Across multiple industries, staffing deficits are a big problem right now. 

There are many different explanations for this, but certainly in a post-COVID world all of us are redefining work, evaluating our priorities, and learning how precious our time is…..if people are unhappy at work/in their career, it makes sense that the past 2 years would push them to DO something about that.

 

But let’s talk about RBT’s, specifically.

 

The RBT credential is an entry level position into this field. When a clinician company hops, it is usually for a different BCBA position. After all, there was tremendous time, energy, money, and schooling that went into the decision to become a BCBA, so most will try a new company out before trying a new profession.

For RBT’s though, many are not that connected to the field. They may still be figuring out if this is what they want to do long-term. Or, they may already know that they plan to pursue education, mental health, counseling, or other degrees, and are working as a RBT now for valuable experience. The point being, its often true that RBT’s not just company hop, but industry hop/leave the field. Especially right now, when the impacts of quarantine and the pandemic are still lingering. Client cancelations, health scares (e.g. sessions canceled for a week until a clear COVID test), companies lowering rates or decreasing benefits to ease financial strain, funders decreasing reimbursement rates, etc. All of this contributes to the experience of the RBT.

I mean, just look at current gas prices. If you think that isn’t impacting the job satisfaction of RBT’s who spend most of their day driving from client to client, then you are deluding yourself.

 

So, what can be done?

 

What is often attempted is increasing incentives. Things like: pizza day, bonuses, raffle drawings, trivia nights, casual Fridays, referral bonuses, public recognition/"Shout Outs" from management, use of a company iPad, etc.

Here’s the problem though: did anyone ask for that? 

 

What are your frontline staff asking for? When people leave, WHY did they leave? When people turn down an offer, or decline moving forward in the interview process, WHY did they lose interest? What happened? When staff complain or bring up concerns, are they addressed and resolved? Or bounced from person to person in the company? Is management toxic to deal with, unprofessional/gossipy (especially in center based settings), incompetent, etc.? Toxic managers are one of the largest reasons why people leave otherwise good companies.

 When I speak with unhappy RBT supervisees, the issues they describe to me tend to be systemic/management level problems (meaning, the supervisee cannot fix the issue), or a symptom of RBT mistreatment/low regard. For example:

• Low pay/Pay rate has not budged since hire/Low hours (hired as FT but only working PT hours)
• Client cancelations or schedule changes that cause loss of income
• Poor fit to clients on caseload/Working outside of clinical competency
• Not supported by BCBA/Minimal supervision
• Issues with admin or management (rude, unprofessional, incompetent, etc.)/Inaccessible owner, management, or HR/Management does not support or "back" the RBT when there are issues with the client parent
• No company policy on parent involvement or participation/No company policy on respecting the staff or employees/No consequences when client families regularly arrive late to sessions or cancel frequently
• Excessive driving (only client is 2 hours away)
• No benefits/No healthcare due to unable to maintain FT hours
• Company does not provide needed equipment and supplies to perform job/RBT must provide their own supplies
• Being expected to do extra work for free (required to train new hires for free)
• Insufficient training on company required technology (required to use data software, but minimal training on it or support when it isn't working correctly)

If I was working with a client, and providing access to pizza, gift cards, and trivia nights, but the target behavior was not improving, my conclusion would be that I need to reevaluate my reinforcers. Looks like they aren’t so reinforcing after all!

Okay, then let’s apply that same conclusion to our workforce. If they are continuing to quit in large numbers, the reinforcers and motivating variables are lacking. Something is wrong, something is off. And as owners, bosses, managers, and stakeholders in this conversation (supervising BCBAs may not actively hire or employ RBTs, but we can certainly advocate and speak up for them in the workplace) we need to do better for our highly important RBT workforce.

 

So, what do RBTs want?

Heck, I don’t know. 😊

 

You need to ask THEM that. Individually. Consistently. Intentionally. At the onset of employment. As well as on a recurring basis once they take the job.

 

Don’t wait for people to become unhappy and dissatisfied and only then start pouring on the incentives, gift cards, and bonuses. Be proactive and intentional about building a strong workforce, demonstrating value (link), and probing individual employee preferences and reinforcers, so that the workplace can be an enjoyable setting (and reinforcing stimulus) for the people wo work there.

 

…… Or it’s highly likely they won’t work there for long.

 

*Recommended Reading & Resources

Improving Employee Retention

Predictors of Burnout in Behavior Technicians

Reinforcer Preference Assessment 

Identifying Staff Reinforcers 

How to Retain Great Employees

 

 

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Tameika Meadows, BCBA, Blog Author

 Recommended Read: Toxic Staff 

If toxic staff is 1/2 of the conversation about what creates and perpetuates sick, dysfunctional work culture, then toxic leadership is definitely the other 1/2 of the conversation. You can't discuss one without discussing the other.

Unhealthy work demands, narcissistic managers, unrealistic productivity metrics, all of these contribute to the "revolving door" staffing issues that many, many ABA companies face.

Who is at the top? Who is getting promoted to the top (and who isn't)? And what characteristics and concerning behaviors do those in leadership consistently exhibit?

Examples? Sure:

Employees who sacrifice/neglect their OWN families to work long nights and weekends for clients are seen as “go getters” and “customer satisfaction focused”

A lot of hype and focus is placed on giving “110% every day”, with little discussion about how that is also the definition of burn out culture

Leadership decisions are not to be questioned. They are to be accepted. Questioning or disagreeing leads to the employee being seen as "insubordinate", "disrespectful", or "problematic"

“Hit the ground running” is a euphemism used to communicate the expectation that you will jump headfirst into a project or assignment and not bother anyone with questions, or requests for assistance

“Soft skills” like compassion, empathy, or person-centered treatment is retwisted as being “too soft”, “too emotional”, or just weak. You are encouraged to be firmer with clients, “convince” families of hours they don’t want, and project “confidence”

 

And on and on and on. 

Source: www.betterup.com 

Toxic leaders create and worsen toxic work cultures, resulting in staff who are timid, fearful for their jobs, indecisive/do not trust their ability to be a self-directed employee, and hesitant to provide constructive feedback. These are not fun places to work, and the work being produced typically reflects that.

Taking that a step further, what happens when people working in a field intended to help, support, coach, teach, or instruct vulnerable populations, is suffering under toxic leadership? What is the impact on quality of care and client outcomes? I don't think this is a question of "Will this affect the clients", but a question of "How will this affect the clients".

If the point of a leader in a company is to guide, instruct, and lead those under you, then following a toxic leader is like walking on a circular road that doesn't go anywhere. Its a pointless exercise in futility, and a good way to ignite a great resignation. 

In my latest book, 'The Practical ABA Practitioner', I talk at length about my experiences in this field working for toxic owners/managers. The way those experiences impacted my job satisfaction, my passion for Behavior Analysis, and my emotional and mental health (burnout, anyone?). My experience is not unique. Employees: talk to your colleagues. How many of them have sat under toxic leaders, and what impact did that have on them? Employers: talk to your team. How many of them view their current managers or supervisors as toxic, and how does that impact their day-to-day work?

Dangerous leaders are not just dangerous because of their pathological mindset and questionable behavior. They are dangerous because they expect the people under them to become like them. To focus on profits over people, to "hustle hard"/work until they drop, and to prioritize company health over their own mental health. 

When we examine the rates of position resignation in this field, as well as clinician burnout, how much of that is caused by toxic leadership? Many companies have systems and procedures in place that can actually encourage professional burnout. When employees feel isolated from colleagues and distant from ownership/management (silo mentality), 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 the 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 highly challenging consumers, or working 12 hour days 6-7 days a week? Does the work culture intentionally promote cooperation, teamwork, and open communication? Can staff  directly access management to voice complaints, or even just vent? Or, do 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.

It takes healthy, rested, emotionally stable people to perform the challenging work of supporting vulnerable populations through behavior analytic interventions in the community, home, and classroom. Toxic work cultures don't only impact your team, they also impact the very clients you are supposed to be helping.

Source: www.hcamag.com 

** More Info:

Preventing Burnout 

Lipman-Blumen J. (2010) Toxic Leadership: A Conceptual Framework. In: Bournois F., Duval-Hamel J., Roussillon S., Scaringella JL. (eds) Handbook of Top Management Teams. Palgrave Macmillan, London.

What is Ethical Leadership?

Developing Leadership in Your ABA Team

Esquierdo-Leal, J.L., Houmanfar, R.A. Creating Inclusive and Equitable Cultural Practices by Linking Leadership to Systemic Change. Behav Analysis Practice 14, 499–512 (2021).

A New Model for Ethical Leadership 

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Tameika Meadows, BCBA, Blog Author

 

As an industry, ABA is a billion dollar market with large, multi-state, companies becoming more and more common in the US. 

That's billion, with a B.

There are many reasons for this massive boom, such as the increasing visibility of ABA as a career field, which drives more people to pursue credentialing and certification, and ultimately to seek ABA employment. The insurance mandates across states has also led to this boom, with more and more people now able to access ABA treatment through their insurance plans (removing cost as a barrier to treatment). ABA as an industry has become very attractive to investors and equity firms, which means more businesses and clinics being opened, or existing businesses and clinics expanding and multiplying. 

Lastly, the increase of ABA services outside of the world of Autism has led to an overall increased demand for/awareness of  BCBAs, with clinicians moving into areas such as criminal justice, the business world, education, geriatrics, and policy change. 

Unless you live in a very small town (or outside of the US) you've probably already seen ABA businesses and clinics pop up in your community, with a more aggressive presence than before.  

As a clinician, it can be a dizzying process to look at the  vast array of ABA employment options out there and choose the best place to pour your time, energy, and talent into, day after day after day. 

This specific question of "Where should I work?" is something I've posted about multiple times (see here, here, or here).

We talk about clinician burnout, we discuss the problematic high turnover rates in this field, but where are the resources to help clinicians weigh their employment options to select a reputable, ethical, and professional organization to work for?

Beyond just tips and commiserating by swapping stories of companies from hell, I'd like to offer some actual evidence- based action steps (see sources below), to help when it comes to scrutinizing an employer pre-hire, successfully navigating The Contract, and enjoying where you work!

What in the world was the point of all those college courses, 2am study sessions, supervision hours, and textbook paper cuts, if you're just going to get up every day to "clock in" at a company you loathe? Why work somewhere where all you are viewed as is a means to billable hours? That makes no sense at all.

Before jumping into some red flags of unethical organizations, I want to emphasize the importance of the pre-hire process. From that initial email or phone call, all the way up to the point where you sign your name on the offer letter or contract, you should be evaluating that employer just as much as they are evaluating you. It should be a mutual process, or dance, of "Show me what you got". For example:

Who owns the company? (super important question to ask these days) How many BCBAs are in leadership positions? How long has the company been around? What is the mission statement or company vision? How about the company culture? How reasonable is the clinical workload? How much of the work day is paid time (billable hours vs non-billable time)? Why did the last person in this position leave? What is the staff turnover rate? How is value demonstrated to employees, in tangible and concrete ways that are NOT tied to meeting productivity quotas? How does the company make diversity and inclusion a necessity, not just at the practitioner level, but at the executive level as well? Is work-life balance a buzz word, or actually attainable at this company? 

Also, we live in the Jetsons age. Your entire life is on the internet. If you think that interviewer is not looking you up before the interview, you are delusional. Have you looked the organization up online? Have you read over the company reviews, written both by consumers and by employees? Have you searched for any lawsuits/legal action, or ethical investigations the company was involved in? You should.

Identifying Unethical Organizations

• Pre-Interview/Interview process - Organization does not or cannot provide clear, logical answers to persistent applicant questions, supervision and training as described is insufficient/does not meet best practice standards, cannot explain/no process of onboarding new hires, poor management of client health records (HIPAA concerns), scope of competence is not a consideration when staffing cases, both a very brief or a drags on and on interview process are not good signs, beware of recruiters who make grandiose promises during pre-hire (get it in writing), vague or shifting caseload expectations, cannot explain efforts/no efforts made to accommodate the diverse cultures of client population

• Evidence Based Practices- Organization promotes/advertises or clearly offers non-behavior analytic services while claiming to be an ABA agency, unethical practices or non-evidence based procedures are observed or discussed (e.g. BCBA supervisor implements Floortime with clients), executive level staff lacks BCBA's or clinicians, minimal to no understanding of Behavior Analytic Code of Ethics, clinical competency is not considered or critical to caseload assignments (e.g. brand new RBT's are placed on high intensity cases), clinical supervision and training is too minimal for RBT's to refine their skillset

• High-Quality Service - Workload expectations are unrealistic to an amount that impacts clinical quality (e.g. Supervisors carrying huge caseloads), clinician mentoring and emotional support is replaced by micromanagement (incessant "check-ins" that are only focused on productivity), job description is unrealistic/multiple jobs crammed into one position, treatment hours are mandated regardless of client need (e.g. push for "40 hours a week" for all clients), "cookie-cutter" treatment planning, lack of parent training/caregiver involvement in treatment, no company policy or procedures for gaining parental adherence to participation guidelines, no company policy or procedures for families who frequently cancel/show up late/"no show-no call", unethical and/or unprofessional behavior is being modeled by senior or executive level employees (e.g. BCBA supervisor is dating his RBT supervisee), ethical conduct is not taught, expected, or maintained by the organization, company online presence/website is heavy on outdated, Ableist, or anti-Autistic language such as "cure", "recovery", "suffering with Autism", or "saving" children

• Non-Certified Supervisors or Owner - While not automatically a red flag, the owner must be knowledge of the Code of Ethics, must understand that credentialed and certified employees are required to practice ethically, must demonstrate understanding of appropriate clinical caseloads, clinical supervision, and clinical training, must be committed to clinicians practicing within competency,  and must not attempt to make clinical/treatment decisions due to not being qualified to do so. Any RBTs or non-certified staff must also be under the direct supervision of a BCBA (or state level equivalent). If staff are hired, assigned to cases, and have NO supervisor/1 supervisor is responsible for far too many people, that is a giant red flag

• Contract Terms - Offer letter or contract contains terms, restrictions, or information never previously mentioned or explained during pre-hire (e.g. "surprises" in the contract), information that was verbally stated is not put in writing/not in the offer letter or contract, highly restrictive and punitive non-compete or non-solicitation clauses that prohibits the employee from reasonably working in the field during, or post-employment, length of employment conditions that require the employee agree to work at the organization for a specific amount of time ("handcuffing" employees to the organization), requirement to sign any document after accepting the position (e.g. 10 days after signing offer letter, only then is employee asked to also sign a non-compete agreement), huge bonuses/perks/incentives that only kick in after a specific duration of employment (indicates the company has high turnover rates), being offered an independent contractor position if you are a RBT or BCaBA (you cannot work independently)

**References:

BHCOE Position Statement on Non-Compete Agreements

Brodhead, M. T., & Higbee, T. S. (2012). Teaching and maintaining ethical behavior in a professional organization. Behavior analysis in practice, 5(2), 82–88. 

Brodhead, M. T., Quigley, S. P., & Cox, D. J. (2018). How to Identify Ethical Practices in Organizations Prior to Employment. Behavior analysis in practice, 11(2), 165–173. 

Brown, K.J., Flora, S.R. & Brown, M.K. Noncompete Clauses in Applied Behavior Analysis: A Prevalence and Practice Impact Survey. Behav Analysis Practice 13, 924–938 (2020). 

Brown, K.J., Brodhead, M.T. Reported Effects of Noncompete Clauses on Practitioners in Applied Behavior Analysis. Behav Analysis Practice (2022). 

Kazemi, E., Shapiro, M., & Kavner, A. (2015). Predictors of intention to turnover in behavior technicians working with individuals with autism spectrum disorder. Research in Autism Spectrum Disorders, 17, 106–115. 

Rubenstein, A. L., Kammeyer-Mueller, J. D., Wang, M., & Thundiyil, T. G. (2018). “Embedded” at hire? Predicting the voluntary and involuntary turnover of new employees. Journal of Organizational Behavior, 40, 342–359. 

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Tameika Meadows, BCBA, Blog Author

 Yup, pretty accurate.

Need more tips? Well, if you want a surefire way to generate clinician burnout, be sure to hire highly qualified, intelligent, and experienced practitioners, and then micromanage them to death.

Lather, rinse, repeat.

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Tameika Meadows, BCBA, Blog Author

ABA employers/managers: During this crisis, are you actually listening to your staff? Because without them, there really is no company.

"Leaders who don't listen will eventually be surrounded by people who have nothing to say." 

Andy Stanley

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Tameika Meadows, BCBA, Blog Author

Today's quote of the day is from ..... Me!


See below for an excerpt about knowing your identity as a clinician, from my newest book, The Practical ABA Practitioner:

*Recommended Reading:

Runnin' on Empty

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Tameika Meadows, BCBA, Blog Author

"Bad bosses compel good employees to leave"
www.Forbes.com

"The way your employees feel is the way your customers will feel. And if your employees don't feel valued, neither will your customers"

Sybil F. Stershic

"The only thing worse than training your employees and having them leave not training them and having them stay"

Henry Ford

"Strive not to be a Success, but rather to be of Value"

Albert Einstein

"You don't get paid for the hour. You get paid for the value to bring to that hour"
Jim Rohn

Get Excited!

For those of you out there, laboring away, giving your all to your clients, working from 8am to 8pm every day (and getting paid for 1/2 that time), typing up 20 page reports at 2 am, laminating flashcards until your fingers are sore, putting hundreds of miles on your car, going to work bruised, discouraged, and exhausted, and eating your lunch in your car...I have something for YOU.

My newest book, 'The Practical ABA Practitioner', uncovers and openly discusses all aspects of ABA practitioner life, as in the good, the bad, & definitely the ugly. ;-)
This book is all about the practitioner experience working in this field, the day-to-day reality, how to plan out a successful career, and what common pitfalls to avoid. Especially for those of you brand new to the field, or newly certified.


If you want to work in this field, you need to read this book.
If you're tired of working in this field, you need to read this book.
If you LOVE working in this field, you need to read this book.

In preparing to write this book, I talked to lots and lots of practitioners about their experiences working in this field, reached back into my own early days as an in-home ABA therapist, and I also perused the resources out there about ABA as a career: What's it like being a BCBA? What are the pros and cons to becoming an RBT? What are the joys, the pressures, and the challenging to meet expectations of this industry?


Dying for some specific details about the book? Sure!
 "The Practical ABA Practitioner" addresses:

• Professional Burnout. Yup. I dedicated an entire chapter to discussing loving what you do, but hating the way you have to do it, and being eternally exhausted. You're welcome.
• The end of the book is a huge treasure trove of practical practitioner tips and resources (handouts, job performance tips, staff satisfaction surveys, suggested parent policies, etc.) that will help you do your job better. Seriously, its just pages and pages of stuff. :-)
• Work-Life balance as a busy full-time BCBA: Fiction or Reality?
• Developing and refining your clinical identity as an ABA practitioner.
• What are employers looking for when hiring RBT's? What about BCBA's?
• Should you pursue BCBA certification? Is it really for you?
• How to revitalize your passion for this field.
• What kinds of pitfalls should newbie BCBA's watch out for (because they're vulnerable to these issues)?
• Why are the staff retention rates in this field so terrible? To put it another way, why are so many ABA companies bleeding staff?
• Tips for choosing between various employment options, and red-flags to look out for.
• How to BE the change when working in less-than-ideal conditions.
• Holding this field accountable for the way we treat direct staff/ABA implementors.
• How to to develop your personal value system in this field, and practice with integrity.
• How to be truly successful as a practitioner, for years and years to come.
• What are some of the main reasons why quality practitioners walk away from this field, and don't look back. And how we can keep them from walking away.

Treat yourself, and do something GREAT for your career... get this resource and be encouraged and strengthened.

Click here to find this brand new resource on Amazon!

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Tameika Meadows, BCBA, Blog Author

ABA employers: You listening?

'You don't build a business, you build people.

And then people build the business'

Zig Ziglar

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Tameika Meadows, BCBA, Blog Author

"Burnout is the process of spending too much time doing things that don't properly utilize your unique Tool Kit" - Runnin' on Empty


If you are new to this field or perhaps if not new, recently became a BCBA, you may not have a very strong understanding yet of who you are as a clinician.

It's ok, it took me time too... Lots and lots of time.

It's hard to solve a problem you don't realize you have, so this is something I didn't even think about for many years in this field. I accepted work opportunities based on what was available, and when those opportunities didn't work out or left me feeling quite underwhelmed I just moved on to a new opportunity.

But, doesn't it make more sense to intentionally and strategically map out your career based on who you are and how you want to practice? Then why aren't are more of us doing that?


Burnout, which is a known fact of life in this field, can very much be connected to a lack of goodness-of-fit. Think about a vegan who works full-time at a BBQ restaurant. Or a pacifist working for a guns manufacturer. Or a daycare teacher who can't stand kids.

How much personal satisfaction and enjoyment do you think those employees would report after a work shift? I'm guessing low to none.

It's easy to just tell someone working in this field that Clinical Identity is important, but how many of us really understand how to ~discover~ our clinical identity?

Expect this process to take some time (I know, waiting is the worst), as knowing who you are not doesn't happen in the blink of an eye. It will also take perspective, which means you need to do more than one thing. If you've always worked with adult populations, or always worked in school settings, then how do you know what else might be a good fit for you? You kind of can't know that, if you only do one thing over and over.

Let's start at the beginning by first defining what is meant by a clinical identity: Defined as one’s professional self-concept based on attributes, beliefs, values, motives, and experiences (Ibarra, 1999; Schein, 1978).

Basically, your clinical identity is a combination of why you entered this field in the first place, combined with what keeps you in it. There you go, nice and simple definition :-)


Still struggling to put your finger on the unique clinical identity that fits YOU? Here are some tips:

•    Take money off the table (no, I’m serious). If you had to work for free, what would you choose to do?
•    Think about the last time you were truly passionate about work. What were you doing?
•   What part of the work you do makes you full (energizes you, excites you, lifts you up)? What part empties you (depletes you)?
•    Seek feedback: ask people who have worked with you, alongside you, or for you, to honestly list your best and worst clinical attributes
•   Does your current work allow a place for your unique personality, or does it require minimizing or turning off parts of your personality? *If you’ve never taken a personality inventory before, I super recommend doing that.
•   Write down your value system. Use this list during interviews to determine if your personal values and the values of the organization are complementary, or if they clash.
•   Anger can be highly educational. Identify the things that make you the most angry/frustrated/annoyed about your work. Honestly examine why these things bother you so much (they likely conflict with your value system).
•  What is your ‘niche’? What is it that you bring to the table that no one else can?

*References:

Slay, H.S., & Smith, D.A. (2011). Professional identity construction: Using narrative to understand the negotiation of professional and stigmatized cultural identities. Human Relations, 64(1), 85-107.   

Michael Tomlinson & Denise Jackson (2019) Professional identity formation in contemporary higher education students, Studies in Higher Education

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Tameika Meadows, BCBA, Blog Author

BCBA Position Summary: 

The primary function of the Board Certified Behavior Analyst (BCBA) is to plan, develop, and monitor a variety of behavioral support service delivery options to meet the needs of individual clients. The BCBA also consults with and teaches staff/client caregivers/team members regarding pro-active, educational, programming, and behavioral supports; develops and implements comprehensive treatment plans; and collaborates with related services providers as appropriate. The BCBA also provides direct staff supervision, and evaluation of staff performance both verbally, and in writing.

Essential Duties: 

• Use appropriate assessment instruments and data to develop and implement teaching programs that reflect behavioral outcomes and objectives 
• Ensure the accurate implementation of treatment plans, document contacts and observations; use professional knowledge and independent judgment to strategize continuous improvements.
• Establish and maintain data measurement, collection, and analysis systems for clients
• Maintain appropriate documentation and prepare and complete reports as required
• Ensure that all treatment plans and programs comply with contract requirements, satisfy all relevant insurance certification and other expectations, and meet or exceed professional standards
• Maintain highly organized, consistent, thorough, and systematic recordkeeping (session notes, data sheets, etc.)
• Seek creative options for ensuring the continuity and consistency of treatment and support services across settings for the lifespan of the client
• Develop strategies for the stability of quality services when clients experience transitions
• Conduct structured periodic service reviews to monitor the effectiveness of treatment programs and their implementation; modify and document plan changes as needed
• Provide staff development, training, and modeling for team members (including client caregivers) in strategies and methodologies for successful implementation of the treatment plan
• Provide consultation regarding crisis interventions and critical incident supports; complete Incident Reports as needed 
• Participate in Individual Education Program (IEP) team meetings for clients as appropriate; advocate for client needs in school settings 
• Participate in professional growth activities such as conferences, classes, team meetings and program visitations; remain a lifelong learner
•  Accept all other responsibilities as assigned.

This is a real job description for a BCBA position, and it's fairly accurate to most online job postings.

Yes, the typical day-to-day role of any BCBA will vary greatly depending on where they live, which setting they work in, the population they serve, etc. So to keep things simple and brief, I will focus on clinicians who primarily manage cases and supervise direct staff (as this is overwhelmingly what most BCBA's do).

The problem with most job descriptions (that may be written by administrative staff, not clinicians) is they leave out important details about the actual job.
I hear fairly often from people pursuing their BCBA, full of misinformed ideas about what it will be like on the other side. Or, I hear from current BCBA's who have been working in the field for years and are now burned out and exhausted because they weren't prepared for the realities of the job.

-- If you think you may be at a point of professional burnout, my 1st recommendation to you would be to stop & assess: When was the last time you felt passionate about your work? When was the last time you felt valued by leadership/your employer? Has your dissatisfaction at work started to seep into your personal/family life?
If so, please check out the resources below about dealing with burnout. It's a serious problem in many human service fields, and as BCBA's we are not immune.


While there are some great resources out there about professional burnout, my 2 cents is that clinicians would need triage to "stop the bleeding" much less if they enter the field with a realistic picture of what they're getting into. Let's prevent the bleeding, not patch it up.


Using the example job description above, I'll just sprinkle some fresh reality on top of it ;-) :


Position Summary: 

The primary function of the Board Certified Behavior Analyst (BCBA) is to plan (always planning....most clinicians are continuously monitoring the effectiveness of their interventions which requires intentional thinking about what will come next), develop, and monitor a variety (what works for Mickey will not necessarily work for Minnie, so this requires staying abreast of current research and trends within the field to best serve your clients) of behavioral support service delivery options to meet the needs of individual clients (no matter how impressive your intervention is, ultimately if social validity is low then you have more tweaking to do). The BCBA also consults with (this can be translated as 'remains available to', or in other words 'on top of your regular duties') and teaches staff/client caregivers/team members regarding pro-active, educational, programming, and behavioral supports; develops and implements comprehensive (comprehensive is key, and this is why we spend so much time planning and thinking--> the more deficits the client needs assistance with, the more comprehensive your intervention) treatment plans; and collaborates with (again, this is best translated as 'remains available to') related services providers as appropriate. The BCBA also provides direct staff supervision (it is common that direct contact with the client or with staff is billable time, but not so much the other important components of the position that still must happen), and evaluation of staff performance (this could include staff feedback, written evaluations, meeting with each supervisee monthly, or a mixture of all of the above. Again, this may not be considered billable time).



Essential Duties: 

• Use appropriate assessment instruments (Some companies do not provide business equipment/tools for you, so you will have to purchase these) 
• Ensure the accurate implementation of treatment plans, document contacts and observations; use professional knowledge and independent judgment to strategize continuous improvements (Being a quality BCBA requires excellent self-analysis skills....you must seek to continually improve your skillset)
• Establish and maintain data measurement, collection, and analysis systems for clients (Some companies provide access to data management systems, others do not)
• Maintain appropriate documentation and prepare and complete reports as required (Keeping in mind that what is required will change)
• Ensure that all treatment plans and programs comply with contract requirements, satisfy all relevant insurance certification (Credentialing is a PROCESS, and an employer with top-quality billers is a must) 
• Maintain highly organized, consistent, thorough, and systematic recordkeeping (As needed, you must be able to produce accurate, timely, complete client documentation)
• Seek creative options for ensuring the continuity and consistency of treatment and support services across settings for the lifespan of the client (The 'across settings' part can  be challenging, especially for school or center based services where you don't see the client's home life)
• Develop strategies for the stability of quality services when clients experience transitions (As the BCBA, you are responsible for successful client transition. This could include if hours decrease, if the program decreases in intensity of goals, or if services terminate)
• Conduct structured periodic service reviews to monitor the effectiveness of treatment programs and their implementation; modify and document plan changes as needed (Everything you create as a BCBA must be open to revision as needed. Much of your time will be spent editing protocols, programs, or revising systems) 
• Provide staff development, training, and modeling for team members in strategies and methodologies for successful implementation of the treatment plan (You must make time for this, which can be challenging)
• Provide consultation regarding crisis interventions and critical incident supports; complete Incident Reports as needed (When working with severe behavior or populations in crisis, your employer should provide adequate training, protective equipment, and support. Also, ethically you must practice within the boundaries of your clinical competence)
• Participate in Individual Education Program (IEP) team meetings for clients as appropriate; advocate for client needs in school settings (See why time-management skills are critical?)
• Participate in professional growth activities such as conferences (Your employer may or may not pay for this)
•  Accept all other responsibilities as assigned. (Pretty  much a vague and blanket statement isn't it? I would add the following reality check to this section: Accepting an insane caseload does not make you Superman/Superwoman, it will make you a very miserable BCBA. Understand that owning an ABA company does not qualify someone to actually be a good/ethical/honest employer, and hating the boss is the #1 reason why employees quit. Understand that staff turnover is scary high in this field..... there is a reason for that.  Understand that as a clinician there are many tasks you will complete that you just can't bill for. Understand that when you get home at the end of the day you likely still are not done with documentation/tasks. Understand that 'work life' may creep into your weekends too. Understand that many ABA employees report feeling underappreciated, devalued, and ignored by their employers, particularly at the RBT level.  Understand that there is a mental fatigue that comes with this type of work, and the more dissatisfied you are with your employer the more it increases. Understand that as clinician you will get frustrated by ever- changing funder requirements, and increased time-sensitive demands upon clinicians. Understand that employment offers for ABA positions often come with more strings attached than Pinocchio.... if you don't agree with something in the offer letter, do not sign it) 

*Resources:

Preventing Burnout 

Running on Empty

BCBA Burnout

Battling Burnout

Stress in the ABA Workplace

Addressing ABA Employee Turnover

Waldman, J. D., Kelly, F., Arora, S., & Smith, H. L. (2004). The shocking cost of turnover in heath care. Health Care Management Review, 29, 2–7

Griffith, G. M., Barbakou, A., & Hastings, R. P. (2014). Coping as a predictor of burnout and general health in therapists working in ABA schools. European Journal of Special Needs Education, 29, 548–558.

Gibson, J. A., Grey, I. M., & Hastings, R. P. (2009). Supervisor support as a predictor of burnout and therapeutic self-efficacy in therapists working in ABA schools. Journal of Autism and Developmental Disorders, 39, 1024–1030

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Tameika Meadows, BCBA, Blog Author

What is your work to you?

A daily grind?
A paycheck?
Monotonous?
A place where you are surrounded by incompetent idiots?
Your main source of frustration?


What should your work be to you?

"The place God calls you to is where your deep gladness and the world's deep hunger meet"

Frederick Buechner  

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Tameika Meadows, BCBA, Blog Author

If you are a clinic/business/agency owner, is it important to you that your team looks forward to coming in to work?

If not, then you have no idea the kind of harmful impact a miserable employee can have on their team members, on their superiors, and on the consumers being served.

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Tameika Meadows, BCBA, Blog Author

*Recommended Reading:

Ready for the Interview

The Other Side of the Interview

The interview process is a time where both the Interviewer and Interviewee assess each other to determine Goodness-of-Fit, and make a decision about partnership. Sound odd? It shouldn't. As an employee/contractor of a company, family, or organization, you are partnering up with the vision, goals, and plans of the organization when you agree to work there. Even if just for a brief contract where you offer your expertise, you are leaving a stamp on that company for years to come.

I've posted before about the interview process from the perspective of a parent hiring ABA professionals, or an ABA professional landing a great job. But what about the perspective of the interviewer? If you own an ABA company/employ direct staff, or hold a Director/Executive position, then you likely will have the responsibility to recruit, hire, and possibly train staff. Are you up to it? Based on my own experiences in this field....no. You're likely not :-).

I have had some just dreadful interviews for ABA positions. Totally terrible. Regardless of company size, if the company CEO was clinical or non-clinical, or whether I was interviewing as a contractor or an employee, I have observed that many people wearing the hat of "interviewer", should probably give that hat to someone else. A bad job interview is like a bad appetizer at a restaurant, in that it definitely doesn't leave you wanting more.

If you are finding that it's difficult to fill positions, or that applicants are turning down job offers from you regularly, there is definitely a reason for that. You may be thinking it's the pay rate, or the area, or just super hard to recruit in-demand ABA professionals, but might I suggest it's your interviewing skills?? If I am not impressed or intrigued during a 1st interview, I definitely won't return for a 2nd. Guaranteed.

So, let's look at what does work---->

When interviewers get it right (I mean, really right), they leave the interviewee excited about the opportunity to partner up with them. If either the interviewer or the interviewee feel resigned, so-so, or apathetic about the possibility of working together, that's a pretty good sign that something about the interview process was lacking.

To get the interview process right, and succeed at the goal of recruiting and hiring the BEST (which should always be your goal) 

Here's to attracting & hiring the BEST!

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Tameika Meadows, BCBA, Blog Author

It's been way-y-y-y too long since my last audio post, so now seems like a good time for one focused on ABA Consultation, and being a Consultation C-H-A-M-P ;-)

ABA Consultation is an interesting animal that can be very different from the typical BCBA supervision or case management role, in terms of pay, workload, clients served, time demands/responsibilities, and on and on. I use the word "Consultant" specifically to mean an ABA professional who works independently (self-employed) to serve clients. 

There are many snares and barriers that can pop up and impede effective service delivery when consulting, and I am often contacted by ABA peeps confused if they are ready to wade into the consulting waters. There are many things to consider beyond the obvious question of possessing the clinical skillset to practice independently. To name a few: 

How to find clients, Where to advertise, How to bill for services, What materials to use, Ethical issues when joining multi-disciplinary teams, How to address contract violations, etc.


Two quick tips before you start listening to the audio post:

- Legally, a CPA and/or an attorney who knows the laws of your state would be the best person to answer specific tax, income/1099 filing, billing, etc. sort of questions when it comes to consultation.
- If you are located outside of the US, "consultation" may mean something completely different for you as an ABA professional. For my international readers, you may need to speak to professionals in your local area to determine how much of this information will be applicable for you. On that same topic, if you live in the US but consult with individuals outside of the US, you need to get familiar with differences in how ABA services can be provided in that location. 



You can download the presentation HERE, then just start the slideshow and the audio narration should run automatically.




* Resources for further learning:

"Soft Skills" related to successful ABA Consultation 

Consultation in Applied Behavior Analysis 

Functional Behavioral Assessments in Schools

School Consultation in Rural Areas

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Tameika Meadows, BCBA, Blog Author

Value -  1) the regard that something is held to deserve; the importance, worth, or usefulness of something.; 2) a person's principles or standards of behavior; one's judgment of what is important in life.

"Value" is currently a hot buzzword with employers/recruiters looking to fill ABA positions, and if you haven't been on an interview yet and heard the "We value our team" speech.... you will.

Employers will tell you how much they VALUE their team, value their employees, "couldn't do what they do without them", and value the contributions of the clinicians, but without observable action steps does this word actually mean anything?


I can't count how many times I've heard employers go on and on about how much they value their team/staff, and see the importance of each team member. Yet when talking with the staff, they are often overworked, underpaid, and frustrated. So it would seem there is a disconnect somewhere, or ABA companies would not have such high turnover rates.


What's going on here?


Let's look at both parts of the definition of Value, to shed some light on the problem:

1) The importance or usefulness of something: This is basically how the employer values YOU. Are you viewed as a unique individual, possessing specific talents and unique perspective, as someone who would benefit the company, and a much needed addition to the current team? No? Well then what kind of "value" is that? To quantify value, yes, we do need to touch on the financial aspect. As an ABA provider, are you being paid a reasonable wage based on average salaries in your area, your education, and your experience? Are you working somewhere where you can give feedback to management, have a say in how you perform your job, and receive the level of support you need to grow? If you are truly an important part of the team, what happens when you disagree with a decision from management? Is your viewpoint heard and respected, or dismissed? Worse yet, does management simply pacify you (pretend to hear your concerns), but no change actually happens?Employers far too often focus on their bottom line, without intentionally working to put together a team of highly-valued ABA clinicians who will approach their work with passion and excellence. I've been in this field for a long time, and trust me: passion will take a person much farther than just talent. 

2) A person's principles/standards of their own behavior: This is basically how YOU value you. Have you truly sat and considered all that you bring to the table as a RBT/BCaBA/BCBA? It's probably much more than you realize. No 2 clinicians are exactly the same, so even though you may have the same educational background and certification as every one else applying for the position, you possess a unique personality, perspective, and style, that would be hard to replicate. What is most important to you about a position? Do you value income the most? Or flexibility? Or not being micro-managed to death? Or working for ethical professionals? Or a family-like atmosphere? Or cool perks and paid vacations? What really matters to you? And here is the tough part---> Once you learn what your values are, don't toss them out the window just because an employer approaches you with a really good offer. You won't thrive in a position that cost you your values. To put this another way, if you apply for a company that seems FAR more interested in your certification than who you actually are as an individual: run. Do not walk, run from places like that.


*Resource:

Know what your core values are, and hold firm to them: Personal Values Assessment

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Tameika Meadows, BCBA, Blog Author