BCBA Clinical Onboarding / Manual

Start

We warmly welcome you aboard! Our training program is tailored to help you assimilate into PCH's organization as a BCBA. As you get started in your new role, feel free to use this training as a resource manual whenever you need it.

BCBA Clinical Onboarding

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Preparing for Success: Essential Tools for a Strong Start
Before diving in, let's take care of some housekeeping.

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It's important that you have all of the necessary tools to begin your journey with confidence. Watch the HIPAA compliance video to start.

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Two-to-Three-Tier System

Aloha is used for scheduling, billing and for viewing reports.

Aloha

ABA Clinical Data Collection Software

Motivity

Collaboration among PCH staff is crucial to help individuals navigate their work environment.

Role of Team

Clinical documentation is an essential aspect of our practice as clinicians.

Clinical Documentation

Reviewing the supervision handbook will be an ongoing process.

Review Supervision Handbook

Meet the Team

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About PCH

Pivotal Curve Health Values

• PCH, soley provides Applied Behavior Analysis (ABA)
• We service the high and low desert regions of Socal
• Pivotal Curve Health is a boutique ABA service provider.
• Funder Source: IEHP (Medi-cal & Private)

Transparency: We embrace transparency and share information related to our performance, and are accountable for our results and commitments. Effective Treatment: PCH is dedicated to patient care. Our families are our priority. We prioritize care by treating our families with respect and compassion, but also... no single treatment is appropriate for all individuals, treatment is readily available, we are continually evaluating patient progress and make changes as needed. Collaboration: We expect all team members to join in obtaining optimal clinical outcomes and parent/caregiver satisfaction. There's no pecking order at PCH. All members must collaborate in sharing knowledge - reinforces high quality care, maximizes productivity, and it is cost-effective.

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Our top priority at PCH is to foster a workplace culture that is positive and supportive. We've observed that employees who enjoyed working at PCH are more likely to excel in their duties and build strong relationships with their families, treatment team, administration, and HR. These individuals are effective communicators who understand their role, responsibilities and seek support regarding issues that may impact their work. Finally, you will be expected to stay up-to-date on the latest research and best practices in the field of behavior analysis and with PCH company updates. This may involve attending conferences, reading scholarly articles, and participating in ongoing training and professional development opportunities. By staying informed and engaged, you will be better equipped to provide the highest quality care to the individuals you serve.

As a behavior analyst at PCH you need to meet the clinical responsibilities, you will also need to be an effective communicator and collaborator. You will be working closely with other clinicians, including therapists, stakeholders, and caregivers, to ensure that your interventions are effective and consistent across all settings. You will also need to be able to explain complex concepts to families and other stakeholders in a way that is professional, clear and understandable.

Expectations

Preparing for Your Role as a BCBA at PCH

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Parental involvement and collaboration

Collect parent training data

Applying evidence-based strategies

Determine objective & mastery criteria

Prioritize Treatment Goals

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Parent Training meetings provide parents/caregivers with the necessary skills and knowledge to understand their child's behavior and how to best respond to it.

Parent Training

Programming treatment plan goals can be challenging, but breaking goals down into manageable steps can help make the process easier. First, begin by reviewing the authorized FBA treatment goals. Next, begin adding treatment goals from the FBA/PR:

Programming for Patients

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Treatment Process

Step 6

Day-to-Day Tasks

Step 4

Create Collaborative Feedback Meetings

Step 2

Best Practices:

The BCBA will perform various tasks within his/her workday to support his her families and team.

Administer Indirect Assessments

Introducing Yourself to the Treatment Team and Member

Step 5

Individualized Treatment Plan

Step 3

Initial Observations

Step 1

Actions to Take After Receiving an Assigned Case

Establish Goals

Carry out the direct assessment

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One of the core standards of Pivotal Curve Health is the well-being of its employees and their families. The company recognizes that a healthy work-life balance is crucial for the overall happiness and productivity of its staff. Pivotal Curve Health offers various benefits to support its employees' physical and mental health, such as health insurance, and opportunities for social interactions. Additionally, the company encourages its employees to take time off for personal reasons and provides flexible scheduling options to accommodate their needs. By prioritizing the well-being of its staff and families, Pivotal Curve Health creates a positive and supportive work environment that fosters development and growth for everyone involved.

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Overall, reports are a vital component of clinical documentation, serving as a means of communication and providing a comprehensive record of a patient's medical history.

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Reports

Review of Company Timeline for Upcoming Activities and Events

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Company Timeline

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Administering Performance Evaluations for All Clinicians (BT, CS, & BCBA)

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Performance Evaluations

To ensure consistent service, it is crucial to establish and maintain a member's authorization.

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Treatment Authorizations

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Gain insight into the current state of affairs at Pivotal Curve Health.

Past Team Meetings

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Our team is here to support you in any way we can.

Support

Staying On Top of Your Treatment Schedule

Cancellation Notice

You have worked hard to get to this point and we are excited to have you as part of our team. We understand that starting a new job can be overwhelming, so please don't hesitate to reach out to us if you have any questions or need any support. We want you to feel comfortable and confident as you begin your new role. Remember, now is the time to take everything you have learned and apply it to your work. We have no doubt that you will hit the ground running and make a valuable contribution to our organization and families. Welcome aboard!

Congratulations on completing your onboard training!

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Reassessment Checklist

FBA Criteria & Checklist

Discharge Report Criteria & Checklist

Progress Report Criteria & Checklist

Transition Checklist

Report Writing: For three-tier cases, the CS is tasked with initiating the report, while the BCBA completes the report and makes any necessary final revisions. Both parties are allotted a combined total of 10 hours for reassessment and report writing, split equally (5 CS hrs & 5 BCBA hrs). Discharge & Transition Reports: Ensuring Continuity of Care - In the event a member discontinues their treatment, it is important to complete the discontinue checklist. For members reassigned to a different BCBA within PCH, please complete the transition checklist. These checklists must accompany the completed reports to support the insurer and future provider. Discontinuing ABA Checklist

Overview

Reports

Report Types:

• Progress Reports - due every 6 month period
• Discharge Reports

• Functional Behavior Assessments - due 10 days after the final observation.

Progress Reports: It is recommended that progress reports are submitted 1-month in advance before the authorization period ends. Completed reports must be emailed to reportsubmission@pivotalcurve.health, 2 weeks prior to the authorization end date. The reassessment checklist should be reviewed and completed during a PT meeting when the patient's progress is shared.

Supervision Handbook: Pivotal Curve Health employees encourage families to make-up sessions for previously canceled sessions. Lead staff and admin will collaborate with families to ensure that clients establish and maintain consistent treatment. Please communicate with your families and staff to address cancellations. PCH reserves the right to terminate staff for concerns that are clinical and HR related and may discharge families that fail to utilize services.

• BCBA Intervention troubleshooting is highly recommended.

What can you do when you begin to receive recurring cancellation emails?...

• Communicate with the family re: cancellations during the treatment session.
• Flag emails
• Text family to address concerns and find a resolution.
• Collaborate with the family & team to ensure continuous treatment sessions.

Cancellations

pch notifications

Admin may send emails to alert you when your family or therapist cancels a treatment session. It's important to keep track of these emails since cancellations can reasonably happen within a 6-month period. PCH, aims for no more than 10% of cancellations within a current authorization period. If you receive frequent patient notifications regarding cancellations, please reach out to the cancelling party by encouraging make-up sessions, preferably within the month. BT staff turnover is high in our field, we want to prioritize client treatment and support our staff by maintaining effective continuous treatment sessions.

Matthew White

Nyvia Randall

Mishele Yashita

Anna Singer

Christina Perez

Caitlin Haney

Marjie Gopez

HR

HR

Celine Hendrix

Kaylen Rainbolt

MaribelZavala

Daisy Frias

Teresa Bowlin

Dineli Eckroth

BCBAs

meet the TEAM

Teresita Hernandez

Haley Nixon

CLINICAL COORDINATOR

Miesha Dorsey

case supervisors

clinical director & bcba

Strauss Abdul-Rahman

clinical liaison

SUPERVISORS

CLINICAL ADMIN

ADMIN

BCBA Housekeeping

• Setup Gmail Account
• Respond to welcome email!

Respond to Group Welcome Notification Google Suite Training

• Google Chat

• Set Up Your Drive

• Google Drive

• Calendar

• Settings > Video

• Click > Setup Email Signature

Please complete all parts of the prefilled note template. Additionally, PCH requires that all meetings be terminated 15 minutes prior to the end time to allow time for clinical documentation. All clinical notes should be completed in Motivity, which is a user-friendly platform that allows for efficient documentation and data collection. Once the documentation is completed, it is synced to Aloha, and becomes an electronic health record retained by PCH. By following these guidelines, we can ensure that we provide the best possible care to our patients while also maintaining accurate and complete records of our clinical encounters. The responsibility for approving and rejecting clinical session notes falls on Behavior Analysts and Case Supervisors.

Session Notes

clinical documentation

Clinical documentation is an essential aspect of our practice as clinicians. It serves as a record of the care provided to our patients and is necessary for billing and legal purposes. Therefore, it is crucial that we document any billable and non-billable meetings that we have with our patients to ensure that we provide accurate and complete information. For every direct and indirect supervision meeting, it is important to provide a thorough and complete clinical document that stipulates what occurred. This documentation should include details such as patient progress, any changes in treatment plans, and any other relevant information that could impact the patient's care.

Supervision is an essential aspect of any workplace that involves managing and overseeing employees and patients. As a supervisor, it is your responsibility to ensure that your team is working efficiently and effectively towards achieving the organization's goals. To do this, you need to have a clear understanding of the company's policies and guidelines regarding supervision. One of the most important resources for any supervisor is the supervision handbook. This document outlines the company's expectations and procedures related to employee and patient management, including protocols, and training opportunities. It is crucial to review and understand this handbook thoroughly to ensure that you are providing your team and patients with the best possible leadership and support. Reviewing the supervision handbook should be an ongoing process. It is essential to stay up-to-date with any changes or updates to the policies and procedures outlined in the handbook. Additionally, you should regularly refer back to the handbook when handling specific situations or making decisions related to employee and patient management.

The Importance of Reviewing the Supervision Handbook

Aloha

Aloha is integrated with Motivity to streamline operations. This integration enables us to keep track of schedules and authorizations, verify meetings, obtain client and staff information, review records, clinical documentation, monitor productivity, cancellations, and generate reports with ease.

Once a patient has been assigned, there are certain steps that must be taken to guarantee the delivery of quality treatment. It's also essential to have all the necessary tools to support you in providing patient care. Begin by ensuring that you have obtained the necessary forms:

Gather Information

Contact Admin

• Member Reports (progress reports, FBAs, etc.)
• Member contact information & know where to locate info.
• Treatment team contact information (BT & CS).
• If applicable, transition/discharge forms.

For three-tier cases, BCBAs fulfill a fixed number of monthly supervision hours per month.On the other hand, the Case Supervisor is responsible for supervising 20% of the direct treatment hours rendered each month. For two-tier cases, BCBAs are responsible for supervising 20% of the direct treatment hours rendered each month.

Managing Active Member Authorizations for ABA Services

To access active member authorizations for ABA services, navigate to the Aloha app/website and refer to the 'client list' found on the dashboard. It is crucial that authorizations do not expire to ensure continuous service. Remember, services should never be rendered without a valid authorization in place. To avoid any interruptions in service and to streamline staff workload, submit all required clinical documentation promptly. You can find treatment plan hours on the member's most recent report (progress report or FBA). A narrative description and request for treatment hours (BCBA supervision hours, Case Supervisor hours, Parent Training hours, and Reassessment/Progress Report hours) is located at the bottom of the report. Locate the member authorization start and end dates for ABA services, please disregard the authorization units. IEHP is PCH's sole funder, and behavior analysts should use the relevant insurance codes for each service.

Billable Services - Direct Services, Direct Supervision, Indirect Supervision, Parent Training & Report Writing

• BCBA - H0032-H0
• CS - H0032
• BT - H2019
• FBA - H0031

As a Board Certified Behavior Analyst (BCBA), one of the most important responsibilities is conducting assessments to inform treatment plans for clients. While direct assessments, such as functional analyses, can provide valuable information about behavior function, indirect assessments can also provide important insights into a client's behavior and environment. An effective indirect assessment will involve gathering information from a variety of sources, including interviews with caregivers and treatment team, review of medical and educational records, previous reports, transition forms, communicating with previous provider(s), past data, etc. It is important to gather information from multiple sources to ensure a comprehensive understanding of the client's behavior and environment.

Indirect Assessments

Once information is gathered, it is important to analyze the data to identify patterns and potential factors that may be influencing the client's behavior. This analysis can inform the development of treatment plans tailored to the individual client's needs. As a BCBA, it is crucial to have strong skills in conducting indirect assessments to ensure the development of effective treatment plans for clients. Ongoing assessment and analysis can also inform modifications to treatment plans as necessary to ensure continued progress towards goals.

Behavior Reduction - Please include a protocol (BIP) to address the challenging behavior(s): a. Goal b. Target Behavior (BOI- Behavior of Interest and 17 topography) c. Examples and Nonexamples (nonexamples should be functionally equivalent) d. Onset e. Offset f. Baseline Duration & Frequency g. Intensity h. Precursor Behaviors / Current Antecedents i. Current Consequences j. Hypothesized Function of Behavior k. Replacement Behavior l. Environmental Arrangement m. Antecedent Strategies n. Consequence Strategies o. Reinforcement Schedules (DRO, Positive Reinforcement, NCR, etc.)

Each skill acquisition program must include the following program criteria for therapists to follow by default. Additional criteria are optional:

Skill Acquisition - a. Procedure/Protocol (instructions for how to implement the program) b. SD (discriminative stimulus) c. Number of Trials Per Day d. Materials e. Correct Response description f. Incorrect Response description g. Prompt Level h. Reinforcement Schedule i. Any additional information necessary for intended implementation of the following program.

Programming Criteria:

Motivity

Motivity is an online platform designed for managing interventions in applied behavior analysis and collecting relevant data. Please reach out to the Clinical Coordinator to schedule an appointment with the Associate/Clinical Director for an overview of the platform and additional support.

Additionally, providing support to the team, troubleshooting issues, and guiding the future directions and plans for PCH. This role necessitates close collaboration with the associate clinical director, administration and HR, as well as managing clinical and administrative duties. The Role of the Human Resource Director is a representative for all staff members, the Human Resource Director is responsible for upholding compliance and professionalism within the organization. This includes upholding state laws, updated regulations and company policies. In addition, the HR Director safeguards potential liabilities, and assists staff members with administrative questions and concerns.

Team Roles

clinical & administrative

The Clinical Coordinator plays a vital role in ensuring that cases are allocated efficiently, scheduling needs are met, resources and materials are available, and more. They work closely with the clinical liaison and clinical director to monitor case progress, make treatment adjustments (when required), and prioritize client interests. In addition to these tasks, they also handle administrative responsibilities that safeguard potential liabilities, support staff, and HR. The Clinical Liaison is a vital support to the Clinical Coordinator, assisting with various administrative tasks and needs. This includes responding to queries and answering questions, organizing and managing tasks. The Clinical Director of PCH, is responsible for overseeing staff and clients' progress from a comprehensive overview.

You will have a better understanding of the topics and concerns that have been previously discussed, which will allow you to contribute more effectively to future meetings. Additionally, reviewing the previous meetings will help you to identify any recurring issues or themes that need to be addressed. We encourage you to take the time to review these meetings thoroughly and come prepared with any questions or suggestions you may have. You can find these meetings located in the 'Clinical Staff Folder' under 'Team Meetings'. Thank you for your commitment to our team and our mission at Pivotal Curve Health.

Team Meetings

Whether you have questions about patient care, administrative tasks, or human resources, we have dedicated professionals who are ready to help. Our associate clinical director and clinical director can provide guidance and support for any clinical questions you may have. If you have questions about administrative tasks, such as scheduling or billing, our Clinical Coordinator and Clinical Liaison are here to assist you. And if you have any concerns or questions related to human resources, our HR administrator is available to provide guidance and support. We are committed to providing excellent care and support to our team members, and we encourage you to reach out if you need assistance or have any questions.

Support / Assistance

To foster a successful and harmonious team dynamic, it's important to get to know your team, family and stakeholders. Share your professional background and expectations to help your team members gain a better understanding of who you are, what drives you, but also how to support you. Additionally, take the time to ask each person on the team about their experiences and interests to demonstrate that you respect and value their perspectives. Remember, effective paring and collaboration is built on open communication and mutual respect, so always listen attentively, share your ideas, and work together to achieve common goals. By doing so, you'll not only develop meaningful connections with your team, but also improve productivity and overall success.

Arrange Introductions

As a BCBA, daily tasks can differ extensively. Conducting assessments of clients, collaborating with the team to develop treatment goals, creating behavior intervention plans, supervising plan implementation, and providing staff and caregiver training all fall under a BCBA's purview. In addition, data analysis and treatment adjustments are crucial. Troubleshooting, mentoring Case Supervisors, and offering consultation for behavior management and patient skill acquisition goals on three-tier cases are all essential. BCBA's must use evidence-based practices to improve the lives of individuals with developmental and behavioral difficulties. Dedication to the well-being of clients is essential for success.

Day-to-Day Tasks

Please complete all required fields on the clinical session notes form. Additionally, PCH requires that all meetings be terminated 15 minutes prior to the end time to allow time for clinical documentation. All clinical notes should be completed in Motivity, which is a user-friendly platform that allows for efficient documentation. Once the documentation is completed, it is synced to Aloha, and becomes an electronic health record used by PCH. By following these guidelines, we can ensure that we provide the best possible care to our patients while also maintaining accurate and complete records of our clinical encounters. Behavior Analysts and Case Supervisors are responsible for overseeing Clinical Session Notes.

Session Notes

clinical documentation

Clinical Documentation serves as a record of the care provided to our patients and is necessary for billing and legal purposes. Therefore, it is crucial that we document any billable and non-billable meetings that we have with our patients to ensure that we provide accurate and complete information. For every direct and indirect supervision meeting, it is important to provide a thorough and complete clinical document that stipulates what occurred. This documentation should include details such as patient progress, any changes in treatment plans, and any other relevant information that could impact the patient's care.

The company timeline is an important aspect, as it lays out the key meetings and milestones that the organization is striving towards. Priming staff of upcoming events and activities can assist in understanding where the company is headed and how they can contribute to its success. In addition to highlighting the major events on the horizon, the timeline can also serve as a way to celebrate the company's past accomplishments and recognize the hard work of its employees. Ultimately, our company timeline can help to foster a sense of cohesion and shared purpose among staff members, driving the organization towards its goals with confidence and enthusiasm.

Company Timeline

As a healthcare provider/BCBA, it's cruicial to evaluate the progress of the member's existing treatment plan regularly. This helps you, the member and treatment team determine whether the current plan is working effectively or if any changes are needed.

Case Overview Questionnaire

Individualized Care

In order to assess the treatment needs of a member, it's important to hold a case overview discussion with the parent, behavior therapist, and, the Case Supervisor. This evaluation should occur during both the initial and subsequent observations.

Get a sense of the therapist's approach and areas of expertise, as well as their relationship with the patient and family. Finally, observe the Case Supervisor's role in overseeing the patient's care and coordination among the team members. By gathering this information, you can tailor your session structure to meet the unique needs of the patient and their support system. You can also identify potential challenges to prevent and address before they become major issues, following these initial observations. With careful observation and thoughtful planning, you set a foundation for successful treatment that benefits everyone involved, specifically the patient.

Direct Assessment

initial observations

It is recommended that several initial observations are administered. These observations can help you become acquainted with the patient, family, therapist, and Case Supervisor. The observations should be unobtrusive and can be conducted in-person or through telehealth. These observations can provide valuable information to help you better support the team and family while avoiding potential issues. During these observations, pay attention to the patient's behavior, level of communication, and any specific needs or preferences they may have. Take note of the family's level of involvement and support, as well as any challenges they may be facing in caring for the patient.

The ultimate goal of parent training is for parents/caregivers to become experts in their child's behavior and to be able to support their child in all environments, not just during therapy sessions. Parent trainings should foster strong relationships that open communication between the team, and offer support in obtaining effective treatment. Questions or concerns may also be addressed by all parties about the child's progress or behavior. Parent meetings should go beyond mere discussion and focus on teaching parents about their educational goals. Additionally, it is essential to collect data to monitor the parent's/caregiver's knowledge and progress over time.

Parent Meetings

• Programming Parent Educational Goals in Motivity
• Establish recurring parent meetings
• Update parent/caregiver regarding child's progress

• Administer initial observations via telehealth/in-person & establish rapport with family & treatment team
• Review patient's treatment plan in Motivity
• Ensure programs are implemented as intended and support is provided.

Step 3

• Ensure parent training(s) are scheduled
• Schedule recurring supervision meetings with your CS and entire team

Step 2 - Direct Sup

Step 1 - Indirect Sup

• Obtain the patient's most recent progress report(s), FBAs, etc. and review
• Introduce yourself to the team via phone call (family, BT & CS).
• Review and organize your schedule.

Completing the QA Form is required before the observer and supervisor's QA overlap.

Annual Performance Evaluations for CS' & BCBA's:
CS' and BCBA's undergo annual performance evaluations. The clinician's assessment, report writing, interpersonal skills, treatment programs, supervision, organization, attendance, billing, and professionalism are assessed by the administration, BTs, families, and other staff. Quality Assurance (QA) Checks: QA overlaps are admistered quarterly in person or virtually between the CS/BCBA and observer. In healthcare, quality assurance ensures that patients receive the best possible care and treatment. It is a critical process that ensures ABA services meet the company and field required standards and specifications. It involves a range of activities carried out throughout the service life cycle to ensure that treatment meets the expectations of the patient and stakeholders.

Staff Development

performance review

To ensure high quality care and compliance PCH lead clinican staff undergo several performance reviews. BT Evaluations: A Comprehensive Breakdown
To ensure quality assurance and compliance, BT competency checklists are conducted by a BCBA and CS. These checklists consist of 3 observations with a 90% fidelity requireement. Once completed, evaulations are submitted to the admin and CD for final review and are filed as part of the staff's record. Subsequently, BTs undergo annual performance reviews.