*Recommended Post: Preventing Burnout (practitioner tips)


If you're an ABA peep working in this field and you haven't experienced burnout yet, it's likely that you will at some point in your career.


The way I see it, there are 2 main prevention strategies when it comes to professional burnout:

  1. Proactively prevent it at the employee/practitioner level
  2. Proactively prevent it at the business owner/employer level
Let's talk about option #2.


People who work in human service fields such as counseling/mental health, psychology, social work, in general often report high levels of stress, mental strain, and burnout, but there are also multiple factors outside of the direct control of the practitioner that can worsen this issue.

In my position, I regularly recruit, hire, and onboard new staff. I regularly observe that many of the new hires are seeking a position with quality supervisor/management support, clear channels of communication, and a liveable wage, which were all lacking in their previous positions.

I also regularly observe that multiple applicants come to me from a handful of agencies in my local area. I refer to this as places that are "bleeding staff". Meaning, their employees are quitting in droves
Ever wonder why some companies/agencies seem to have a revolving door when it comes to ABA staff? Glad you asked.


There could be pervasive, unresolved issues with:

  • Inconsistent hours which = inconsistent pay
  • Hard to reach or chronically unavailable supervisors
  • Lack of goodness-of-fit (company culture is lacking)
  • Insufficient program eligibility requirements (clients being accepted are not on board with treatment/abrasive to staff/highly resistant to change, etc.)
  • Lack of variety in your role/position or Lack of advancement opportunities beyond your position
  • Lack of proper training and/or low-quality training

For employers or agency owners, what can we do to ensure that we put systems in place to help prevent burnout from occurring, and also to quickly identify and address burnout that is already occurring?
PLENTY.

Focus on quality right from the start - Quality recruiting practices, quality training, quality onboarding. Ensure that people are properly prepared for their role, understand the demands of their position, and have been trained to competency to perform their role with excellence.

Leadership training yields professionals, not workers - When leadership training (accountability, initiative, critical thinking skills) is built in to the staff training process, what this produces is future leaders who will produce high-quality work. Leaders add value to organizations, versus just holding a position.

Create company policies and procedures of operation ... and actually enforce them - Speaking from experience, the only thing worse than working for an employer that lacks appropriate policies, is working for an employer that has policies but never enforces them. This may sound odd, but a lack of appropriate operating systems can hinder effective employee performance. For example, when the illness policy is not enforced, clients get sick. When clients get sick, employees get sick. When employees get sick, they cannot work. When employees cannot depend on reliable, consistent income, here comes job dissatisfaction and stress. 



To put it simply, the work that we do is far too important to approach it from a space of frustration or mental fatigue. We have to guard our own emotional well-being, as well as hold low-quality employers accountable for consistent business practices that contribute to lowered levels of job satisfaction. It's NOT okay.



* Professional Burnout Resources:






Recommended Post: Parent Resource: When you're waiting to access ABA


Inevitably (sorry, but it is somewhat inevitable), somewhere on your Autism treatment/therapy journey you will suddenly and unpleasantly find yourself wait listed.

A company or provider may explain that while they may accept your insurance, accept clients the age of your child, and serve the area you are located in, at the moment they are going to have to wait list you.

So why does waitlisting happen? And how should a parent/caregiver respond?


First, let's look at some reasons for being placed on the dreaded wait list:

  • If a provider is in the process of credentialing (securing relationships with funding sources), they may have to temporarily wait list clients until the set up process for billing is completed
  • If the provider/company is brand new, then there could be renovations to the physical location, staffing needs, or legal red tape on the part of the company that is causing a wait list
  • If a provider is expanding into serving new areas, there can often be a wait list for services because they would need a certain amount of clients in the new area to be able to hire staff
  • If a provider is going through significant unforeseen changes (e.g. a critical member of management abruptly quits), this will absolutely cause a temporary wait list situation for all new clients
  • If a provider is new to your particular funding source (i.e. a grant or waiver for therapy), you could be temporarily wait listed while they go through the process of securing funding, and completing any documentation the funding source may require

As you can see from the list, there are varied, and very understandable reasons why a provider may say, "We can help you, but just not right now". If a company does not have enough staff to cover your case, or is in the process of properly training or onboarding a new hire, then there will be a delay before you can access services. Being placed on a wait list is not always a bad thing, although it may feel like it is.

What many, many parents want to know is what they are supposed to be doing while on that wait list. For that and other common parent questions, please see below.


"Is there anything I can do to prevent being wait listed?" - To a degree, yes. Keep in mind that the service you are trying to access is probably in very high demand, with a a limited supply of clinicians/professionals. This is true for ABA therapy, Speech therapy, Occupational therapy, etc. Across the board, we need more qualified professionals serving Autistic populations. But, as a parent you can request parent/family training by a BCBA (this doesn't require RBT level staff), just to complete the Initial or Functional Behavioral Assessment, or ask if you can start as private pay to speed up the process. Depending on the reason for the wait list, any of these options may get things moving more quickly.

"How long will I be wait listed?" - This is the absolute wrong question to ask. I don't say that because there is something wrong with you asking. I say that because the reality is the answer will be a guess. The problem is, people drop off and get added to the wait list constantly. Add to that unforeseen challenges or road blocks, and that "2 month wait" someone promised you could easily stretch to several months long. Also asking "Well how many people are on the wait list?", is typically a question providers won't answer.

"Okay...then what should I ask instead?" - Instead of asking, try telling. Decide how long you will give this provider/company to be available to you, and inform them of your decision. For example, "Yes, please add us to the wait list but after 6 weeks we will be reaching out to other providers". This way you already have a plan B ready to go, but just in case a spot becomes available you still have plan A.

"What should I be doing with my child while we are stuck on this wait list?" - Something. Yes, that's intentionally vague. I couldn't possibly know what your child needs to do while you sit on a wait list, but I do know the absolute last thing they need to do: NOTHING. The worst mistake you can make is to be placed on a wait list, and then just go back to life as normal. Obviously, you are requesting therapy services because you need help. So still pursue ways to get help, while you are waiting for the professionals to step in. Especially with the technology options today, you could consult remotely with a BCBA, take online courses in ABA or behavior change, attend conferences to learn, join an Autism support group, etc. What you will be able to do while you are on the wait list is going to vary depending on your local area, and the resources available to you.

"How long should we remain on a wait list for treatment?" - And this is the #1 question I hear from parents/families. I don't have a specific answer for you, but instead I would emphasize the importance of treatment. Think of this way: If you arrived at a restaurant and were told there wouldn't be any tables available for 3 months, would you just sit in the waiting area and not eat for 3 months? No, right? Well, the treatment you are trying to access for your child is as critical as food and water. You do not have time to waste. If you have been idly sitting on a waiting list, not hearing from the provider, and not receiving any updates, it may be time to move on.





* Further Reading:



For a variety of reasons (some preference based, some due to circumstances) many parents today are choosing to homeschool their ASD child.

Thanks to technology, if you are a parent considering taking the often scary step into not just being Mom or Dad, but also Teacher, then there are websites, apps, and all sorts of tools that can help you. Which is great.

So is homeschooling all great, ALL the time? Hmmmm.....not really.
Just like any educator, every day will not be sunshine and roses. However there's a huge difference between an occasional rough day, and ending each homeschooling lesson sobbing at your kitchen table. Let's avoid that 2nd scenario, when at all possible.

Many of my clients are homeschooled by one or both parents, so I get an upfront view of the difficulties these parents have when it comes to teaching their own children.

This post isn't about answering the question "to homeschool, or not to homeschool", as that's a decision parents should make. But, I do hope to give some helpful tips for making the homeschool process a bit easier and less frustrating.


Moving from Amateur to Master

“Adapt” is now your favorite word
 If you have spent any amount of time inside a Special Education classroom, or speaking with a Special Education teacher, then you should know that Adaptation is the name of the game. Most purchasable curriculum does allow for  customization (some more than others), but if your child is not progressing well with the curriculum/can't keep up, or isn't understanding the material, the beauty of homeschooling is that you can adapt the material to fit the child. I know some parents who don't even teach certain skills/certain subjects because in the grand scheme of things it just isn't functional for their child. When I say "adapt", I mean the materials, the tests/quizzes, the textbooks, the lesson plans, EVERYTHING! What you are teaching should be functional for your child, and presented in a manner they find interesting, and clear to understand. If it isn't, then you have some adapting to do.
Reinforcement is key
 Life is about reinforcement. The quicker you accept that, the easier teaching will become. Using a combination of visual/auditory supports, and tangible rewards, embed frequent, powerful, doses of reinforcement into teaching. Ideally, you want your child to be a willing and compliant learner who enjoys learning, right? Well, the way to get there is by breaking tasks down (see the previous point) and wrapping up demands in a thick layer of reinforcement.
Knowledge is your strongest weapon
 Knowledge of subjects? Nope. I mean knowledge of your child. If you have a teaching background that's great, but many parents who choose to homeschool do not. But you definitely do have knowledge of your child :-) Use what you know about your child (temperament, motivation, personality, etc.) to design instruction. I know of a family where the mom created lesson plans focused around the movie "Zootopia", as that was a special interest for her daughter. So they used "Zootopia" to learn about history...math...science....etc. Use what you know about your own child to your advantage.
“Prompting” & “Teaching” are not synonymous
 See my Prompting post if you are unfamiliar with this word. Here is a common error I see many parents make when homeschooling: child responds incorrectly, parent delivers prompt, child responds incorrectly, parent delivers prompt...repeat 500 times. The problem with confusing a prompt with teaching, is "What is the child learning"?? A prompt is always intended to be lessened, or fully removed, so we can reach independence. If you stop prompting your child, and they suddenly have no idea what to do, then you have been over- prompting. Which will slow down the rate of acquisition (it will take longer for the child to learn).
Masters seek help when they need it!
 The most important tip is not to try and do everything on your own. Educators working for school systems know when to reach out for assistance, and so should educators working around their kitchen table. If your child has significant behavior issues, attention problems, or their academic performance is far below their age (a 7 year old working on Kindergarten level assignments) then you need some professional assistance to design intervention. Reach out to an educator, the support available through the homeschooling curriculum/website, or a qualified BCBA so they can help you learn the best ways to teach your child.




*Resources:

If you aren't already familiar with TPT (Teachers Pay Teachers) it's an awesome site full of resources made by and for educators

"The Value of Homeschooling"

"Homeschooling Your Child with Autism Spectrum Disorder"

*Recommended Reading: Therapy Intensity/How Much Therapy


Behavior analytic research as well as best practices for ABA treatment recommend robust/intensive treatment for the most significant results. Typically, "focused" treatment would require at least 15 hours a week of therapy, while more "comprehensive" treatment would require at least double that. 

There are many reasons why therapy hours could be low. Maybe the funding source only approved half of the service authorization (e.g. BCBA asked for 30 hours per week, the insurance company approved 12). Or sometimes the family isn't available for therapy very often, or the child has multiple other therapies and a full day at school.

Regardless of the reason, if treatment hours will be low does that mean its pointless to pursue ABA therapy at all?

No. It does not.

BUT, it does mean that the goals selected for treatment and the modality of treatment need to be super, super realistic and practical.

It's hard to know in advance how long it will take a client to progress through goals, or to reach mastery with a specific skill, but for the most part complex or multifaceted goals are going to take lots of repetition and time. So during intake, when I meet a family and they are discussing goals like toileting, language acquisition, severe problem behaviors, school refusal, etc., I explain very clearly that these goals will need a more comprehensive approach. ABA therapy every Tuesday for 2 hours, is not going to make much of a dent when it comes to comprehensive goals.
However, if the family is requesting help with more focused goals such as shoe tying, eating with utensils, or following instructions, then such comprehensive treatment may not be necessary.

So to parents: If your child has been receiving ABA services for some time with minimal progress, the problem could be that treatment is not intensive enough (doesn't occur at a high enough frequency).


Beyond keeping treatment goals highly realistic/practical, if a client receives minimal therapy hours I also recommend the following:

1. Intensive parent training: If the ABA professional is only going to see the client once a week, what is the best use of that time? Working directly with the child, or the parent? If the professional works with the parent, then outside of session time (and when services end) the parent is now equipped to teach their child, handle challenging behavior, and modify the home environment to help the child be successful. To me, it just makes the most sense to teach the parent as much as you can during the time you have together so they can keep the demand on when you leave.

2. Self-management/Coping skills: If appropriate for the client, teaching using more self-management strategies and less of an instructor-led format is very beneficial when therapy hours are low. I am a huge fan of implementing activity schedules/checklists/task analyses with clients, and showing them that they control their own reinforcement (not me). As long as they are doing what authority figures need them to, they will always be able to access what they want. Also, if behavioral issues are occurring and there is inadequate time for implementation of a comprehensive behavior plan then teaching replacement behaviors, or coping strategies, could be very helpful for the client. For example, when the client escalates and gets upset instead of the adults present reacting to that, the client can be taught how to independently de-escalate. 

3. Self-help/Adaptive functioning: Think of adaptive goals as those daily living skills that are non-optional. You either do them, or someone has to assist you/do them for you. Examples: getting dressed, feeding, toileting, cleaning up after yourself, etc. I have *sadly* had some clients with therapy hours far-r-r below what they actually needed. In situations like that, at a bare minimum I need to know from the family what day- to- day issues are causing the MOST difficulty in the household. Then we start to tackle those, being sure to take small bites of the problem rather than try to squeeze multiple goals into a 1 hour therapy session. For example, if the client fights the morning routine everyday before school and it's causing them to regularly be late to school, that is an awesome place to start. Just helping the parents tackle that one problem with clear strategies, visuals, and support, will make a huge impact in the day- to- day stress levels for the household. 


With low therapy hours, the focus should zoom in and get very practical and answer the question, "What can we do today, to make a difference in this family's life".


Resource: BACB Practice Guidelines for Applied Behavior Analysis


"In reality, there is no single Lovaas model because the work done at UCLA was dynamic, creative, and ever-changing"

"1:1 was certainly critical. It was the starting point of treatment. But as soon as possible we wanted children to be able to learn in small and then large groups"

"You have to experiment and look at your results. When something works, you stay with it; when you try something that doesn't work, you drop it"

"Ivar did not believe in protocols. He wanted us to probe and of course evaluate if what we were doing was effective"

"We needed to be flexible. And we needed to be critical thinkers"

Quotes are from "The Lovaas Model: Love it or Hate it, But first Understand It" (Ch. 2)



Quality, effective, and authentic ABA treatment will be dynamic and ever- evolving. If it isn't, then that's not ABA.

Pretty simple.



*Quality treatment should be individual focused. This means that programming/goals are functional for the person receiving treatment. Is it critical at this time that your 4 year old client learn to label a photo of a giraffe? No? Then why are you teaching it?

*Quality treatment requires the active involvement and engagement of the parents or caregivers. Otherwise, who is all this for?? If your client can mand, wait appropriately, transition, and answer simple questions for you but can't do any of that with a parent, then what was the point of that?

*Quality treatment puts a high value on staff training (as in: both initial AND ongoing training and supervision). When staff are not properly trained in conceptual ABA theory, as well as real-life application, that will absolutely impact the quality of treatment. While you're training, don't forget that critical thinking must often be taught as well. For example, "Always follow THIS protocol, except for when ______", or "Follow the child's motivation by doing ________", or "When in doubt, be sure to avoid ________". Create training scenarios where the staff must fill-in-the-blank of those types of critical thinking questions.

*Quality treatment uses assessment tools to guide and help conceptualize treatment planning, and not as a paint by number manual that must be followed grid by grid for every single client.

*Quality treatment is not a slave to any specific "way" of delivering intervention. You could absolutely love discrete trial, or incidental teaching, but if the method is not effective for a particular client then guess which one needs to change? (It's the method....not the client)

*Quality treatment understands and supports the need for a high level of clinical supervision and oversight. Regardless of the amount of supervision the funding source will approve, ask for the amount of hours needed to ethically oversee a case. If you cannot effectively provide supervision under the constraints set forth by the funding source, then do not accept the case.



My best (and often my favorite) kind of sessions are the ones that probably look highly chaotic. Lots of impromptu suggestions, changing data sheets on the spur of the moment, jumping between training the staff and the parent, and on the spot functional analysis of behavior. These sessions may look chaotic, but the end result is treatment gold: Specific and intentional treatment improvements that will help the client learn more effectively, across both the ABA team and the parents.

Contrast that with some seriously poor examples I've observed of dead, boring sessions, where the staff is glued in one spot for 2 hours, never deviates from the data sheet (even as scores begin to plummet), the client is disinterested and disengaged, and the parents are nowhere to be seen.


Quality treatment must be dynamic (lively, changing, energetic) both by design and in its application. This should be the goal of any quality ABA provider.
Think more of cars rapidly racing around a track, making minute -by -minute performance decisions and adjustments, and less of sitting on a motionless lake with a pole in the water, waiting for fish to come to you.





Related Posts: NET, Program: Toy Play


A great program for teaching or increasing appropriate play skills would be: Play Stations.

I usually teach this during NET portions of the session, and the specific way it is implemented will vary according to client age, current play ability, and the setting. So what follows should really be considered a template that will need to be individualized to your specific client(s).

Teaching play stations would be ideal for a client with play deficits, to teach independence/leisure activities, or for pre-school age clients struggling in that setting.
Many of my young clients spend their time at pre-school/daycare wandering aimlessly around the room, or engaging in problem behavior. In that type of setting there's often less of a strict schedule of activities, and more "free play" time with multiple choices around the room. So the client would be at a disadvantage if they are unable/unwilling to interact with the play choices.

A play station is just an all-contained area for play with a related group of toys. For example: clay/Play Dough area, play kitchen area, water play area (I like to include sensory play as well), blocks/Lego area, etc. Think of a typical pre-school classroom. The room usually will have specific play areas sectioned off, in what teachers often call "centers". Toys stay in the specific designated area, and there are many choices available for the children to rotate through.
A play station could also include one themed toy, such as a carwash toy, a marble maze toy, or a railroad set. The options are endless.

I like to label the play areas, this can be done textually or visually, and also include teaching prompts for both the therapist team and the parents/caregivers. A huge benefit of this program for me, is that it's often so easy to generalize to the parents/outside of therapy sessions.

Teaching prompts for the therapist team could include current targets that can be embedded into the play. For example, at an art play station the therapist could embed color ID, tracing/writing, imitation, one step instruction, sharing or turntaking, and multiple fine motor targets ("open the ______","pick up the _______, "use the scissors to cut", etc.).  Mastered targets could also be embedded as a maintenance skill or to target generalization across stimuli.

Teaching prompts for the parents or family could include suggested ways to interact/engage the child with the play, as well as a handful of teaching examples (that have been modeled for the parent during therapy sessions). For example, at a water play station the parent could start an imitation game of pouring out water, implement manding trials to have the child request, or redirect the child to a play station activity when the parent needs to take a phone call, do laundry, etc.

For older clients or as appropriate, play scripts could also be used to teach this skill. For example, a play station with dress up clothing could be made with the following script used as a prompt:

Characters: Civilian (C), Firefighter (F)
Props: Firefighter's hat, empty spray bottle, crayon drawings of fire

  1. C: "Oh no! There's a fire."
  2. F: "Don't worry, I'm on the way to help."
    (Make fire engine sounds and drive a pretend fire truck over to client)
  3. C: "Help, there's a fire"
    (points to crayon drawing of fire)
  4. F: "I'll save you!"
    (squirts crayon drawing with empty squirt bottle)
  5. C: "Help, there's another fire!"
    (points to another crayon drawing)
  6. F: "I'll save you again"
    (squirts second crayon drawing)
    --Continue until all fires are out--
  7. C: "Thank you Mr./Ms. Firefighter."
  8. F: "You're welcome!"
Over time this script prompt can be faded, the acting roles can be alternated, and the language used can vary for spontaneity.  For example, the firefighter can pretend to be unable to put the fire out to see how the civilian will respond.


Keep in mind that this program is aimed at teaching play skills, meaning it should be FUN!
If the client isn't enjoying interacting with the play stations then reinforcement needs to be examined, perhaps the time interval is too high, perhaps the adult isn't all that fun to play with, or maybe the play choices available just aren't that interesting.
Does the client love straws? Iron Man? Beads? My Little Pony? Insert their interests/likes into the play stations, and remember to bring along lots of creativity when designing their play choices.

Below are some examples of varied play stations. All images found on www.pinterest.com:


Repurposed sink into an outside play station for kids! Love this! #diywoodprojectsforkids #woodworkingforkids


May Morning Work Stations. 43 Tubs to keep your students engaged in hands-on learning.

Here are a couple flower color sorting activities that you can make with a Hawaiian lei. Kids can work on color sorting, number sense, and patterning with these cute activity ideas. Perfect for your flowers theme, plant theme, spring theme, summer theme units and lesson plans. For your tot school, pre-k, and preschool class math centers or math work stations. teach colors, color sorting, color matching, flower activity ideas

teaching children with autism how to do imaginary play using visuals

Teaching How To Play -Autism

Speech Universe: Mr. Potato Head

Considerate Classroom: Early Childhood Special Education Edition: Tour Our Classroom's Independent Work Area


*Resource:

Ideas for Teaching Play Skills

*Read the 1st part of this topic:  Preventing Burnout


Burnout is quite real, and goes farther than just having some workplace stress. 

If you think of Time as your biggest commodity (psst....it is), and your talent, energy, effort, intellect, as your "Tool Kit", then what we all want is to spend our Time investing or using our tools in ways that are satisfying and fulfilling. Right?
Right.

Burnout is the process of spending too much Time doing things that don't properly utilize your unique Tool Kit. 

There are parts of my job that are AMAZING, and then there are parts that are stressful and not-so-great.
Constantly changing employer expectations are not so great. Seeing clients severely reduce, or completely discontinue, needed therapy services due to funding issues is not so great. Working for/under incompetent people is not so great. Striving to meet unrealistic funding source requirements is not so great.

But stressors will come and go, and in an ideal scenario: the impact of this stress does not exceed the enjoyment and satisfaction the job provides.

When those scales tip out of balance (stress/fatigue/frustration has exceeded any benefit of the job), THIS is when you have entered burnout territory. And it's critical not just to recognize you have entered into burnout, but to do something about it.

Come on, we're behavior people. Action steps are just what we do. :-) 

According to the my brain (aka in my opinion), there are 2 main culprits for why burnout not only happens but may even go unnoticed for weeks..months..years. I see both as systemic issues that contribute to the rapid turnover common to this field:


Issue #1: You - Yup, you. Did you fall into the harmful way of thinking that once you became certified, you now wear an invisible cape and can solve all problems? Or, did you enter this field thinking you could be ALL things to ALL people? Both assumptions are incorrect, and inevitably harmful because of the let down that will occur when you realize that you actually are not without flaw. Like many other caring/serving professions, such as teachers, social workers, etc., ABA professionals often place unrealistic expectations on themselves to be perfect, to know everything, and to be able to help everyone. That just isn't possible, and placing impossible to acquire expectations on yourself just sets you up for failure. It is crucial to know/establish your professional identity, and discover how you can best use your unique gifts in this field. ~ If you have no idea what I mean by professional identity, this training video may be helpful~  Do you work best with younger or older clients? Which parts of the day are you most productive? What type of staff personalities do you mesh well with, and which types are like combining oil and water?? As providers/practitioners, we are all different, with varying strengths and weak areas, and sometimes what feels like professional burnout can really be the result of a client that needs to be referred out, a lack of support or training for your role, or a company that doesn't need/is unwilling to recognize what you have to offer.

Issue #2: Your Employer - Many, not all of course, but many, ABA employers have systems and procedures in place that actually can encourage professional burnout. When employees feel isolated from colleagues and distant from ownership/management, or when unrealistic caseload expectations are presented as being non-optional, staff will try to rely on their smarts and training to get them through these challenges. But sometimes, it isn't the staff that needs to change, it's the system that needs to change. How well does your employer evaluate staff for signs of professional burnout? Are boundaries or guardrails put in place so that staff are not experiencing excessive driving, highly variable scheduling, regularly dealing with resistant or uninvolved client families, or working 12 hour days 6-7 days a week? Does the work culture intentionally promote cooperation, teamwork, and open communication? How much time is spent getting to know each individual staff so that cases can be matched based on expertise and experience level, not just based on availability? Can staff (no matter their position) directly access management to voice complaints, or even just vent? How are interpersonal conflicts addressed? If at all?? Or, do direct staff know that complaining about people higher up than them will lead to swift retaliation? All of these issues can lead to staff who feel devalued and unappreciated on a regular basis, and how effective can that person be in their position if they think what they do doesn't matter to anyone?



I see burnout as a symptom of a larger issue (think of how your body uses pain to signal to you that something is wrong), and that issue is usually a lack of Goodness-of-Fit. There are people perfectly content to wash dishes for a living, and there are people in high paying corporate jobs who are miserable. So this issue has to be about more than just what you do for a living.

Once you know what to look for, it is easy to see traits in yourself (or systems your employer has in place) that contribute to a perpetual state of job dissatisfaction and discontentment. 
The question at that point would be: what to do about it.


Suggested Resources:








Lately I've been getting lots of inquiries and questions from people new to the field who aren't quite sure what BCBA's do all day.

It's not an unusual question, I don't even know if the families I work with know what I do all day. Obviously they see me in action during a session, but once I leave I don't think they have a good grasp of the typical BCBA workload.

So this post could actually be helpful for ABA peeps and families/parents.

**Upfront disclaimer: I could not possibly detail what every BCBA on earth does on a day-to-day basis. For one, I don't know every BCBA on earth. For two, many BCBA's work in unique settings or with unique populations outside of the developmental disabilities domain. For those non-typical work settings, I'm sure the day-to-day responsibilities are very different from what I do everyday. Possibly more exciting, but possibly more stressful too. Either way, individuals in those kinds of settings would be the best person to talk to if you do NOT plan to enter the developmental disabilities domain.  


The main question I keep getting from people is some variation of:
"Once I'm a BCBA, does that mean I will be stuck behind a desk/a supervisor only/can't work 1:1 with clients/students anymore?"

It's a great question.

It isn't a question I had pre-certification because I knew pretty early in my career that I wanted to be the one designing treatment and being a strong support system for the staff and family. Yes, I LOVED working day after day with the kids and seeing them learn and grow, and watching them gain more independence right in front of my eyes. But the person who fascinated me even more than my client was always the Consultant/Supervisor. I wanted to know how they knew what they knew. How did they know what skills to teach next? How did they know how to reduce challenging behaviors? When they looked at the raw data, how did they know what decisions to make next?
I saw that in the typical ABA therapist position, no one was interested in having me help with those kinds of duties. So I knew I needed to pursue certification if I wanted to do more than implement a treatment plan.


As far as the typical day in the life of a BCBA, on an average day my responsibilities could include the following:

  • On-site supervision of staff/program implementers, which typically includes parent meetings (if in-home), administrative contact or follow up (if at a school), or consultation with your direct supervisor (if in a clinic)
  • Ongoing and on-the-job training and support for program implementers, which often necessitates treatment plan revision, program writing, and/or creating staff training materials
  • Research/Literature review/Colleague or Mentor contact to generate treatment planning ideas, problem solve, or create potential hypotheses about client issues 
  • Data collection, data review, data analysis, data based decision making, pulling out your hair because they "forgot" to collect data, crying because you pulled out your hair, etc....
  • Creating and/or purchasing therapy materials, helping teach program implementers how to appropriately select therapy materials and reinforcers
  • Carefully assessing the overall quality of the ABA program (Is the learner progressing? Are the staff energetic in their role and receiving enough support? Is everyone practicing ethically? Are the parents involved and participating? Do related providers know what is being targeted in ABA therapy? Could any current systems be revised, edited, or tweaked to be more effective or more efficient?)
  • Maintaining compliance with various company policies and procedures, client confidentiality, funding source requirements, etc.
  • Be available for contact by program implementers/parents/stakeholders who may have questions, request meetings, ask for you to attend IEP's, ask for copies of documents/reports, report new behavioral issues, report new skill regressions, etc. All of the above can necessitate treatment plan revision, program writing/revision, creating training materials, updating/revising the progress report, etc.

Yup. All in a day's work.


After reading the typical responsibilities of a BCBA, it may already be apparent that there are a few barriers to being able to work 1:1 with clients. Such as? Glad you asked:
  • Umm, time. Did you see that list above?? When exactly did you plan to have time for seeing clients 1:1?? In a typical BCBA position, you will have a full caseload of clients that could be served at settings spread all over town (at school, in the community, in-home), and there will be a team attached to each client. That team will depend on you and regularly need your assistance or support outside of work hours. This particular barrier is why many BCBA's choose not to accept full-time positions (that often come with billable hour requirements), and instead to contract their services or work independently.
  • $$$. If you are working for a company, they often would prefer to staff a case with non-BCBA's because it is cheaper. The BCBA hours allowed by insurance are often far less than what we need to do our jobs. So money plays a big role in where your employer decides to use you, as your hourly rate is much higher than what direct staff get paid. If you work directly for a consumer, it's not uncommon for parents to contact BCBA's because they want the most credentialed person to work with their child directly. However, these parents are often unprepared for the higher hourly rate a BCBA charges. Which means consumers may not be able to afford to hire you as direct staff.
  • Opportunities available. In this field, a tiered-delivery model is super common. What this means is unlike other therapy models, with ABA treatment there are 2 main roles: program implementer and program supervisor. Many funding sources set up their ABA therapy reimbursement based on this delivery model, which means many organizations and employers hire staff based on this delivery model. If you do a quick search for BCBA positions in your area, you will probably find that most of them are hiring at the supervisor or director level. I rarely see BCBA job postings that mention providing direct services.


Am I saying that no BCBA does any direct, and you have to kiss this dream goodbye in order to pursue certification? Of course not. 
As a BCBA you will be a trained and competent professional, in a high-demand role. Go do what you want!

However, just know that there may be barriers to continuing to do direct/work 1:1, and it can be difficult to locate an employer who wants that/can afford that.


*Recommended Posts:







Today's QOTD isn't quite a direct inspirational quote, it's more of a helpful -and important- resource.

From Dr. Mary Barbera, here is a short and sweet vlog on teaching non-vocal individuals to communicate distress due to pain:




For parents and professionals alike, this hits home. I have worked with many kids who had recurrent medical issues or problems, such as frequent colds (which can bring an unpleasant head fog and nose irritation), bowel/indigestion issues, acid reflux, ear infections with painful blockage, etc.

Can you imagine for a sec, experiencing some kind of painful event and not having the means to communicate that to anyone? Especially if you are a child, and cannot just run to CVS and pick up some medication to make yourself feel better. And we wonder why some of our clients get so frustrated or angry??

Taking this beyond physical pain for just a sec, in my own life when I am in a funk/sad, furious, or anxious about something, it can manifest in my body as physical symptoms. Ever heard of "butterflies in your stomach"? Or "a stress -anger headache"? WOO, I've definitely had more than a few of those.
But unlike many of my clients, I have the ability to communicate I feel like being left alone. Or, I can obtain and then ingest medicine. Or, I can choose to postpone tasks until I feel better (i.e. "Guess I'll be finishing up that report tomorrow...").


The ability to communicate not just thoughts & wants, but private events (feelings, moods, sensations, etc.) is SO critical, regardless of age or ability. I consider it a life skill.


You will never achieve a coveted Boring Award without working really hard to have the most dull therapy sessions possible.


I believe you can do it, and I have observed multiple therapists over the years strive and stay consistent and next thing you know-- they earned a Boring Award. Believing is achieving.


So what do you do? What are the action steps? What can you change right now, TODAY, in order to kill any enthusiasm, energy, or fun in your therapy sessions?
I'd be happy to tell you some action steps towards being a totally boring ABA therapist:


  • Cookie-cutter is your friend - Did you learn a specific strategy several years ago? Be sure to apply it on all your clients, whether it seems to be effective or not. For example, everyone knows all early intervention clients love to work for Skittles. So just keep a huge bag of Skittles in your car and use that as reinforcement across your entire caseload. Have a client who tosses the Skittle on the floor or gives it back to you? That's fine, just keep giving it to them anyway. You know what motivates the client better than they do, of course.

  • Research, what research?? - It's best to try out strategies and techniques based on whats the easiest option, doesn't require reaching out to your supervisor/BCBA, or won't eat up too much session time. You do have a datasheet to get through, after all. Be sure to stay out-of-date with current ABA research, especially in the areas of motivation and reinforcement, or your sessions might accidentally start to get pretty fun.

  • Stay as still as possible - As much as you can, plop down in one place at the start of the session and then just stay there. Work in one room of the home, or at one table of the center, or in one tiny corner of the classroom. Another advantage of this strategy is it's easier to keep up with your materials because of the lack of moving around. Who needs to be bothered with all that multitasking and carrying around stuff in the natural environment? 

  • Avoid or reject feedback - Don't reach out to your supervisor/BCBA to ask for recommendations to embed more fun and energy into your sessions, and take any feedback from them in this area as a personal attack. You can't be expected to show up for a session, run trials, collect data, AND authentically engage the client all at the same time. Again, that multitasking stuff is nonsense. It's not like clinical feedback is meant to improve and sharpen your skillset, so it's best to ignore it.

  • Tunnel vision for the WIN - Lastly, the best way to earn yourself a fancy Boring Award is to make up your mind at the top of the session to never deviate from your plan. Does the client keep asking to go outside? Or are the parents requesting additional parent training? Does the client seem bored to tears when you pull out those same animal flashcards?? None of that should impact the plan you already decided on. Spontaneous changes, mixing up materials, and embedding the family into the therapy session would just slow you down, and require more effort on your part....and who needs that? It's far easier to show up for each session, do the same things, in the same order, and then go home. Autopilot ABA sessions are for winners.



It's important to remember that being a boring ABA therapist takes effort and resolve! No one is that boring on accident, it's a choice.

It's a choice to say "Hey client, I know what we should do today: We should have a dull therapy session that has nothing to do with what you're motivated to do, your interests, your unique personality, and your current M.O.'s. The best way to teach you is to implement a variety of strategies that I would never want used on me, and that have little connection -if any- to the vast ocean of ABA research. Nope, it's best if I just plod through this datasheet and pull out these same tired reinforcers session, after session, after session. That would be what's easiest for me, and not what's best for you. Yes, let's do that".



(This entire post is sarcasm: do the opposite)
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