BCBAs, clinical directors, and other supervisory staff in the ABA field commonly wear multiple hats, juggling a never-ending to-do list. Heavy workloads combined with a lack of support and resources is a recipe for burnout. Burnout in the ABA field is increasingly prevalent. One study found that 72% of ABA clinicians reported medium to high levels of burnout.
Burnout among RBTs and BCBAs can have devastating consequences. In a field with already high turnover rates, burnout only exacerbates staffing challenges. The consequences of turnover are immense, including financial costs, discontinuation of care, and lowered morale among existing staff. Identifying and resolving the clinical challenges your team faces is imperative to prevent burnout, improve retention, and ensure the highest quality care.
While burnout is a complex issue, many of its root causes trace back to specific clinical obstacles that ABA organizations face every day. These challenges often create inefficiencies, hinder quality of care, and place additional strain on an already overextended workforce. By understanding the operational and clinical barriers that contribute to stress and overwhelm, leaders can take targeted action to support their teams. The following seven challenges highlight the key areas where organizations can make meaningful improvements to reduce burnout and strengthen both staff and client outcomes.
1. High Turnover Creates a Never-Ending Training Cycle
High turnover presents many challenges for an entire organization. One particular struggle is the never-ending training cycle. It can be frustrating for supervisors and clinic directors when a staff member is fully trained with a client, only to quit weeks or months later. A significant amount of time and resources go into training staff members with each client on individualized programming.
Staff turnover and this repetitive training loop also have a significant impact on client progress. The constant cycle of hiring, training, and reestablishing rapport with new staff can interrupt treatment and contribute to skill regression. This can be of tremendous concern to parents and caregivers who have high expectations for their child’s progress, and frustration from existing team members.
2. Poor Communication Between Supervisor and Staff
Ineffective communication is a challenge that many industries face. In the healthcare field, poor communication can have particularly damaging effects, most notably for the individuals receiving services. However, poor communication can also impact the professional development of staff.
Communication barriers may be the result of an employee’s underdeveloped interpersonal skills, unclear expectations, or they may be part of a larger organizational issue. Identifying where the barriers lie and developing strategies to improve communication at both the individual and organizational level is key.
3. Lack of Data Leads to Stalled Progress
Supervisors need accurate and timely data to guide the progression of care. When they don’t have complete visibility into a learner’s progress, every decision slows down, delaying their ability to update programs.
Clients aren’t the only ones who experience the impacts of stalled progress. Behavior technicians also feel the strain when they’re left running outdated programs. A lack of momentum in a learner’s progress can quickly lead to frustration for the technician.
4. Non-standard Formats for Funding Sources
Each funding source has different requirements for documentation and reporting. This lack of standardization means providers need to thoroughly review the specific requirements of each funding source they work with and create templates that work for each funder, which can be time-consuming. For RBTs, unclear or inconsistent documentation expectations can create confusion and uncertainty when documenting sessions.
When organizations fail to set up documentation and reporting that match each payor’s mandates, they also risk costly claim denials, failed audits, and clawbacks. Using software that offers customizable, payor-specific templates can help therapy teams ensure compliance without added strain on staff.
5. Measuring the Quality of Care for Outcomes-based Reimbursement
Outcomes-based reimbursement is a payment model that has started moving into the healthcare industry. Most ABA therapy services are reimbursed based on a fee-for-service. However, some healthcare leaders and policymakers are encouraging the move toward value-based care and outcomes-based reimbursement, in an effort to improve care and prioritize the recipient of the services.
The potential shift toward outcomes-based reimbursement has some ABA organizations concerned. While providers would be financially rewarded for positive outcomes, this method of payment also comes with financial risk.
One of the biggest challenges ABA providers are facing in making a shift toward outcomes-based reimbursement is determining how to measure the quality of their outcomes. Clients receiving insurance-funded ABA services typically have an autism spectrum diagnosis (ASD). Children with ASD can present with many various traits and levels of severity. Each child also progresses at their own pace, making outcomes more challenging to measure.
ABA providers can start preparing for the potential for outcomes-based reimbursement by defining and standardizing quality and outcome measures. Additionally, understanding the data you have available and identifying what type of data is needed to demonstrate quality measures is another important area ABA organizations can focus on to prepare.
6. Wasted Manual Reporting Time
Completing progress reports and treatment plans is a necessary component of BCBA’s job duties. However, these tasks can take up significant amounts of time, particularly when an organization is using outdated or manual processes.
Funding sources typically only reimburse 6-10 hours every 6 months for reassessments. These hours include the face-to-face time spent conducting assessments, as well as the assessment analysis and report writing. However, using manual processes such as creating the treatment plan in a word doc and pasting excel graphs into the document, can take up significantly more time than the hours allotted for reimbursement. This results in increased non-billable work and adds to the BCBA’s already heavy workload.
Streamlining report writing can improve your team’s job satisfaction, reduce non-billable hours, and most importantly, increase the quality of care by allowing the BCBAs to dedicate more of their time and energy to caring for their clients and families.
7. Administrative Burden Pulls Clinicians Away from Clients
When BCBAs are heavily loaded with administrative, non-billable tasks, this takes away from the time they could be spending with their clients. Reduced BCBA oversight of cases can result in less positive outcomes for the client. Less time spent with clients also means less time spent with RBTs. One of the best ways to combat turnover is by better supporting RBTs through face-to-face time with supervisors. When supervisors are spending an exorbitant amount of time on administrative tasks, they miss out on vital opportunities to support their clients and their RBTs.
Reassigning administrative tasks and using technology to automate these tasks can greatly increase the time your BCBAs are able to spend with their clients. When your BCBAs are empowered to invest their time in case oversight rather than paperwork, RBTs feel more supported and the overall quality of care improves.
Moving Forward: Strengthening Clinical Excellence Through Sustainable Systems
Addressing these seven challenges is not just about easing daily frustrations; it is about building a more resilient, efficient, and supportive clinical environment where both clients and staff can thrive. As ABA organizations grow and the industry continues to evolve, leaders have an opportunity to rethink outdated processes, invest in tools that reduce administrative strain, and champion practices that elevate the quality of care. When teams are equipped with the right resources, communication channels, and data-driven insights, burnout decreases, job satisfaction rises, and client outcomes improve.
By proactively identifying barriers and implementing systems that support clinicians at every level, ABA organizations can create a sustainable model of care that empowers staff, strengthens retention, and ensures that each client receives the high-quality, individualized support they deserve.
References
Slowiak, J. M., & DeLongchamp, A. C. (2021). Self-care strategies and job-crafting practices among behavior analysts: Do they predict perceptions of work-life balance, work engagement, and burnout?. Behavior analysis in practice, 15(2), 414–432. https://doi.org/10.1007/s40617-021-00570-y
Coward, K. (2021, May 27). Obstacles ABA providers must overcome to successfully transition to value-based care. BH Business.
Posted in Clinical, Practice Management
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