Barriers in Telehealth Supervision: A Recent Survey's Findings

Introduction

The rapid expansion of telehealth has transformed the field of applied behavior analysis (ABA), making supervision more accessible, cost-effective, and convenient. However, providing effective supervision via telehealth presents unique challenges that require careful consideration.

Supervision plays a critical role in ensuring ethical and high-quality ABA services. Effective supervision helps behavior analysts develop clinical skills, adhere to best practices, and receive mentorship as they grow in their careers. When supervision shifts to a virtual setting, new logistical and technological barriers can arise, potentially impacting its effectiveness.

A recent study by Sipila‑Thomas and Brodhead (2024) surveyed barriers that behavior analysts experience when providing telehealth supervision. Their findings provide valuable insights into the challenges faced by both supervisors and supervisees in remote settings. This blog post summarizes their research and highlights key takeaways for practitioners.

The Growth of Telehealth in ABA

Telehealth, the use of digital communication tools to deliver healthcare services remotely, has become increasingly popular in ABA practice. Research supports its effectiveness in various applications, including:

• Parent training programs
• Direct therapy sessions for specific skill acquisition
• Supervision of RBTs and BCBA trainees

The benefits of telehealth include reduced costs, improved access to services, and flexibility for both professionals and clients. However, while telehealth has been well-studied for clinical applications, the supervision process itself has received less attention. As more professionals rely on virtual supervision, understanding its barriers becomes essential for maintaining quality training and oversight.

Why Research on Telehealth Supervision is Important

Effective supervision is the foundation of ethical and competent ABA practice. Board Certified Behavior Analysts (BCBAs) must provide high-quality oversight to trainees to ensure they develop the skills necessary to serve clients effectively. Poor supervision can lead to:

• Gaps in clinical knowledge and decision-making
• Ethical concerns due to inadequate mentorship
• Challenges in implementing evidence-based interventions

Despite the growing use of telehealth for supervision, limited research has explored the specific difficulties practitioners face in providing virtual oversight. Sipila‑Thomas and Brodhead’s study aimed to fill this gap by collecting data on common barriers and potential strategies to overcome them.

How the Study Was Conducted

Participants & Recruitment

The researchers recruited participants through a mass email to eligible individuals on the Behavior Analyst Certification Board (BACB) mailing list. To qualify, participants needed to be BCBAs who had provided telehealth supervision. The final sample included professionals with varying levels of telehealth supervision experience, allowing for a comprehensive overview of challenges faced in different contexts.

Survey Design

The survey was structured into four key sections:

1. Inclusion criteria – Ensuring participants met requirements to participate
2. Supervision logistics – Gathering details about how supervision was conducted remotely
3. Barriers experienced – Exploring the difficulties encountered during virtual supervision
4. Strategies used – Identifying methods employed to address challenges

Participants answered a mix of multiple-choice, ranking, and open-ended questions, providing both quantitative and qualitative insights.

Data Analysis

The researchers used descriptive statistics to assess common challenges. Additionally, they compared responses between supervisors with prior telehealth experience and those who started supervising remotely due to COVID-19.

Key Findings: Barriers to Telehealth Supervision

Supervisee Challenges

Supervisees faced multiple barriers that impacted the supervision process. The most commonly reported issues included:

• Internet connectivity problems (reported by 66.7% of participants)
• Distractions in their environment that interfered with sessions
• Scheduling conflicts due to time zone differences or other obligations
• Limited access to therapy materials needed for supervision exercises
• Technical difficulties with video conferencing software

These issues often made it difficult for supervisees to participate fully in sessions, ask questions, or demonstrate competencies effectively.

Supervisor Challenges

Supervisors also encountered challenges in delivering high-quality remote supervision. The most common difficulties included:

• Demonstrating strategies effectively due to the limitations of video communication
• Limited visibility of the supervisee’s actions, often due to poor camera positioning
• Time constraints in providing comprehensive, individualized feedback
• Access to necessary supervision resources for assessments and intervention planning

These barriers made it harder for supervisors to ensure that supervisees received thorough feedback and hands-on learning opportunities.

Does Prior Telehealth Experience Matter?

One key finding was that challenges were similar across supervisors, regardless of whether they had prior telehealth supervision experience before COVID-19. While one might expect that those with more experience would report fewer difficulties, the study found that barriers such as internet issues, visibility problems, and demonstrating techniques remained consistent.

This suggests that the challenges of telehealth supervision are intrinsic to the medium itself, rather than a result of individual professionals’ levels of experience.

Implications for ABA Professionals

These findings highlight a critical need for solutions to improve the effectiveness of telehealth supervision. Some potential strategies for overcoming barriers include:

• Providing guidance on ideal technology setups – Encouraging supervisees to use proper lighting, stable internet connections, and camera setups that allow clear visibility
• Using multiple camera angles or additional video recordings – Ensuring that supervisors can see all necessary details in real time or for later review
• Incorporating structured supervision protocols – Developing checklists and training exercises specifically designed for remote settings
• Scheduling supervision sessions strategically – Finding times when distractions are minimized and ensuring both parties have access to necessary materials

Additionally, future research could explore interventions tailored to managing supervision challenges, including training programs to help both supervisors and supervisees navigate telehealth more effectively.

Final Thoughts

Supervision is a cornerstone of effective ABA practice, and as the field continues to embrace telehealth, addressing its barriers is essential. Sipila‑Thomas and Brodhead’s (2024) study provides a vital look into the challenges of remote supervision, helping behavior analysts better understand the difficulties they may face.

For those providing or receiving telehealth supervision, being aware of these barriers can lead to more proactive strategies that enhance the quality and effectiveness of training.

To read the full study and explore the detailed data, check out the publication in Behavior Analysis in Practice: https://doi.org/10.1007/s40617-023-00860-7.