Tools For Managing Sensory Sensitivities

Discover effective tools for managing sensory sensitivities in autism. Empower individuals and caregivers with practical strategies.

Understanding Sensory Sensitivities in Autism

Individuals with autism often experience sensory sensitivities, which can significantly impact their behavior and daily functioning. Sensory sensitivities refer to intense reactions or under-reactions to sensory input, such as noises, lights, textures, smells, or tastes. These sensitivities can vary among individuals, with some being hypersensitive (over-responsive) and others being hyposensitive (under-responsive) to sensory stimuli.

Impact of Sensory Sensitivities on Behavior

Sensory sensitivities can trigger challenging behaviors in individuals with autism. For example, a person might exhibit behaviors like screaming or hitting when overwhelmed by loud noises or bright lights. Understanding and managing these sensitivities is key to reducing challenging behaviors and improving overall well-being [1].

Types of Sensory Sensitivities

Sensory sensitivities can manifest in various ways, affecting different senses. Individuals with autism may experience sensitivities in one or more of the following senses:

It's important to note that sensory sensitivities can vary from person to person. While one individual may experience hypersensitivity in one sense, another individual may exhibit hyposensitivity. Understanding and addressing these sensory sensitivities is crucial for creating a supportive environment and promoting the well-being of individuals with autism.

Strategies for Managing Sensory Sensitivities

Managing sensory sensitivities in individuals with autism is essential for promoting their well-being and reducing distress. By implementing effective strategies, caregivers and educators can help create a more comfortable and supportive environment. Here are some strategies for managing sensory sensitivities:

Creating a Sensory-Friendly Environment

Creating a sensory-friendly environment involves making modifications to minimize sensory triggers and provide a more comfortable space. Some ways to achieve this include:

Recognizing Triggers and Developing Coping Strategies

It is crucial to identify specific triggers that can lead to sensory overload or distress in individuals with autism. By recognizing these triggers, caregivers and educators can develop coping strategies to help individuals effectively manage their sensory sensitivities. Some strategies include:

Occupational Therapy for Sensory Sensitivities

Occupational therapy can be highly beneficial for individuals with autism and sensory sensitivities. Occupational therapists can provide specialized interventions and techniques to help individuals regulate and respond to sensory input appropriately. Some techniques used in occupational therapy include:

By implementing these strategies and seeking support from professionals, caregivers and educators can empower individuals with autism to better manage their sensory sensitivities and navigate their daily lives more comfortably. It is important to remember that each individual is unique, and strategies should be tailored to their specific needs and preferences.

Supporting Individuals with Autism and Sensory Sensitivities

When it comes to supporting individuals with autism and sensory sensitivities, there are several strategies and techniques that can help enhance their well-being and overall quality of life. This section will explore three key approaches: establishing predictable routines, offering choices and control, and providing comfort items for sensory calming.

Establishing Predictable Routines

Creating predictable routines can be incredibly beneficial for individuals with autism and sensory sensitivities. Predictability provides a sense of structure and security, helping individuals feel more comfortable and reducing anxiety. Establishing consistent daily routines can help individuals anticipate what will happen next, making transitions between activities smoother.

By incorporating visual schedules or timetables, individuals with autism can have a clear understanding of their daily routines. Visual cues can include pictures, symbols, or written words, depending on the individual's communication abilities. These visual supports serve as a guide, reducing uncertainty and promoting independence.

Offering Choices and Control

Offering choices is another effective way to support individuals with autism and sensory sensitivities. Providing choices allows individuals to have a sense of control over their environment and activities, which can reduce feelings of anxiety and increase engagement.

When offering choices, it's important to provide options that are appropriate and manageable for the individual. For example, when choosing an activity, present two or three options that align with their interests and preferences. By giving individuals the opportunity to make decisions, they can feel empowered and more engaged in the activities they participate in.

Comfort Items for Sensory Calming

Comfort items can play a significant role in helping individuals with autism manage their sensory sensitivities. These items provide a source of comfort and can help regulate their sensory experiences. Some commonly used comfort items include soft toys, weighted blankets, noise-canceling headphones, and fidget toys.

Soft toys can provide tactile comfort, allowing individuals to feel a sense of security through touch. Weighted blankets, which provide gentle pressure, can be calming and soothing for individuals who experience sensory overload. Noise-canceling headphones can help reduce auditory stimuli, providing a quieter and more controlled environment. Fidget toys can offer a sensory outlet, allowing individuals to channel their sensory needs in a constructive and calming way.

By incorporating these comfort items, individuals with autism can better manage their sensory sensitivities and regulate their experiences in daily life. It's essential to observe and understand each individual's unique sensory preferences and provide the appropriate comfort items that best suit their needs.

Supporting individuals with autism in managing their sensory sensitivities through predictable routines, choices, and comfort items can significantly enhance their well-being, comfort, and overall quality of life. These strategies enable individuals to engage more effectively in social interactions and daily activities while promoting a sense of control and reducing anxiety.

Accommodations for Sensory Sensitivities in Education

In order to support autistic students in an educational setting, it is important to provide accommodations that address their sensory sensitivities. These accommodations aim to minimize or eliminate the effects of the student's disability, ensuring they have an equal opportunity to succeed alongside their peers. Here are some common accommodations for sensory sensitivities in education:

Sensory Accommodations for Autistic Students

Autistic students may have sensory sensitivities that can significantly impact their ability to learn and participate in a traditional classroom environment. By implementing sensory accommodations, educators can create a more inclusive and comfortable learning environment for these students.

Some common sensory accommodations include:

These accommodations can help autistic students feel more comfortable and focused, enabling them to fully engage in the learning process.

Related Services for Individuals with an IEP

In addition to accommodations, students with an Individualized Education Program (IEP) may also receive "related services" as part of their educational support. These services go beyond mere accommodations and provide comprehensive support to address various areas of need. Some common related services for individuals with an IEP include:

These related services are tailored to the individual needs of the student and are detailed in the IEP to ensure a comprehensive and supportive educational experience.

IEP vs. 504 Plan: Understanding the Difference

Students with disabilities, including autism, may have an Individualized Education Program (IEP) or a 504 Plan to ensure they receive appropriate accommodations and support. It is important to understand the difference between these two plans.

An IEP provides both accommodations and modifications to meet the unique needs of the student. Accommodations refer to changes in timing, formatting, settings, scheduling, response, or presentation to enable the student to demonstrate the same level of mastery as their nondisabled peers. Modifications, on the other hand, alter what the student is taught or expected to demonstrate.

In contrast, a 504 Plan offers accommodations only, without modifications. It ensures that students with disabilities have equal access to education and related services necessary for them to thrive academically. While both plans aim to provide support, the IEP offers more comprehensive services beyond accommodations.

Understanding the distinction between an IEP and a 504 Plan can help parents, educators, and students work together to develop an educational plan that meets their specific needs and ensures a successful learning experience.

Sensory Sensitivities and Social Interactions

Navigating social interactions can be challenging for individuals with autism due to their sensory sensitivities. These sensitivities can affect various aspects of social communication, impacting their ability to understand and interpret social cues, gestures, and facial expressions. Let's delve into the challenges in social communication and the impact of sensory sensitivities on social interactions.

Challenges in Social Communication

Individuals with autism may face difficulties in both verbal and non-verbal communication, making it challenging to comprehend social cues, gestures, and facial expressions in daily interactions. This can lead to difficulties in understanding tone of voice, humor, sarcasm, and idiomatic expressions, making social interactions complex and potentially overwhelming [4].

Some common challenges in social communication for individuals with autism include:

It is important for caregivers, educators, and peers to be patient, understanding, and supportive when engaging in social interactions with individuals with autism. Providing clear and direct communication, using visual supports, and employing alternative communication methods, such as social stories or visual schedules, can enhance understanding and promote successful social interactions.

Impact of Sensory Sensitivities on Social Interactions

Sensory sensitivities in autism can significantly impact social interactions. These sensitivities can lead to sensory overload, anxiety, and affect a person's daily functioning, making it crucial for caregivers and educators to understand and address these sensitivities effectively.

The impact of sensory sensitivities on social interactions can vary among individuals with autism. Some may experience hypersensitivity (over-sensitivity) to sensory input, while others may be hyposensitive (under-sensitivity). These sensitivities can affect different senses, including touch, taste, sound, smell, or sight.

The challenges posed by sensory sensitivities can manifest in various ways during social interactions, such as:

Understanding and addressing sensory sensitivities are essential in supporting individuals with autism to navigate their surroundings and manage their sensory experiences effectively. Creating sensory-friendly environments, recognizing triggers, and developing coping strategies can help individuals with autism feel more comfortable and engaged in social interactions. Additionally, providing opportunities for choice and control, establishing predictable routines, and offering comfort items can also contribute to a positive social experience for individuals with autism.

Sensory Integration Therapy for Autism

For individuals with autism who experience sensory sensitivities, sensory integration therapy can be a valuable intervention. This therapy aims to help individuals process and respond to sensory information more effectively. By providing structured and controlled sensory input, sensory integration therapy assists in developing better sensory processing skills.

The Importance of Sensory Integration

Sensory integration therapy is commonly used to help individuals with autism manage sensory sensitivities by providing sensory input in a structured, repetitive way to help the brain adapt and respond more effectively to sensations [2]. It focuses on helping individuals develop the ability to process and respond to sensory stimuli, leading to improved functioning and well-being.

The sensory integration process involves the brain receiving and interpreting information from various senses such as touch, sight, sound, taste, and smell. For individuals with autism, the processing of sensory information can be challenging, resulting in sensory sensitivities and difficulties in daily life. Sensory integration therapy helps individuals develop better sensory processing skills and reduces sensitivities, allowing them to engage more effectively with their environment.

Techniques and Benefits of Sensory Integration Therapy

Sensory integration therapy utilizes various techniques and activities to provide controlled sensory experiences that can help individuals with autism improve their sensory processing abilities. These techniques typically involve engaging in activities that stimulate different senses in a structured and repetitive manner. Some common techniques used in sensory integration therapy include:

The benefits of sensory integration therapy can be significant. Through regular participation in sensory activities, individuals with autism can improve their sensory processing skills, reduce sensory sensitivities, and enhance overall functioning and well-being. This therapy can also contribute to improved attention, self-regulation, motor skills, social interactions, and overall sensory integration abilities. By helping individuals better process and respond to sensory input, sensory integration therapy can enhance their quality of life and empower them to navigate the sensory aspects of daily life more effectively.

Sensory Sensitivities and Daily Life

Individuals with autism often experience sensory sensitivities that can significantly impact their daily lives. These sensitivities can affect various senses, such as touch, taste, sound, smell, or sight. Understanding and managing these sensory sensitivities is crucial for promoting the well-being and quality of life of individuals with autism.

Sensory Overload and Meltdowns

Sensory sensitivities can lead to sensory overload, which occurs when an individual experiences an overwhelming amount of sensory input that their brain struggles to process. This overload can result in potential meltdowns, impacting daily routines and relationships. Some common behaviors associated with sensory overload in individuals with autism include covering ears, avoiding certain textures or foods, being sensitive to bright lights or loud noises, or experiencing challenges with personal grooming or hygiene routines.

Coping Strategies for Managing Sensory Sensitivities

To help individuals with autism manage their sensory sensitivities and regulate their experiences in daily life, various coping strategies can be employed. These strategies aim to create sensory-friendly environments and provide accommodations and supports tailored to individual needs.

Here are some coping strategies that can be effective in managing sensory sensitivities:

It's important to remember that each individual with autism may have unique sensory sensitivities and preferences. It may be necessary to experiment with different coping strategies and accommodations to identify the most effective approaches for managing sensory sensitivities. Consulting with occupational therapists or sensory integration specialists can provide additional guidance and support in developing personalized strategies.

By implementing these coping strategies, individuals with autism can better navigate sensory sensitivities and participate more fully in daily activities, routines, and social interactions.

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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