Integrating ABA Therapy with Cognitive Behavioral Therapy

Discover how ABA therapy for cognitive behavioral therapy can enhance your child's development and well-being.

Understanding ABA Therapy

Applied Behavior Analysis (ABA) therapy is a scientifically validated approach that focuses on understanding and changing behavior. It involves techniques centered around the principles of behavior, specifically the antecedents (what occurs before a behavior) and consequences (what occurs afterward) of behavior. ABA aims to increase helpful behaviors and reduce harmful behaviors, using positive reinforcement as a key strategy [1].

ABA is widely utilized for children with autism, as it equips them with essential life skills. The therapy helps enhance social interactions, facilitate the learning of new skills, and mitigate challenging behaviors such as kicking, hitting, and self-injurious actions. It is recognized as one of the most researched and effective treatments for behaviors commonly associated with autism spectrum disorder (ASD) [1].

Importance of ABA for Autism

ABA therapy has played a significant role in the treatment of autism spectrum disorder for over forty years. It effectively addresses various challenges faced by individuals with autism, including communication barriers, social difficulties, learning challenges, and problematic behaviors. A meta-analysis highlights that early application of ABA interventions leads to positive results, particularly in language development, social functioning, and daily living skills among those diagnosed with ASD.

The therapy promotes a child’s independence while honoring their unique neurodiversity. It targets essential skills, such as self-care, attention span, academic achievements, language proficiency, and safety skills. By positively impacting undesirable behaviors like aggression and self-injury, ABA therapy helps children navigate their daily environments more effectively.

In summary, the integration of ABA into the therapeutic landscape for autism emphasizes its significance in fostering positive behavioral change and skill acquisition, ultimately benefiting children and their families. Families exploring different therapies may consider how ABA can work alongside other approaches, such as aba therapy and speech therapy integration or aba therapy and self-regulation.

ABA vs. CBT Therapy

Understanding the differences between Applied Behavior Analysis (ABA) therapy and Cognitive Behavioral Therapy (CBT) is important for parents of children diagnosed with autism. Both approaches can be effective but they serve different purposes and use different methods.

Approach to Behavior Modification

ABA therapy focuses on modifying behaviors through techniques that address antecedents (triggers) and consequences (results) to increase helpful behaviors and decrease harmful ones. Positive reinforcement is a cornerstone of ABA, used to encourage desired behaviors in children with autism. This method creates tailored lesson plans for individual needs, aiming to improve developmental skills such as communication, social interaction, and adaptive learning [4].

On the other hand, CBT focuses more on the thoughts and feelings surrounding behavior. The principle underlying CBT is that changing negative thought patterns can lead to changes in feelings and therefore alter behaviors. This therapy helps children learn how to cope with anxiety, stress, and other emotional challenges.

Effectiveness Comparison

Both ABA and CBT have been recognized as effective treatments by the U.S. Surgeon General and the American Psychological Association. Evidence indicates that a combination of cognitive and behavioral therapies has proven to be effective for various psychological issues, often being more effective than medications.

A comprehensive analysis comparing several interventions, including ABA-based treatments, demonstrated that there were no significant differences in effectiveness between ABA, Early Start Denver Model (ESDM), and Picture Exchange Communication Systems (PECS) regarding core symptoms of autism spectrum disorder (ASD), socialization, communication, and expressive language [6].

For parents, understanding the nuances between these therapies can facilitate informed decisions on the best approach for their children. Both therapies can be incorporated into a holistic treatment plan when considering the needs and characteristics of the child with autism.

Implementing ABA Therapy

Effective ABA therapy implementation for children with autism involves systematic, evidence-based practices designed to meet each child's individual needs. Two fundamental components of this process are the Functional Behavior Assessment (FBA) and the development of Individualized Treatment Plans.

Functional Behavior Assessment (FBA)

A Functional Behavior Assessment (FBA) is a critical step in the ABA process. It involves gathering information about a child's behaviors to determine the underlying causes of unwanted negative behavior. By identifying the triggers and consequences associated with these behaviors, a board-certified behavior analyst (BCBA) can develop a targeted treatment plan that addresses specific needs.

The FBA process typically includes several components. One key component is direct observation, which involves observing the child in different settings to understand behavior patterns.

Interviews are also an important aspect of the FBA, as they collect insights from parents and caregivers about behavior contexts. Additionally, data collection is crucial for gathering quantitative data on behavior frequency and intensity.

These components work together to provide a comprehensive understanding of the child's behavior, ultimately informing the development of effective interventions.

Following the FBA, the BCBA creates an individualized treatment plan that not only focuses on reducing negative behaviors but also emphasizes teaching adaptive behaviors. Training and support are provided to parents and caregivers, enabling them to practice and reinforce skills learned throughout the day.

Individualized Treatment Plans

Individualized Treatment Plans (ITPs) are key in tailored ABA therapy. These plans are designed to improve developmental skills and behaviors such as communication, social interactions, and adaptive learning skills.

Each plan is customized for the specific needs of the child and reflects their unique strengths and challenges. An ITP may include various treatment focuses and corresponding goals to address the child's development.

For example, communication skills aim to enhance verbal and non-verbal communication. Social skills focus on improving interactions with peers and adults, while adaptive learning seeks to foster independence in daily activities.

The focus on personalization ensures that each child receives effective, targeted intervention as it incorporates approaches that can also cross over to cognitive therapies, such as cognitive behavior therapy. This integration allows for a comprehensive approach to therapy that can also aid in treating related issues like phobias and anxiety disorders [5].

Evidence-based Practices

In exploring the integration of ABA therapy with cognitive behavioral therapy (CBT), it's essential to highlight the support and recommendations provided by reputable organizations, as well as the scientific evaluations that back these therapeutic approaches.

U.S. Surgeon General and APA Recommendations

Both the U.S. Surgeon General and the American Psychological Association (APA) recognize ABA therapy as an effective treatment for individuals diagnosed with autism. Their evidence-based best practice treatments endorse both ABA and CBT, emphasizing their effectiveness in supporting various therapeutic needs when appropriately implemented. The recommendation for these treatments underscores the importance of applying scientifically validated methods in clinical situations.

These recommendations further indicate that the effectiveness of both methodologies is evaluated through scientific testing, ensuring that they contribute positively to treatment outcomes for children with autism.

Scientific Evaluation of ABA and CBT

Research has evaluated the quality and effectiveness of both ABA and CBT across numerous skills and behaviors pertinent to children with autism. The outcomes analyzed include socialization, communication, expressive language, adaptive behavior, daily living skills, IQ, verbal IQ, nonverbal IQ, restricted and repetitive behavior, motor skills, and cognitive skills. The results indicate moderate quality of evidence supporting these treatments, implying that they yield reliable benefits and improvements.

A combination of cognitive and behavioral therapies has emerged as one of the most effective treatments for various psychological problems, showing greater efficacy than many medications in addressing numerous disorders. This research recognizes that Applied Behavior Analysis not only integrates with cognitive therapy but also enhances the therapeutic process.

The financial implications of autism spectrum disorder (ASD) further emphasize the need for effective treatments like ABA therapy. Estimates suggest that families with a member diagnosed with ASD may incur lifetime costs ranging from approximately US$1.4 million to US$2.4 million, reinforcing the necessity for proven, impactful interventions.

Choosing therapies backed by scientific scrutiny and solid recommendations is crucial for parents navigating the complexities of autism treatment options.

Impact of ABA Therapy

Applied Behavior Analysis (ABA) therapy has proven to be effective in various areas, especially when it comes to improving social skills and cognitive and adaptive behaviors in children with autism.

Social Skills Development

One of the significant impacts of ABA therapy is its ability to enhance social skills. Research highlights that ABA interventions facilitate advancements in social communication, enabling children to engage more effectively with their peers and navigate social settings.

Indicators of improvement in this area include an increased frequency of initiating social interactions. Additionally, children show an improved ability to recognize and respond to non-verbal cues, which is crucial for effective communication.

Furthermore, ABA therapy enhances children's abilities to share and take turns during play. This leads to greater success in forming and maintaining friendships, fostering a sense of belonging and connection with others.

Furthermore, a meta-analysis involving numerous studies indicated significant positive effects on socialization, communication, and expressive language as core focuses of ABA interventions for children diagnosed with autism spectrum disorder (ASD) [6].

Cognitive and Adaptive Behavior Improvements

In addition to social skills, ABA therapy also fosters cognitive and adaptive behavior improvements. Through individualized treatment plans, ABA practitioners focus on teaching adaptive behaviors that allow children to function more effectively in daily life. This includes skills such as dressing, feeding, and using the bathroom independently.

Improvement indicators for various behavior areas are significant. For language development, there is enhanced vocabulary and communication abilities, while daily living skills show increased independence in personal care routines.

Self-regulation reflects better emotional regulation and coping strategies. Additionally, problem-solving skills indicate an improved ability to handle everyday challenges. These improvements contribute to the overall growth and development of children receiving ABA therapy.

Research demonstrates that early implementation of ABA therapy can yield notable improvements in language development, social functioning, and daily living skills for young children with ASD.

By integrating ABA therapy with various supportive techniques, such as aba therapy and speech therapy integration and aba therapy and emotional development, parents can maximize their child's potential for cognitive and adaptive success.

Overall, the focus of ABA therapy on skill development helps set a foundation for a child's ability to thrive both socially and in daily life.

ABA Therapy Success Factors

When considering ABA therapy for cognitive behavioral therapy, there are several key factors that can influence its success, particularly for children diagnosed with autism. These factors include the timing of the intervention and the duration and intensity of the treatment.

Early Intervention Importance

Research shows that ABA therapy is most effective when initiated before the age of 3. This early intervention is particularly beneficial for children who exhibit more severe deficits or who are diagnosed with Level 3 Autism. Engaging children in ABA at an early age can significantly improve their developmental outcomes, as the brain is more adaptable and receptive to learning during these formative years.

Starting therapy early can lead to better skill acquisition and a greater overall impact on the child's life. Additionally, addressing behavioral challenges and emotional development early can have long-lasting positive effects on the child's ability to navigate social interactions and academic settings. For more on the emotional benefits, readers can explore our section on ABA therapy and emotional development.

Duration and Intensity of Treatment

The effectiveness of ABA therapy is also closely related to the duration and intensity of treatment. Children undergoing ABA typically require intensive 1:1 therapy, often ranging from 20 to 40 hours per week.

While the amount of time required can vary, studies indicate that consistent therapy over an extended period—usually between 12 to 24 months or more—is essential to produce noticeable progress in behaviors and skills. A summary of the recommended weekly hours for different age ranges includes the following details.

For children under 3 years, the recommended weekly hours of therapy are between 20 and 40 hours. For those aged 3 to 5 years, the suggestion is 15 to 30 hours, while for children 6 years and older, 10 to 20 hours is recommended.

It is important for families to be aware that the appropriate amount of ABA therapy can vary significantly based on the individual needs of the child and the specific challenges they face. However, general estimates suggest that consistent application is crucial for achieving clinically meaningful outcomes.

Parents may also want to consider additional therapies in conjunction with ABA, such as speech therapy integration, to further support their child's development and learning. The combination of therapies can enhance the overall effectiveness of treatment for children with autism, leading to improved outcomes across various skill areas.

In conclusion, early initiation and sustained, intensive therapy are critical components for maximizing the benefits of ABA therapy in children with autism.

References

[1]: https://alphaschool.com/aba-vs-cbt-what-is-the-difference/

[2]: https://www.discoveryaba.com/aba-therapy/aba-therapy-for-cognitive-behavioral-therapy

[3]: https://blueabatherapy.com/aba/aba-therapy-vs-cbt/

[4]: https://www.handscenter.com/aba-therapy-vs-cbt-therapy-what-is-the-difference

[5]: https://www.appliedbehavioranalysisedu.org/psychotherapy/

[6]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265021/

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How To Find A Great BCBA Supervisor

Understanding the Role of a BCBA SupervisorWhen seeking autism treatment, finding the right Board Certified Behavior Analyst (BCBA) supervisor is crucial. A BCBA supervisor plays a vital role in overseeing and guiding the treatment process for individuals with autism. Let's take a closer look at what a BCBA supervisor is and why their role is essential in autism treatment.What is a BCBA Supervisor?A BCBA supervisor is a professional who has earned board certification as a behavior analyst and has extensive experience working with individuals with autism. They have completed advanced coursework, gained hands-on experience, and passed a rigorous examination to obtain their certification.Typically, BCBA supervisors work directly with individuals with autism, their families, and a team of behavior technicians or therapists. They design and implement behavior intervention plans, assess progress, and provide ongoing supervision and support to ensure effective treatment.The Importance of a BCBA Supervisor in Autism TreatmentA BCBA supervisor plays a crucial role in the success of autism treatment. Here are a few key reasons why their involvement is vital:Expertise and Knowledge: BCBA supervisors possess specialized knowledge and expertise in applied behavior analysis (ABA) and autism treatment. They stay up-to-date with the latest research and best practices, enabling them to provide evidence-based interventions tailored to the unique needs of each individual.Treatment Planning and Oversight: BCBA supervisors are responsible for developing comprehensive treatment plans based on thorough assessments. They oversee the implementation of these plans, ensuring that interventions are appropriate, effective, and aligned with the individual's goals and needs.Supervision and Training: BCBA supervisors provide ongoing supervision to behavior technicians or therapists working directly with individuals with autism. Through regular meetings and observations, they offer guidance, feedback, and training to ensure the highest quality of care and treatment fidelity.Data Collection and Analysis: BCBA supervisors monitor and analyze data collected during the treatment process. This data helps them evaluate progress, make data-driven decisions, and modify intervention strategies as necessary.Collaboration and Advocacy: BCBA supervisors collaborate with other professionals, such as speech therapists, occupational therapists, and educators, to ensure a comprehensive and integrated approach to treatment. They also serve as advocates for individuals with autism and their families, helping them navigate the healthcare and educational systems.Finding a qualified and experienced BCBA supervisor is a crucial step in the autism treatment journey. Their expertise, guidance, and support can make a significant difference in the progress and overall well-being of individuals with autism.Identifying Your NeedsBefore embarking on the search for a BCBA (Board Certified Behavior Analyst) supervisor, it is important to clearly identify your goals and needs. This will help you find a supervisor who aligns with your specific requirements and can provide the support necessary for effective autism treatment.Assessing Your Goals and NeedsTo begin, take some time to reflect on your goals for autism treatment and the specific areas where you need assistance. Consider the following questions:What are your primary goals for autism treatment?Are there any specific areas of concern or challenges that you would like the BCBA supervisor to address?What are your expectations regarding the frequency and duration of supervision sessions?Do you have any preferences or requirements regarding the location or format of supervision sessions?By assessing your goals and needs, you will have a clearer understanding of the qualities and expertise you are looking for in a BCBA supervisor.Determining the Scope of Supervision RequiredThe scope of supervision required will vary depending on the individual and their unique circumstances. Consider the following factors to determine the level of supervision needed:Experience and expertise: Are you seeking a supervisor with extensive experience in working with individuals with autism or specific expertise in certain treatment approaches?Intensity of support: Do you require intensive supervision, including frequent in-person meetings and regular feedback, or are you looking for a more flexible arrangement?Treatment setting: Will the supervision primarily take place in a clinical setting, a school, or in the home environment?Legal and ethical considerations: Are there any specific legal or ethical requirements that need to be considered, such as adherence to state or local regulations?Understanding the scope of supervision required will help you narrow down your search and find a BCBA supervisor who can meet your specific needs.By assessing your goals and determining the scope of supervision required, you will be better equipped to find a BCBA supervisor who can provide the necessary support and guidance for effective autism treatment.Finding Potential BCBA SupervisorsWhen searching for a BCBA (Board Certified Behavior Analyst) supervisor, it's important to explore various avenues to find potential candidates who can meet your needs. Here are three ways to find potential BCBA supervisors:Referrals from ProfessionalsOne effective way to find a BCBA supervisor is through referrals from professionals in the field. Reach out to your child's primary care physician, pediatrician, or any other healthcare professionals who specialize in autism treatment. They often have connections with BCBA supervisors and can provide recommendations based on their knowledge and experience. Additionally, therapists, educators, and other individuals who work with individuals with autism may also be able to offer valuable referrals.Online Directories and DatabasesUtilizing online directories and databases can be a convenient and efficient method of finding potential BCBA supervisors. There are several reputable websites and platforms that provide comprehensive listings of BCBA supervisors in your area.These directories often include information about their credentials, experience, and areas of expertise, allowing you to narrow down your search based on your specific requirements. Consider using trusted directories, such as those provided by professional organizations or autism advocacy groups.Local Autism Support GroupsEngaging with local autism support groups can be an invaluable resource for finding BCBA supervisors. These groups typically consist of parents, caregivers, and individuals with autism who share information, resources, and recommendations.By connecting with these groups, you can tap into their collective knowledge and experiences to identify potential BCBA supervisors. Attend support group meetings, participate in online forums, or join social media groups dedicated to autism support in your community. These interactions can help you gather insights and recommendations from people who have firsthand experience with BCBA supervisors in your area.By exploring referrals from professionals, utilizing online directories and databases, and engaging with local autism support groups, you can broaden your search and find potential BCBA supervisors who may be a good fit for your needs. It's important to keep in mind that each method has its own advantages, so consider using a combination of approaches to maximize your chances of finding the perfect BCBA supervisor for your situation.Evaluating BCBA SupervisorsWhen searching for a BCBA (Board Certified Behavior Analyst) supervisor, it is crucial to thoroughly evaluate potential candidates to ensure they meet your specific needs. Here are some key factors to consider when evaluating BCBA supervisors:Reviewing Credentials and ExperienceReviewing the credentials and experience of BCBA supervisors is essential in determining their qualifications for the role. Look for the following information:Credential or Experience and Importance‍‍Board Certification as a BCBA: EssentialYears of Experience as a BCBA: ImportantSpecializations or Areas of Expertise: Relevant to Your NeedsContinuing Education and Professional Development: Demonstrates CommitmentTake note of the BCBA supervisor's credentials and experience to determine if they have the necessary knowledge and skills to provide effective supervision.Assessing Communication and Interpersonal SkillsEffective communication and interpersonal skills are vital for a successful BCBA supervision relationship. Consider the following factors during your assessment:Skill and Importance‍‍Active Listening: EssentialClear and Concise Communication: EssentialEmpathy and Understanding: ImportantCollaborative Approach: ImportantA BCBA supervisor with strong communication and interpersonal skills will be able to effectively communicate goals, provide feedback, and establish a positive working relationship.Requesting References and Client TestimonialsTo gain insights into the BCBA supervisor's performance and reputation, it is recommended to request references and client testimonials. This feedback can provide valuable information about their professionalism, effectiveness, and ability to work with individuals with autism.When contacting references, consider asking questions such as:How long have you worked with the BCBA supervisor?Did they demonstrate expertise in your specific needs?How did they communicate and collaborate with you?Did they provide constructive feedback and support?Were they responsive to your concerns or questions?Client testimonials can also offer valuable perspectives on the BCBA supervisor's approach and effectiveness in delivering quality supervision.By thoroughly evaluating BCBA supervisors based on their credentials and experience, communication and interpersonal skills, and client feedback, you can make an informed decision when choosing the right BCBA supervisor for your needs. Remember, finding the right fit is crucial as the BCBA supervisor will play a significant role in guiding and supporting autism treatment.Interviewing Potential BCBA SupervisorsOnce you have identified potential BCBA supervisors for autism treatment, the next step is to interview them to ensure they are the right fit for your needs. This section will guide you through the interview process, including preparing questions, discussing their approach and treatment philosophy, and addressing availability and logistics.Preparing Questions for the InterviewBefore the interview, it's helpful to prepare a list of questions to gather relevant information and assess the suitability of the BCBA supervisor. Consider the following questions:Can you tell me about your experience working with individuals with autism and your specific expertise in this area?How do you approach individualized treatment planning for your clients with autism?What strategies do you use to address challenging behaviors in individuals with autism?How do you involve the family and caregivers in the treatment process?Can you describe a successful case or outcome you have achieved with a client with autism?Asking About Approach and Treatment PhilosophyDuring the interview, it's important to ask the BCBA supervisor about their approach and treatment philosophy. Understanding their methods and beliefs will help you determine if they align with your goals and values. Consider asking the following questions:What is your overall treatment approach for individuals with autism?How do you incorporate evidence-based practices into your treatment plans?Do you take a collaborative approach, involving other professionals such as speech therapists or occupational therapists?How do you stay up-to-date with the latest research and advancements in autism treatment?Discussing Availability and LogisticsIn addition to assessing their qualifications and treatment approach, it's crucial to discuss practical matters such as availability and logistics. This will ensure that the BCBA supervisor can accommodate your needs and fit into your schedule. Consider discussing the following points:What is your availability for supervision sessions? Are you able to accommodate my preferred days and times?How frequently will supervision sessions occur, and for how long?What is your preferred mode of communication? Are you accessible for questions or concerns outside of scheduled sessions?Do you have any geographical restrictions or limitations on the areas you serve?By asking these questions and having open discussions during the interview, you can gain valuable insights into the BCBA supervisor's approach, experience, and availability. This will help you make an informed decision when selecting the right BCBA supervisor for your autism treatment journey. Remember to take notes during the interview process to compare and evaluate the candidates effectively.Making the DecisionWhen it comes to finding the perfect BCBA Supervisor, making the right decision is crucial for the success of autism treatment. It's important to carefully consider various factors and weigh the pros and cons before finalizing your choice. Trusting your instincts and starting the supervision process are also essential steps in this decision-making process.Weighing the Pros and ConsTo make an informed decision, it's helpful to weigh the pros and cons of each potential BCBA Supervisor. Consider the following factors:ProsExtensive experience in autism treatmentStrong communication and interpersonal skillsPositive client testimonialsConvenient location and flexible schedulingConsLimited availabilityHigher cost of supervisionDiffering treatment philosophyLimited references availableBy evaluating these pros and cons, you can gain a clearer understanding of the advantages and potential drawbacks associated with each BCBA Supervisor. This analysis will help you make a decision that aligns with your specific needs and goals.Trusting Your InstinctsWhile it's important to consider objective factors when choosing a BCBA Supervisor, trusting your instincts is equally valuable. Pay attention to your gut feelings and instincts during the evaluation process. If you have a positive connection with a particular BCBA Supervisor and feel comfortable discussing your concerns and goals, it may indicate a good fit.Remember that the trust and rapport between you and the BCBA Supervisor are crucial for effective collaboration. If you have reservations or doubts about a potential supervisor, it's important to listen to those feelings and continue your search until you find someone you trust and feel confident in.Starting the Supervision ProcessOnce you have made a decision and selected a BCBA Supervisor, it's time to start the supervision process. This typically involves an initial meeting to discuss goals, expectations, and logistics. The BCBA Supervisor will provide guidance, support, and ongoing supervision to ensure the effective implementation of autism treatment plans.During this initial meeting, it's important to establish clear lines of communication and discuss any specific requirements or preferences you may have. This will help set the stage for a productive and collaborative relationship between you and the BCBA Supervisor.Remember, finding the perfect BCBA Supervisor is a process that requires careful consideration and evaluation. By weighing the pros and cons, trusting your instincts, and starting the supervision process, you can make an informed decision that sets the foundation for successful autism treatment.FAQsWhat qualities should I look for in a BCBA supervisor beyond just their credentials?It's not just about the letters after their name. Seek someone who values mentorship, understands your goals, and resonates with your approach to learning.How do I know if a BCBA supervisor will be a good fit for my learning style and career goals?Look for supervisors who take the time to understand your individual learning needs and align with your professional aspirations. A good fit goes beyond just qualifications.Is it okay to ask potential BCBA supervisors about their teaching philosophy or mentoring approach?Absolutely! In fact, it's encouraged. Understanding their approach gives you insights into whether it aligns with your learning preferences and goals.Should I consider geographical location when choosing a BCBA supervisor?It depends on your preferences and the flexibility of the supervisor. Some interactions may be in person, but many supervisors are open to virtual meetings, expanding your options.How important is it to find a BCBA supervisor with experience in my specific area of interest within Applied Behavior Analysis?It can be beneficial, but it's not the only factor. A supervisor with a broad understanding of ABA principles can often guide you effectively, even if they haven't specialized in your specific area.SummaryAs we wrap up the quest to find that perfect BCBA supervisor, remember that this journey is as much about connection as it is about credentials. It's about finding someone who not only guides you professionally but also understands your unique aspirations and learning style.So, go beyond the checklist, trust your instincts, and seek a supervisor who not only helps you grow in the field of Applied Behavior Analysis but also supports you in becoming the best version of yourself. Your ideal BCBA supervisor is out there – here's to a collaborative and fulfilling professional partnership ahead!Sourceshttps://hoomhouse.com/blog/how-to-find-a-bcba-supervisorhttps://www.iloveaba.com/2014/12/are-you-great-supervisorhttps://readysetaba.com/finding-quality-supervision-for-bcba-bcba