Harla B. Frank, M.S., BCBA
bSci21 Contributing Writer
What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others that will determine the significance of the life we lead. – Nelson Mandela
Reflecting on the words of Nelson Mandela, I found myself pondering the reasons students give for majoring in psychology – any field of psychology. Almost without exception, students report that they want to give back, to share some bits of wisdom that will make others’ lives better. Many have shared that they have experienced addictions and are now “clean” and that they feel they have something, from their own experiences, that can help others who are walking the path they have tread. Many students majoring in Applied Behavior Analysis (ABA) share stories of how ABA has improved the lives of their children, loved ones, or friends and express a desire to be able to help others in the ways that they, or loved ones, have been helped. I can definitely state that of the many hundreds of students I have taught, almost all express the desire to give back.
In attempting to find research articles illustrating reasons students give for majoring in ABA, I found that there was very little information out there. However, the Association of Professional Behavior Analysts’ (APBA) 2014 U.S. Professional Employment Survey shows that the vast majority of behavior analysts (BCaBAs and BCBAs) were providing one-on-one ABA therapy to clients diagnosed with Autism Spectrum Disorder (ASD) (60.9% of respondents), with the next highest service categories being intellectual/developmental disabilities and education (13.1% and 12.5%, respectively) (p.7). The results of the APBA survey seem to provide support for the reasons students have given me for majoring in ABA. Many behavior analysts currently working in the field can probably share similar stories of why they chose ABA as undergraduate or graduate majors.
Beyond the noble reasons for entering the field of ABA is reality. Dan Sundberg, Behavioral Science in the 21st Century contributing writer, in his April 25, 2016, article, “The High Cost of Stress in the ABA Workplace,” discusses the many pressures behavior analysts face in the real world and the “burnout” that can result (para. 13). I decided to conduct an informal review of the job responsibilities of Board Certified Behavior Analysts (BCBAs) and Board Certified Assistant Behavior Analysts (BCaBAs). Examining the job board on the Association for Behavior Analysis International (ABAI) website, I found the top responsibilities listed by employers for BCBAs and BCaBAs. The most frequently listed job responsibilities of over 30 companies are as follows:
|BCBA Job Responsibilities|
|1. Gather intake information|
|2. Collaborate with parents, teachers, and other stakeholders for comprehensive approach to care.|
|3. Collaborate with service providers for each case.|
|4. Conduct Functional Behavior Assessments (FBA); Functional Analyses (FAs), and VB-MAPP or ABLLS-R – as needed.|
|5. Design function-based, behavior intervention plans (BIP) according to the analysis of the FBA data.|
|6. Implement BIPs one-on-one.|
|7. Develop data collection systems. Record data and graph for visual analyses.|
|8. Update BIP goals within a week of mastery of current goals and maintain ongoing analysis of progress in order to make timely changes to the BIP.|
|9. Train parents, teachers, RBTs, BCaBAs, and other stakeholders in the proper implementation of each BIP and in data recording – and provide the rationale for each goal and the methodology for training.|
|10. Train staff, parents, and others in crisis management for the purpose of de-escalation.|
|11. Meet billable hour expectation (usually 20 hours/per week)|
|12. Assign, train, and oversee RBTs and BCaBAs, as well as BCaBA and BCBA candidates, in each case.|
|13. Complete reports regarding client progress.|
|14. Conduct weekly staff training and provide feedback on staff performance (individually and in writing) and provide updates on client progress.|
|15. Complete progress reports as required by insurance companies.|
|16. Maintain billing records.|
|17. Participate in weekly/bi-weekly clinical meetings.|
|18. Complete procedural and treatment integrity checks on RBTs, BCaBAs, and BCaBA and BCBA candidates. Results of assessment will be presented to the staff member in person and a written copy of the assessment will be given to the supervisee and a copy will be kept in supervision records.|
|19. Create formal plan for termination of services/discharge.|
The job responsibilities are many! While behavior analysts have been well trained in each of these responsibilities, trying to squeeze every requirement into the 40-hour work week can be overwhelming. Let’s take a look at an average week in the life of the behavior analyst.
Typically, the behavior analyst must meet the company’s billable hour expectation, which is usually around 20-hours per week. That does not sound too intimidating, does it? In a 40-hour week, one can certainly devote 20-hours to one-on-one therapy. But, figuring this time does not include the travel to the client’s home or school, where most of the therapy takes place. So, the behavior analyst rises at dawn and, with coffee in hand, races to the office early enough to check in with coworkers and supervisors and still make it to the first client of the day. Why not just go straight from home to the first client appointment, you may ask. Well, if you go straight to the client’s home from your home, you are not reimbursed for the travel expense. But, travel from client-to-client and from office-to-client is reimbursed.
So, the week has begun, but the behavior analyst has a new client and must schedule time to conduct the Functional Behavior Assessment (FBA); that’s going to be approximately 10-hours over the course of two weeks. That will definitely impact the weekly schedule. Let’s say the behavior analyst met the billable hours for the week and those 20-hours required one hour of travel time for every 2-hours of therapy . . . hmm. The analyst now has 30-hours invested in making billable hours for the week. Well, that’s not so bad. There are still 10-hours in the 40-hour work week. But, oh my, there is a clinical meeting and the schedule has to be changed to accommodate it – that means working late in the evening to make up for the 2-hour appointment that had to be rescheduled. Oh yes, the FBA initial interviews and record reviews for the new client have to be done in the same week – and, it would be good to squeeze in a direct observation at the new client’s school. Now we are up to 37-hours. Well, the analyst is still under 40-hours you say. True. But, the behavior analyst has not had time to observe the Registered Behavior Technicians; BCaBAs, or the BCaBA and BCBA candidates that she is supervising. Maybe some of the supervision can be done next week, after all, the analyst has to make training materials for the clients, graph all the collected data from those 20-hours of one-on-one therapy, and submit re-authorization requests to the insurance companies of several clients. And, yes, those Continuing Education Units (CEUs) . . . . So, why do we put ourselves through this reality? We stay in it because we are still operating out of a desire to make a difference! And, we see evidence of that difference in the most delightful ways!
This evidence of making a difference is seen in the teenager who is so excited at being able to make his first purchase all by himself that, in the middle of the transaction, he quickly gets his cell phone out and calls his mom: “Mom, guess what? I just bought a video game!” This evidence is displayed in the child with whom you have worked for over a year who just tested at grade level in kindergarten, and you overhear his mom telling the principal, “This doesn’t just happen!” This evidence is made apparent in the little girl who, at age 6, is no longer afraid to go to the potty. This evidence is in the child with whom you have been working to teach social skills who is now running to play with the other kids – without your involvement in the game! Finally, this evidence is in the little boy who has learned to love spelling because you made him the teacher and you the student, when he looks up at you and says, “Maybe I’ll marry you when I grow up.” Precious moments – priceless. These are the reasons we stay!
Unless someone like you, cares a whole awful lot, nothing is going to get better. It’s not. Dr. Seuss
How do you make a difference in your daily work as a behavior analyst? Let us know in the comments below, and be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!
Harla Frank, M.S., BCBA earned her Master’s degree in Psychology, with an emphasis in Applied Behavior Analysis, from Florida State University. Since receiving her certification as a Board Certified Behavior Analyst (BCBA) in 2007, she has worked primarily with children and young adults on the Autism Spectrum, but has also worked with adults with a variety of diagnoses and needs. She has served as an expert witness for Applied Behavior Analysis (ABA) in the Colorado court system and has had the privilege of providing “ABA approaches” training to foster care staff and families.
Since 2010, Harla has taught ABA course sequences, as well as general psychology courses, for Kaplan University. Currently, she also contracts with a pediatric home healthcare company in Denver to provide ABA therapy to children with a variety of diagnoses. You can contact her at [email protected].
Thank you for this article! I see this in action regularly within our field and I personally experience the juggle as well. This will be especially helpful in explaining the nature of the job to administrators.
Thank you so much for your kind comment, CF! I think sharing our experiences “in the field” will help our new colleagues develop reasonable expectations.
The juggle is real. Thank you for sharing this astute breakdown of the primary essential tasks of a BCBA providing in-home and in-school consultation services. Do you think that a center based delivery model for ABA services would increase the BCBA’s ability to regularly meet their essential services in 40 hours each week?
Thank you so much for your kind words about the article! Yes, I do think clinic-based treatment would mitigate the “race” we engage in to get in all the billable hours and take care of our other responsibilities. I’d love to see a combination of “natural” setting and clinic-based delivery so we could still effectively promote generalization of skills. I believe that if companies (or even private practices) were to go to more clinic-based services, there would have to be more afternoon and evening hours – which BCBAs are doing anyway. 🙂 I apologize for my delay. Thank you for commenting on my article! Harla
How do you view agencies that have expectation in the 30-35 billable hours per week range? Many of the for profit agencies I have spoken with target 32 billable hours a week. Factoring in a 1:2 hour ratio for drive to billable service hour that would put a 48 hour commitment on the BCBA weekly just to achieve billable hour requirement. Definitely a challenge.
I believe that when a company places extreme expectations on its employees, it will ultimately lose its workforce – irregardless of the type of business. In ABA, we know that companies feel a need to increase their billable hours in order to stay viable; but, my observation of companies that do this is that the punishment can create an environment in which “sneaky” behavior occurs – or unethical behavior. For example, employees may compromise quality for hours or find ways to bill for services not rendered. This opens the behavior analysts and the company to criminal as well as ethical charges. To make a long story short – and to step down from my soapbox, I do not believe that companies should place unrealistic expectations on its employees. Thank you for the opportunity to address something I’m passionate about – on many levels! Harla
I am a special education teacher in the public schools. I am also an RBT and I will say the 2 jobs hold most of the same responsibilities. The burn out is huge. I truly wish that society recognized this enormous impact service providers are making g in families lives. Too bad we reward some professions and not others.
Thank you so much for your service as an educator and as a RBT! Burnout is a serious problem in most service fields and, as an educator and RBT, you must feel the strain even more deeply. In both service fields, demands on one’s time must be very great and, sometimes, progress can be slow. So, we often hear from significant others that change isn’t happening fast enough, which can be very disheartening when we are working so hard to make those changes happen. Hang in there! You are doing so much good in both of your service fields! Thank you so much for responding to my article! Harla