bevisee, and fac
c supervision
form listed com
erformance fe
prove supervhavior conceptualizaes vior program
al service delis performance
r analytic, prisee’s perforsion may coues in a one w
of experienc prove supervhavior conceptualizaes in group setvior program
on a minimumerformance in
L
MS in Appl
College of
y changes to
ch supervisioistrative Cooience
urs
pervisors can(the majority
ehavior analycilitate the d
n should inc
mpetences (N
eedback to giv
isee’s skills
ation, problem
ms, data sheetsivery e and effects
rofessional, armance in thunt for no m
week period.
ce (that is th
isees’ skills in
ation, problemtting
ms, data sheets
m of once eachn group superv
Last Revised Jun
lied Behavior ADepartm
Social and Beh
schedule tha
on meeting ordinator of a
n be found iny of which isytic, delivery of h
clude:
Note* it is like
ve corrective
m-solving, pro
s, reports)
of supervisio
and ethical he field based
more than hal
is syllabus)
n group settin
m-solving, pro
s, reports) and
h semester vision
82
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
at
any
n the s in-
igh-
ely
ogram
n
d on lf of
ng
ogram
d
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Requ
Cour
The class contain anhelpful re
Clas
The followor email f
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Protecthe tim
Notifymay r
uired Text
Bailey, J. SRoutledgeBailey, J. SBehavior ARoutledgeCooper, J.OUpper Sad
rse Websi
web site can nnouncementsources. You
s Meeting
wing is a schefrom the CSU
, September 3
, September 1
, October 1st
, October 15th
, October 29th
, November 1
, November 2
, December 1
hasing & Contrace of Insurance & LO Documents
ct the time anme allotted. y superviseeesult in resc
ts:
S., & Burch, M. S., & Burch, MAnalyst: Expe. O., Heron, T.
ddle River, NJ
te:
be found whes, links, hand
u will be expec
g Times:
edule of meetUN Practica In
3rd
17th
h
h
12th
26th – off for T
0th
ct Administration Risk Manageme
nd space for
, at the earliheduling a m
M. R. (2011)
M. R. (2009)ert Tips for M
E., & HewardJ: Pearson Pre
en you log intd-outs, researccted to check
tings for the snstructor.
Thanksgiving
Documents ent Documents
r supervision
est possible meeting.
. Ethics for B
. 25 EssentialMaximizing Co
d, W.L . (200entice Hall.
to Moodle (hch informationk the board for
semester, any
g
n, by keeping
time, of any
Behavior Analy
l Skills and Stonsulting Effe
07). Applied B
http://moodlen, readings anr announceme
changes will
L
MS in Appl
College of
g to agreed a
y changes to
lysts (2nd ed.).
trategies for tectiveness. Ne
Behavior Ana
e.csun.edu). Tnd a discussioents daily.
l be communi
Last Revised Jun
lied Behavior ADepartm
Social and Beh
appointment
schedule tha
New York:
the Professionew York: NY
lysis (2nd ed.
This site will on board, and
icated via Mo
83
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
ts and
at
NY,
nal ,
.).
d
oodle
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Students arequired f
Wednesda
Individua T
P Y
Thursday,
Thursday,
Thursday,
Thursday,
Thursday,
Com
Eteis
Ycob
S
om CSUN Purchrom CSUN Officefrom CSUN CIEL
are required tfor the semest
ay, October 4
If you havPractica Ilearning o
al supervisioThis is a mini
ractica supeYour instruct
, September 1
, October 15th
, October 29th
, November 1
, December 1
position o
Each student’ermination os not upholdi
Your grade iompetenciey your site-
upervised EEach (see thaboveto meeevent duringfor a ghttp://conditof theCharg
hasing & Contrace of Insurance & LO Documents
o attend specter:
4th – ABA Spe
ve a valid exnstructor an
opportunity.
on with CSUimum requirrvisor, you mor will provi
17th 6-7pm
h 6-7pm
h 6-7pm
12th 6-7pm
0th 6-7pm
of Course G
’s performanof the superving their resp
in XBEH 90s, group att
-supervisor:
Experience Csemester youhe Selected Ce the assigneet the designthat there is
g the semestgrade of Inco/www.csun.etions by whi Incomplete
ged (“IC”), w
ct Administration Risk Manageme
ific CSUN M
eaker Series 4
xcuse for misd complete a
UN Practica Irement, if yomay contact ide informat
Grade
nce will be reision relationponsibilities
03 will be batendance an:
Competencu will work Competencid competencnated compe a reasonabler (e.g., supeomplete (“I”edu/anr/soc/gich the compcontract bef
which is equi
Documents ent Documents
MS-ABA Spon
4-5:15pm in W
ssing the evean alternativ
Instructor ou would like
them and setion on how
eviewed at thnship by the
s in the pract
ased on yound participa
ies (20% of on specific ces below). Ycies to obtain
etencies will e excuse forervisor turno”) by compleguides/incompetencies wilfore the deadivalent to an
nsored Events
Whitsett Room
ent, you mayve assignmen
e additional et additional these timesl
he end of eae supervisor(ticum setting
ur completioation, and pr
f your gradecompetencie
You are expen a passing gresult in a g
r not meetingover), the stueting an Incomplete.htmlll be met. Fadline will resn “F”.
L
MS in Appl
College of
s. The follow
m
y send an emnt to make up
time with yoappointmen
lots will be a
ach semester(s) is possiblg.
on of the desrofessionali
e) es in the Supected to comgrade in XB
grade of C- og certain comudent may inomplete Conand specifyi
ailure to comsult in a grad
Last Revised Jun
lied Behavior ADepartm
Social and Beh
wing dates are
mail to your p for the mis
our CSUN nt times. assigned.
r at which pole if a superv
signated ism as repor
pervision foldmplete 80% o
EH 903. Faior below. In tmpetencies nitiate a requntract ing the term
mplete the terde of Incomp
84
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
e
ssed
oint visee
rted
der or ilure the
uest
ms and rms plete
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
G
P
P
T
No msatisfformsNo msatisfformsNo mOnly superNo m
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Group Partico This i
sciencintereengaga partiby atteMissibeing
Professional o You a
Supertop pothe suconduperforUnsatdetermsigned
Professional o Your
are reqwhen Formsemesis conethicaaskingwith cweekl
Table 1: RelaSu
ore than one factory overals for given semore than two
factory overals for given semore than two one unsatisfarvision forms ore than 3 NI
hasing & Contrace of Insurance & LO Documents
cipation ands a graduate
ce and practisting group
ge in discussiicular groupending a grong two or m
g limited to a
and ethicalare expected rvision form ortion of the upervisory peucted during rmance in patisfactory (Umine this pord by your pra
and ethicalsite supervisquired to preasked, durin
m”). You willster confirminducted not oal behavior. Sg for and recclients and coly site evalua
ationship betupervision
EvaluatioNI working tol performancemester NI working tol performancemester NI working to
actory overall for given semI working towa
ct Administration Risk Manageme
d attendanc course on aice. To gain dynamic, yoions. If you meeting, yo
oup meeting more group a maximum
l behavior ato provide yat the end oform (includ
eriod, and chthe period. O
articular areaU), or Not Ap
rtion of youractica instru
l behavior asor will evaluesent the bi-wng group mel also submiting you are ronly on yourSome of the ceiving superolleagues. Tations and m
tween your pExperiencen Forms owards compe on all month
owards compee on all month
owards compeperformance
mester ards compete
Documents ent Documents
ce (50% of yapplication othe most fro
ou are requirmiss a group
ou are requirheld by onemeetings fo
m of “C“.
at practica myour practicaf each practiding the dateheck mark thOn the formas was Satisfpplicable (NAr grade based
uctor.
at practicumuate your peweekly evaluetings (See “t a form (proreceiving supr skill acquisskills evaluarvision and f
The table belomarks for in-f
performancee
etences and hly supervisio
etences and hly supervisio
etences and on all month
ences and on
your grade)of principles om the practired to attend p meeting, ored to make-e of the otheror any reaso
meetings (15a instructor wica meeting.e and duratiohe characteri
m, the instructfactory (S), NA). Table 1, d on the Exp
m sites (15%erformance oluations to th“BACB® Exovided by inpervision frosition but alsated includefeedback, anow shows thfield work.
e evaluation Ma
on
on
hly
ly
L
MS in Appl
College of
) of applied bica, and to crgroup meeti
or arrive later-up the misser Practica suon will resul
5% of your with a BACB. You shouldon of the groistics of supetor will noteNeeds Impro below, will
perience Sup
% of your gron a bi-weekhe CSUN praxperience S
nstructor) oncom a BACBso your profee appearancend professionhe relationsh
and course ark for Profe
Ethical B100
90
80
70
Last Revised Jun
lied Behavior ADepartm
Social and Beh
behavior anareate a rich aings on timer than 30 mied group me
upervisors. lt in your gr
grade) B® Experiend complete thoup superviservision e if your ovement (NIbe used to
pervision for
rade) kly basis andactica instruupervision ce during the. The evaluessional and e, attendancenal relations
hip between
grade essional an
Behavior 0 %
%
%
%
85
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
lysis, and e and in for eeting
rade
nce he sion),
I),
rms
d you uctor,
e ation
e, hips
nd
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
one usuperTwo osuper
Grade BrAs noted profession84-86 % i
Acad
You MAown worexpectedstandardsfor the unresult in Academi
Stude
If you haEducatiooffice is office is 2611. If yset up an
om CSUN Purchrom CSUN Officefrom CSUN CIEL
unsatisfactoryrvision forms or more Unsarvision forms
reakdown above, your cnal behavior. is B) will be u
demic Inte
AY NOT plagk (this appli
d to adhere tos will be hanniversity polacademic saic Affairs Of
ents with D
ave a disabilinal Serviceslocated in Blocated on Byou would li
n appointmen
hasing & Contrace of Insurance & LO Documents
y overall perfofor given sem
atisfactory oveduring a sem
course grade wA plus-minus
used with cou
Percent Ran93-100%90-92% 87-89% 84-86% 80-83% 77-79% 74-76% 70-73%
69%
grity
giarize; meanes to work o
o the Univerndled in accolicy on acadeanctions, sucffice or the D
Disabilitie
ity and need s (DRES) offayramian Ha
Bertrand Streike to discusnt.
ct Administration Risk Manageme
ormance on amester erall performa
mester
will be based s grading syst
urse grades.
nge %
ning presentof peers as wsity’s Acadeord with the emic dishonh as a failing
Dean.
es
accommodafice or the Nall, room 11eet in Jeanness your need
Documents ent Documents
ll monthly
ance on mont
on your cumtem (e.g., 93-
t ideas, opiniwell as expertemic DishonUniversity’sesty). Failurg grade in th
ations, pleasNational Cent
0 and can bee Chisholm H
for accomm
thly
mulative score -100 % is A, 9
Letter GrA A- B+ B B- C+ C C- F
ions, or the wts and resear
nesty standars policies (sere to complyhe course and
se register witer on Deafne reached at Hall and can
modations wi
L
MS in Appl
College of
Fa
on participat90-92 % is A
rade
writing of otrchers). All srds, and violaee the curren
y with these sd a referral t
ith Disabilityness (NCOD(818) 677-2
n be reached ith me, pleas
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ail
tion and A -, 87-89 % is
thers as yourstudents are ations of thent CSUN catstandards wito the Studen
y ResourcesD). The DRE2684. The NCat (818) 677
se contact m
86
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
s B+,
r
ese talog ill nt
s and ES COD 7-
me to
ABA)ology es & llege
Selecte
I. Use
III. Fo
III. D
* Adopted fr**Adopted fr***Adopted f
ed Competen
the professio
Demonstrate
Demonstrate
Demonstrate
Deve Appl Baily
oundationaGive example
FK-0Develop and
Selec
Use voooooooo
o
o
oo
o
o
Assesoo
om CSUN Purchrom CSUN Officefrom CSUN CIEL
nces for the F
onal and ethi
knowledge o
knowledge o
professional
elop resume aly and secure y & Burch, 20al Knowledes of and exp
01 to FK-46 use behavio
ct & define targ
various direct oo A-01 Measo A-02 Measo A-03 Measo A-04 Measo A-05 Measo A-06 Measo A-07 Measo A-12 Desig
recording).o A-13 Desig
whole intero H-01 Selec
of the behao H-02 Seleco H-05 Evalu
sessions, tio FK-47 Iden
inter-respoo FK-48 Stat
proceduresrecording,
ss quality of bo A-08 Asseo A-09 Evalu
hasing & Contrace of Insurance & LO Documents
Fall semester
ical guideline
of ethical, resp
of HIPPA and
conduct
and letter of ininternship po
010 dge lain philosop
or measurem
get behavior fo
observation mesure frequencysure rate (i.e., csure duration. sure latency. sure interresposure percent ofsure trials to crgn and implem. gn and implemrval, momentact a measuremeavior and the loct a schedule ouate temporal rime series). ntify the measu
onse time). te the advantags and discontinmomentary timehavioral measss and interpreuate the accura
ct Administration Risk Manageme
r -1st year
es with collea
ponsible, prof
d Confidential
ntent by end oositions no lat
hical assump
ment metho
r change
ethods to collecy (i.e., count). count per unit t
nse time (IRT)f occurrence. riterion.
ment continuous
ment discontinury time samplient system to oogistics of obsef observation arelations betwe
urable dimensi
ges and disadvanuous measuremme sampling).surement (Accet interobserveracy and reliabil
Documents ent Documents
agues and cli
fessional and
lity rules
of September ter than end o
tions of behav
ods, record a
ct baseline data
time).
).
s measurement
uous measureming). obtain represenerving and recoand recording peen observed v
ons of behavio
antages of usinment procedure
uracy & Reliabr agreement. lity of measure
ients
disciplinary g
of October
avior analysis
and analyze
a
t procedures (e
ment procedures
ntative data givording. periods. variables (withi
or (e.g., rate, du
ng continuous mes (e.g., partial
bility)
ement procedur
L
MS in Appl
College of
guidelines
and concepts
e data
e.g., event
s (e.g., partial &
ven the dimensi
in & between
uration, latency
measurement l- and whole-in
res.
Last Revised Jun
lied Behavior ADepartm
Social and Beh
EP
s
BMe
&
ions
y,
nterval
87
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
Ethics & Professionalism
1
2
2.1
3
Behavior easurement
4
5
6
ABA)ology es & llege
m
IX. Co
* Adopted fr**Adopted fr***Adopted f
Graphooooo
onduct ongoi
Evaluoo
Com
If you, thebe signed your Prac
The hoursthe superv
O M A
Tofho
The respoGuidelineStandards All partieI have car
________Practica In________Practica S
om CSUN Purchrom CSUN Officefrom CSUN CIEL
h & analyze gao A-10 Desigo A-11 Desigo A-14 Desigo H-03 Seleco H-04 Evaluing assessme
uate effectiveo K-01 Provio K-07 Evalu
mpare effective
e practica studwithin 2 weetica Instructo
s included on visee:
Obtained a graMet 80% or mAND either of
o All expo The su
instrucfaculty
The following ff on a supervours were trac
Superv Egregi
Analysmemb
Supervto the
onsibilities dees for Responss.
s agree to therefully review
____________nstructor Sign
____________Student Signa
hasing & Contrace of Insurance & LO Documents
athered informagn, plot, and ingn, plot, and ingn, implement ct a data displauate changes innt of interve
eness of intervide for ongoinguate the effectieness of diffe
dent, meet theeks of the semor.
the BACB® E
ade of C or higmore of all supf the followingperience hour
upervisor-supctor recommey member’s sucircumstance
visee’s accruecked through visee does noious violationsts and/or behers visor-supervisinternship agr
scribed in thisible Conduct
e stipulations hwed this syllab
___________nature ___________ture
ct Administration Risk Manageme
ation nterpret data usnterpret data usand graph cho
ay that effectiven level, trend, antions
ventions g documentatioiveness of the brent treatmen
e requirementmester ending
Experience V
gher pervised experg occur: rs were compervisee relatio
ends that the supervision) es would justied hours on th
Individual Sut receive a pa
n of the BACBhavior that jeo
see relationshreement or po
s document wt for Behavior
herein: bus and agree
___ _______ Date
_ _______Date
Documents ent Documents
sing equal-intersing a cumulatioice measures.ely communicaand variability.
on of behaviorbehavioral prog
nts
ts listed belowunless otherw
Verification Fo
rience compe
pleted satisfaconship was tesupervisee acc
ify a practica he Experienceupervision Do
assing grade inB® Guidelinesopardizes the
hip is terminatolicies of the
will be carriedr Analysts an
e to the items
_________
_________
rval graphs. ive record to d
ates relevant qu.
ral services. gram.
w, your Expewise explicitly
orm are ONL
etencies
ctorily erminated undcrue experien
instructor (ore Verificationocumentationn XBEH 903s for Responswell-being o
ted as a resultinternship/cli
d out in accord Professiona
listed.
L
MS in Appl
College of
display data.
uantitative rela
rience Verificy specified be
LY those for s
der positive cnce hours und
r supervisor) n Form (i.e., en Form). sible Conduct
of clients or ot
t of the superinical site.
rdance with thal Disciplinar
Last Revised Jun
lied Behavior ADepartm
Social and Beh
ations.
OA
cation Form wetween you a
semesters in w
onditions (e.gder a different
refusing to seven though th
t for Behaviother team
rvisee not adh
he BACB® ry and Ethica
88
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
7
Ongoing ssessment
20
21
will nd
which
g., the t
sign he
r
hering
al
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Below, plFBAs mayinterventiinterpretatfor Behav
Criteria f Identi Reaso
a.b.
c.
The pa.b.c.d.e.
Reason foBACKGR Includ
Format ofContent o
a. Fab. Prc. Hd. Re. Hf. R
g. D
Format ofMedical H
a. Ab. R
c. HFormat ofEducationa. Historb. Date oc. Instrucd. Histor
Fr
om CSUN Purchrom CSUN Officefrom CSUN CIEL
lease see the gy differ basedons will diffetions, and int
vior Analysts
for Componeifying informaon for Referra Source of re. The reason
(e.g. elopem If the target
target behavurpose of the Gather base. Identify sett Identify ant. Identify the Recommen
interventiondecrease oc
r referral sentROUND INFOdes informatio
If records a Re
secf Family Histof Family Histoamily memberrimary care tak
History of houseRecent moves Home LanguageRegional Center
Home bDepartment of C
Placemf Medical Hist
History (In a paAny health, visiRelevant medica
History of hospif Educational nal History (Inry of schools atof initial IEP anctional setting(ry of specific brequency, dura
hasing & Contrace of Insurance & LO Documents
general guided on the requier based on thervention rec(e.g., 1.01. R
ents of the FBation al eferral clearly child/adolesce
ment or tantrumt behaviors havvior to justify tFBA
eline (e.g. frequting events thatecedents that ee function(s) ofd intervention ns and also teacccurrence of thetence structur
ORMATION on about the mare available ecord review anction
ory ory s with whom th
ker and their avehold changes
e r involvement base behavior Child and Fami
ment in Foster htory aragraph formaon and hearingation informati
italizations andHistory
n a paragraph fottended nd Eligibility ((s) and past andehavior difficu
ation and intens
ct Administration Risk Manageme
we developeirements of th
he referral proommendation
Reliance on Sc
Functional B
BA
stated (teacherent was referredm). ve been presentthe need for as
uency, durationat could supporevoke the targef the target behstrategies that ching strategiee problem behare
methods used t
nd interviews w
he child/adolesvailability for pincluding chan
services ily Services (Dhome
at) g issues that miion
d recent injures
ormat)
if applicable) d current serviculties (e.g. diffsity of each beh
Documents ent Documents
ed for writing hird party payoblem. Howevns to meet BAcientific Know
Behavior Ass
r, parent, Regiod, which includ
t in the past, insessment
n) data on targert occurrence oet behavior(s) havior(s)
address necesses that will incraviors
to obtain back
with parents an
scent lives parent training nges in family
DCFS) Involvem
ight impact lea
s
ces ficulties that arhavior
FBAs. We reyees. We also ver, we expecACB® Guidelwledge, 2.10.
sessment
onal Center) des general des
ncluded inform
et behavior(s) of the problem b
sary environmrease occurrenc
kground infor
nd or teacher(s)
members
ment
arning and curr
re documented
L
MS in Appl
College of
ecognize the frecognize tha
ct the assessmlines for RespTreatment E
scription of pro
mation on worse
behavior(s)
ental changes, ce of socially a
rmation:
) must be inclu
rent behaviors
in school reco
Last Revised Jun
lied Behavior ADepartm
Social and Beh
formatting ofat assessment
ment procedurponsible Condfficacy, etc.).
oblem (target)
ening or impro
function basedacceptable beha
uded as method
ords)
89
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
f ts and es, duct .
behaviors
ovement in
d aviors and
ds in this
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
In
D
Ine. Brief d
a. b.InterventiSummary Includ
The taa.b.c.d.
Possibobserv
Approa.
Imme The ta
a.b.
Possib The ta
a.b.
Settina.
Settina. If spec
I. II.
Summand pa. Seb. Imc. Po
om CSUN Purchrom CSUN Officefrom CSUN CIEL
nclude all probo Examp
adults. Discipline histor
o Office o Suspen
nclude a graph,discussion on c Report card Current work
ion history of Indirect A
des informatioIf records a
Resec
Usint
Reable for identi. Behavior (g. Occurrence. Duration . Severity ble response clve sequence of opriate behav. Appropria
skills) are cediate Antecedable for identi. Behavior (f. Immediate ble Maintaininable for identi. Behavior (f. Consequenc
ng Events Effe The setting
ng Events Effecific setting ev
List the settThe possibldays when Jincrease)
I. Sema
mary of Indireotential functietting events remmediate antecossible functio
hasing & Contrace of Insurance & LO Documents
lem behaviors ple: according t
ry Discipline Ref
nsions or expul, if there is avacurrent achieved information (i
samples and c
ssessments on about the mare available ecord review anction se of a structureterview (providelevant dates ofification of thegeneral descripe (could have a
lass hierarchyf behaviors rangiors te behaviors iclearly describdents ifying possiblefrom indirect asantecedents (frng Consequenifying possiblefrom indirect asces (from indircting Problem
g events are des
cting Problements are identifting events idenle relationship John gets less t
etting events araking causal stect Assessmention(s) of probelated to each tcedents that co
on(s) (from indi
ct Administration Risk Manageme
documented into IEP dated 11
ferrals (ODR)sions
ailable data, to vement history tif available) lassroom test p
methods used t
nd interviews w
ed interview ande a sample of f interviews ine problem beh
ption is ok) range)
y is described iging from less
n the child’s rbed
e antecedents mssessment) rom indirect as
nces e consequencessessment) rect assessment
m Behavior scribed using l
m Behavior fied the report ntified and posbetween the sethan 8 hours of
e possible corratements. ts and Hypothlem behavior(target behavior
ould evoke the tirect assessmen
Documents ent Documents
n school record1/14/2011 John
visually show to document im
performance (i
to obtain indir
with parents an
nd/or rating scaquestions) cluded
haviors must i
f the indirect asevere to more
repertoire (inc
must include:
ssessment)
es must includ
t)
anguage that is
should addressssible factors thetting event andf sleep, the freq
relates. Withou
hesized Predic(s) table must r target behaviornts)
ds with appropn exhibited agg
the occurrencempact of behav
if available)
rect assessmen
nd or teacher(s)
ales (e.g., FAI
include:
assessment resue severe.
cluding any ba
e:
s not technical
s the followinghat could have d the target behquency and du
ut an experimen
ctor(s) (settinginclude for ea
r
L
MS in Appl
College of
priate referencegressive behavi
e of problem bevior on access t
nt information
) must be inclu
, FAST, MAS,
ults show that t
asic verbal op
l
g for each settinevocative effe
havior is addreuration of tantru
ntal test, autho
g events and imach target beh
Last Revised Jun
lied Behavior ADepartm
Social and Beh
es iors towards pe
ehaviors over tto academic cu
n:
uded as method
, QABF) or un
the parents or t
perant, adaptiv
ng event: ect on the behaessed (e.g. poorums have been
ors should refra
mmediate antehavior:
90
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
eers and
time. urriculum:
ds in this
nstructured
the teachers
ve and social
avior r sleep: On
n reported to
ain from
ecedents)
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
DIRECT A The ta
a.b.
Operaa.
b.
Baseli
a.b.c.d.
DESCRIP
Descr Result
a.b
Summa.b.
FUNCTIOThe proce a bIf parame
a.b.c.
For severesafety wasResults of
F
FA graph a. Ab. Dc. A
SUMMARSummary First paraa. Referrb. Schooc. Eligibd. Currene. Previof. MedicSecond pa
a. Rb. R
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ASSESSMENable describin The observe. The dates aational Definit Definition i
Behavior . Definitions
I. Ta
ine Data for T Average lev. References Graphs are . Data is corr
PTIVE ASSES
iption of DA mts Data is sum. Graphs of r
mary Summary st. Hypotheses
ONAL ANALYedures for FA . You can act o. Procedure inctric analysis i You can act. The materia. Procedure ie problem behs addressed. Af Functional Aor each Targe
a. Referenb. Functioc. Antece
All axis are corrData is correctlyAll graphing reqRY of FUNCT
has three sepagraph includeral question ol of attendanceility of specialnt academic peous and currentcal history aragraph inclu
Reported settingReported Baseli
hasing & Contrace of Insurance & LO Documents
NT ng direct obserer nd times of eaction of Targetis objective, cle
are observablearget behaviors
Target behaviovel is reported to graphs inclupresent and ax
rectly plotted SSMENT (DA
method (e.g., A
mmarized usingesults are inclu
tatements are rs about functionYSIS (FA) are technolog
out the proceducludes a referens used the prot out the procedals used duringncludes a refer
haviors (e.g. seAlso, the asses
Analysis (see taet behavior: nce to the grapon is stated andedent evoking t
rectly labeled y plotted quirements (see
TIONAL BEHparate paragraes the followin
e, grade and cla education and
erformance t interventions
udes the followg events matchine data matche
ct Administration Risk Manageme
rvation session
ch observationt Behaviors ear, and discrim
e and measurabs are defined to
ors uded xes are correctly
A)
ABC data, eve
g an appropriateuded and corre
relevant to the n are tentative
gical ure without havnce to an articl
ocedure is techdure without h
g the analysis arence to an artielf-injury, elopsor lists that c
ask analysis fo
ph is made d matches the rthe TB is stated
e Cooper) are mHAVIOR ASSEaphs ng:
ass d current servic
and their effec
wing:the setting eve
es the baseline
Documents ent Documents
n must include
n session
minates betwee
ble. Definitionsopographically
y labeled (base
ent recording)
e measure (e.gctly labeled
Indirect Asses
ving any questile that was usehnological having any queare clearly descicle that was uspement, aggreconsent was obor sample)
results shown od (antecedent m
met (e.g. blackESSMENT
ces
ctiveness
ents included indata included
e:
en what is and
s are situation or functionally
ed on data coll
) is technologi
g., conditional p
ssment and the
ions about howed as a referenc
stions about hocribed sed as a referenession) the FAbtained and b
on the graph manipulated du
k data points, co
n the report. in the report.
L
MS in Appl
College of
what is not an
specific and iny
ection method
ical
probabilities fo
data collected
w to do it ce for the asses
ow to do it
nce for the asseA procedure deby whom.
uring the FA)
onditions are l
Last Revised Jun
lied Behavior ADepartm
Social and Beh
n instance of Ta
ndividualized
)
or ABC data)
in the DA
ssment
essment escribes how t
abeled…)
91
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
arget
the child’s
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
Third par F
a.b.
RECOMM R R
cr
RConsequen
a. Fob. Lc. If
d. Apl
II
Data collea. Hb. Dc. Pd. C
We sugge
1. Ban
2. BexB
3. Bap32
4. Bdi
5. Cev
6. CP
om CSUN Purchrom CSUN Officefrom CSUN CIEL
ragraph includor each behav. Antecedent. Consequenc
MENDATIONRecommended aRecommendatioriteria:
a. For eacb. For eacc. All ant
developi.
ii. iii.
Recommended Cnce based interor each problemeast intrusive i
f recommendinI. There i
evidencbased l
II. Punishmthat com
All consequencelans.
I. The iniII. Specifi
III. Use of IV. When tctions and an
How often dataData collectionPerson responsClear criterion
est reviewingBaer, D. M., Wnalysis. Journ
Bijou, S. W., Pxperimental f
Behavior AnalyBloom, S. E., Ipplication of 2.
Broussard, C. Disruptive beha
Camp, E. M., Ivents as predi
Carr, E. G. (19Psychological
hasing & Contrace of Insurance & LO Documents
des the followivior s that have moce that maintai
N antecedent inteons for anteced
ch setting evench problem behecedent intervepment of the in
Procedure foUse of promHow to fade
Consequence iventions do nom behavior theinterventions is
ng punishment is a statement ace that the inteless restrictive ment procedurmbined punishe based interve
itial schedule oic items or actiprompts to thin the schealysis
a should be colln forms (includible for data enfor review of e
g the followinWolf, M. M., &nal of AppliedPeterson, R. Ffield studies alysis, 1, 175-1Iwata, B. A., trial-based fu
D., & Northuavior in regulIwata, B. A., ictors of prob977). The motBulletin, 84,
ct Administration Risk Manageme
ing:
ost control overins the behavio
erventions are edent interventio
nt there is an anhavior there is entions includentervention plaor initial implem
mpts (if needed)e in and out theinterventions arot need to be teere is a recomms recommendedstrategies (timas to why the aervention is mointerventions w
res are combinehment strategieentions must in
of reinforcemenons to be used
edule of reinfor
lected e sample in thentry and analyseffectiveness o
ng selected re& Risley, T. Rd Behavior AnF., & Ault, M.at the level of 191. Fritz, J.N., Runctional ana
up, J. (1995). Alar education Hammond, J.
blem behaviortivation of sel800-816.
Documents ent Documents
r the behavior or
evidence-basedons do not need
ntecedent interva recommendee specific detaians. mentation ) e antecedent stire evidence-bachnological bu
mend function bd e out or respon
assessor recommost effective wiwere used but wed with reinfor
es with reinforcnclude specific
nt (based on thas possible rei
rcement
e Appendix) sis f the plan is se
eferences: R. (1968). Sonalysis, 1, 91-. H. (1968). Adata and emp
oscoe, E.M.&lysis. Journa
An approach classrooms. S. L., & Bloomr. Journal of Alf-injurious be
d d to be technol
vention that aded antecedent iils (does not ha
imulus (criteriased ut have to meetbased consequ
nse cost) mends a more ith the presentiwere ineffectivrcement procedcement procedudetails that wi
he baseline datainforcers (from
et
ome current di-97.
A method to inpirical concep
& Carreau, A.l of Applied B
to functionalSchool Psychm, S. E. (2009Applied Behaehavior: A re
L
MS in Appl
College of
ogical but have
ddresses the setintervention ave to be techn
ia for fading)
t the followinguence based int
restrictive inteing problem or ve) dures (i.e., reseures). ill help in deve
a) m preference as
imensions of
ntegrate descpts. Journal of
B. (2011). CBehavior Ana
l assessment aology Quarte
9). Antecedenavior Analysiseview of some
Last Revised Jun
lied Behavior ADepartm
Social and Beh
e to meet the fo
tting event
nological) that w
g criteria: tervention
ervention (e.g.,evidence that
earch based int
elopment of the
ssessment)
applied beha
riptive and of Applied
Classroom alysis, 44(1), 1
and analysis oerly, 10, 151-1nt vs. consequs, 42, 469-483e hypotheses.
92
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
following
will help in
, research evidence-
terventions
e intervention
avior
19-
of 164.
uent 3.
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
7. Cco
8. Dbe
9. Gpr
10. Him
11. Hre
12. IwB
13. Iwfufr
14. IwTWan
15. KSJo
16. Lm
17. Mst
18. MQag
19. PthA
20. SbeB
21. Stin
22. TanB
23. Tpr
24. Tst
25. VpoAp
26. VasAp
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Carr, E.G., & Dommunication
Durand, V. M.ehavior. Jour
Gable, R. A. (1ractitioners. B
Hanely, G.P. (2mplementatio
Hanley, G.P., Ieview. Journawata, B. A &
Behavior Analywata, B. A., Dunctional analrom Analysis wata, B. A., P
T. A., Lerman,Willis, K. D. (nalysis. Journ
Kahng, S., Iwamith, R. G. (1ournal of App
Lerman, D. C.maintaining seMarion, S.D., Ttructure for se
Matson, J. L., BQuestions Aboggression, andence, S. T., R
hree descriptivnalysis, 42, 4mith, R. G., &ehavior disor
Behavior Analyturmey, P. (1
nstruments. JoThomason-Sasn index of res
Behavior AnalyThompson, R.
roblem behavTouchette, P. Etimulus contro
Vollmer, T. R.ossible continpplied Behav
Vollmer, T. R.ssessments topplied Behav
hasing & Contrace of Insurance & LO Documents
Durand, V.Mn training. Jo., & Crimminrnal of Autism1996). A critiBehavioral Di2012). Functin obstacles, aIwata. B.A., &al of Applied BDozier, C.L.
lyst in PracticDorsey, M. F.lysis of self-inand Intervent
Pace, G. M., D, D. C., Shore1994). The funal of Appliedata, B. A., Fis1998). Tempoplied Behavio, & Iwata, B.
elf-injurious bTouchette, P.elf-injurious bBamburg, J. W
out Behaviorad stereotypies
Roscoe, E. M.ve methods: I
425-446. & Churchill, Rders through lysis, 35, 125-994). Assessiournal of Autissi, J. L., Iwatsponse strengtlysis, 44, 51-6H., & Iwata,
vior. Journal oE., MacDonalol of problem, Borrero, J. C
ngencies durinvior Analysis, , Marcus, B.
o extended expvior Analysis,
ct Administration Risk Manageme
. (1985). Redurnal of Appl
ns, D. B. (1988m and Developical analysis oisorders, 22, ional assessmand developin& McCord, BBehavior Ana(2008). Clini
ce, 3-9. , Slifer, K. J.,njury. Journation in DeveloDorsey, M. F.e, B. A., Mazaunctions of sed Behavior Anscher, S. M., Poral distributir Analysis, 31A. (1993). D
behavior. JourE., & Sandm
behavior. AmeW., Cherry, Kal Function (Qs. Research in, Bourret, J. CImplications f
R. M. (2002).functional an-136. ing the functiism and Deveta, B. A., Neith during fun
67. B. A. (2001)of Applied Beld, R. F., & L
m behavior. JoC., Wright, Cng descriptive34, 269-287.A., Ringdahlperimental an28, 561-576.
Documents ent Documents
ducing behavilied Behavior8). Identifyinpmental Disorof functional a36-40.
ment of probleng new lore. BB.E. (2003). Fualysis, 36(2), ical Applicati
, Bauman, K. al of Applied Bopmental Dis, Zarcone, J. Raleski, J. L., G
elf-injurious bnalysis, 27, 21Page, T. J., Trons of proble1, 593-604.
Descriptive andrnal of Appliean, C.A. (200erican JournaK. E., & PaclaQABF) scale: n DevelopmenC., & Ahearn,for behaviora
. Identificationalysis of prec
ons of aberraelopmental Ddert, P. L., &ctional analys
. A descriptivehavior Analy
Langer, S. N. (ournal of AppC. S., Van Came analyses of , J. E., & Roa
nalyses in the
ior problems tr Analysis, 18ng the variablerders, 18, 99-assessment: I
em behavior: DBehavior Anaunctional ana147-185.
ion of Functio
E., & RichmBehavior Anaabilities, 198R., Vollmer, Goh, H., Cowbehavior: An e15-240. readwell, K. Rem behavior b
d experimented Behavior A03). Sequentiaal on Mental Rawskyj, T. R. Predicting tre
ntal Disabilit, W. H. (2009
al assessment.
on of environmcursor behavi
ant behavior: Aisorders, 24,
& Roscoe, E. Mses of problem
ve analysis ofysis, 34, 169-(1985). A scalied Behavior
mp, C., and Lsevere behav
ane, H. S. (19evaluation of
L
MS in Appl
College of
through funct8, 111-126. es maintainin-117. Issues for rese
Dispelling myalysis in Practalysis of prob
onal Analysis
man, G. S. (19alysis, 27, 19782, 2, 3-20.
T. R., Smith,wdery, G. E., Kexperimental
R. H., Williambased on scatt
tal analyses oAnalysis, 26, 2al analysis revRetardation, (1999). A va
eatment succties, 20, 163-19). Relative co. Journal of A
mental determiors. Journal o
A review of p293-304.
M. (2011). Rem behavior. J
f social conse178.
atter plot for ir Analysis, 18
Lalli, J. S. (200vior disorders
995). Progressf aberrant beh
Last Revised Jun
lied Behavior ADepartm
Social and Beh
tional
ng self-injurio
earchers and
yths, overcomtice, 5(1), 54-lem behavior
s Methodolog
94). Toward a7-209. Reprin
R. G., RodgeKalsher, M. J-epidemiolog
ms, D. E., & ter plot analys
f variables 293-319. veals a uniqu108, 301-313
alidity study oess for self-in176. ontributions o
Applied Behav
minants of of Applied
psychometric
esponse latencJournal of App
quences follo
dentifying 8, 343-351. 01). Identifyi. Journal of
sing from briehavior. Journ
93
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
us
ming -72. r: A
y,
a nted
ers, J., & gical
sis.
ue 3. on the njury,
of vior
cy as plied
owing
ng
ef al of
ABA)ology es & llege
* Adopted fr**Adopted fr***Adopted f
27. Windu
28. ZanD
In additiohttp://onli
om CSUN Purchrom CSUN Officefrom CSUN CIEL
Worsdell, A. Snfluences of euring function
Zarcone, J. R.,nalysis of the
Disabilities, 12
n to the abovinelibrary.wil
hasing & Contrace of Insurance & LO Documents
S., Iwata, B. Aestablishing opnal analyses. Rodgers, T. Motivation A
2, 349-360.
e, we stronglyley.com/doi/1
ct Administration Risk Manageme
A., Conners, Jperations andJournal of ApA., Iwata, B.
Assessment S
y recommend0.1002/jaba.v
Documents ent Documents
J., Kahng, S., d reinforcemepplied BehaviA., Rourke, Dcale: A failur
d the Special Iv46.1/issuetoc
& Thompsonent contingencior Analysis, D., & Dorseyre to replicate
Issue of JABAc
L
MS in Appl
College of
n, R. H. (2000cies on self-in33, 451-461.
y, M. F. (1991e. Research in
A, Spring 201
Last Revised Jun
lied Behavior ADepartm
Social and Beh
0). Relative njurious behav
1). Reliabilityn Developmen
13,
94
e 2017
Analysis (MS‐Ament of Psychohavioral SciencThe Tseng Co
vior
y ntal
ABA)ology es & llege