WSR 17-01-141 PROPOSED RULES DEPARTMENT OF HEALTH [Filed December 20, 2016, 4:56 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 15-24-090.
Title of Rule and Other Identifying Information: Chapter 246-805 WAC, Applied behavior analysis, creating a new chapter to implement a program for certified and licensed applied behavior analysis (ABA) professionals, including licensing, certification and practice standards and credentialing fees.
Hearing Location(s): Department of Health, Point Plaza East, Room 152, 111 Israel Road S.E., Tumwater, WA 98501, on January 25, 2017, at 10:00.
Date of Intended Adoption: February 10, 2017.
Submit Written Comments to: Brett Lorentson, P.O. Box 47852, Olympia, WA 98504-7852, email https://fortress.wa.gov/doh/policyreview, fax (360) 236-2901, by January 25, 2017.
Assistance for Persons with Disabilities: Contact Brett Lorentson by January 16, 2017, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Chapter 18.380 RCW (chapter 118, Laws of 2015) directs the secretary to adopt rules necessary to implement a program for certified and licensed ABA professionals. The proposed rules establish three new health care credentials: Certified behavior technician (CBT), licensed behavior analyst (LBA), and licensed assistant behavior analyst (LABA), and set licensing, certification, and practice standards. The proposed rules also establish fees to regulate these new credentials.
Reasons Supporting Proposal: The proposed rules establish enforceable credentialing requirements that will enhance and protect patient safety by having qualified ABA professionals certified and licensed in Washington state. The department has determined through fee analysis that the proposed fees should be adequate to cover the costs of administering the ABA program. This is required in RCW 43.70.250, which states that the cost of each licensing program must be fully borne by the professional's members and licensing fees must be based on the licensure costs.
Statute Being Implemented: Chapter 18.380 RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of health, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Brett Lorentson, 111 Israel Road S.E., Tumwater, WA 98501, (360) 236-4611.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
Small Business Economic Impact Statement
SECTON [SECTION] 1: Describe the proposed rule, including a brief history of the issue; an explanation of why the proposed rule is needed; and a brief description of the probable compliance requirements and the kinds of professional services that a small business is likely to need in order to comply with the proposed rule.
The department of health (department) is proposing a new chapter in rule to establish three new health care credentials: LBA, LABA, and CBT. The proposed rules set:
SSB 5488, enacted in 2015 and codified as chapter 18.380 RCW, establishes the ABA program. Chapter 18.380 RCW grants the secretary rule-making authority to set licensing and practice standards for LBAs, LABAs, and CBTs. The statute establishes a new advisory committee, the applied behavior analysis advisory committee (advisory committee) to consult with the secretary in determining the qualifications for licensure and certification. As of July 1, 2017, chapter 18.830 [18.380] RCW prohibits the practice of ABA without holding the necessary credential.
The behavior analyst certification board (BACB) is the national certifying body that sets professional standards for ABA professionals and administers a national examination to qualify for certification. The BACB defines ABA as "a systematic approach for influencing socially important behavior through the identification of reliably related environmental variables and the production of behavior change techniques that make use of those findings".1 The United States Surgeon General asserts that ABA has been proven effective in promoting the health and well-being of children with autism spectrum disorder (ASD) and other conditions by decreasing unwanted or harmful behaviors and increasing positive behaviors.2 ABA is practiced in a variety of settings including hospitals, clinics, private homes, schools, nursing homes, group homes, and businesses.
1 BACB, http://bacb.com/about-behavior-analysis/.
2 Mental Health: A Report of the Surgeon General (1999), page 164, www.surgeongeneral.gov.
Chapter 18.380 RCW closely parallels the department's recommendations in a 2014 sunrise review on this issue.3 A sunrise review is an evaluation of a proposal to change the laws regulating health professions in Washington. Unregulated health profession must go through a sunrise review by the department to determine whether there is a need to require a state credential. The department evaluates whether the profession meets criteria in the law that show unregulated practice can clearly harm or endanger the public4. The department makes recommendations to the legislature based on these criteria.
3 Behavior Analyst Sunrise Review, Department of Health Publication, Number 631-05, (December 2014).
4 Sunrise Act (RCW 18.120.010).
The 2014 sunrise review was requested by the legislature to review a proposal to establish licensure of behavior analysts and assistant behavior analysts. The proposal was based on BACB certification. The sunrise recommendations supported the proposal because it met the criteria, finding a strong potential for harm from the unregulated practice of ABA. The department added a recommendation to require department certification of behavior technicians, who have unsupervised contact with vulnerable clients in their homes.
Rules establish enforceable licensing and certification requirements for the credentials identified in statute, and provide a safety mechanism for clients receiving ABA services. These safety mechanisms include minimum education, training, and supervision standards.
The following sections are anticipated to create compliance costs for businesses:
The department estimated compliance costs to implement the proposed rules from stakeholder feedback during the six stakeholder workshops held in the summer and fall of 2016 and received in writing.
SECTION 2: Identify which businesses are required to comply with the proposed rule using the North American Industry Classification System (NAICS) codes and what the minor cost thresholds are.
There is no NAICS four- or six-digit code that closely aligns with ABA provider businesses. While ABA is not considered mental health treatment, the closest code found was 621330 – Offices of mental health practitioners (except physicians).
Table A.
SECTION 3: Analyze the probable cost of compliance. Identify the probable costs to comply with the proposed rule, including: Cost of equipment, supplies, labor, professional services and increased administrative costs; and whether compliance with the proposed rule will cause businesses to lose sales or revenue.
The following sections are anticipated to create compliance costs for businesses:
WAC 246-805-230 LABA—Supervised experience.
The statute requires applicants seeking an assistant behavior analyst license to complete one thousand hours of supervised experience in behavior analysis (or an alternative approved by the secretary), but does not describe required elements of the experience. The proposed rule describes these elements including: Minimum hours the LABA trainee must be supervised, what activities the supervisor must observe the trainee performing, a required supervisory plan, and supervisor qualifications.
Small businesses such as behavioral therapy agencies and independent LBAs or board certified behavior analysts (BCBA) may incur the costs of developing a supervision plan and the actual hours required to supervise the LABA trainee. The proposed rule requires that at least five percent of the total one thousand hours (at least fifty hours) of experience be supervised by an LBA or BCBA5. The proposed rule aligns with the supervised experience required for national certification as a board certified assistant behavior analyst (BCaBA) from BACB.
5 Before July 1, 2017, there will be no LBAs, so the rule allows supervision of LABA students in Washington state by BACB-certified BCBAs. As of July 1, 2017, only LBAs may provide student supervision in Washington. But the rule anticipates that LABA candidates trained outside of Washington may be supervised by BCBAs.
Supervision costs may be incurred by the employer or the individual pursuing an LABA credential (through a contractual agreement with an ABA agency or behavior analyst). The employer-incurred costs would include providing supervision in-house or by contracting with outside training entities. The estimated cost for a private ABA agency or individual behavior analyst providing supervision during this experience is $3,500 to $5,000 (see Table B).
It is anticipated that compliance will not add additional costs for ABA agencies or providers who already train and supervise individuals as part of their employment practices, and for individuals seeking to meet the BACB's national certification requirement of supervised experience. Other ABA agencies and providers choosing to train prospective LABA applicants may incur new costs of developing training plans and providing the fifty hours of directly supervised experience. For agencies that are offering the opportunity for supervised experience for LABA credential candidates, the activities may affect the supervisor's time working directly with ABA clients. The supervisor would not need to focus on meeting the supervised experience requirements with the LABA trainee.
These activities have the potential to reduce business revenue due to the LBA or BCBA repurposing their time spent with clients towards the supervised experience activities. The reduced revenue will depend on the type of services that would not be able to be performed with new or existing clients, and based on the type of reimbursement source.6 The impact to revenue will also be determined on the amount charged by an ABA professional. The estimated wage range for a BCaBA is $24-33 per hour;7 and for a BCBA the estimated median hourly wage is $408. The potential added cost to an employer will range from $3250-3650.
6 Health care authority ABA Treatment Fee Schedule (effective July 1, 2016). Provider billing guides and fee schedules. ABA. http://www.hca.wa.gov/billers-providers/claims-and-billing/professional-rates-and-billing-guides.
7 http://www.payscale.com/research/US/Job=Board_Certified_Assistant_Behavior_Analyst/Hourly_Rate.
8 http://www.payscale.com/research/US/Certification=Board_Certified_Behavior_Analyst_(BCBA)/Hourly_Rate.
Cost of Compliance
Table B. Examples of costs of supervision by an LBA or BCBA during the LABA trainee's supervised experience
WAC 246-805-320 Behavior technician training program.
The statute requires behavior technician applicants to complete forty hours of training plus any other requirements set by the secretary. In addition to a forty-hour training component, the proposed rules require an ABA agency, individual ABA provider or training entity to observe the trainee with clients and perform a competency assessment.
The course work portion of the training program may be provided directly by the entity staff, or from outside training providers either in-person or online. The competency evaluation and assessment could be conducted by the training entity, or separately by an LBA or BCBA. The cost range for employer-led trainings with experiential training and competency component is $1,140-$2,754. The cost range for only the course work required by statute is $85-$680. The combined cost range for course work, observation, and competency assessment is estimated to be between $1,820 and $2,754. See Table D.
Supervision is an integral part of the training program. The proposed rule also requires that a supervising LBA or BCBA must be within sight and hearing and available to intervene when a behavior technician trainee is working with clients. This may require the supervisor to either:
Some agencies/behavior analysts report paying trainees a training wage of between $9.74 and $12 per hour (see Table C). Stakeholders have raised concern about needing to pay wages of behavior technician trainees even when they are not serving clients due to the requirement for the supervisor to be within sight and hearing until the technician obtains his/her CBT credential from the department. While this concern is noted, the department determined that reducing the risk to ABA clients being served by noncredentialed trainees outweighs the cost to ABA agencies and LBAs of providing hearing and sight supervision.
Cost of Compliance
Table C. Examples of CBT training program costs.
SECTION 4: Analyze whether the proposed rule may impose more than minor costs on businesses in the industry.
The proposed rules are anticipated to impose more than minor costs to business that must comply. Training LABA or CBT candidates is voluntary in these proposed rules. Some LABA's and CBT may be trained in college settings that are exempt from these rules by statute. However, many ABA agencies and LBAs need to train and employ LABAs and/or CBTs in order to meet the demand for ABA client services.
The estimated costs of complying with the supervised training requirement is between $3,000 to $5,000 per LABA trainee, and between $1,755 and $2,755 per CBT trainee. These costs exceed the minor cost threshold of $1,130 either separately or combined. A small business economic impact statement is required for the proposed rules.
Table D. Proposed WAC sections are not expected to create costs to businesses, or if there are costs they would not be more than minor:
SECTION 5: Determine whether the proposed rule may have a disproportionate impact on small businesses as compared to the ten percent of businesses that are the largest businesses required to comply with the proposed rule.
All ABA agencies and provider businesses in Washington are small businesses (fifty or fewer employees). The proposed rules may impact the smaller businesses with fewer alternatives for supervising LABA or CBT training than larger ABA businesses that may have multiple potential training supervisors.
Small businesses have an option to minimize the impact of the proposed rules by hiring RBTs or department-credentialed agency affiliated counselors.9 There are an estimated one thousand three hundred agency affiliated counselors with sufficient ABA training to qualify for a CBT credential without further training. The estimated number was determined by analyzing DOH's professions database (ILRS) which reported active agency affiliated counselors who are associated with an approved ABA agency or reported providing ABA services.
9 An agency affiliated counselor is a person who is engaged in counseling and employed by an agency, county or federally recognized tribe. They must be registered under chapter 18.19 RCW.
Small businesses do have the option to reduce the impact of the proposed behavior technician training program. The small business may identifying [identify] less costly training options through outside providers who meet the rule requirements and offer training in the content areas for the behavior technician training program.
SECTION 6: If the proposed rule has a disproportionate impact on small businesses, identify the steps taken to reduce the costs of the rule on small businesses. If the costs cannot be reduced provide a clear explanation of why.
We have made an effort to mitigate costs by considering that training does not solely need to be provided inhouse by the employer, and some training content may be presented to the trainee via online providers. By providing training through online providers, the supervisor will not have to develop the content or deliver the training, thus reducing the amount of contact hours with the trainee. The supervisor is still responsible for determining the content of the training and adherence to the training.
Additional efforts to mitigate costs includes the portions of the supervisor led-instruction activities during the training program. These activities:
The department considered mitigating supervision costs for CBT trainees by reducing the requirement for the supervisor to be within direct hearing and sight to twenty percent of the hours the trainee works with clients. However, the department determined this alternative created an undue risk to the public because it would not provide a level of supervision that would adequately protect the health and safety of clients and would not allow the department to take disciplinary action on the trainee if he or she acted in a manner that jeopardized the health and safety of the client.
SECTION 7: Describe how small businesses were involved in the development of the proposed rule.
The advisory committee held six meetings which were open to the public. Out of these six meetings, two specifically addressed the CBT training program rule. At most of the meetings, draft language was presented to small ABA business stakeholders, and these stakeholders contributed significant input to the content of the proposed rule.
SECTION 8: Identify the estimated number of jobs that will be created or lost as the result of compliance with the proposed rule.
ABA stakeholders and businesses reported a high demand for ABA services within Washington state. As reported in the article titled the Next Generation of ABA Providers, the demand for services is not just a Washington state issue.10 The proposed rules provide viable pathways to get an ABA credential that will help providers to legally provide ABA services after July 1, 2017. We do not anticipate any lost jobs as a result of compliance with the proposed rules.
10 The Next Generation of ABA Providers by Mark R. Dixon. Behavior Analysis in Practice—Association for Behavior Analysis International Behav Anal Pract. 2014 Oct; 7(2): 145–146. Published online 2014 Jul 29. doi: 10.1007/s40617-014-0009-0. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711752/.
We anticipate that with the proposed rule, which includes an option for CBT applicants to meet the training program requirement through a postsecondary school or college accredited by a regional or national accrediting organization, may create jobs when such school or college programs are developed to meet the initial training needs of behavior technicians.
A copy of the statement may be obtained by contacting Brett Lorentson, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4611, fax (360) 236-2901, email Brett.Lorentson@doh.wa.gov.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Brett Lorentson, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4611, fax (360) 236-2901, email Brett.Lorentson@doh.wa.gov.
December 20, 2016
John Wiesman, DrPH, MPH
Secretary
Chapter 246-805 WAC
APPLIED BEHAVIOR ANALYSIS NEW SECTION
WAC 246-805-010 Definitions.
The definitions in this section apply throughout this chapter unless the context clearly states otherwise:
(1) "ABA" means applied behavior analysis.
(2) "Behavior Analysis Certification Board" or "BACB" means a national organization that certifies individuals as meeting education, training, supervised experience and examination standards of the behavior analytical profession.
(3) "Board certified assistant behavior analyst" or "BCaBA" means a person certified with the BACB as meeting the education, training, supervised experience, and examination standards of the BACB.
(4) "Board certified behavior analyst" or "BCBA" means a person certified with the BACB as meeting the education, training, supervised experience and examination standards of the BACB.
(5) "Certified behavior technician" or "CBT" means a person certified under chapter 18.380 RCW.
(6) "Close, ongoing supervision" means procedures or tasks that are performed under a supervisor's overall direction and control. The supervisor must be accessible, but the supervisor's presence is not required during the performance of the procedures or tasks.
(7) "Department" means the Washington state department of health.
(8) "In good standing" means an active credential issued by the department of health without:
(a) Conditions;
(b) Current discipline;
(c) Pending discipline; or
(d) Restrictions on the practice of ABA.
(9) "Licensed assistant behavior analyst" or "LABA" means a person licensed under chapter 18.380 RCW.
(10) "LABA trainee" means a person participating in a supervised experience described in WAC 246-805-230.
(11) "Licensed behavior analyst" or "LBA" means a person licensed under chapter 18.380 RCW.
(12) "Registered behavior technician" or "RBT" means a person registered with the BACB as meeting the education and training standards of the BACB.
(13) "Secretary" means the secretary of the department of health or the secretary's designee.
(14) "Trainee" means a person participating in a behavior technician training program described in WAC 246-805-310.
LICENSED BEHAVIOR ANALYST
NEW SECTION
WAC 246-805-100 Licensed behavior analyst—Application requirements.
An applicant for initial licensure as a LBA shall submit the following to the department:
(1) A completed application on forms provided by the department;
(2) Proof of completion of at least four clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;
(3) Fees as required in WAC 246-805-990; and
(4) Proof of:
(a) Current BACB certification as a BCBA. Department verification of the applicant's BCBA certification number is accepted as proof of current certification; or
(b) Meeting the requirements in RCW 18.380.050 (1)(a) including:
(i) A master's or doctorate degree in behavior analysis or other natural science, education, human services, engineering, medicine, or field related to behavior analysis approved by the secretary;
(ii) Successful completion of a minimum of two hundred twenty-five classroom hours of graduate level instruction in behavior analysis topics;
(iii) Successful completion of a supervised experience requirement, consisting of a minimum of one thousand five hundred hours; and
(iv) Successful completion of the national BACB examination as meeting the requirement in RCW 18.380.050 (1)(iv).
LICENSED ASSISTANT BEHAVIOR ANALYST
NEW SECTION
WAC 246-805-200 Licensed assistant behavior analyst—Application requirements.
An applicant for initial licensure as a LABA shall submit the following to the department:
(1) A completed application on forms provided by the department;
(2) Proof of completing at least four clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;
(3) Proof of supervision;
(4) Fees as required in WAC 246-805-990; and
(5) Proof of:
(a) Current certification as a BCaBA from the BACB. Department verification of the applicant's BCaBA certification number is accepted as proof of current certification; or
(b) Meeting the requirements in RCW 18.380.050 (1)(b):
(i) Graduation from a recognized bachelor's degree program under WAC 246-805-210;
(ii) Proof of successful completion of a minimum of one hundred thirty-five classroom hours of instruction in behavior analysis topics described in WAC 246-805-220; and
(iii) Proof of successful completion of a supervised experience requirement under WAC 246-805-230.
NEW SECTION
WAC 246-805-210 Licensed assistant behavior analyst—Recognized educational programs.
The department will accept a bachelor's degree in any discipline from an institution accredited by the council for higher education accreditation or United States Department of Education as meeting the requirements under RCW 18.380.050 (1)(b)(i) for applicants applying for a LABA credential.
NEW SECTION
WAC 246-805-220 Licensed assistant behavior analyst—Required topics for classroom hours.
(1) An applicant for initial licensure as a LABA shall complete one hundred thirty-five classroom hours of instruction in specific behavior analysis topics from a recognized educational institution in compliance with WAC 246-805-210. Topics must include the following content areas and the minimum number of hours specified:
(a) Ten hours of ethical considerations;
(b) Forty hours of definitions and characteristics and principles, processes, and concepts;
(c) Twenty hours of experimental evaluation of interventions, measurement of behavior, and displaying and interpreting behavioral data;
(d) Twenty-five hours of behavioral assessment and selecting intervention outcomes and strategies; and
(e) Forty hours of behavior change procedures and systems support.
(2) Classroom hours under this section may be taken as part of or in addition to the applicant's bachelor's degree program.
NEW SECTION
WAC 246-805-230 Licensed assistant behavior analyst—Supervised experience.
(1) Prior to submitting an application to the department, an applicant for initial licensure for a LABA license shall complete a minimum of one thousand hours of supervised experience in behavior analysis.
(2) The LABA trainee must be enrolled in or have completed the requirements contained in WAC 246-805-220 to be eligible to begin the required supervised experience as a LABA trainee.
(3)(a) The LABA trainee must complete his or her supervised experience within five years of the start date of the supervised experience.
(b) When actively participating in a supervised experience, the LABA trainee must participate in supervised experience at least ten hours and no more than thirty hours per week.
(c) At least five percent of the total monthly hours of supervised experience must be under the supervision of a LBA or BCBA.
(d) Supervision must be conducted at least every two weeks.
(4) A person is qualified to supervise a LABA trainee if he or she:
(a) Holds an active license in good standing as a LBA, or holds a current certification as a BCBA and meets the BACB supervisory requirements;
(b) Has practiced by providing at least one thousand five hundred hours of behavior analytic services to clients as a LBA or a BCBA; and
(c) Is not related to, subordinate to, or employed by the LABA trainee during the supervised experience period. Employment does not include compensation received by the supervisor from the LABA trainee for supervision services.
(5) Supervision shall include:
(a) Observing and providing feedback to the LABA trainee on his or her behavior analytic activities with a client in the natural environment;
(b) Observing the LABA trainee by synchronous (real time) web camera, video conferencing, or similar means when the supervisor is not physically present; and
(c) Supervising in small groups of up to six LABA trainees for no more than half of the total supervision required in subsection (3) of this section.
(6) The LABA trainee shall perform the following activities during the supervised experience:
(a) Directly implementing behavioral programs delivering therapeutic and instructional procedures, which may not exceed fifty percent of the total accrued experience hours; and
(b) Designing and systematically monitoring behavioral programs, naturalistic observation, staff and caregiver training, researching literature related to the program, and conducting assessments related to the need for behavioral intervention.
(7) Supervised experience must include the following content areas:
(a) Ethics and professional conduct;
(b) Measurement;
(c) Experimental design;
(d) Behavior-change considerations;
(e) Fundamental elements of behavior change;
(f) Behavior-change procedures;
(g) Behavior-change systems;
(h) Problem identification;
(i) Assessment;
(j) Intervention;
(k) Implementation, management and supervision;
(l) Philosophical assumptions of behavior analysis;
(m) Verbal operants; and
(n) Respondent and operant conditioning.
(8) The supervisor and LABA trainee must develop a supervision plan before the LABA trainee begins performing any behavior analytic tasks. The supervision plan must be maintained in the LABA trainee's file for seven years after completion of supervised experience. The supervision plan shall include:
(a) Types of duties and responsibilities the LABA trainee will perform;
(b) Dates, time and duration of supervision;
(c) Type of supervision, as described in subsection (5) of this section;
(d) Brief description of supervision activities; and
(e) Signatures of both the supervisor and LABA trainee.
(9) A supervised experience under this section may be completed as part of or in addition to the LABA trainee's bachelor's degree program.
BEHAVIOR TECHNICIAN CERTIFICATION
NEW SECTION
WAC 246-805-300 Certified behavior technician—Application requirements.
An applicant for initial certification as a CBT shall submit the following to the department:
(1) A completed application on forms provided by the department;
(2) Proof of being at least eighteen years of age;
(3) Proof of a high school diploma or equivalent;
(4) Proof of completing at least four clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;
(5) Proof of:
(a) Current registration as a RBT from the BACB. Department verification of the RBT registration number is accepted as proof of current registration;
(b) Current behavior technician registration or certification from a nationally accredited professional credentialing entity accepted by the secretary; or
(c) Successful completion of a behavior technician training program outlined in WAC 246-805-320.
(6) Proof of supervision that meets the requirements of WAC 246-805-330; and
(7) Fees as required in WAC 246-805-990.
NEW SECTION
WAC 246-805-310 Behavior technician training program.
An applicant who does not hold RBT registration under WAC 246-805-300 (5)(a) or other behavior technician registration or certification accepted by the secretary under WAC 246-805-300 (5)(b) may qualify for a CBT credential by completing a behavior technician training program.
(1) Behavior technician training programs meeting the requirements described in this section are approved by the secretary.
(2)(a) The behavior technician training program must be affiliated with a postsecondary school or college accredited by a regional or national accrediting organization recognized by the U.S. Department of Education; or
(b) The behavior technician training program must be through an agency, business or individual meeting the following criteria:
(i) Has a supervisor within sight and hearing and available for immediate intervention when the trainee is working with clients.
(ii) Has a supervisor that is:
(A) A LBA who holds a current and active credential in good standing with at least one year of full-time equivalency; or an active BCBA with at least one year of full-time equivalency who meets the supervisor requirements of the BACB.
(B) Responsible for the conduct of the trainee at all times when working with clients under his or her supervision.
(iii) Responsible for the training program, who will be referred to as the "training program supervisor," and shall:
(A) Be unrelated, subordinate to, or employed by the supervisee during the training period. Employment does not include compensation received by the supervisor from the supervisee for supervision services.
(B) Be responsible for determining the content of the training, adherence to the training, and ascertaining the competency of the trainee.
(C) Supervise the trainee until he or she demonstrates entry level competency, as provided in subsection (2)(a)(v) of this section.
(iv) The behavior technician training program must include at least forty hours of classroom, online or supervisor-led instruction in the following content areas:
(A) Measurement;
(B) Assessment;
(C) Skill acquisition;
(D) Behavior reduction;
(E) Documentation and reporting; and
(F) Professional conduct and scope of practice.
(v) Supervisor-led instruction:
(A) Practicing techniques in a simulated situation incorporating content areas in this subsection (b)(iv).
(B) Observing and performing behavior analytic services with clients incorporating content areas in this subsection (b)(iv).
(vi) Evaluation and assessment of knowledge and skills of this subsection (b)(iv) and (v) by the training program supervisor demonstrating entry level competency of the trainee.
(3) Trainees who only complete the forty hours through classroom or online instruction in the content areas in subsection (2)(b)(iv) of this section, from a training provider who is not a training program supervisor affiliated with an agency, business, or individual, must meet the requirements of subsection (2)(b)(v) of this section.
(4) After the trainee demonstrates entry level competency, as provided in subsection (2)(b)(vi) of this section, supervision may be provided by any behavior analyst who meets the requirements of subsection (2)(b)(i) and (ii) of this section.
(5) Prior to or at the time of the first visit with a client, the supervisor shall make sure that the client or client's parent or guardian is notified in writing that the trainee is participating in a behavior technician training program. The notification must be within the client's treatment plan or other documentation that must include the supervisor's name and contact information.
(6) A trainee must complete the training program and submit an application to the department on a form provided by the department within one hundred eighty days of starting the training program.
(7) Documentation of all behavior analytic training, supervision, duties, and responsibilities of the trainee must be completed and signed by the training program supervisor and the trainee, and placed in the trainee's personnel file. Copies of the documentation will be maintained by both the trainee and the training program supervisor.
(8) Upon successful completion of the training program, the training program supervisor will sign an attestation that the trainee has completed the behavior technician training.
NEW SECTION
WAC 246-805-320 Certified behavior technician—Tasks.
(1) A CBT shall not:
(a) Initiate or implement a treatment program with a client until the client has been evaluated by a LBA or LABA, and a written treatment and instructional program has been prepared by a LBA or LABA;
(b) Independently perform a client assessment or evaluation, but may assist in the process under the direction of a LBA or LABA; and
(c) Independently design or modify client treatment plans or instructional programs.
(2) A CBT shall:
(a) Monitor the need for reassessment and report changes in status that may warrant reassessment or referral by or under the direction of a LBA or LABA; and
(b) Immediately discontinue and notify the supervising LBA or LABA about any treatment procedure that appears harmful to the client.
NEW SECTION
WAC 246-805-330 Certified behavior technician—Continuing supervision.
(1) A CBT must work under close, ongoing supervision of a LBA or LABA for each client receiving ABA services.
(2) A supervisor:
(a) Must hold an active license in good standing as a LBA or LABA; and
(b) Shall be responsible for the conduct of the CBT at all times when working with clients under his or her supervision.
(3) The CBT and the supervisor must develop a supervision plan before the CBT begins to provide any behavior analytic tasks. A copy of the supervision plan must be maintained both by the supervisor and CBT. The supervision plan must include, but not be limited to:
(a) Duties and responsibilities the CBT will perform;
(b) Type and frequency of supervision, as described in subsection (5) of this section; and
(c) Signature of both the supervisor and supervisee.
(4) The supervisor shall review the CBT's progress with the CBT as necessary but at least every six months.
(5) The supervisor shall:
(a) Meet in person with the CBT to provide guidance in working with new clients;
(b) Provide supervision for a minimum of five percent of the CBT's hours with client per month;
(c) Conduct at least two face-to-face contacts per month with the CBT. Face-to-face contact may occur in-person, on-site or by videoconferencing;
(d) Observe the CBT at least once per month when CBT is providing services to clients. Observation may occur in-person, on-site or by videoconferencing; and
(e) Observe the CBT with each client on his or her caseload at least once every three months.
NEW SECTION
WAC 246-805-990 Applied behavior analysis fees and renewal cycle.
(1) Credentials in this section must be renewed every two years on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2.
(2) The following nonrefundable fees will be charged:
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