The importance of defining your ABA business programs to measure success, evaluate outcomes, and more — Part I of II.
Our children have attended a specialized swim school every week for the past several years. The reason they have taken part in classes for so long is not that they haven't learned to swim. On the contrary, they are excellent swimmers, and our daughter now participates on the school's swim team. The school has four distinct and well-organized programs for its swimmers: Baby Swim, Learn to Swim, Swim Team, and Special Abilities. Each program is broken down into levels, and specific skills are taught at each level.
The levels are like building blocks – skills learned in the previous level lay the foundation for the next. Children move up levels and complete programs as they reach fluency on the targeted skills. To make it worth the price of lessons, the school keeps us informed as to what to expect; provides insight into how our children are progressing at their current stage; and informs us of what is coming next. We know exactly what we are paying for, and the swim school has defined programs with clear goals and objectives so parents know whether or not they are delivering on their assurances.
One evening while waiting for the kids' lesson to end, I surveyed posters outlining skills taught across the curriculum inside the swim school lobby. It occurred to me that they may have a thing or two to offer ABA service companies.
When we work with leaders of behavioral health organizations, they regularly emphasize that their highest priority business results are in the areas of Quality Services, Client Progress, Quality of Life Outcomes, and Customer Satisfaction. They often lament the challenges they face in determining whether or not they are producing these results. That night at the swim school, it occurred to me - many ABA organizations do not have well-defined programs and services. Their descriptions are often vague and lack depth (i.e., “we provide ABA services”). That phrase doesn't communicate anything specific. Instead, it encapsulates the entirety of the technologies derived from the science of applied behavior analysis. So, it's not surprising that leaders can't confidently say if they are reliably achieving their priority business results -- many do not have defined programs to compare against!
In interviewing leaders and assessing organizational performance, my hunch has proven accurate. Companies lacking defined programs, instead offering broad "ABA services," encounter barriers to producing those priority business results. In these organizations, it is not uncommon for me to speak to three clinical supervisors (BCBA®s who manage caseloads) and hear three different approaches to core components of behavior analytic service delivery such as selecting assessments, identifying treatment goals, and measuring progress. Directors often express frustration at being pulled in different directions as they are asked to build out services for learners with increasingly diverse needs. For example, they might add services like social skills groups or school consultations because one or two learners require them rather than because the company is strategically rolling out these services. In these situations, boundaries of competency are tested as new learners are enrolled based on whether or not they would benefit from ABA services (generally) rather than if they would benefit from the specialized expertise, experience, and capabilities of the organization's clinicians.
The inverse is true as well. Organizations with clearly defined and distinct programs that provide specialized services matched to their target clients' needs are more likely to measure those customer-oriented business results that others find so elusive. By planning and describing their program elements in advance, leaders and supervisors can set clear expectations for their staff, ensuring they understand the distinct focus and limitations of the services provided to clients within each program. This approach helps with recruiting and hiring, onboarding, new hire training, and professional development. Clients who receive services from these organizations are happier because the "fit" is better from the outset -- and they know what to expect when they enroll their child in a program.
Clearly defined programs also prevent organizations from enrolling prospective clients whose needs and/or preferences don't align well with the program. And, perhaps most importantly, these companies can "walk their talk" when it comes to producing socially valid and statistically significant outcomes for their clients. By defining their programs, they can engage in program evaluation and measure outcomes across learners. That, in turn, allows for more accurate predictions about likely achievements for any single client. And, spoiler alert: this specific benefit is likely to pay off substantially as the field moves toward value-based care, which depends on demonstrated outcomes. Organizations with clearly defined outcomes will likely be better positioned to negotiate contracts that reflect the quality of services they provide.
A closing note -- and what’s coming next.
When we identify this need in our performance analyses, we collaborate with business owners and clinical leaders to help them organize existing services into programs -- and then describe them.
In our next blog, we will:
- Share tactics for defining programs.
- Outline key elements of a suitable program description.
- Make a case for “kid-friendly” program names and special recognition for completing levels.
And, who knows -- maybe one day a parent will sit in your lobby and appreciate the care you put into planning and defining your services -- making it easy for them to understand what they are investing in, and whether it's yielding results.
About the authors.
Shane Isley, M.S., BCBA, LBA
Shane Isley is an entrepreneur, performance thinking® practitioner, and management consultant who earned his bachelor’s and master’s degrees in behavior analysis from the University of North Texas. He serves as a Senior Consultant for the Performance Thinking Network and leads the company’s emerging Performance Thinking® For Behavioral Health/ABA Organizations service line. In his role, Shane works with a team of organizational performance consultants to deliver performance improvement programs and services to companies of all sizes to help them establish or improve their performance infrastructure, processes, policies and procedures, job definitions, and management capabilities. Shane collaborates with business owners and executives to develop and implement solutions that increase profitability and improve operational efficiency, employee engagement, and service quality.
Shane has over fifteen years of specialized experience and expertise in the behavioral health care market as a business owner, executive director, and performance improvement consultant. Shane remains committed to helping behavioral health organizations lay the foundation for sustainable, ethical, and profitable growth, focusing on organizational alignment, leadership & management development, and process improvement.
Jennifer Castellanos-Bonow, PhD, BCBA-D, LBA
Jennifer Castellanos-Bonow earned her PhD in Behavior Analysis from the University of Nevada, Reno (UNR), an experience that laid the foundation for her work with children with autism and other behavioral disorders. Jen has extensive experience leading clinical initiatives, designing training programs, maintaining best practices in delivering behavioral and psychological services, and developing and managing processes to support ethical and compliant service delivery. After serving for several years as the clinical director for Blueprints, based in Bellevue, WA, in 2019, Jen transitioned back to her hometown of Reno, Nevada. In partnership with a group of behavior analysts, she has helped establish The Learning Consultants, which aims to provide behavioral support and services to children with autism and parents and families facing acute behavioral challenges.
Jen serves as the managing partner and CEO applying her experience administering performance management systems, designing processes and implementation planning, navigating healthcare funding of behavioral services, and developing and maintaining policies and procedures to ensure regulatory compliance. She is also actively involved in the behavior analytic community, most recently by serving as the President of the Nevada Association for Behavior Analysis. While her roots are in early intervention, Jennifer’s foundation from UNR and recent work has provided her with wide-ranging experiences applying the science of behavior.
 Examples of program elements include: (a) the target population (e.g., children under the age of four with a diagnosis of autism, (b) the setting (e.g., a clinic), (c) the clinical processes (e.g., the steps in the assessment process), and (d) the service components (e.g., the teaching formats employed).
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