Chapter B2 – Article 10. BHA Supervision and Scope of Practice

Sec. B2.10.100. Supervision of Behavioral Health Aides and Behavioral Health Practitioners.

1. Clinical Oversight.
   1. Program Responsibility. A behavioral health aide or practitioner may only practice in a program in which clinical oversight of the behavioral health program is provided and responsibility is taken by a licensed behavioral health clinician who must be:
      1. familiar with the BHA/P program, the Standards, and the BHAM; and
      2. employed by the federal government or employed by or under contract with a tribal health organization operating a community health aide program in Alaska under the ISDEAA.
   2. A licensed behavioral health clinician or behavioral health professional providing clinical oversight or clinical supervision:
      1. must have demonstrated the ability to provide culturally competent services; and
      2. if providing direct supervision of behavioral health aides or practitioners:
         1. must have demonstrated the ability to provide such services in a village setting; and
         2. through education and experience, be able to supervise village-based behavioral health aides and practitioners.
      3. Levels of Supervision. The clinical supervision of a behavioral health aide or practitioner may be direct, indirect, or general as defined in section B2.10.100(c) [supervision of BHA/Ps; definitions of level of supervision] provided that:
         1. the person providing clinical supervision must either be a licensed behavioral health clinician or behavioral health professional, provided that a behavioral health practitioner acting within the scope of his or her certification may provide day-to-day support and mentoring of behavioral health aides;
         2. the behavioral health aide or practitioner must be supervised at the level of supervision required for the specific service or care being provided;
         3. the supervisor may impose a higher level of supervision on the behavioral health aide or practitioner than that provided in this article; and
         4. the supervisor may develop an individualized protocol under which the behavioral health aide or practitioner is permitted to engage in a wider range of activities than that allowed under this article, provided:
            1. (A) the individualized protocol is in writing signed by the behavioral health aide or practitioner and a licensed behavioral health clinician who is both familiar with the work of the behavioral health aide or practitioner and the setting in which the authorized services will be provided;
            2. (B) the level of supervision and level of performance required for each service to be provided under the individualized protocol is specified; and
            3. (C) the individualized protocol must be reviewed and updated upon recertification of the behavioral health aide or practitioner.
         5. Definitions of Level of Supervision. For the purposes of this article:
            1. “Direct supervision” means that a licensed behavioral health clinician or a behavioral health professional:
               1. (A) consults in advance with the behavioral health aide or practitioner prior to the behavioral health aide or practitioner performing service;
               2. (B) is available in person or through the use of telehealth, which for the purposes of supervision and consultation with behavioral health aides and practitioners includes instant messaging and telephone communications, while the behavioral health aide or practitioner performs the service; and
               3. (C) reviews the outcome of specific services performed with the behavioral health aide or practitioner on a relatively contemporaneous basis after their completion.
            2. “Indirect supervision” means that a licensed behavioral health clinician or a behavioral health professional:
               1. (A) consults in advance with the behavioral health aide or practitioner with regard to the plan for performing services; and
               2. (B) routinely reviews with the behavioral health aide or practitioner services provided.
            3. “General supervision” means, with regard to:
               1. (A) direct client services, that a licensed behavioral health clinician or behavioral health professional has authorized and or planned with the behavioral health aide or practitioner and client a treatment, case management, or services plan that is intended to be carried out by a specific behavioral health aide or practitioner subject to regular case review by the supervisor; or
               2. (B) outreach (including initial contacts with individuals who may seek or be referred for services, community-based education and prevention activities, and community organization work) that a licensed behavioral health clinician or a behavioral health professional has consulted with and authorized the behavioral health aide or practitioner to perform such activities independently so long as the behavioral health aide or practitioner is within the scope of practice for which the behavioral health aide or practitioner is certified and will be reported to and periodically reviewed by the supervisor.

Sec. B2.10.200. Scope of Practice Prior to Certification as a Behavioral Health Aide or Practitioner.

1. Minimum Requirements. A person who satisfies the requirements of subsection B2.10.200(b) [scope of practice prior to certification as a BHA; employment] may perform services of a certified behavioral health aide or practitioner prior to being certified to the extent the services are performed:
   1. as part of the required training for certification;
   2. as part of a clinical practicum;
   3. to satisfy work experience requirements required for certification; or
   4. after the application for certification has been submitted to the Board, while certification is pending after successful completion of all training, clinical practicum, and work experience requirements.
2. To be eligible to perform services under subsection B2.10.200(a) [scope of practice prior to certification as a BHA/P; minimum requirements], the person must:
   1. be employed by the Indian Health Service or a tribe or tribal health organization operating a community health aide program in Alaska under the ISDEAA;
   2. provide only those services for which the person has been trained and has demonstrated successful performance; and
   3. provide services only under the direct, indirect, or general supervision as required under section B2.10.200 [supervision of BHA/Ps] and other relevant sections of this chapter B-2 [standards for BHAs].