Truth Telling and Good Hiring in ABA: A Couple of Drinks with Holli Beth Clauser (Part II)

ABA on Tap is proud to present Holli Beth Clauser (Part 2 of 2):

Grab a comfortable seat and get ready for your second pour of truth telling and good hiring. 

"They’re just RBTs” might be the most expensive sentence an ABA organization can say. We sit down with Holli Beth Clauser to talk about truth telling, good hiring, and what happens when companies optimize for speed and margin while ignoring training, retention, and the human reality of autism services delivered in a family’s home.

We dig into the hidden costs of turnover in applied behavior analysis: paid onboarding time, unstaffed cases, added BCBA supervision load, inconsistent sessions, and the reputational damage that follows. From there we get into the messy “soup” leaders actually face, balancing living wages, competitive market pay, and insurance reimbursement rates, plus the pressure to keep profit margins high. We also challenge the industry’s obsession with blanket hour recommendations and talk about what it means to “prescribe” ABA therapy with real clinical reasoning and empirical humility.

Then we shift into what to do about it. Holli breaks down how to reduce silos between clinical leadership and talent teams through visibility, feedback loops, and accountability, and why “vibe check” interviews quietly bake bias into your hiring. You’ll hear a practical interview question you can steal, simple ways to create belonging through specific reinforcement, and a powerful reminder that protocols are for people, not the other way around. We also cover BCBA burnout and realistic career pivots, plus Holli’s personal diagnostic journey and what it taught her about communication, systems, and support.

If you care about ethical ABA, RBT retention, sustainable growth, and better outcomes for kids and families, hit subscribe, share this with a leader on your team, and leave a review so more clinicians can find the conversation.

Tune in, drink up AND ALWAYS ANALYZE RESPONSIBLY.

Transcript

Part Two Setup And Parent Skills

SPEAKER_05 0:01

Welcome to ABA on tap. I'm Mike Rebio with Dan Lowry. So without further ado, sit back, relax, and always analyze responsibly. And welcome back to ABA on Tap. And this is part two of Truth Telling and Good Hiring in ABA. A couple of drinks with Holly Beth Clauser. Cheers.

SPEAKER_02 0:43

No, I I agree with that. And I would add to that that when you're thinking about transferring skills to parents, you know, learning about DRO, DRA, and all that is not something that's going to be helpful when they're trying to carry over the changes that you're doing with their child when you're gone, but modeling de-escalation and kind of explaining what you're doing and like and how they could potentially do that. And you know, that's more helpful. And I can tell you, as a parent who had had two kids, both of them had respite. And I would come home and the respite care each one that we tried, undoubtedly, would be crying. I had one, actually, I had one good one, but they'd be crying and I'd come home and give respite to the respite. And I was just like, gosh, like, are my children? Like, I work with really challenging kids, and I don't see my kids as all that challenging. And so when I see that, then I'm wondering, am I missing something? Are they harder than I know? And also, if the professionals can't handle it, how am I supposed to handle it? And it just becomes, and then I did, I ceased having respite. I was like, forget it, forget respite. Like I'll just bring them everywhere with me, like you know, and and I ended up not doing it because they couldn't handle it. And I know respite's different than RBTs, but I would say that having them be able to manage their behaviors in front of the family is very, a very important skill set.

SPEAKER_05 2:09

Yep. That's a that's a tall order, too. I mean, that's that's a lot again, back to that idea of a young professional. At this point, I you know, few things scare me. So I understand what that means, but even then, I'm sitting there kind of reading the room, like what faces are the parents making? How much time do I have before I need to interject, even though I may not want to? I'm doing it for the optics on this side.

SPEAKER_03 2:32

Plus, you're at the BCBA. It's not like the RBT can be like, let me ask my B C B A.

SPEAKER_05 2:36

Well, I mean I'm working on 30 years of experience doing this in and out of different settings. I've you know, I've done the uh I know the DROs and the DRAs, and you know, to heart, I I know both sides of it. Uh it's a it's a very complicated impromptu dance. Yeah, and as you have to know the steps, and then you have to know when to use certain steps, and that's that's a tall order. That's that's a lot that we ask of these young professionals. Back to your original point, Holly. Sometimes without having given them any inkling of semblance of a training of something on that topic.

SPEAKER_03 3:11

Yeah. I'm

The Hidden Cost Of Turnover

SPEAKER_03 3:14

gonna request the soapbox back for one more second because it's something uh Holly said that I really uh resonated with. And you talked about the kind of hidden costs of turnover. And so I remember at that the first company that we were that I met Mike at that company. I was the trainer for a long period of time, and it went from a nice two-week training where we were doing the training to uh iPad supported training. So basically, the training was just on an iPad where they did the 40 hours on the iPad and then gave a certificate. And I just saw the deterioration of the services and also the significant increase in turnover because people didn't even know anybody at that. There wasn't even really a trainer or anybody they could connect to. They just basically got this iPad, literally sat on it with oversight for 40 hours, and then it was like, Okay, well, we'll call you when you get your cases. It was it was super weird. So I remember I wrote this like four-page drafted letter because I was just so frustrated with it, and I believed in the company and and wanted to with like the hidden cost of turnover. Like, look, you're spending 40 hours paying for this person, so that's an hourly wage. You're also waiting to staff a client for 40 hours, so that's money that you could if you had if the staff that they're replacing didn't leave, you would be getting that money. This is the extra time that supervisors are now gonna have to allocate to this client instead of other clients. So I like you know, broke it all down and just I gave it to higher ups, and one came down and was like, Yeah, I want to review that letter. I was like, Yeah, you made some interesting points, but at the end of the day, you know, they're just RBTs. If if they want to leave, they'll leave and we'll replace them. I was like, okay, because I had a relationship with these people, like I knew them because I I trained them. It wasn't just a number to me, it wasn't a name, like it was a face that I saw. I was like, Oh, okay, I get it, but even taking all that out of the the picture, do you see how expensive this is? Could we just like train them a little better, maybe pay them a little better, and then you don't have to worry about that? And that just didn't resonate with them. So then I I left the I left the position because it was so weird to me that not only because of the lack of training, the poor recruitment, and all of those things was the client getting less services, but even from a business perspective, it made way less sense.

SPEAKER_02 5:29

Right, you start to not trust their decision-making skills because you're like, I know you can see this, right? But you're still some something is overcoming that. I'm gonna press pause for just a second so I can go to the bathroom. Absolutely, please.

SPEAKER_00 5:41

Absolutely.

SPEAKER_03 5:42

Go ahead. We're back, we're back, Holly. What are your thoughts?

SPEAKER_02 5:46

My thoughts are it's bananas. It's like it's like going to, I don't know, somebody who's this might turn out to be a horrible comparison, but that's okay. It's like going having somebody run an auto repair shop and them saying, Yeah, they're just like they're literally just mechanics. It's fine, it's whatever. They don't need to know all that. Well, there, if you don't have mechanics, you do not have a business, right? Like what are you thinking? So yeah, I think that there's a lot of bad math when and surprisingly, even with PE guys, I actually was sitting down with one of the P A guys, PE guys, when I was creating a vacancy cal calculator like three years ago. And he was super humble. He's like, you know, Holly, I've looked at this from so many different angles, but I've actually never thought to sit down and look at it from this angle. And he's even though and he's like, and I'm a smart, I'm a smart dude. And like I've been in this space for a long time. I'm very good financially, but I've never thought about it from that angle. And I think that again, with us understanding so much how ABA is ran, we understand if you if RBTs, if you do not have good RBTs, you do not have a good company or a good reputation. And I don't think that they're thinking long-term, like you said in turn earlier about reputation. You know, you might have a quick fix of getting people in and being able to serve your clients because you're hiring faster than you're losing them, which is a horrible model.

SPEAKER_00 7:14

Sure.

SPEAKER_02 7:14

It's going to eventually catch up to you in your reputation.

SPEAKER_03 7:18

So well, that's what scares me with the whole PE piece, is that a lot of times I don't think they care because they're going to sell it within four to five years before the reputational, that's the next person's problem to fix that reputational piece. But that's a whole different tangent.

Pay Reimbursement And Profit Pressure

SPEAKER_03 7:32

The math is always interesting, right? Because we've even had to deal with it in our with our own company because you've got a few different metrics at once, right? You've got kind of the the living wage that somebody needs. So in San Diego, it's crazy expensive, just how much does somebody need to live, and then the comparable, the wage of a comparable position, but then you also have the reimbursement rates. So all of those are like they're kind of in a soup, and it's like, well, yeah, the living wages, I'm throwing a random number, $20 an hour, and the comparable wages are $23 an hour. It's like, okay, that's a that's a starting point. But if we're only getting reimbursed $26 an hour, then it like it doesn't make sense. So there's a lot of a lot of different metrics that kind of have to go into the soup to line up to make it so that it works. Because certainly you're like, oh, well, let's pay somebody more, um, which I think that that we do from time to time. But then it's like, then your profit margins decrease, but certainly the goal is that you make it up on the back end of having the consistent sessions and things like that. But again, a lot of times people on the the more managerial side are like, no, then now we've gone from 30% profit to 25% profit. We're not gonna do that. You're paying them too much based on our average reimbursement rate. So I think it just it's tricky to get all those numbers to line up in a way that makes sense for the RBT.

SPEAKER_05 8:58

Yeah, it's hard to come up with the ranges, I would say, right? So any any decrease is a problem. Uh back to Holly's original point without looking at the function or the reasons why. But as soon as you get into and again, it's not every private equity discussion for sure, but it's always about that singular variable that things go up or down, and we expect this exponential continuous growth uh and increase in profits no matter what. And I think that I mean, in my experience, that's where that we get stuck on the conversation. So now discussing quality of services, retention, continuity, that's that hope is lost. Yep. That's so far off in the weeds, like you know, now you're being ungrateful or insubordinate in some meeting because you're talking about those things, and it's seen as though you're pushing back aggressively, although you're just kind of saying, Hey, wait a minute. You know, I like the phrase you've been using, which is this is the real life. This is how this is really happening. I appreciate your numbers and all that, but like this is a person and they're providing treatment to a child within a family in their home, and it's a medical service and there's a reimbursement rate. And then, yes, if we pull off 15 to 17 percent on top of that, guess what? That's pretty darn good. You know, and again, I wouldn't call us exceptional businessmen. We're clinicians first, but I think we're we're trying to we talk a lot about compassion. I think there's compassion to to be had here in these numbers, you know, and in how you read these numbers. Everybody wants more money, I won't deny that, but at the expense of what? At the expense of quality of services, at the expense of integrity, at the expense of reputation? No, no way, it's not worth it.

SPEAKER_02 10:33

No, and I'll throw that out too on the flip side of the expense of good employment, you know. So it goes on the other side too. I mean, sometimes I'm talking to BCBAs who are their certificate is still hot off the press, and they're asking for 120, 150,000, you know, it salaries. And I'm like, what are you willing to give up?

SPEAKER_03 10:55

So it's yeah, our the last company that we that we ran together, we were very candid with people. Like, don't come to us to make the most money. We really prioritize work-life balance and and quality of care. And we were like, if you you can make more elsewhere. So, and we we had very low turnover. Every once in a while, people would be like, they would they would be with us for a while and be like, Well, I see I can make more elsewhere. And we're like, Go, go make more elsewhere. Like, that's that's totally fine.

SPEAKER_02 11:22

And then they'd come back, and then and then they come back, and this is what I always tell them too, Mike. Like, serious, seriously, I will tell them it's okay if you want to go for the one that makes more money. But here's my advice don't spend as if you're making that money, because it's very hard to go get the job you love again. Because if you get the bills that match that salary, you're gonna have a hard time or you're gonna have to work two jobs. So take the job if that's what you want to do, but understand that you might be coming back for the heart and the love of what you do and give yourself the space to do that.

SPEAKER_03 11:54

I'm still not seeing how, and and what you said, it was so uh enlightening when we did like the CPABA conference and things like that. When I found out how much some new BCBAs are getting paid, yeah. Well in the six figures, I'm like, what how are these places getting number one? How many billable hours are you doing? But I even look at the reimbursement rates we get, which I think are pretty industry average. I'm like, I don't know how a company could support you even with a lot of billable hours and make that that kind of money. Like, I don't know, I don't know how that's that's sustainable or if that's where fraud's coming from or stuff, but I know that then people hear about it and they're like, Well, I hear a BCBA makes a hundred plus thousand fresh off the press, and it's like, what? How is this how is this happening?

SPEAKER_02 12:41

Yeah, social media has not been our friend when it comes to that. You know, they're being told you're getting taken advantage of, you're being told that you're the profit mar margins are this, but to your point, what they're missing is behind the scenes for some of those is fraud, is the stress of it, and it they're not considering that. Some organizations are also building their model around making no profit off of the BCBA and only profit off of the RBTs and BTs. But that also puts a lot of strain then on their BTs and their RBTs and trying to figure out a different avenue to go. I mean, people are trying to figure it out, but I'm going to tell you that if you are in this because you love this industry and then not just the ABA industry, but the industry of ABA in autism care specifically, if you are passionate about that, don't be part of the problem. I'm not saying don't get what your worth is, but be realistic. Like, know, do the research yourself. Know what the reimbursement rate is, know what things you know go into it and be reasonable about it. And I also always will ask, I'll push back a little bit, especially to the new ones and say, what's your niche? Like, what's your special thing that you're bringing to the company that gives you the six figures? And they're like, Well, what do you mean? Exactly, right? Like, so you're going to get all this training invested in you, but you're asking as if you're an expert in specifically something. So, what is your expertise that this company is going to be paying you for? And they don't know. And so that's when I'm able to then talk them through it and say, listen, this is what you're seeing on social media. Let me just be real with you. This is kind of what you're going to get here is mentorship. You're going to become an expert from our mentorship that we're investing in you. But I can't invest in you if you're asking for this figure. Like eventually you can get to that, but you're just starting out.

SPEAKER_03 14:25

Yeah. Right. There's it's definitely a different like an entitlement in piece coming out. Cause yeah, we even had at our current company one of our uh our founding people, remember she was at the previous company, she left to make more money, and then what three, four months came right back, was like, yep. We were like, I just understand that there's trade-offs, nothing in life is free. It's not like you'll keep the same work-life balance. And you brought up an interesting point about the RBTs, and this is actually something that when I did some consulting when we started our current company about BCBA and RBT rates, that people were saying it's like you don't really make much off of BCBAs, you make much more off the RBTs, which is really interesting because we were always more BCBA direct as we are even currently. We don't really want a whole lot of hours, and we don't want it's not it's not like we're making a sandwich, right? And I'm not comparing RBTs to say line cooks, but in this analogy, like line cooks are pretty much doing the same thing over and over and over again. There's not a lot of deviation from that. And then you've got the chef, which would be more like the BCBA that makes all the the changes and things like that. But I would contend that RBT has a lot more variables that they have to deal with that are unexpected than like a generic line cook would have, right? So they need to be able to make a lot of these these alterations. And if all of your hours are done at that level of competency, then that I think that creates maybe a business model that might be problematic. Although that certainly is where the field, I don't know if it's headed or heading, or that's where it's been, but that that model of very limited BCBA oversight with a whole lot of RBT direct hours seems to be where the field resides a lot.

Prescribing Hours Without Guesswork

SPEAKER_05 16:07

Yeah, I would agree. It's one of our favorite questions on the phone these days, right? Uh when parents call and say, So we we don't have to do 30 hours a week with you guys for you guys to give us services. And it's like, how do we know your child needs 30 hours a week? In fact, we're gonna be very candid. We don't have any clients right now who are receiving 30 hours a week, and we're gonna be even more candid. If we did and you guys were agreeing to that, wow, our business model would be so much more profitable and easy to run. But yeah, that's not what we do here. So yeah, come on over. We we don't have a wait list, we can start you next week.

SPEAKER_03 16:41

I was actually uh speaking with a BCBA at outside maybe like two weeks ago, and she was like, Yeah, isn't that ridiculous? Our company only requires 15 hours of work. And I was like, I think you're kind of missing the point. That's half the problem.

SPEAKER_02 16:58

Yeah, but not the hours. That's funny. That's funny. But they are, but I think it's the difference between understanding what quality means, right? Like we're not in agreeance to what quality means, but yeah, to your point, and if we're gonna call ourselves healthcare and we're gonna say that we're prescribing, then we better prescribe. And part of prescribing is knowing I'm gonna use this as like your height, your weight, your whatever. Like there are certain things that you have to plug in, so to speak, to figure out what is the actual number that it needs to be, not just this blanket prescription, if you will. I mean, that's quality.

SPEAKER_05 17:33

Yep. Well, it's even better when we try to, you know, support it with empirical validation, right? Well, these studies said that the 15 hours a week is what makes the difference. And it's like, oh, great point. And then was Johnny part of that study where he also gets all these other services, and then mom and dad have this co-pay for their services and all these other factors that, yes, again, we would love it if every client we had signed up for 30 hours a week and we had a big beautiful center that was being supported by that. We we're not even talking about the insurance company and their their insurance companies, for example, and their uh viewpoint on that now. We some of you guys do 30 and then you guys do 15, and you know, and then we wonder why they don't trust us.

SPEAKER_03 18:16

Yeah, yeah. It's that's interesting. Like, imagine having cancer, and your doctor's like, sorry, we can only give you chemo if you do chemo three days a week. If you need if you only need two days a week of chemo, sorry, can't do it, can't do it. Go ahead, Holly.

SPEAKER_02 18:34

No, and we have to be able to also adjust for it too, right? So yeah.

Breaking Silos With Visibility

SPEAKER_03 18:38

So you've talked a little about the silos, and and and I know we've talked about that as well on this podcast. So, how do you think the clinical directors or the talent acquisition teams, any any of these organizations, whether it's big or small, can go away from moving organizing in silos or moving in silos to more of like a collaborative team-oriented approach?

SPEAKER_02 18:59

Yeah, I will say I don't think that you can team build your way out of a silo problem. So I don't think it's about getting together more often. I think that what you actually need is that visibility I spoke about. I think there needs to be feedback, so a time that is dedicated for you guys to talk about what's going on. I think there needs to be accountability and trust in your peers and shared goals and information allows for that. So I can kind of go into what I mean by each one of those, but overarching. Okay, cool. So, like with visibility, again, just talking about what is what is, for example, when somebody's doing interviewing, what are they evaluating in the candidate? And are they evaluating the things that lead to better outcomes in terms of employer behavior? And if not, then we need to collaborate and figure out what are the needs of what we need to evaluate. So looking at that visibly, and part of that is having an actual interview to be able to look at so that everybody knows what's being asked and getting on the same page. And on the same page, pardon me. Imagine that. I I love when I go into a company and they're like, Yeah, we do, we have, you know, we're evaluating evaluating everybody the same. And I'm like, cool. Like, can I see your interview? And they're like, well, but we'd more like chat it up and go off a vibe. I'm like, so the opposite, right? Like what we're saying. Vibe check. Um, vibe check. Yeah. I mean, listen, I I'll give you, I'll share a little bit about myself. I mentioned when I first started, I wanted to make sure that I was doing a good job and hiring better. And part of that was checking my own biases. And the only way I could do that was by building out this very structured interview for myself. And what I realized is that I was originally doing a lot of higher vibe vibes, like with you guys, like, for example, like I'd love to catch a beer with them, but what are they reliable? And so I had to catch my own patterns of what where my biases were so that I can improve that. And once I had that in check, I started to see my retention improving. And so vibe, vibe check doesn't really work. It's important that you listen to your gut, but then you verify whether your gut is accurate or not. And then feedback, you know, like I mentioned with the recruiting is making sure that we're hearing and not having our hires just go into a void. Most recruiters have no idea if the people that they're hiring, if they stay or not, right? And that's bananas to me is like, how can they get better at hiring if they don't even know if the people who are staying are there? I think also having realistic conversations with your clinical team on is this something I need to hire for or is it trainable? And so, for example, I got stuck where I could not hire for the center for the life of me. I'm like, why is like nobody I'm sending in? Is they're all getting kicked back. Like, why is that? And I realized it was with some specific BCBAs and they kind of worked the system, in my opinion. They didn't want to hire anybody who did not have at this time DTT on. Their resume or in their experience. And I was like, that is the most trainable skill. Like, are you kidding me? And so that that was their way of trying just to get an experienced person.

SPEAKER_00 22:10

Interesting.

SPEAKER_02 22:10

We aren't we don't have that luxury in this in this business. We have to be able to listen to what is trainable, right? And what is not. Your soft skills are more important for your BTs and how they look at things. So I'm going to share

Hiring For Soft Skills That Last

SPEAKER_02 22:24

another thing. I'm going off off topic here, but I'm going to share another thing. One of my favorite questions when I'm interviewing an RBT or a BT is tell me about the most challenging behavior that you've ever managed and walk me through that. And what I'm listening for is what do they consider to be the most challenging, right? How are they defining that? I'm listening to how what's the dignity that they're giving the client or how are they looking at the perspective taking and all of that? But I'm also listening to if they were my BT, could they describe the ABCs? They don't need to know it, but can they describe it to me or are they not able to identify it? So even if the person isn't an RBT, if they don't give me the full set of what it is, I'll ask them, well, what happened before the behavior? Like, can you can you think about that? And okay, cool. So that happened, then the behavior happened, and and then what happened afterwards? And if they can't identify that and they struggle with that, they're probably going to have a hard time communicating those things to a BCBA or even looking at it like that. So that's one of my favorite questions that I have. But I went off, I kind of went off.

SPEAKER_03 23:29

No, we're uh we're stealing that quest. How do you how do you word that exactly? Because I really like that idea. We're stealing that. Yeah.

SPEAKER_02 23:35

So and I actually I tried it out at the time. My son was working at Pertillo's, which is a hot dog joint. My daughter was a lifeguard. They were both in their their early teens. And I wanted to see, could they answer this question? Because if we're interviewing people who are not necessarily RVTs, and they could. So I just asked, like, what's the most challenging behavior that you've managed in a professional setting? Professional setting is key, or you'll get a lot of weird answers that you should not be listening to. So from an HR perspective, make sure you say professional setting, and then you listen, and then and then you ask up follow up question follow-up questions if they're not able to identify certain things, or if they say things like, Yeah, it was tantruming. What does the tantruming look like? Can you describe that? You know, things like that so that you can hear. And again, if they say their most challenging behavior, you want to be able to identify, okay, that we're gonna be dealing with behaviors that are a lot more extreme. Are they gonna be able to manage that? So then you might throw out, you know, have you ever witnessed this behavior? And just I start to identify, like, can they visualize the job even? I like that. Right.

SPEAKER_05 24:38

And that's that's super pragmatic, right? So that you somebody could ask that question and easily say, well, they're not well versed on contingencies, or they they don't know this yet. But but then back to your point is we can train that, we can define that in two minutes. The the fact that this person can uh immediately start identifying those pieces based on this conversation. I think I maybe we do something similar when we're hiring for uh in-home for younger demographics with like having people describe play situations or how they approach play. That's a skill that I think you you can know nothing about ABA, but if you're a good babysitter and you know how to play with a child, come on board. We we got you. Because you're already doing a million things that we want you to do. We're just gonna define them as you do that.

SPEAKER_03 25:22

You're already doing the DROs in the DRAs. You're doing all of it.

SPEAKER_05 25:25

You just don't know that this is what it's called in this fancy technology, right? So, yep, just keep doing that. We call that this, and then keep doing that. You see how that child did that again? Perfect. Just yep. So it's it's awesome. I like that with the soft skills. We can train that stuff, they don't have to come in with that stuff. You can, I like to say, right, we can train all those technologies, we can train somebody to pass the competency test. They still may not know a lick about how to run a session. So they have all this fancy terminology, but they don't know how to do the interaction. And it's it's both parts of it, it's both sides of it that really make a good professional in this field.

SPEAKER_01 25:58

Yeah, I agree. I agree. Yeah, go ahead.

Belonging Through Specific Reinforcement

SPEAKER_03 26:02

Okay, so what is one small, like intentional change you think a leader could make this week? So, like immediately to improve their team's sense of belonging.

SPEAKER_02 26:13

Oh, belonging. Again, it goes beyond just like the the the pizza parties and the things like that. It's it's not just one moment, it's more of making sure that the culture of continued systems of reinforcing. So make sure that you're looking at what are you reinforcing to make sure that they're seen. But I guess if I were to say one intentional action, if you were to do, I would, I would say, you know, even sending a specific message of, hey, listen, want to thank you for doing X, Y, Z specifically. Just want to point out this is what we want to see more of, right? Like, thank you. We we see what you're doing and we appreciate it. And you are part of the success on X team or you know, for us. And so I think, you know, what I would do. So what I would do is that not I think I would I would do something like that. And I would also just pick a system to look at again. Are we just talking about our values and culture, or are we actually able to identify a system to reinforce the values and the culture that we want and making sure that you start to look at that?

SPEAKER_03 27:18

I love that. I think it's fairly easy for us to do that now. And again, I'm looking at it from a managerial perspective. Yeah, for all I know, the RBTs are like, screw that, this this is false. I don't, I don't think so because they all seem like they're happy. But what since we're smaller, I think it's easier for us to do that. We check in regularly. Yeah. Seems seem would be a little bit more challenging, obviously, as it gets bigger, and then you get the the the the client silos, right? So that was something that happened with with the first company that I worked for and is still super pervasive in the field. Is you might have people that work on the same clients that don't even know each other because you've got the Monday, Wednesday, Friday staff, and the Tuesday, Thursday staff. They might have teams messaged each other or something like that, but never seen each other's face. Never seen each other. So they're they're really like the the team dynamic is almost a facade. Like you've used the term Road Warrior, yeah, Mike. Like that that also can create like a little bit of a silo as well.

SPEAKER_05 28:13

I'm gonna I'm very proud of something that we've been able to do. We'll see how we continue this when we scale. I think it's worked very effectively. We have site-based professionals that work on school sites, so they uh there's other people around them, but there may not be other professionals from our team in that setting, and I'm not always there to provide oversight. I go in, you know, maybe a couple two or three times a month or so. But all of those professionals every morning get a text message from me that just says, Have a great day. This is what I'm doing today, so I might be on the field, but you know where to find me if you need anything. And I I didn't know what it, you know. Yeah, I sometimes I get feedback and they're kind and they like it or whatever. But the other day, one of our employees actually sent me a hey, I just wanted to say hello, have a great day, and then she she wrote, Beat you to it. And I I felt really good about that. I felt like that was feedback for me that said, Hey, this is working, like this is cool. She she thinks this is cool, and let's keep doing it, you know. Yeah.

SPEAKER_02 29:15

I love that, and then that's somebody to watch too. Like a good employee that can give to give up again essentially to their supervisors is always somebody to watch because they're predicting what you need too. And so that's that's really cool.

SPEAKER_05 29:29

Yeah, no, it was. It was it's we'll see again. You know, this is where uh AI maybe comes in, but this is something that I would love to keep as we scale. And you know, we only have a handful of those professionals right now, but let's say we've got 15 or 20. I still want to be able to keep that practice somehow, whether it's me as their direct supervisor or somebody else that just, hey, I'm not gonna see you today, but I'm vis I'm here. I'm here. All you have to do is send me a text. Sure enough, throughout the day, sometimes too, they'll send a question. Hey, this and this happened. What do you think I should do? I'm able to fire back really quickly. And I, you know, again, without being there in person, it feels like a nice, effective way to you're not on your own. You work on this team. I know I'm not there, but I'm only a text or a phone call away.

SPEAKER_02 30:10

And you can pass that down too. I forgot what podcast I was listening to and what company did this, but they were saying a small tweak that they made was an important value for their company, was making people feel welcomed and seen. And so they started each meeting with what did you do this week specifically to make one person feel welcomed and seen. And so their behaviors, they wanted to start coming to the meeting, sharing. Like this is how I made somebody feel welcomed and seen. So I think there are ways to kind of send it out to other people as you as you grow. But I love what you're doing.

SPEAKER_03 30:45

Yeah, you do a really good job too of making I think we all do, but you're more direct-facing and making team bi-directional. Because I think in in my experience, a lot of times companies love to tout the team when things are going well, and it's like, oh, the team's bringing in all of the executives' money, like it's great. Like, look at this lovely team we have. But then when stuff doesn't work out as expected, then then it's no longer a team, then it's everybody protect themselves, right? So it's like team when it's good, not team when it's bad, kind of thing. So you keep that, you know, not like oh, it's you're able to give that energy to show that you're willing to put forth for the team, not just take from it.

SPEAKER_05 31:22

Well, I mean, I think it all goes back to everything that we've been talking about here. We we have that personnel right now, right? I mean, I'd like to think that again that we're gonna be able to maintain this as we scale, but the idea that we don't necessarily have anybody on staff who's had a lot of trouble, so it's it's I don't know, maybe a little easier to keep that momentum, right? And in in terms of not worrying about it, or if something does go wrong, I'm not looking at somebody like, oh, this happened again. It's like, no, this is a one-off. Or oh no, you're good. Wait, what happened? There's trouble. Uh I'll be right there. You know, let me show up on the site, let me come talk with you and let you know, hey, everything's cool. These things happen. I'm here to to help resolve it. And you're an adult, you you're gonna make a mistake, and if you make it again, we'll talk about it again. And if you make it a third time, we're gonna talk about it a third time. Outside of anything, you know, grossly irresponsible, we're gonna address the problem. And it's okay, it's cool. You got it, and yes, there's a screaming child now, there's an angry parent. It's okay. We're the this is part of this is why you're here. This is remember the interview? Yeah, this is why you're here, this is what you do.

SPEAKER_03 32:28

I think you've that speaks to that we've done a really good job of onboarding and interviewing. Because I would say even the training aspect isn't as robust as I would want it to be because of my availability, but we do a really good job of onboarding and then ongoing support. So I I feel like a lot of times almost is the flip side of a lot of the companies that I work for, maybe a really crappy job of onboarding, like interviewing and being selective there. The training in theory is robust, meaning that it's extensive, but then there's no support. So it's almost like we've kind of flipped the script where there's a lot of onboarding, a lot of support.

SPEAKER_05 33:07

I think people find a way to plug and play, and as long as that slot's being filled, the clients being seen, the revenues coming in, oh, okay, that's it. We're we're good. And and sure, that that is a basic description of what we have to do, and then there's everything else that Holly's been talking about, and everything else that we've you know disseminated or sort of dissected here is all these little they seem nuanced, but they're ever important. They really add value and compound to the idea of value and integrity and and the quality of the work that you're providing within this medical or educational service. It's huge. And it all compounds. I mean, it's it's every little tidbit needs to be there to hit that point of excellence. And and then when it misses, it it can become very obvious, uncomfortably obvious.

SPEAKER_02 33:50

Yeah, and can I point out just what you guys are doing? That's so great. And I think to your point, like you said, like it doesn't have to be perfect, right? You can still have areas that you want to improve on. But I think that I want to point out really uh what I think is really important for listeners to walk away that you guys get right, is you can't withdraw from an empty bank, right? And in what you guys are doing is you're investing in onboarding and interviewing and you're investing in the person so that when you do falter a little bit, you can withdraw from the bank that you've already invested in. You're already giving, giving, giving, giving. And so you have a little bit more grace with your employees because they trust you because you've already given them so much and that they know that the training will come or that it will be, you know, these one-offs will be managed well. And so there's not as much fear that you're just gonna kind of go beyond this withdrawal, if you will. And so I think that you guys have it sounds like you guys have done that so well, and I wanted to just reinforce that and and highlight it.

SPEAKER_05 34:47

Thank you. Well, thank you.

SPEAKER_03 34:48

That's a great analogy too. I I love that.

SPEAKER_05 34:51

And I I'm gonna keep thinking about that. And I I mean, we were talking about it before we hopped on, but like if if we look at our call out rate, I don't think we've ever calculated it strictly, but I'm gonna say it's super low. I mean, if we look at our school employees, I I could compare to, I mean, it's every it's five days a week across many, many months, and I have to say that none of them have more than five days at this point, maybe even less than that. So you think about an entire school year. So again, we're getting something right. How else do we how else do we uh augment that? How do we how do we make that louder?

SPEAKER_03 35:24

It's it's that human piece, right? And it kind of brings me to my next

The Human Element Beyond Protocols

SPEAKER_03 35:28

question. How so you say you kind of believe the human the element the human element is the most overlooked variable in clinical success. So what are your thoughts on that, Holly?

SPEAKER_02 35:38

Okay, so stay with me here, but I think that the I think that the human element is overlooked because the field has gotten really good at running protocols and really bad at remembering what the protocol is for, which is a person. And so I think ABA is a science, which in a science, you know, there are hypotheses and in there testing and there's flexibility. And somewhere along the way, it became this this is the way we are doing it. We are plugging in programs, and that is it. And we stop thinking about it for a while. We stop looking at it at the human that is not only receiving the care, but also giving the care and what it looks like for them. And so I think there needs to be more flexibility in allowing there to be a human-to-human interaction when you're looking at something like ABA and being applied in this way. And so it reminds me of uh can I share off? I'm gonna share this. It's a and hopefully I'll make the connection to how it relates. But I was in RBT a long time ago and I was working with a client who perseverated a lot. And he he, in this situation, we came back from getting in the mail, and the brother had locked the door, and he went through this cycle of opening the door, closing the door, opening the door, closing the door, like over and over and over again in a very aggressive, obsessive manner. And mom was with me and she it it kind of freaked her out. She had never seen him behave in that way either, and it became a little unsafe. And so I said, you know, go ahead and go in. I'm gonna stick with him. And and I was able to observe him and kind of, I don't know if it's because I'm autistic or or not, but I was able to get into his mind of like he is stuck, and so he can't on stick himself. And how do we do that? Well, we do that usually with an inner dialogue that helps us get to the point we need to get to. But maybe he doesn't have an inner dialogue. I don't know. So I started sharing my own inner dialogue and I was just like, I went to get the mail and I came back and the door was locked, and that doesn't happen. And what if it happens again? And and now I want to like go back and I want to do that. And I kept repeating it on over and over and over again until he looked at me and and I said, and that's okay, and I can go inside and I can still think about this from the safety of my couch. And then I said, Can we do that? And we walked in and we sat down and and we sat on the couch, and I continue to do it over and over again until he started to say it himself. And I'll be honest with you, it's like it's gonna make me cry because it is probably my most the the biggest impact that I've made in my long career is that he is now in high school. He still has an outer dialogue that he does as his inner dialogue to process through things so he doesn't get stuck like that. It unlocked something, and it was really cool. But the point of that is I was able to do that because I worked with a BCBA that was like, Holly, you have this like natural ability. If these if situations come up, I want you to have the freedom to try things and then let me know what they are, and we'll talk it out and from a behavioral lens and we'll work it into a program if it makes sense. And so I felt comfortable. I didn't feel like I needed to be like, wait, hold on a second. I what is the ABCs? And uh what do I need it? Is there a bit for this?

SPEAKER_00 38:56

Can I transcribe it? Where's the bip? We gotta use the bit for this. Yeah, we're gonna be able to do that.

SPEAKER_05 39:01

First, second, third, these are the steps, right? Yeah. Here, hold on, buddy. You just keep opening and closing the door. I gotta check the paperwork.

SPEAKER_03 39:09

Where does that relate to the vinyland? What which question on the vinyland does that go back to?

SPEAKER_02 39:13

I I think those are all shirts, and then also one I like to kid about about with one of my VCBA friends. We always say, like, Cooper didn't teach me that shit. Like it's just not, it's just not in there. And so it's uh, yeah. So I think that those are the human parts, right? It's allowing for RBTs to know, like, we we trust you, you're gonna be in some of these situations and we're gonna have a conversation around it. There are gonna be moments that you have to live in the moment. Um, and here's what I can do and this and that, and I trust you, you got it. Come back to me and let's talk about it after it happens.

SPEAKER_05 39:47

That that's I I love that story. Just in terms of again, the everything the way you just audio went out.

SPEAKER_02 39:55

I think is it on my end? I can't hear you.

SPEAKER_05 39:57

Um we can hear you. Hold on here. Let's see.

SPEAKER_02 39:59

Oh, it came back. Okay, okay, sorry.

SPEAKER_05 40:01

Yeah, we did we did glitch for a little bit. I was just saying, I love that whole story you just shared in terms of the the trust element, the idea that okay, you're an RBT, you're a person. I just saw you do something, and uh it's off script, but I think it could be effective. Let's explore it. And and that means that I'm confident enough that I'm gonna come see you enough to be able to check in on this and help you shape it and help you see. And and these are those untrainables. That's a very salient human element. This is like, ah, wow, you've got this natural intuitive characteristic that we can use here. Let's do it. I think it applies to parent training. Yep. So so often we come in and we're trying to teach these parents how to parent. And it's like, you know, as I like to say, hey, your child eight for the most part, they're semi-clean, they're doing okay, they got a little uh a few bumps and bruises, they should given their age. You know how to parent. I'm not here to teach you how to do that. I'm here to teach you how to address those things that seem to be concerning to you and the rest of us based on our diagnostics. And that's a I mean, again, just that whole mindset and approach. Now we're moving away from that traditional authoritarian. I'm here to fix this thing that's off of the trajectory, which in and of itself isn't detrimental notion, but if it's the singular focus, then I think it's the source of a lot of our problems.

SPEAKER_02 41:20

Yeah. And I think it becomes that way, and I think we can, and I can confidently say that based on what I hear from RBTs when I'm doing interviews, and then also, you know, being able to see that I think even RBTs and maybe even especially newer ones kind of get stuck in this. I need I don't know how to kind of look at it from different angles. And so I'm gonna almost even sometimes copy the assessment and then make it a program, even though it's not meant for that, because they're just so focused on that is their outcome that they need to do is to come up with these programs that they forget the process of that.

unknown 41:58

Yeah.

SPEAKER_03 41:59

I knew that was gonna be your soapbox. Anything else on uh we've hugged the soapboxes here. Anything else on that?

SPEAKER_05 42:05

No, no, no. We're good. But I do want to say is when time flies when you're having fun. So we're we're we're getting close to the end

Burnout And Real Career Pivots

SPEAKER_05 42:12

here. I'm never sure what the end is. I'm just based on the time, we want to get you back to your uh your nice, windy, uh brisk day uh in your neck of the woods.

SPEAKER_03 42:20

So so another question that we that we had here is for BCBAs feeling burnt out, how can they leverage their ABA experience to pivot into maybe a different field? I know that Mike and I were very burnt out. If we didn't start our own company, speak for myself, I wouldn't probably be in this this field, at least the ABA autism, I was I was done. So I feel like there's a lot of BCBAs kind of in those those shoes where they're just burnt out. So what are what are your thoughts on pivoting to even outside of the the autism you know direct field?

SPEAKER_05 42:53

Just just briefly, you literally were done. You you left. I did. And I and I said, and I was looking for yeah, all sorts of other analysis jobs. I mean, outside of behavior, yeah, for sure. I we were done. It was it was over, yeah.

SPEAKER_02 43:06

Yeah. So I would first say look at the why again behind the burnout. So just hearing you guys, and I could be wrong because we've just this first time we're meeting, but even hearing some of your stories, it sounds like you had more of a misalignment with your values in those positions with your companies. It sounds like you your skills were not being used right. It sounds like your like your values again were not aligned, and the expectations of what your work would be like and what you were able to have maybe control over had changed. And so I would say that most often that is the case when we're talking about burnout, is that there's some sort of misalignment or there's there's some sort of miscommunication that is happening. And so I would first say, you know, write it out and figure out what that is, and then try to go and stay within the relationship if you can and go to the people and say, here. Maybe I'm overworking and you're not actually asking me to do this stuff, or maybe I think that this is your North Star because of X, Y, and Z, but is that true or not? And then, and then if it's not the right location or the right environment, maybe figuring out what the right environment is still in the same industry. But if you truly know you're done with the industry and your heart's not in the industry any longer, and you have another passion that has erupted that you think you can use behavioral science in, such as marketing or something where it's you are still looking at groups of behavior that you're going to manage and manipulate, or whether it's operations, we're going to look at an organization's behavior that can transfer there too. I would say start to connect with individuals who are already doing that. So, like if it's marketing Matt Harrington, if it's, you know, you think that you have something that you want to sell in certain terms of a training and you have an expertise, you know, reaching out to Melanie Page and maybe discovering like how can I do that in reality? Those would be my recommendations. And sometimes, though, I do have to be honest, sometimes I get individuals who come to me with that, but they don't really know what they want to do. And you that's really important because you also have to assess, do you have the skill set to go into the other things? And if not, what do you need to do to add on to your experience to get that skill set to make the crosswalk? So it's not as easy as just crosswalking because you're good at behavior management or data analysis. You have to really make the connection to the people that you're going to try to get employment from. And so you better know that first and be able to identify your own gaps to be able to fill that as well.

SPEAKER_03 45:43

I like that. Just because you think you're good at what you're currently doing doesn't mean you'll be good at the next field. You got to bring more value to that.

SPEAKER_05 45:52

So we we might be doing

Late Diagnosis And Family Realities

SPEAKER_05 45:54

this backwards. I'm gonna go off script. I realized that we didn't prepare or inquire at all about your own personal diagnostic journey and and that with your kids. Is that something you want to talk about for a little bit before we end, or would you rather not?

SPEAKER_02 46:09

Sure.

SPEAKER_05 46:10

Okay.

SPEAKER_02 46:10

No, I'm happy to I'm happy to talk about it.

SPEAKER_05 46:12

You alluded to it, so I figured you would, but I, you know, we could probably do a whole other hour on it. I don't want to cut you short, but I I did want to give you a a chance to do that because it, I mean, that's remarkable. So I you have you have insider knowledge that many of us don't have in many ways.

SPEAKER_02 46:26

So uh I'll cut it short. I actually I didn't talk till I was three. I didn't talk well well until I'm still struggling. I didn't talk well until I was about seven, where other people outside of my family could understand. So I definitely would have been my own early intervention client. I went to Easter Seals for speech, but they didn't really have ABA at the time. And and so I really had to overcome a lot. And then I actually, when I went into the training position, I was just struggling with the next level of employment. So in each level of employment that you move up for an autistic and probably for others, is it's a different language you have to learn in communication. Um, it's your it shifts on how you communicate with your peers and how you communicate with your seniors. It just changes. And so I was struggling with that. And so I actually went seeking a diagnosis of OCD or I don't I didn't know what I was looking for. Um, and they came back and they're like, you know, you might be surprised, but you have autism. Would you like some books on it? And I was like, oh, that makes so much sense, right? And and so I I said, you know, sure, you can recommend some books, but I'm pretty sure I I I got it down. I've been in in this industry already for so long. But I but I understood, and it was a relief to me to get that diagnosis because it it helped explain what I was doing. So she's like, it's not that you have OCD, it's you controlling your environment. So you actually don't have OCD, you're just extremely good at identifying barriers and patterns, and you want to control the environment by putting systems in place to control what's happening. And so it was like, uh. And then with my son, my son went back and forth with misdiagnosis for most of his life. You know, we got we had Tourette's at one point, we had like a whole bunch of different different diagnoses. And so it took a long time to get the correct diagnoses, but he was lucky he had me. So for the most part, everything that he did, I just always from the beginning had this natural ability to to provide him with ABA, but he never got services because at the time as a single parent, I was on, I was on Medicaid and I could not get any providers to help him. And so I just did it myself. And then my daughter had a lot of physics, she's got spinobifida cultus. So I was focused more on her physical stuff and and we'll you know, share that I under I underestimated the amount of social challenges or different challenges that were happening. And they're adult, and I want to respect their privacy on on some of the things, but it took a long time to get her an accurate diagnosis. It didn't come until this year, and she is 21. And so it took a long time and the right people to diagnose it because they just kept saying, is the like most extreme anxiety we've ever seen. And I'm like, do they understand autism, these people? And they they were open about the fact that autism is not their specialty. So make sure if you're gonna pay, pay once, not twice, get an expert in autism. Because when we took her to the right people, they were able to see it whereas others couldn't, including myself.

SPEAKER_05 49:35

Wow. Wow, thank you. Thank you for sharing that here

ABA CARES Invite And Final Rules

SPEAKER_05 49:39

in closing. Where you know, shamelessly self-promote here. Where do you want people to find you if you want them to find you, if you want to list out your websites or your organizations just as we close here, so that right at the end people know where to where to find Holly Beth Clauser.

SPEAKER_02 49:54

Yeah, so it's funny. I was thinking you're shamelessly self-promoting, and I was like, Oh, support you, but you've left it on the outer. Yeah, let's let's do that. I can tell you right now from what I'm hearing. Great job. And so I would encourage people just to start to become part of the community. I know this is gonna be coming out ahead of time. I encourage people if you want to be surrounded by a lot of individuals who are looking to support the quality of not only workforce but outcomes as well. Go to ABA Care's. It's gonna be in Boston this year. We're on Behavior Live. You can find us there. And I just think that you're gonna find a community. I like to say that there's a lot of people there who are experts that normally charge $250 an hour. You're gonna get so much value in the return on your investment just coming out. I know it's not inexpensive, but I work really hard to curate um an environment that is going to create such lasting, repeatable improvements in your network and in your company. And so I encourage you to do that. And then I'm always on LinkedIn. It's kind of my place to be. So you will find me on LinkedIn every day.

SPEAKER_03 51:01

So with ABA Care is what are there a couple of highlights or super memorable moments you want to share with the audience? Anything you know to leave them with on the ABA care side of things?

SPEAKER_02 51:12

I mean, I'll just say that I hear the feedback that I get is how different of an experience it is. I was just actually editing a podcast that we're doing. Again, I can't cook the same thing twice. So this year I decided why not throw a podcast and we're gonna interview people ahead of time so people will get to be able to listen to those podcasts before they even come to the event. So there's value for them right away. They know who they want to spend time with, all of that. Didn't anticipate the amount of time it takes to edit, especially when I'm super detailed at editing. But I was editing a recent one, and Melanie Page and Amanda Kelly were talking, and they have both been to my past ones, and they were just talking about what a different conference it is because of how it sets everybody up and really helps curate really important conversations and give people a voice and a seat at the table. And so I'm paraphrased paraphrasing, but you know, I I'll I'll share that's what other people are saying and and what what I hope to deliver.

SPEAKER_05 52:12

That's exciting feedback. Awesome, awesome. That's awesome.

SPEAKER_02 52:15

Thank you.

SPEAKER_03 52:16

If there's any way that we can help out without, let us know. Anytime. Yeah.

SPEAKER_02 52:19

Well, come on by. Okay. If you guys want to come, I'll give you a discount ticket. DM me after this. Let's talk. But I would love for you guys to come for sure.

SPEAKER_05 52:27

All right, all right. When is it when is uh when is it uh this year?

SPEAKER_02 52:30

Oh yeah. So it's August 4th through the 7th in Boston on the seaport. Super pretty area, and there's gonna be a lot of uh fun activities as well.

SPEAKER_05 52:40

That sounds fantastic, Molly. It's been an absolute pleasure to talk with you for nearly two hours. We cannot thank you enough for taking the time to sit with us and and share of your content expertise. I do a little closing here with some closing remarks to set up our tagline. So what I've got uh today is uh firstly go to ABA CARES in August, tell the truth, put first the human element, take a night to sleep on it, and always analyze responsibly. Cheers, Holly. Thank you so much for your time.

SPEAKER_01 53:10

Cheers, guys, thank you. Always analyze responsibly.

SPEAKER_04 53:15

ABA on chat is recorded live and unfiltered. We're done for today. You don't have to go home, but you can't stay here. See you next time.