Behavioral healthcare jobs, particularly those in behavior analysis, are abundant as the need for Board Certified Behavior Analysts® is disproportionately higher than the amount of BCBA®s currently practicing (Yingling M. E., Ruther M. H., Dubuque E. M., 2022), but job searching is not as simple as choosing the highest paying offer.
Turnover is an inevitable concern across all career fields but poses a unique issue for human services. When working in human services, especially with a vulnerable population who relies on our commitment to their medically necessary services, it is important to choose the right company to avoid disruptions in services that will unfortunately occur when switching jobs. ABA companies are frequently under intense scrutiny for various issues, which contradict the values that most clinicians hold in this helping profession.
Finding a reputable company that prioritizes their clients’ progress and wellbeing over profits can be difficult. Whether you’re still in grad school seeking a practicum site, a newly minted Analyst exploring your options, or more seasoned Analyst looking for a new company better suited for your career goals, there are many factors to consider when deciding between different companies. The following items are meant to serve as a guide when thinking of questions to ask during interviews or when comparing multiple job offers.
Job Security
If it sounds too good to be true, it probably is. Empty promises are not uncommon. When trying to determine if a company is here to stay, some things to consider, which often go hand in hand, are who owns the company, how long the business has been operating, and what their growth has looked like. Many ABA companies are backed by private equity companies, which can negatively impact the quality of care when the pressure to maximize profits outweighs the ability to focus on clinical integrity and individualized care. Companies privately owned by a BCBA® tend to offer deliver higher quality care as the decision makers are trained in behavior analysis and are bound by an ethics code. Additionally, while growth can be positive as it allows more families to access services, controlled growth is important for the quality and longevity of a company. Rapid expansion may be a sign that a company’s practices are not sustainable, risking job security and client services.
Populations Served
Applied Behavior Analysis has many different applications. When researching various companies, consider if their populations served align with your interests and area of expertise. Companies with a less broad range of ages, diagnoses, behaviors, etc. may mean that they are more experienced and competent in their services because they have a more specialized focus. During the interview process, consider asking about how the company determines if their services are a good fit for a client. It may be a red flag if a company is lenient with their onboarding process as it could be a sign that appropriate resources and expertise are not adequately available. Funding sources accepted can also be an important consideration as clinicians tend to encounter issues that pose as barriers to providing effective services. Companies who accept Medicaid, and other similar funding sources, may place pressure on quantity of hours and clients over quality of care.
Settings
The setting in which services are conducted is equally as important to consider as the population in which services are provided. There is no one “right” setting as different individuals have different needs that are better served in different locations and clinicians have different preferences for work culture. For those who prefer to work in an environment with opportunities for support from and engagement with colleagues and/or prefer to avoid traveling due to time constraints and gas prices, a clinic-based setting is likely preferable to home or community-based settings. Clinic and home-based settings may be preferable over school-based settings for clinicians who value caregiver involvement. If you are open to a role requiring travel, some considerations include compensation for travel (e.g., mileage reimbursement, drive time) and amount of traveling. Don’t only consider the mileage involved with travel, but more importantly the amount of time the commutes would involve when factoring in traffic, as well as how cases are distributed, which could affect how efficient your day is. Time spent traveling between locations is time not working.
Total Compensation
Of course, compensation is a big factor to consider when choosing a job, but it is important to fully understand the total compensation package, benefits available, and employment classification rather than just looking at the hourly rate to get the full picture.
Independent Contractors (individuals paid via a 1099) are often offered a higher hourly rate but typically do not get paid for non-billable hours or when cancellations occur, rarely receive benefits, and must handle taxes and business expenses themselves. Those in the field who have been independent contractors likely have experienced the frustration of arriving to a client’s house after spending an hour in traffic, just to be greeted by silence because their client isn’t home and forgot to inform them of the cancellation. To add insult to injury, that time is very likely all unpaid. Because contractors are responsible for their own business expenses, that typically means they must purchase their own materials and reinforcers to use with their clients, as well as transport all the materials between locations, effectively turning their car into a moving van.
Conversely, W2 employees are on payroll with taxes handled by the company and are typically eligible for benefits. Salaried employees, opposed to hourly staff, receive consistent pay regardless of cancellations and billable hours. Offered benefits vary across companies, so it is important to inquire about specific benefits that align with your lifestyle and needs. Popular benefits include paid time off (PTO), health insurance (medical, dental, vision), short-term disability, retirement benefits (some employers will match contributions), and continuing education opportunities. Companies who invest in their employees may offer CEU stipends or other paid training opportunities for professional growth.
Contractors and employees may both be eligible for performance bonuses. It is important to ask if bonuses are offered, and if so, what the requirements are to earn the bonuses, if those requirements are feasible, and what the consequences are if the criteria are not met.
Fellowships
Some companies may offer fellowships or tuition assistance, which can be great opportunities for graduate students. For example, BCOTB partners with several universities such as University of South Florida, Auburn University, and Ball State University to offer one and two-year fellowships.
Staff Retention and Promotion
As previously mentioned, turnover is rampant within the field of ABA and can lead to burnout amongst the other staff at a company. When interviewing for a BCBA® position, consider asking about the turnover rate of both BCBA®s and RBT®s and ways the company promotes staff retention. It may also be helpful to inquire about upward mobility and opportunities for future growth.
Caseloads and Billable Expectations
Analysts are primarily providing services which are billed to private funders when working in ABA therapy, specifically for autism. Nearly all companies have billable hour requirements but can vary widely. Likewise, the caseloads will vary by company and there is an ethical obligation to provide effective services. When choosing a company, consider if the requirement will allow you enough time to adequately serve all of the clients on your prospective caseload, still completing necessary non-billable tasks, such as collaborating with other therapy providers to coordinate care. It is important to consider what the consequences are for not meeting the billable expectations and if there are any penalties.
Staff Training and Support
Whether you are a newly minted or seasoned Analyst, everyone benefits from feedback and support, especially from others with more diverse backgrounds or experience. New graduates often find themselves feeling “thrown into the fire” and unprepared for handling all that comes with a full caseload with little to no guidance or support. Training and feedback should not end once you pass the big exam. Ask questions to get an idea of the amount and quality of support you will receive from your supervisor and other colleagues.
Operations
Analysts often wear many hats to make sure their clients are receiving services. A lot happens behind the scenes of direct therapy to make it happen. While BCBA®s are responsible for developing and updating treatment plans for therapy hours to be authorized, it is incredibly helpful to have operations team members who are available to assist with things such as submitting treatment plans to funders, following up on insurance authorizations and issues, scheduling, securing coverage, etc. Not all companies budget for this overhead expense, so it is worth asking about to get an idea of your responsibilities beyond the typical BCBA® tasks.
Clinical Values
There are many different styles of providing ABA therapy and not all align with everyone’s values. As the field progresses, a greater emphasis is placed on assent-based practices and trauma informed care as opposed to more traditional methods that rely on extinction and rote responding. Ask questions to determine the level of autonomy clinicians have in deciding and using various assessment tools, programming, interventions, etc. Ask if and how quality is assessed and clinical integrity is maintained.
Red Flags
To summarize some of the items detailed above, here is a quick list of some things that could potentially be red flags when looking into various ABA companies for a BCBA® position:
- New company and/or not much information available when searching online
- Private equity backed
- Rapid growth
- Questionable billing practices (Billing should always be transparent and accurate to be ethical.)
- Standardized prescribing of hours (Hours recommended should be based on the learner’s individual needs rather than the highest possible or based on a company’s standard expectation.)
- Wide range of populations and/or services provided (Companies that provide a laundry list of different therapies and services to a wide variety of populations may be casting their net too wide rather homing in on an area of expertise.)
- Fully remote (Unless serving an area where in-person services are not feasible, relying on only remote supervision can be associated with lower quality outcomes for clients and staff.)
- Advertised sign on bonus (While tempting, this can mean that turnover is high and the company is motivated to hire candidates quickly without necessarily evaluating appropriate fit.)
Reference
Yingling ME, Ruther MH, Dubuque EM. Trends in Geographic Access to Board Certified Behavior Analysts Among Children with Autism Spectrum Disorder, 2018-2021. J Autism Dev Disord. 2022 Dec;52(12):5483-5490. doi: 10.1007/s10803-021-05402-0. Epub 2022 Jan 5. PMID: 34985719; PMCID: PMC8727480.
