Building a Stable ABA Workforce

Simone 00:00:00 Welcome to the Flychain Reaction, a podcast designed to empower healthcare providers like you to master the business side of running a practice. Each episode sparks a chain reaction where actionable insights on financial management, operational efficiency, and growth strategies build upon each other, creating a powerful ripple effect to help your organization thrive. With Flychain's financial expertise and insights from industry leaders, we'll dive into everything you need to ignite success. Join us and let the Flychain reaction spark growth in your healthcare business.

Simone 00:00:39 Hi, everyone, and welcome to today's webinar on building a stable ABA workforce. My name is Simone Deverall. I'm the head of growth here at Flychain, and I'll be hosting the conversation today. So just some background on the conversation. We know that staff turnover is one of the biggest challenges and really a major productivity killer in the ABA field. So that's why we're so excited today and with today's topic, which is on financial and staffing solutions to reduce turnover.

Simone 00:01:09 So enough of me speaking, we're joined here today with three incredible thought leaders. Thank you, Nicole, Gabriella, Ethan for joining and for sharing your expertise. So before we start, I'd love to turn it over to the three of you to introduce yourselves and also your companies. Maybe we can start with Nicole and Gabriella.

Nicole 00:01:32 Sure. Hi, I'm Nicole. I am a BCBA. I'm also a special education teacher. And along with Gabby, we co-founded Supervision Reimagined. So we previously worked together at a small center in Manhattan. And we're in different roles and just, I think the two of us took such an interest in staff management, staff training, I think from very different perspectives, just from the way our careers have evolved.

Nicole 00:02:01 And so we have created Supervision Reimagined with the mission of supporting both staff training and BCBA, in particular BCBA development so that anybody in the audience who is a BCBA or anybody who listens to this, you know that we often are overworked and burnt out and 2,000 hours of field work often isn't enough for us to feel ready to practice independently.

Nicole 00:02:29 And people sometimes, you know, people aren't even, I think for me, my big passion is really making sure that that 2000 of hours, there's as much bang for your buck as possible. And so I'll turn it over to Gabby to talk a little bit about her passion and in supervision and staff training.

Gabriella 00:02:47 Hi everyone, I'm Gabriella. I think Nicole really explained this well. I've been in the field of psychology, ABA, and education kind of combined for the past 10 years. And one of my, Nicole and I also own our own practices along with our shared business. And one of my favorite parts of my job is supervising and really just seeing my BCBAs and my RBTs flourish into really providing such ethical and effective care. And that's really why I partnered with Nicole so we can really create such a higher standard of field work for our supervisees.

Gabriella 00:03:39 We're so excited to present with Flychain on this topic. I think it's so relevant, and it's such a nice way to combine the finance side and how training kind of go hand in hand. We're a successful company, so we are so excited to do this.

Ethan 00:04:01 Awesome. Yeah, we're pumped to have you on this discussion. And you hit the nail on the head. I feel like financing, managing and growing a staff and everything are kind of almost opposite sides of the same coin because they're so related. But really quickly, we're Flychain. I'm Ethan, one of the co-founders here and CEO. And we've built what we call the financial toolkit for ABA therapy providers, behavioral health with a focus on ABA.

Ethan 00:04:29 Just not to do like a sales pitch here, but just in terms of our our products and everything, our mission is really to help ABA therapy owners manage their business from a financial lens, because we know you're very overworked and busy. And generally speaking, doing things in terms of hiring, coding, billing, prior authors, a million things as it relates to running, we kind of just want to say, hey, you do not need to worry about finances again.

Ethan 00:04:56 So we provide working capital to folks, specifically in deductible season, covering payrolls as, you know, things get a revenue gets depressed, as well as full service accounting and bookkeeping. We take that off of your plate. And then that gives us the ability to show a lot of really cool insights into your business by first getting your books and your data in the right format, specifically in the way that, you know, an ABA therapy provider would need it.

Ethan 00:05:22 But then that enables us to do a lot more with our customers and provide, I think, a lot of granular analytics that is actually really related to a lot of things as it pertains to like hiring, having the money to hire and planning and budgeting, et cetera. So yeah, really excited about this conversation. And this is certainly a topic of conversation that we don't have an expertise in, which is why we love bringing folks to the table like yourself. I'll pause and would love to get into it.

Simone 00:05:54 Perfect. Thank you all for the introductions. I think for the first part of the discussion, we want to understand what are the key drivers of staff turnover within ABA organizations today. Maybe I'll pass that question on to Gabriella and Nicole to answer this.

Gabriella 00:06:12 Sure. I think as a supervision company, it's super unsurprising that we're gonna boil this down to inadequate training. It's such a simple but yet complex answer because something that can just be said in two words has such a large ripple effect to cause issues for every participant in the treatment process. And so how that happens, we made this cool little diagram. Nicole, you wanna share it real quick?

Nicole 00:06:43 Yeah.

Gabriella 00:06:42 And then I can show you how it starts with some kind of barrier. And a barrier would be something I know where we're, sorry, those are our pretty faces.

Nicole 00:06:58 It's a little laggy.

Gabriella 00:07:02 A barrier would be something we either can or cannot control and that hinders us from setting up a system to provide high quality supervision. So a common one in our field would be the limitations put on us by insurance companies. Our services tend to be heavily funded by insurance and with low reimbursement rates, our field tends to hire RBT's and BCBA's at low wages. And so companies will then hire very green staff with little ABA experience or will experience high turnover rates due to job dissatisfaction.

Gabriella 00:07:42 And so we find is that the monetary reward is not really matching the work demand, but salary isn't everything. So our field is also growing very rapidly, but the number of clients needing services surpasses the supply of therapists that we have available within our companies for the most part. So that leads companies to quickly hire without the proper vetting. And so we're hiring therapists unfit for the role that they're placed in.

Gabriella 00:08:18 And then we can't forget about non-fillable hours, right? So just wanted to highlight that quickly because that's such a huge part of our issues is that many insurance companies do not cover for non-direct care services or they reimburse for limited hours. So companies that need to pay for those hours without reimbursement, which cuts into profits or the bottom line.

Gabriella 00:08:48 Limited non-billable hours tends to lead to less supervision time for BCBAs. And so we can see how now this is starting to set up a disruption in the system to cause the inadequate staff training, which in turn causes like a ripple effect.

Gabriella 00:09:05 This can in turn cause the RPT to lack efficient oversight and support from the BCBA and in turn becomes discontent, burns out, possibly quits. Additionally, this causes a lack of client progress, which leads to upset and concerned parents, which we know will bring about more supervision time, focus on the parent meetings and the problem solving of the programming. And then we have less time to towards the actual training piece.

Gabriella 00:09:37 What else do we get? We get BCBAs who feel ineffective at their jobs because of the lack of support and time they receive to officially do their jobs. They're either constantly training someone new because of the high turnover rates, or they're constantly training on the same skills because they don't have enough time to teach them to mastery.

Gabriella 00:10:01 So these are our problems, but we don't have to live or function this way. We might not be able to fix everything, but we for sure can fix what we can control. And I just wanted to say as a business owner or someone in an administrative role, which I know many of you are, you have likely already recognized that these barriers exist. Maybe you have taken steps to alleviate some of those barriers.

Gabriella 00:10:29 For example, if your BCBAs don't have enough time to do non-billable work, maybe for you that has resulted in your outsourcing to have AI session notes. That's a big thing now, right? Created auto-generating goals from electronic database companies or having your employees complete free online RBT courses.

Gabriella 00:10:56 Just upfront, we want to be very clear that none of those answers are inherently wrong to us. But what we can say is that they don't all improve clinical and financial performance across all companies. And therefore more introspection and analysis of how these shortcuts are affecting your own company is so crucial. Sometimes those temporary quick fixes the ability to see the long-term impact of these solutions on our bottom line or clinical outcomes.

Gabriella 00:11:41 So just to wrap it up, the question, there's so many reasons driving high staff turnover, some being those thorns we can't currently control like the stipulations and restrictions placed on us by funding sources. And then others being quick fixes we find through outsourcing, which when doing a deeper analysis into companies, they are saving our employees time in the short term, but they're not creating overall performance with the company and staff retention.

Gabriella 00:12:19 So more money tends to be wasted in the long run. We would suggest allocating some of that money into what we know actually works, which is proper training and vetting, which we're gonna get into a little later.

Nicole 00:12:31 Yeah, and I was just gonna provide like a little color, just like a story of mine. I feel like I've been in, I've been an ABA for almost 20 years, and a couple months ago, I had somebody reach out to me from an electronic data collection platform, and I need to name names. They're all big, they're all doing their thing and doing a great job.

Nicole 00:12:52 But they they're asked, they said, do you want a demo? Our initial assessments will only take one hour. Our platform has gotten initial assessments down to one hour. I'm like, God, an hour that in theory, that sounds great, right? Because we're all overworked. If I can do something that used to take me 12 hours in 1 hour, that's great. Or even more, you know, when I was a new BCBA and initial assessment probably took me 20 hours to do.

Nicole 00:13:19 So if I could do that in an hour, that sounds great. But the reality is like, I can't know the ins and outs of a client's strengths, their needs, their family dynamic, their environment, their behaviors, emotions, all of that information. I can't learn all that in an hour. So how am I going to assess and write treatment goals for them and that? And that kind of like got me thinking a lot about these outcomes when we take away the heart of that science to save time.

Nicole 00:13:44 So if I write treatment goals in an hour, I'm gonna miss some factor, which means that now, the progress is going to be slowed down or I'm going to have to like, I've definitely written treatment goals where I think it's a good idea. And then I don't know how to train anyone to do it. And so now the training involved in the treatment goals is higher than my capacity or my RBTs aren't seeing progress. So then they're leaving. So now I have more people to train.

Nicole 00:14:09 And so that whole, it jams up the whole system because even though it sounded great at first, it actually like, what I always said, and it didn't save future Nicole. It like actually like caused bigger problems for future Nicole. And I think like, you know, in the best case scenario, you pivot and think on your toes. In the worst case, the parents are frustrated. Maybe they leave, maybe like worst case the client's not making progress.

Nicole 00:14:34 So I just think that like, it really, those things sound really great in theory. And what's been really cool about meeting with you guys at Flychain is that you're also looking at these sustainable financial solutions, not these quick fixes. And I really love that because I think that that's kind of our whole mission is to find these sustainable solutions for the ABA field.

Simone 00:15:00 Yeah, no, I love that. And it's really a balance, right? You have on one hand, you're still running a business, you still need to be profitable. But at the other hand, it's such a human facing business. Like everything you do is giving care and giving care to kids. You can't rush that process. You can't expedite that process and make it like a machine line, like next, next, next. That's not how it works. So it's really finding that balance. So I love what you were saying there.

Simone 00:15:28 And I think you also make a good point about how Flychain is supporting here. And I think this is a good opportunity, Ethan, maybe to talk a little bit about why is financial security crucial for ABA organizations and how does this directly impact staff loyalty and retention?

Ethan 00:15:46 Yeah, absolutely. And so I kind of mentioned a lot of what we're doing in our origin, the first year of our business, we were providing kind of lines of credit and advanced payment on claims. And the design for that was we understand ABA therapy has a lot of cashflow issues. And that's generally speaking, because you have a fixed expense of payroll and you don't know when that money is coming in. And sometimes there are lags.

Ethan 00:16:11 Those little blips in the radar, those little lags can have like material ripple effects. You've said that multiple times, Nicole, like there's these ripple effects that if you don't kind of try and solve them in the beginning, a good example of that is getting one of these really predatory loans to solve like a payroll issue. That ripple effect could kill your business because the interest is gonna be so high that it's a very short-term solution to cover a payroll. And if you're thinking about it, but don't think about it in like the 24 hours to cover payroll, think about what that's going to do to your business over the next six months. And you're just going to bleed cash.

Ethan 00:16:47 So I think a lot of what we're doing on that front is kind of setting up these solutions so that our customers don't make those mistakes and kind of try and do like the you'll hear us say that phrase, like the best offense is a good defense. And that's all related to planning, making sure you're doing everything possible to prevent and plan for potential cash flow issues. Because one thing that we're sure of is there will be cash flow issues. Some of our larger customers have those. And it just has to do with these lags.

Ethan 00:17:17 So what is the effect on your staff missing a payroll? You're going to just see attrition. We always see that. If you miss a payroll, people want to get paid. They have rent, they have expenses, and they're going to start losing faith in the organization. Also, we'll see people with customers, customers will say like, I have to furlough our employees, right? Because I can't actually make this payroll. We'll bring them back on.

Ethan 00:17:40 But once again, like if you're getting furloughed, you know, do you have a lot of faith to go back to that organization? And so the whole goal here is, you know, having a stable financial plan. And that's not just like setting yourself up for the stable business. It's really setting yourself up for growth as well. And having that like hiring plan in place, right? You know, so we're talking more of the financial side of hiring. Do you have enough money to hire? It's going to increase your payroll for probably a few cycles before you're realizing the money that these new folks are generating for you. So I think a lot of this is planning. We'll talk a little bit more about that later.

Ethan 00:18:17 But just having an option and making sure that like we always say, have three, three payroll cycles in your bank account. Easier said than done, we realize that. But that is something that we try and really emphasize, because change in healthcare will happen again in some capacity, right? Like these little issues always occur. So best offense, good defense, and making sure that you are financially ready to grow or at least remain stable as you're trying to, you know, deliver services in a very elegant, you know, efficient manner.

Simone 00:18:49 Yeah, no, I think that that's so clear. And we'll talk about that also in a second about like how to really prepare for these financial challenges. But I think, yeah, I think, Nicole, we were talking the other day and you had a really great graph that I don't know if you want to pull up or if you have at the moment. But I think this would really drive home that that same point that Ethan made.

Nicole 00:19:16 Yeah. I do. I love visuals. I feel like graphs are super helpful. Hold on one second. I got to get rid of the closed captions on it. Okay. So this is, I worked for an ABA company and I think, you know, I was a clinical director and then I started my own private practice and started in that transition period. And I think this is a good part too for, you know, I don't know how big different businesses are that people are watching, but like as you're building a business, there may be other things you're doing.

Nicole 00:19:46 And I found that working for other companies actually really taught me a lot about so many different components of business management, how I was on boarded in different places, all of that. And so this is the one company I worked for where they hired me just to do assessments. So they would just want me to do the, come in, do the VBs-MAPPs. Fine, right?

Nicole 00:20:08 So they give me, I've been doing this, and then they give me a client who's about an hour away from my house. I'm like, it's fine, because I can do the whole thing on a weekend, no big deal, not so bad. And then they're like, oh, we don't have a BCBA, so you're going to be the BCBA. I was like, that's not, no.

Nicole 00:20:25 But then, you know, anybody here who's an ABA, you know, you can't say no. This is a kid I've met, I've met the parents. Parents are so desperate for help. They're so eager, they're so excited, they're calling me, when are we getting services? When is somebody starting? It's, you know, the four-year-old child. It's really hard to say no. So I was like, okay, I'll do it.

Nicole 00:20:50 And so they immediately start me, but they also don't have an RBT. So now I have this parent, where's the tech? Where's the tech, where's the tech? So there's nothing for a few weeks. And then the RBT starts. They tell me on a Tuesday. Hey, they're coming to a session on Wednesday. Can you meet them there? No, I have my own children. I can't go an hour. It's not feasible for me.

Nicole 00:21:15 So the RBT starts, they go into this house. They have no training. They've never met me. They've never met the family. They've never been prepped by me. Understandably, after a few days, they leave because they're not in a supportive environment. And so now you have no RBT for a few months and the same pattern just continues to happen. And so over that six month authorization period, we use like, what is this, like 60 something hours, which is maybe 15% utilization of the total nine, seven, five, one, five, three hours we could have used.

Nicole 00:21:47 Had we trained that RBT, had we taken, we found someone and we took them and we spent a couple of weeks training them and the beginning was a little bit slower, they would be more likely to stay. They would feel competent. They would feel like they were supported. They would feel like they knew what they were doing. It wasn't an easy case. And you know what? I would say, I always say that cause there are not really any easy cases. Every family, every child is unique and different. And so, and every program is different. So we need that training.

Nicole 00:22:18 Now let's say we even just did, you know, here's a built in like a vacation, like this is like 95% utilization. That's amazing. And so now your income is gonna be higher because you invested that time proactively that the offense, the defense, you know, you invested that time into preventing those pickups from occurring.

Nicole 00:22:38 And then if we even went one further and we made sure that we hired someone, cause if Gabby mentioned this earlier, you know, sometimes people are so desperate just to fill the hours immediately. You might hire someone who's not the right fit. And so if we really invested time in finding the perfect person, maybe it starts a little slower, but you still end up with this like really close to 90% utilization rate.

Nicole 00:23:01 When I kind of map out these different scenarios of like, what could happen if we invested time in training, it just how, what's the difference here of like, and this isn't even everything going wrong, to be honest. This family still stuck around for this full six months. Imagine if they hadn't, imagine if they'd gone to a different center. The amount of income you're gonna make and the revenue you're gonna make just by investing a little bit of extra time. And you know, if you choose to get extra capital from somewhere and be able to have that and investing it into your training purposes. It's really the payout, like your return on investment is going to be really high, as you can see by this graph.

Ethan 00:23:44 Yeah, I love that. And actually just like to chime in on how we think about this and why we were excited when you kind of first showed us this a few weeks ago. This notion of opportunity cost and investing the time upfront, we can tell you with a lot of confidence, because we see this in the data, that if you don't invest the time, well, then you're gonna have to spend more money with, if that person has a bad experience and leaves, then okay, we have now a whole new training. We have to hire more people. That's a huge cost associated, where if you actually think about it, investing a little bit more time with these folks, versus, okay, if they stick around, then you don't have that huge cost of trying to hire and find new folks.

Ethan 00:24:29 And so I love this notion of like, spend a little bit more time. And then it actually pays dividends down the line. And I think that's where we're trying to communicate here is, is, you know, this is very serious work. And when you want to bring someone on, invest the time so they stay with you. Because like, at the end of the day, why you have cash flow issues is banks can't fund you because you don't have assets on your balance sheet. Your people are your best assets. So invest the time in your best tool, which is your staff and your employees.

Ethan 00:24:59 And so I think treating them the right way, training them the right way creates this organic loyalty and they'll stick around a little bit more. And that's just gonna really, really help that bottom line indirectly as well as directly. So I'd just like to highlight that. And this speaks really well to a lot of the things that we're trying to do at a Flychain to address and save money by, you know, a bunch of different mechanisms, this being one of those.

Nicole 00:25:26 Can I ask you, sorry, I'm going off script a little bit.

Ethan 00:25:30 I love it.

Nicole 00:25:31 Because you said that about the banks, your assets are your people. So somebody went to a bank and they said, our rate of turnover is below the average for this field. And our staff stay with us for an average of five years or, you know, whatever the bank is going to look more favorably on that company for a loan.

Ethan 00:25:52 They actually won't. And it has nothing to do with like tenor of staff that's really thinking about how profitable are you running and efficiently you're running your business. So I'm going to look at that the banks are going to look okay, how much revenue do you do if you're not doing like \$10 to \$20 million in revenue, we're not going to fund you. And that's because they can't collateralize anything. You can't collateralize a human being, which is what I'm saying. Like those are your assets, invest in them. And so that's why the credit solution that we have is like almost bank rates.

Ethan 00:26:24 And we've just taken the time to understand, like, oh, you have outstanding insurance claims. It's seasonality. We can bring that forward for you. So it's kind of dire straits for getting funded by banks these days in this universe. And just to be really clear, like, perhaps a doctor, like a dentist or someone could get a bank loan because they might own the building and they might own like an x-ray machine and a bank will lend to them because there's collateral there. It's kind of the same notion of getting a mortgage, right?

Nicole 00:26:52 Right, right.

Ethan 00:26:53 You don't pay your mortgage, they're going to take your house, but ABA-

Nicole 00:26:56 Going to take your people.

Ethan 00:26:57 There's nothing to take. And so, and so that's why, you know, really, really difficult for banks, but implementing these types of strategies will make you more favorable, because you will have better profits and more predictable revenue. That's the kind of stuff that definitely helps from access, to access of capital, like the Small Business Administration would look at that more favorably.

Nicole 00:27:19 Got it. Okay, that makes more sense. Right. They're not taking your people. They're not exactly possessing your employees. They are, but it is more like honestly, you are having high rates of turnover your return on your initial authorizations is looking like 15% utilization which like if I'm, if I were looking to give somebody a loan, I'd be like, well, you you're leaving so much money on the table as is like why? How do I know you're gonna use my money effectively?

Ethan 00:27:51 Exactly. And that's why having these strategies in place to kind of optimize, you know, utilization in your workforce, while a capital provider is not going to understand that because they're not like, no capital providers really specific to ABA except us. That's kind of why they run for the hills is there's just, it's really risky in their eyes. But if you're doing these things, your business is going to be more profitable. It's going to look better. And therefore you will get better rates and access to credit. Granted maybe not from the bank but from other folks out there. So it will just indirectly shine a light on your business and a positive.

Simone 00:28:33 Great. And I think while we're talking about in that graph, there's a lot of initial upfront time that needs to be invested, but there's also a lot of initial upfront capital that needs to be invested in order to delay that hiring, to train up the people enough to be able to get to that optimal utilization. I think this would be a good chance, actually, Ethan, to talk a little bit about how Flychain can support in that process. It can sound quite daunting to be like you just have to throw more money at it upfront when already in ABA space it's very cash tight. So yeah, we'd love to hear a little bit about like how Flychain can support this and other capital options as well.

Ethan 00:29:18 Yeah, yeah, I think there's like kind of two top tracks here. The first is planning. And what I mean by planning is, you know, taking a look at your financials, right? So that's what we do. We give them a very clear picture of that. And then it gives you the ability to understand how much money do I have in my bank account? Do I have access to capital as well? And then, okay, if I want to hire two people, what does that look like over the course of the next three to six months?

Ethan 00:29:48 Because you're going to have an increase in expenses and that's going to either eat away at your bank account a little bit before that revenue is being realized. Or we can set you up with credit and then you don't necessarily need to use that little cash balance that you have. You can use some credit to finance that as well. We like to say that's like non-dilutive financing, right? You're not using your own money. You're borrowing the money to get you through that gap and we're offering that at a very fair rate.

Ethan 00:30:14 So there's both the actual capital itself, but it's the planning to make sure that you have enough money to kind of hire and grow prudently so that you don't get like over your skis, if that makes sense. You're not going to increase. We've had customers do this where they actually go, they get a nice little lump sum payment from insurance that they maybe weren't expecting. And then they go on a hiring spree and hire three people without really thinking that through because, hey, if you have a good BCBA, we often see like, grab them, like this, let's get them in, right? It's hard to find, right? Staffing shortage is definitely very real.

Ethan 00:30:50 What we're saying there is plan, plan. And then also part of that plan is having the capital portion figured out because it's great to hire a lot of people and everything. But if you don't have the money or options to fund it as you're growing, that can cause payroll issues down the line as well. And that's certainly not something that you want to have to face with your organization or really your employees.

Simone 00:31:15 Yeah, great. And I think, yeah, that really clearly paints a picture of why like, staffing and financial stability really go hand in hand, right. And I think, yes, a question actually for Supervision Reimagined, beyond this like financial security talking point, what other strategies can ABA organizations implement to build that like supportive work culture that meets professional needs and drives those long-term commitments?

Gabriella 00:31:48 I can start this one. So really to improve long-term commitment and overall performance, we want to find an effective strategy that can help each part of the treatment package that we mentioned earlier. So ultimately, leading us to increasing staff retention, maximizing the hours we can bill for and then increasing client performance, right?

Gabriella 00:32:17 So breaking it down to really basically one, wanting RBTs to feel supported and fully trained in providing the therapy. Two, wanting BCBAs to feel empowered that they're making a difference in their clients' lives and having the resources to do their job effectively. And then three, wanting all stakeholders involved, specifically the client and their families to feel content with meaningful progress being made.

Gabriella 00:32:44 So once all those three factors are met, we can then and only then stop putting out these fires that I think a lot of business owners always feel like they're tackling. And then instead focus on goal setting and achieving whatever goals it is that you have put forth for your company, whether it's expansion or increasing the quality of services or whatever it may be.

Gabriella 00:33:12 And so how we suggest to do this is to really just go back to the basics and shaping up the quality of training. So we're identifying the key skills that are needed to do each role in your company and then strategizing how to carry out that training. And so our company does that. We're going to share with you a free resource to assess performance with our, that we use with our staff. This one in particular is for our RBT or behavior technicians. But we also have resources for BCBAs as well.

Nicole 00:33:53 I'm going to share the PowerPoint as well. I have another cat joining me as well.

Gabriella 00:34:02 So this particular resource, we call it the RBT Skills Assessment. It's funny because we're actually in the process of revamping it to align with the most recent changes being made to the test content outline. But because the skills follow a job model approach to supervision, which is how we actually like to train, it actually aligns pretty nicely already. So Nicole, I think shared it in the chat.

Nicole 00:34:35 Hopefully you can see it now.

Gabriella 00:34:38 Yes, yes, we can see it. Stay tuned for our new one. It's new and improved, or it's going to be new and improved. So basically we analyze exactly what skills we expect our RBT's to be fluent in. And then we train each skill to mastery. So this slide just displays one of the four pages within the assessment. In total, the assessment is 102 skills. A trainee should demonstrate to be fluent in implementing direct care to clients. And it's really meant to be a guide for you to adapt to the needs and skills required within your practice or within your organization.

Gabriella 00:35:19 So how this tool can be helpful to address the common issues that we mentioned previously, we like to narrow it down our focus to BCBAs having a lack of time to train, BCBAs having to train very inexperienced technicians, and then what support to provide RBT's who have many skills but have room to grow and those RBT's that you really wanna keep, right? How do we keep our RBT's?

Gabriella 00:35:49 So first, let's address the lack of time. This is super common. I think all business owners experience this at some point. And let's just say that your company cannot afford to have your BCBA spend hours each week training your RBTs, back to those not being able to bill for those, I guess, non-billable hours. The answer is not simply just do the best you can with the time you have. It's super crucial to use behavioral skills training to teach skills, but it doesn't have to take so long.

Gabriella 00:36:24 So it is unlikely that anyone has multiple meeting slots available to teach one skill. We know that. Use the skills assessment to identify the skills needed within your company, and then create a training library for your organization. Gather a team that can work on this, and this will take a little bit of time and effort initially. But then the great thing about it is that those same training videos can be used in the future with newer trainees and RBT's, and it will decrease the direct training time needed weekly moving forward.

Gabriella 00:37:05 The training video can then be watched on your technicians, by your technicians on their own time. So, when your BCBA and RBT, when they have their co-treats or when they meet, the BCBA spends less time on explaining the skills themselves. And then, they focus more of their time on the modeling and observing the programs being run correctly.

Gabriella 00:37:31 Another big issue we have is our hirees having a lack of knowledge or a lack of experience. So if your company cannot immediately move past that barrier of hiring those green RBT's with little to no ABA experience, then let's reduce the burnout for the BCBAs and focus on a behavioral skills training model. And what we mean by that is, you know, you would direct your BCBAs to choose a high priority skill that needs to be taught to the technicians first.

Gabriella 00:38:10 So we would teach it to fluency and then move on to another skill. So the slope for embedding new programming within the client sessions is initially going to be slow. But then what you're going to begin to see is a cumulative effect instead of a plateau effect. And what I mean by that is a cumulative effect will reflect the continuation of programs being run accurately with accurate data to report on. I know that's one of our, when writing our insurance authorizations and every six months we're like, what data are we pulling from?

Gabriella 00:38:54 And so that cumulative effect is where they're building on implementing programs accurately with accurate data, instead of a plateau effect, which a lot of people I think come into contact with, which is it reflects a scenario where a BCBA attempts all the needed skills at once. And then observes no increase in the performance in the following weeks.

Gabriella 00:39:27 So like how often do you hear time after time your BCBAs and RBT's that the RBT's they are supervising are continuing to run program incorrectly, their RBT's can't seem to run behavior plans correctly. Your BCBAs have no data to analyze or the data is just simply incorrect. This is because it's like you're teaching a new language to someone and you're bombarding them with all the skills at once and nothing is sticking. And so that's why teaching core skills one at a time effectively will create that cumulative effect you're looking for.

Gabriella 00:40:06 And I think it really ties into the original graph that Nicole showed with that, you know, I can't speak right now, cumulative hours of how, you know, once we start with that core training in the first few weeks, then we see more of those generalization skills from our RBT's where we trust that their data is accurate, that they're understanding how to run the ABA programming and we know that they're training them well where they will stay with us.

Gabriella 00:40:46 And then last piece, that lack of awareness. So if you actually have seasoned RBT's, this is like something super valuable, you know, to our companies, we never wanna lose them. Focus on retaining them by fostering the development of their clinical skills and then gradually moving them into more advanced roles in the company. So it's a better, it's better for you to grow your talent than outsourcing it. So use the skills assessment as an objective tool to measure their performance. It should be very transparent. Oh yes, thank you.

Nicole 00:41:24 Sorry, hold on, I've gone. Okay, sorry, my mouse went in like all sorts of directions.

Gabriella 00:41:29 It should be very transparent and accessible to the RBT. It would outline exactly what skills they need to learn and perfect. And then these should be partnered with competencies that provide objective feedback and performance review.

Simone 00:41:45 This is great. This is super comprehensive. And I think I guess where we can tie in also that like financial aspect is when you're talking about like the seasoned RBT, it's also, you know, being able to give them bonuses, have these appreciation events, offer these benefits. This all comes with like, yeah, all these activities will help retain these seasoned RBT and increase employee satisfaction.

Simone 00:42:13 And that again, is very much aligned with having that financial stability. So I mean, I think this is wonderful and thank you for sharing that resource as well. We'll also start out to the people who registered for the webinar but weren't able to attend.

Ethan 00:42:30 Just another thing that we've seen some of our customers do. Once again, I think it's harder to kind of swallow that pill when you're really early, but setting up things like a 401k if you can, right? Like these are the types of things that it shows you're investing, not just in the growth of that, but also in their personal financial health.

Ethan 00:42:52 And so, you know, these are things that we see really, really good correlation to stickiness of employees when they're working with you and they feel like the business is not only investing in their professional growth, but actually in them as a person that- there's that age old saying like money talks. And I don't think people, we don't get into this universe to like make a lot of money necessarily, but it's, it does help, right?

Ethan 00:43:14 Like, you know, these folks are working their butts off and any little bonus or some sort of like monetary gift of sorts in whatever format that looks like just helps. It just helps. And once again, it's a luxury, right? When you have some money and can set up these things, but we do see a lot of good success stories there around retention, which really, really helps on that, you know, huge opportunity costs that you could experience down the line by having to replace and hire and constantly kind of keep the staff afloat.

Simone 00:43:48 Yeah, definitely. And Ethan, it makes me think about like how also budgeting is so important, right? So at Flychain, we're about to release this budgeting tool which I think would also really support with how much you should be spending as a percentage of like total expense on hiring, on training, on doing all these like critical activities. And can you even afford to budget for such like a 401k or what should you aim for, strive towards achieving in order to be able to provide those those benefits? So I think, yeah, this is all really great.

Simone 00:44:26 And I think just to wrap things up, I know we're we're approaching the end of this webinar and definitely please leave any questions in the comments if you have any and we'll get to them at the end. But just to wrap things up. Yeah, what are then the key takeaways on how financial health and strategic staffing solutions and training support building a stable ABA workforce? And maybe I'll pass it on to Nicole and Gabriella to kick things off and then we can also wrap it up at the end.

Nicole 00:44:56 Yeah, absolutely. I'd love to hear if anybody wants to share in the comments too, any of your key takeaways. For me personally, having listened to everybody just now, we've been speaking with Simone and Ethan pretty regularly the last couple of months, but even just listening to this now. One of my personal key takeaways was thinking about how you use if you take out a loan, if you take out capital investments or something like that, or if you have, let's say you take out a proactive loan or you end up having a little bit of extra money left over, if you use that to buy your staff a pizza party or have a holiday party, that's great, but it's not going to return on your investment for something like that.

Nicole 00:45:33 I think when you're in this stage where you don't have this solid foundation of hiring processes and like fluent staff training, it's not going to be the same, right? If you take that money and you say like, you know, we're going to hire a consultant for training or we're going to invest one of our BCBAs so that they can have \$10,000 of their salary is dedicated to training purposes, whatever you choose to do, the return on your investment then is hopefully going to allow you to be able to afford the pizza parties and the holiday parties in the future more easily because you won't have to take out a loan in order to like kind of pull out these tricks to try to keep your staff.

Nicole 00:46:16 And I think like, you know, I know there's a point, I don't know how old you guys are, but there was a point at some point like where Google was coming out with all these things, like we have the nap pods and we have the free this and we have the free that. Everybody loves that. Everybody loves a free piece of pizza, free coffee. Like we all love that.

Nicole 00:46:31 But the things that people say at companies because they feel valued and they feel like they're making a difference and they feel supported and heard and understood. And I think when we value our staff and we treat them as such, they're going to stay anyway. And then your financial return is going to be greater because you're not losing like that opportunity cost that Ethan mentioned.

Nicole 00:46:55 I know when I was a clinical director and we would have avoidable turnover, I think is what I would like to call it. It was really frustrating because I would lose hours of time to develop the company or oversee other people and then you're hemorrhaging.

Nicole 00:47:11 And so I think that really proactive planning, that for me is the biggest takeaway having even just listened to this all put together today is like the proactive planning and using that money, if you do get extra money in the beginning or you have investment money or you're a nonprofit and you have grant money, whatever the case may be, if you have funds to invest in your staff training and staff management, it is going to pay off more than staff, like other little pieces and nuggets will in the beginning. I think those things are all like added layers that you keep building on. I see that was like a video game in the 90s where we built the roller coaster, now we can build the second roller coaster, the loop-de-loop.

Ethan 00:47:57 Yeah. I think like to sum it up on our end, it's really just emphasis on planning, right? It's an emphasis on never make a hire or spend a dollar as far as, at least how we think about it, like never make these decisions blindly, right? Like have a plan anytime you wanna hire someone, really take an honest look in the mirror and say, can I afford this? What is that ROI?

Ethan 00:48:21 And we're only one side of that coin again, right? Like it's a lot of the things that you two have been talking about, which they're so correlated. Payroll is your biggest expense and always will be, right? And so having a plan to understand, do I have enough money? What's gonna be the ROI? When will I start realizing actual revenue from a new hire as an example? These are all things that you can do, but we always just say, never make a financial decision without really thinking it through and planning it.

Ethan 00:48:53 And that's what we would really kind of encourage our customers to do, use our platforms, see the data. So you can't make decisions on imperfect data is what we like to say, because if you're using imperfect data, it's probably going to be a misguided decision and could be pretty detrimental. So planning and we're collectively here to help everyone do that.

Nicole 00:49:12 Yeah, and just to add, if you don't know your entry point, we do all the clinical management and staff management as well, not to try to sell our services, but just as an option. If you've heard all this and you're like, gosh, I don't even know where to start with staff management, that's your best, where to start is to ask for help.

Simone 00:49:35 Yep. I mean, in a similar manner with Flychain, we always love to just talk about, you know, provide these free financial consultations, whether or not you're ready to move forwards with this, with our platform, that's not the issue. The issue is more like, you just don't know what you don't know. And that's why it's so important, reach out. You know, we're not gonna charge you for like the first meeting, second meeting. We're here to help. And it's all about building that community of people who are genuinely interested in supporting you.

Simone 00:50:08 And yeah, just know that we're here to help. Flychain, Supervision Reimagined. And we have a growing network of trusted partners. So yeah, with that, I just wanted to close this session. Is there no other questions? And if there are questions, please feel free to reach out to us via email in the Spotify podcast, which we'll be releasing. We recorded this so you can like rewatch everything.

Simone 00:50:40 We'll also have our emails there so you can reach out to us. But at least for the Flychain team, it's just our first name, simone@flychain.us. Same thing, ethan@flychain.us. And for the Supervision Reimagined team, we'll definitely have your email there and we'll send out a follow up email as well with everything there. So thank you so much. Thank you, Ethan. Thank you, Gabriella. Thank you, Nicole.

Simone 00:51:04 Okay, perfect. Nicole put the email address in the chat. But yeah, thank you so much. And this was so informative. Really appreciate it.

Ethan 00:51:14 Yeah.

Nicole 00:51:14 Thank you guys for inviting us on.

Ethan 00:51:18 Yeah, I learned a lot. And that's kind of the goal of these things. So excited to do it again and we'll pick another exciting topic. And yeah, appreciate everyone's time.

Nicole 00:51:28 Love it. Thank you.

Gabriella 00:51:30 Thank you.

Ethan 00:51:31 Take care.

Simone 00:51:32 Thanks for tuning in to the Flychain Reaction. If you'd like to keep the conversation going, feel free to contact us at info@flychain.us or schedule a demo through our website at www.flychain.us. See you next time!

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