Around the Spectrum: Consistency Over Chaos: Rethinking Systems in ABA (with Michael Conteh)

Growth is not the enemy. Poor systems are. In this episode, we explore how ABA leadership and systems shape the ability of autism clinics to grow while maintaining quality care. BCBA, Lean Six Sigma Black Belt, and executive coach Michael Conte joins the conversation to discuss how organizations can scale services without scaling burnout. Michael shares how he moved from direct clinical work into systems level leadership, using what he calls a telescope and microscope approach to separate system issues, process gaps, and people challenges. The result is a practical playbook for leaders and parents who want fewer crises, steadier teams, and better outcomes for children.

We dig into the hours dilemma. Assessments may recommend 30 to 40 hours of therapy, yet family schedules and staffing realities do not always support that level of intensity. Michael explains why consistency often matters more than intensity. He describes how clinics can think in terms of three realities that must align: the child’s capacity, provider quality, and the family’s daily life. We also talk about insurer expectations, realistic utilization, and how pushing “ideal” hours without considering these realities can erode trust and stall progress.

Michael also breaks down the burnout loop many BCBAs experience. Clinicians often carry the pressure of clinical decisions while working within systems that do not support them. Isolation on the floor, unclear expectations, and inefficient processes can slowly drain energy from even the most dedicated clinicians. One of the most powerful solutions, he explains, is teaching leadership as a real skill set rather than assuming it comes automatically with a job title.

From there, we move into concrete changes clinics can implement quickly. Michael discusses the value of structured 90 day onboarding for both families and staff, intentional communication at drop off and pick up, programming systems for younger learners, and ways to build intrinsic motivation so RBTs want to stay and grow. Parents will also hear how sharing “biology data” such as sleep patterns, hunger, and routine changes can dramatically improve collaboration with clinicians and help shape a more responsive treatment plan.

For owners and founders of new clinics, Michael offers a final insight. If the vision for your clinic only exists in your head, it cannot scale. Documenting systems and expectations allows teams to execute the mission consistently and protects the quality of care as organizations grow.

If you want services families can depend on and teams that can sustain the work, this conversation offers practical ideas you can start using this week. Subscribe to Around the Spectrum, share the episode with a colleague who is building or leading an ABA clinic, and leave a review with the system you plan to improve next.

🔗 Parent Resources

To support families navigating early childhood development and regulation, Michael shared the following practical tools:

🧻 Simple Potty Training Guide for Parents

A step-by-step, parent-friendly guide designed for children ages 2–4. This resource breaks potty training into manageable phases, with readiness signs, visual supports, reinforcement ideas, and progress tracking to reduce stress and build consistency.
 👉 Download the Potty Training Guide (PDF)

Transcript

Framing The Systems Conversation

SPEAKER_00 0:00

Hi everyone, welcome to Around the Spectrum, where parents, pros, and those in between pull up a chair for honest conversations, grounded guidance, and real stories about raising and supporting autistic kids. I'm your host, Wendy Banganero. As a parent, marketing leader, and longtime autism ally, I know how overwhelming and isolating this journey can feel. That's why we're here, because when we sit at the same table, we understand more and judge less. Let's get into today's episode. This episode zooms out a bit. We're talking about systems, school services, support structures, and how leadership in those areas impacts real families. If you've ever wondered why does this feel so hard or is anyone listening, this conversation is for you. Today's guest is Michael Conte. He is a seasoned leader in both business and clinical practice. For 13 years, he served as a CEO of a multi-million dollar company, guiding daily operations, training leaders, and supervising teams. Over the course of his career, Michael has worked with more than 1,000 families and trained over 1,000 staff to serve children with autism and other special needs. More than 30 of those professionals have gone on to become BCBAs. Michael brings a rare blend of expertise. He's been a board-certified behavior analyst since 2009, a lean Six Sigma black belt, and a PCC certified executive coach for high performers and leaders. His work centers on improving systems, boosting retention, and helping organizations thrive through organized behavior management and process precision. He's also the co-author of Off the Waitlist, a parent's guide to young children with disabilities. Welcome, Michael. Thanks for being on the show with me.

SPEAKER_01 1:41

Thanks for having me, and thanks for all you do to help both parents and providers.

SPEAKER_00 1:47

Yeah, I think this is going to be great. And this is such a needed conversation in the ABA space. So you're both a BCBA and a systems architect. Can you share how your journey evolved from direct clinical work to focusing on systems and leadership?

SPEAKER_01 2:04

Yes, I ran into systems thinking out of necessity. My clinic started around 2005, when it was really around 2008 when all the insurance mandates started to go state by state. I was fortunate to have a clinic. When those mandates went through, all the clinics grew exponentially. I found myself from 10 staff to 25 staff to 50 staff within an 18-month period. I realized very quickly that I'm finite as a human. And if I really want to grow this company and still keep quality there and still have my influence, I'm going to have to think more about systems at scale. I think that was that revelation because I was just, I couldn't outwork the growth that was taking place. A lot of times we focus on what happens when things go wrong and there's no client. I would argue there's just as much stress when things go right. Because systems break. And I think for a lot of folks in the ABA world, they're like, yay, things are going great. And then they don't realize this other shoe of, oh crap, all the things that I did for five folks does not work at 25 plus. So I think that's how I ran face first into the systems thinking journey.

Telescope vs Microscope: Systems And People

SPEAKER_00 3:31

And you're absolutely correct on that, whether it comes from recruiting, marketing side, leadership side, when there's five kids and you're like, oh, it doesn't matter if we handwrite this paper or take these notes this way, and then suddenly there's 50, it makes a really big difference in how you do that. How does the combination of behavior analysis, executive coaching, and process improvement provide a different approach to solving problems that ultimately affects the family?

SPEAKER_01 3:58

Near the end of the business journey, I got curious about systems, and that's what led me into Six Sigma. And so Lean Six Sigma is the people that make sure that when you have airplanes, that the brakes always work on the airplane. So really what it is is the process of reducing efficiency. And so what it did for me is now I can zoom out with a telescope and really think this complex problem. Is this a system issue? Meaning there's really no fundamental on how this should operate? Is this just a process issue? We don't have protocols. We haven't explained why these things are important. Or is this a people issue? I think that really helped because sometimes we look at problems, but that's a systems problem. You have a different solution. That really allowed me to use the telescope to look at these complex issues. But then as a behavior analyst, I can also look at the microscope, especially on the people side. How are people being motivated? Is there clarity of the vision? I think once I looked at the telescope and the microscope, it allowed me to peel each part of the onion of the problem, and that's what helped to move things along. So I'm a big family using both, and that really helps me to get better insight.

SPEAKER_00 5:21

One of the things that I know for sure is that there's always a balancing act, right? And in that balancing act, you're trying to balance families, you're trying to balance hours, you're trying to balance the actual care the child needs. Like there's all of these balancing things that need to happen. And without systems, I know that it can go certainly awry. So what would you say in there would be the best way to find balance? Because everything, and one of the things that I really do want to ask you as a BCBA, because I am always curious about this as a parent, I fully 100% support BCBAs and when they do an assessment and say this kid needs this many hours. That doesn't always work with the family. So how does that balance? That's a big balance act of what does the business need, what does the child need, and what can the family functionally do? How do we not make the family feel bad, but try to balance that?

SPEAKER_01 6:21

That is complex to find the Venn diagram between the provider company, the amount a child can actually do, and what the environment the family can provide. It's very complex. In our journey, that's something that we had to have lots of conversations about because all three need to go in the same direction and fit into the Venn diagram. So if I had to say what's the central piece that needs to be in the Venn diagram, I would choose the word consistency. A family has to feel comfortable that they consistently bring this child to the place, or if it's in-home, have the place available and have enough power that are consistent that they can do some of the things in the environment that keeps the child growing. On the provider side, can they bring the quality of staff that really helps that child to get consistency in positive repetitions, creating an environment where motivation is rich and not just training a new person on the job? It's more about their age and what they're able to do. And I think we have to recognize that behavior analysis is important, but nothing beats biology. When a kid is two, there's no reason for them to be sitting at a table for long periods of time. A young brain is not fit to work in that environment. Keeping consistency is the overarching theme. When BCBAs are trying to understand, a child may benefit from having a full 40 hours a week, but if the staffing is not behind it, if the parents need time to onboard, and the child is two years old, starting at 20 to 25, if that fits all three diagram, is the current optimum. And then maybe over time you can expand. I know insurances get very cranky when you try to add more hours, but I think we're doing it injustice. There's so much inconsistency that we're really demotivating the parents because they're not really seeing the progress. We're demoing the staff because of so much kind of turnover. And I think you just lose more in that process versus just being consistent with what all three parties can perform.

SPEAKER_00 8:49

And actually, to that point, that makes me curious about this because I'm sure you've seen this is that when you aren't able to be consistent, let's say it's 25 hours or 30 hours, right? And a parent, they're up front and they say, okay, but if you want the service, so now there's 30 hours, right? I'm just saying, for instance, the parent can't be consistent for I'm curious too when we say, but this is what they need, and really stick with that line, and then the family can't do it. Does it tell the insurance company this child doesn't really need those hours? When you go to renew the assessment.

Consistency As The Central Venn Overlap

SPEAKER_01 9:28

If you think as the specialist that they need X amount, but the parent only bring them 10, from a rationale standpoint, that's gonna affect your hours for that particular child. It brings up a big gap when it comes to ABA companies and parents. On the ABA side, we need to really have a conversation with the parent on what does it mean to be a part of this journey? Because a lot of the time, just your insurance covers it, you're eligible. There's not a lot of talk on, and it's not the hey, you gotta go do all this ABA work. It's just rather really understanding how much time do you have to allocate? What times are you potentially available? And by not having that conversation early, sometimes you can go through an assessment and go through all these things, and they're like, oh wait, I just need it for 10 hours. I can't do anymore. So I really think we have to build a relationship with the family. Sometimes it tends to be mom that you talk to a lot, but if you can really explain what ABA will do, especially in those first 30 to 90 days, and get the buy-in of what they can do to optimize it, that makes it where everyone is bought in. And then that creates a good accountability versus everyone hoping and praying. When you do that, that's when all the balls fall down and all the fingers start pointing at each other.

SPEAKER_00 10:57

Absolutely. As a parent who had therapists in her home, felt like day in and day out for a while. It's important to understand and have that conversation without the assumption that this is gonna work at a hundred percent. I think that that's really important to have those conversations with the family early about what that looks like for them and what that looks like for the provider and what they can do. So there's a lot of child. I'm very aware of the amount of BCBA burnout and overwhelmen because there is more child diagnosis. My son was diagnosed in 2007, and we've come a long way since 2007. And so when they don't have a process in place, right? You're a new BCBA, you go to a company and there is no process in place, suddenly they're trying to do 35, 40 hours plus notes. How do you see stress and burnout manifest in their daily work life? Because it's got to affect them.

Insurance, Expectations, And Early Buy-In

SPEAKER_01 11:59

So the way I see stress and management affect the BCBAs, and I had a front row seat as the CEO of a company, and we had up to three locations, and we had our ups and downs. When I think about that question, what really comes to mind, you start to see the essence of burnout and stress when the BCBAs start to isolate from the staff. Because in some ways, the staff are a primary source of their frustration, having to answer all these questions on the spot to get some of the frustration from the staff come directly to them as a clinician. When they start to pull away, they're going less into the room because that ends up to be more work versus reinforcing. I think those are the telltale signs. So what it does, it creates a bad feedback loop. And then it's hard trying to help someone else in the process. It is challenging. You're constantly having to critique someone. But when they start to pull away, they're not in the rooms as much. So then there's more mistakes that happen. So the staff get more upset. As soon as they come in, then the BCBA gets more jaded and starts to detach. Once you do that feedback loop for a while, you get the full disconnect. The BCBA is frustrated with the staff, and the staff were frustrated with the BCBA. That's when the rain cloud of stress envelops the whole clinic. And we've had that happen. And so we have to think how do we find ways that the communication bridge stays open? Once it breaks, that's when most clinics really start to devolve.

SPEAKER_00 13:42

So when stress arises and it's due to poor systems, what's a process change leaders make that would immediately ease the pressure off? I'm sure that all BCBAs would like to know what that is because as they're going through the process of being frustrated, that would be great to understand.

SPEAKER_01 14:00

Yes. One of my biggest soapboxes, BCBAs and any corporation, we must not assume that just because someone has a title, they are a leader. Leadership is a cluster of skills that needs to be taught, needs to be grown. And so much we go, okay, you're a BCBA, you're supposed to help this kid with autism, help the family build a great environment, and lead all these other human beings. I think we're really set eating people up for lack of success. And so if you want to have a well-functioning clinic, you need to have a robust leadership curriculum. It can be asynchronous. There's plenty of videos on YouTube, you can do training, so you have to do all the heavy lifting. But we have to get away from this assumption that you can lead other humans. For all of human history, I would argue that's the hardest thing besides raising a human, which I think is the hardest, the second hardest is leading humans. And I think if we just took a step back and realized how challenging this is, I really see the same problem in corporate with companies that have tons of resources and activities, and they still struggle with this leadership piece. So by far, if a company wants to stand out from competition, if you create leadership for the operational side and on the clinical side, that is one of the big steps to have a better, more healthy clinic.

SPEAKER_00 15:41

I I could see that a hundred percent. And I agree with you that leadership has to be a taught skill because not everybody has that. They're going to school for the science and to work with children. Sometimes that leadership skill set is not taught because they're learning the science and the outcomes. So I think that that's really an important, especially for new BCBAs. I think that's really important. How can parents understand that they have the right to advocate for healthier systems and be part of that process as we were talking about before? So, how can they advocate that and support their child's BCBA, which in turn supports their family?

Burnout Feedback Loops In Clinics

SPEAKER_01 16:18

For parents to see where they can have their impact in communicating with the company and the BCBA. I think the first thing that kind of hops into my mind is biology is so important to know what's happening biologically. And I know we always focus on the behavior, but it's amazing. I can completely change how I approach a day with a child if I know how many hours they slept. Just that little thing of Johnny only had two hours today makes it where I'm gonna try not to push him in a way that's gonna create a behavior. It's not that the child wants to not have good behavior, it's just the biology that they didn't sleep well. And I think those little subtle things of are they fed, how did they sleep, I think actually really helps a behavior analyst to really manage that day appropriately. So that's one on the behavior side. I mean, on the biology side. Now, the second piece is all parents are different, but there seems to be that patient doctor relationship where they drop their kid off and they're afraid to ask questions of what they observe. And so you don't have to be the squeaky wheel and demand of things, but it's okay to recognize when they work with this particular person, I am noticing this behavior afterwards. And it's not creating assumptions, but it's okay for you to be curious on what's happening, or when you notice any trends, Johnny's really starting to mumble a lot more. So I think those little context clues gives if I'm working on a kid who wants to learn how to speak with verbal communication, if I hear that there's more mumbling or more vocalizations, that gives me insight. Are some of the new programs working well or not? So I think giving those little tidbits of things you're noticing that's different, because a parent will really know the subtleties well before I do. And I think if they can give me contact tools early, I can definitely make pivots much faster.

SPEAKER_00 18:36

I like that you said that because so in your summation, is it enough, whether you call it parent training or parent collaboration, is it enough to do it then, or is it more important to have these, especially after a weekend where the schedule has been completely changed? As a parent who had a child that never slept for the first four years, I never slept for the first four years. Any sort of changes in the schedule from the weekends would throw him off on a Monday like there was no tomorrow until we got that rhythm and tried started to have him sleep. But so those type of things, like maybe there should be more of a touch point because the parents are gonna know more than sometimes the BCBA who's just walking in thinking it's another regular day for this child.

Fix First: Teach Leadership, Not Titles

SPEAKER_01 19:19

Oh, yes. Parents have the data. A good company knows how to build a bridge where they can get that data in a very useful way and then communicate back the things to do to alleviate. There are the quote-unquote parent trainings, but you're correct, they're more collaborations that are mandated by insurance. But it's really about as the provider of BCBA, what are your touch points with the family? If all of your touch points are we need this, you need to do this, I don't think that's a great relationship moving forward. I like going back to systems. I'm a huge fan, whether it's the staffing for the first 90 days and having that robust. I think on the family onboarding, there needs to be a 90-day family onboarding. And that is, here are our rules, so some sort of handbook. So that's the structure, but then it's the soft stuff. So it's really telling the staff when you take kids out, just don't say they had a good day. Try to really dig into what went well that day. And it's okay to talk about what didn't go well. That way there's clean communication happening back and forth. The parent is not just leaving with generics. If they realize, hey, he's making progress with imitation skills. That could be a motivator at home. It's not about imitation and do the activity. I don't think we prompt our parents well because we don't give good specific information on what's happening. So those are the soft skills. Those pickup and drop-offs, sometimes a note every month to evaluate, keeps both people in the loop and encouraged to keep communicating because they can now really ping on when something is going the right way or the wrong way and be very proactive.

SPEAKER_00 21:10

100%. Which leads to this next question because consistency in staffing is so important for the child. When it comes to consistent staffing and a family, and how that affects how the family feels about you as an ABA agency, by the way, that's like that consistency and the how the child how well the child does or how well the child could progress, what systems? Because that's probably one of the main things, and it goes back to burnout. A lot of times it goes back to burnout. What can centers do? And what can families do when you have your child going well and then your RBT quits and it's three months before you get another person, it really can affect the child and the family.

Parent Partnerships: Biology And Context

90-Day Onboarding For Families And Staff

SPEAKER_01 22:00

I love the question. I'll start on the provider side and go back to the parent side. Outside of insurance and getting paid for services, it is the most important thing. Because without staffing that are growing and feel invested into the company and the child, you're just going to have chaos. So for all companies and BCBAs, you have to realize employee life cycle is an ongoing living system. From the first time you make contact with a person until the day that they leave with offboarding, it's constantly understanding what is really working and not working. When I had my center, there wasn't as much competition. So we were able to bring people in. And I've worked at well over a thousand just at that clinic alone. And you start to realize patterns. And so if you want to build a good curriculum, you really need to know. Let's say you hire 10 people, and a lot of them have similar resumes, similar GPAs. Why did this one only make it three weeks? And then this one is a case manager and wants to be a BC. I think we spend so much time just saying the people have it or don't have it. And to me, that is completely not the case. It's all about really understanding how people learn, because they learn differently, and then giving them something that gives them confidence early in the journey. So going back to that first 90 days for a staff, I want them in the first 30 days to fall in love with at least one concept or understanding the clients that they're working with and really understand the importance of their work. Because without that internal, that's what gets a RBT up in the morning after they've been had a rough day the day before. If you don't know you're having impact, you're just not going to show up. And so I think that's where a lot of companies drop the ball. They're not building intrinsic motivation, which to me is the only way you survive the early days of early therapy. So from a parent's perspective, I think the simple thing is it's hard to actually know behind the walls if the therapist is really being helpful or just like a happy face. But when you can see any type of positive, meaning they thoroughly engage with your child, right? They bend down. You can tell that they are investing the time and energy. Just indicate the things that you've noticed. Hey, Johnny's getting better at imitation. You guys are doing a great job. That kind of helps them to realize that, hey, I'm getting better at this. I think that's a way the parent can give feedback to help that internal matrix. So more staff stay longer, especially when they start early in the ABA journey.

SPEAKER_00 25:02

I do think that's important. And I know not every parent chooses in home, so you don't always see everything, especially a VT that's there the whole shift with the child. I've met some of the most VTs, a miracle worker, because of the time and patience and tolerance. I think that's really important for them to hear, which is sometimes hard because it's not always easy raising a child on the spectrum. They're not going to always be up and they're not going to always be down, but somewhere in between, it's really important for parents to hear that they're doing a good job too, because sometimes we forget. But and I so I think that's really important to have that communication to celebrate every small win with the staff and with the parents. It's so important from your perspective. What's one common process and efficiency that you could say kind of like hands down that you see an ABA that if approved with free BCBAs to spend more time, more of their time and energy supporting children and families?

SPEAKER_01 26:03

Yes. We talked about this earlier. It's that leadership curriculum. So that the and there's also that the BCBAs recognize they're not, you have the certification, which is great. They're not done learning. I've been fortunate that I got a chance to train BCBAs. And it's like, congratulations. Welcome to the next phase of your growth. And so that way they always had a spirit of learning and curiosity. That sometimes helps when some days are monotonous or challenging. So I think that is the one that really stand up that the BCBA is still learning. I would argue, and I'm a veteran, but if your BCBA feels that they know everything, you're in big trouble. They're not learning the leadership skills. We haven't talked about programming, but programming is something that you can build a great system for, especially for younger kids, say five and under. I think those are the things that really offset some of the stress and energy. So that a BCBA can walk into a room with confidence because they can have the crucial conversation. They can critique someone without breaking them, but then they also can give the honey of encouragement. Those are those soft skills that feel mandatory in a place where there's always a BCBA telling a BT or RBT what to do.

SPEAKER_00 27:27

I have one last question, and I call this the wisdom seek cup. The truth of the matter is A agencies, whether it's a BCBA leaving and wanting to start out on their own or other people who are interested in the world of autism and want help, but their ABA companies opening, I feel like almost on a daily basis at this point. The need is there, so I'm not criticizing by any means. Someone who is looking into getting into this field and starting their own business or journey in it because they want to support families. From your experience, what's the one piece of advice you'd give them to a new owner about how to approach the work and a way that sets them up to thrive and truly support families?

Retention Systems And Intrinsic Motivation

SPEAKER_01 28:08

I love the question because I'm such a fan of entrepreneurship and betting on yourself. But to be a great entrepreneur, you have to convert your vision into a realistic system. A vision by itself with all its hopes and activities is only an idea until it's brought to life and systematized, the company can only grow to the amount of your energy. That's something I learned the hard way. You can do it on a small scale, but relatively quickly you recognize that if you really want a larger company, anything past five people, your vision needs to be documented. You can't just go into a room and say, we want to treat this place like a family. Okay, what does that mean from a documentation standpoint? How are meetings constructed so that it does feel that as a family people can communicate? That's always the biggest guy. And so, entrepreneurs, we tend to fall in love with ideas and then feel that we're done. That we just have to say the idea and it'll just turn into something. I think I realize that I haven't started till my idea is out in front of me that I can show to someone else starts the process. So that's the best advice. Everything in here needs to end up somewhere else.

SPEAKER_00 29:42

Just as a marketing point of view, because I have worked with many companies who have been five years plus and they go, We don't know how we got there. Let's start with the writing that down to that point. The reason why I I love that idea too from marketing standpoint, but a process standpoint. Standpoint is that then you can see where the holes are too. When you start to write things down, and you go, wait, there's a gap in that thought process. There's a gap in that system. When it's on paper, you can finally sometimes see it where you don't see it in theory, when because there is a missing piece of the process you start to see when you start to write it down.

SPEAKER_01 30:23

A thousand percent. It is literally why in the old days humans have to tell stories, they didn't write things down. So much information is missed, so much influence. But it's amazing that when you see it in front of you, huge gaps. And now it allows you to work on your system versus just hoping your system works itself out.

SPEAKER_00 30:48

Absolutely. This has been fantastic, Michael. Thank you so much. I so appreciate your time today. Conversations like today's about process leadership and creating systems to actually support people. Remind me how much impact thoughtful communication can have inside an organization. If this topic sparks something for you and you'd like to explore that connection between leadership and marketing and creating teams that stay, I'm co-hosting a short workshop called Hire to Stay Leadership and Marketing Strategies on Wednesday, November 5th from 12:30 to 1.05 p.m. It's a focused 35 minute session designed to help leaders and business owners take what they already know about people and make it part of how they attract and keep talent. You can find the link to register in the show notes. I'd love to see you there. Thank you again, Michael.

SPEAKER_01 31:44

Thank you very much.