BCBA Caseloads and Supervision

Case supervision activities can be described as those that involve contact with the client or caregivers (direct supervision, also known as clinical direction) and those that do not (indirect supervision). Both direct and indirect case supervision activities are critical to producing good treatment outcomes and should be included in service authorizations. It should be noted that direct case supervision occurs concurrently with the delivery of direct treatment to the client. On average, direct supervision time accounts for 50% or more of case supervision.

Some case supervision activities occur in vivo; others can occur remotely (for example, via secure telemedicine or virtual technologies). However, telemedicine should be combined with in vivo supervision. In addition, some case supervision activities are appropriate for small groups. Some indirect case supervision activities are more effectively carried out outside of the treatment setting.

Although the amount of supervision for each case must be responsive to individual client needs, 2 hours for every 10 hours of direct treatment is the general standard of care. When direct treatment is 10 hours per week or less, a minimum of 2 hours per week of case supervision is generally required. Case supervision may need to be temporarily increased to meet the needs of individual clients at specific time periods in treatment (for example, initial assessment, significant change in response to treatment).

This ratio of case supervision hours to direct treatment hours reflects the complexity of the client’s ASD symptoms and the responsive, individualized, data-based decision-making which characterizes ABA treatment. A number of factors increase or decrease case supervision needs on a shorter- or longer-term basis.

These include:
• treatment dosage/intensity
• barriers to progress
• issues of client health and safety (for example, certain skill deficits, dangerous problem behavior)
• the sophistication or complexity of treatment protocols
• family dynamics or community environment
• lack of progress or increased rate of progress
• changes in treatment protocols
• transitions with implications for continuity of care

Caseload Size

Behavior Analysts should carry a caseload that allows them to provide appropriate case supervision to facilitate effective treatment delivery and ensure consumer protection. Caseload size for the Behavior Analyst is typically determined by the following factors:
• complexity and needs of the clients in the caseload
• total treatment hours delivered to the clients in the caseload
• total case supervision and clinical direction required by caseload
• expertise and skills of the Behavior Analyst
• location and modality of supervision and treatment (for example, center vs. home,
individual vs. group, telehealth vs. in vivo)
• availability of support staff for the Behavior Analyst (for example, a BCaBA)

The recommended caseload range for one (1) Behavior Analyst supervising Focused treatment
› without support of a BCaBA is 10 – 15.*
› with support of one (1) BCaBA is 16 – 24.*
Additional BCaBAs permit modest increases in caseloads.

The recommended caseload range for one (1) Behavior Analyst supervising Comprehensive treatment
› without support by a BCaBA is 6 – 12.
› with support by one (1) BCaBA is 12 – 16.
Additional BCaBAs permit modest increases in caseloads.
* Focused treatment for severe problem behavior is complex and requires considerably greater
levels of case supervision, which will necessitate smaller caseloads.