*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.  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:

The high cost of stress in the ABA workplace

When is burnout a sign to move on?

A meta-analysis of burnout with job demands, resources, and attitudes

Increased stress in the ABA workplace calls for reform

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Tameika Meadows, BCBA, Blog Author

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.

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Tameika Meadows, BCBA, Blog Author

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.

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Tameika Meadows, BCBA, Blog Author