Weeding Out the Bad: You're Fired!


Related post: Hiring ABA Staff: You're Hired!


There are few things I hate about my job (thankfully for me), but right near the top of the list is when I encounter a parent who tells me about a really bad experience with ABA staff/an ABA company.
Some of the stories I hear are bad or unprofessional, and some are just shocking. And hugely disappointing.

I think that if more parents were aware of how to evaluate the quality of therapists/technicians, many of these situations could be avoided. Speaking of: wouldn't it be helpful if I made a checklist for parents to evaluate the quality of ABA staff? Yup, I already did that. Check out my free resources section ;-)


When a parent realizes the "professionals" working with their child leave much to be desired, I usually see 1 of 2 responses:

Response #1: "I don't want to rock the boat/make a fuss/complain, so I'll just deal with it and hope this gets better"
Response #2: "This person/company is horrible, so I will make no complaint and just move to a new company blindly trusting that they will be better"

The recurring word in each response is "Better". I talk to many parents who have unmet desires that their ABA team will get "better". If quality, ethical, and professional treatment is not just expected but demanded, then parents wouldn't need to silently hope for "better". "Better" basically means that whatever is happening right now is not great, but maybe....somehow....all on it's own...the situation will improve. I don't usually see that happen, and I wouldn't advise a parent to follow that kind of cross- your- fingers- and -wish- for- better approach.

Instead, I would urge parents to be aware of what ethical treatment should look like (here, read this) and to remain an informed consumer. I would also urge parents to please speak up if you are dissatisfied with your ABA team. The provider cannot correct an issue they are unaware of, nor can any staff disciplinary measures be enacted if the company is unaware of problems.

What I usually see whether the parent gives response #1 or response #2, is they say nothing about their issues with the staff. Instead, they just hope it improves or they simply move on to a new company.
Looking at it from the staff's perspective, how does that help them improve their skillset?
Looking at it from the company's perspective, how does that help them weed out the weak links from their employee pool?
And most importantly, looking at this issue from the child/client's perspective: how much valuable learning time is wasted hoping staff improves or bouncing from one company to the next?

No matter which perspective you use to look at this issue, it's imperative to maintain clear and open lines of communication between the parent and the ABA team. No one can meet unspoken expectations.


Clear and open communication is not complaining, it isn't rude, and the provider should not take offense. Speaking for myself,  I would much rather a parent tell me plainly they don't like something I am doing, than just silently dislike me. The beauty of ABA treatment is we can always hit "reset" and modify what we are doing. 
Parents: do not feel like you can't openly communicate with the team because they may retaliate, become passive-aggressive toward you, or even openly hostile toward you. If this is a valid concern for you, then you are not dealing with professionals.

When is clear and open communication of grievances necessary? Well, that will depend on your expectations as a parent. While I can't answer that for you, I CAN name several common parent grievances that should always be addressed with the staff directly, and if necessary with the company management/owner:
  • Staff seems under-qualified for their position, visibly lacks confidence, or openly tells you they are "new" - Would you fly on a plane if the pilot walked out and told all the passengers that this is her first time flying a plane and she's a bit nervous? No right? No is the right answer to this question. But I talk to parents all the time who can visibly see that the staff is nervous, scared of their child's behaviors, or even asking the parent for tips! **YES, I have seen scenarios where the staff asks the parent what they should do**  If you are experiencing this issue with your ABA team, address it immediately with the BCBA or agency.
  • Staff either rejects parent input or politely listens to the input and then does the opposite - This is the technology age, where parents can do a quick internet search and find out massive amounts of information about ABA. Parents suggest specific strategies, programs, or goals to me all the time, that they read about or saw online. It is my job to incorporate their input when I can, and explain the reasons against it when I cannot. What is NOT my job is to flat out refuse. Or to nod and smile and then completely disregard what the parent said. Address this issue immediately.
  • Showing up for work seems optional - Probably the #1 reason I see ABA staff get fired off  a case is because they just don't show up for work. They are habitually late or habitually cancel, often with short or no notice at all. Not only is this completely unprofessional behavior, it is detrimental to treatment. If you have a headache and the bottle of aspirin says to take 2 pills, and you take 1/8 of 1 pill, don't expect to feel better. In the same manner, if your ABA treatment plan states that your child needs 20 hours of therapy each week, then they need 20 hours of therapy each week. Address this issue immediately.
  • Issues with billing/payment/co-pays - Many parents tell me that they were shocked to receive a bill from the ABA provider because they thought insurance covered everything. Or they didn't understand how the BCBA could bill for services if she was not at the home. Or the staff was asking them to sign timesheets for hours that weren't actually worked. The HR/Billing department of the company should have thoroughly and clearly explained the intricacies of billing and payment to you before services ever began. If you have a parent co-pay you should know that in advance, and if the staff are billing in codes only (e.g. code 97151) then you should know what kind of service that code stands for. Receiving an invoice for thousands of dollars should not come as a nasty surprise. Address this issue immediately.
  • It's more Babysitting than actual Therapy - I know, I wish I didn't have to state this either. It seems fairly obvious. But I hear it often enough from multiple parents that I know it's happening. ABA therapy sessions can look probably 100 different ways just depending on what skills are being targeted. Will every session be at a small table with flashcards? No, that's a big myth. Can sessions that appear to be just play actually target multiple goals? Yes, they sure can. However there is a large difference between playful yet intentional interaction, and the therapist sitting with your child and watching cartoons. Or texting on their cell phone as your child plays alone in a corner. Or working with your child for a few minutes and then taking a 20 minute smoke break. And no, I am not making these examples up. Unfortunately, I have seen this and worse. The ABA staff should be able to explain to you their goals for the session, which programs they will teach, and which parts of the session you can participate in. Yes, you should be able to participate in at least some parts of the session. If it is not clear to you as a parent when "therapy" is happening, and when the staff is just hanging out with your child: Address this issue immediately.

If clear and open communication does not result in concrete improvements or resolution, or if it directly results in staff retaliation, anger, or hostility, then it's time to move on. 
As a parent you have every right to expect to deal with mature professionals who will put your child first before their preferences or ego.

The ABA provider is there to help you and your child, so if that help comes attached with unethical behavior, poor attitudes, and habitual tardiness, well that's not really any help at all is it?


**Recommended Reading: Signs of a Bad ABA Therapist




5 comments

  1. Great post. Thank you for the insight.

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    1. Very welcome! I'm happy to share this info, so hopefully others can avoid the bad employer situations I've had.

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  2. Our last two BTs have had a lot of personal issues (one with mental health issues and another with a sick child at home) and we’ve had staff routinely miss session with little notice (and twice no one informed me a BT wasn’t going to come that day at all). I’ve been open about the disruption not being okay but feel the guilt of them judging me for not being sympathetic to their employee’s personal issues. It’s been hard to advocate for what my kids deserve and need but I also feel like their attitude of, “this is not okay but we have no other options because of the situation” isn’t making the problem that my kid has received only 60% of his scheduled hours in the last 5 months. I love our BCBAs but the company takes no accountability for their staffing situations and want to lay the blame with us that we are “never happy with what is given.” It’s been so hurtful but im also afraid I won’t find a good company out there or my kid will be without services for months to a year if we move on. It’s so hard being a parent in this situation. I feel like it’s an impossible situation.

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    Replies
    1. That definitely sounds stressful, and I understand how frustrating frequent call outs/cancelations can be. It isn't just chaotic to manage that, it can also be detrimental to treatment.

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