Brandon Herscovitch, Ph.D., LABA, BCBA-D
Partners Behavioral Health can help position your ABA practice for standards, success, sustainability

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The purpose of generating scientific research is to better understand things and help people.

Synthesis and interpretation of scientific research is an important action toward that end.

I feel as though I’ve observed increasing inconsistency and greater liberties in how this occurs.

Some reference and ascribe credibility only to the research that supports their position, while disregarding or devaluing more reliable research.

Subjective and inconsistent critical analysis and valuation of research quality seems to be commonplace – its robustness, perceived conflict among authors and journals, appropriateness and quality of design, reasonable interpretation of findings.

Some don’t understand or value the importance or implications of the peer review and publication process and findings.

Some interpret findings very broadly, and others very narrowly.

Some accept one article of questionable robustness to substantiate their position but hold differentially higher standards for others.

In evaluating and interpreting research and its implications, some conflate experience, evidence, expertise. Some take offense to calling out the difference between these things. Some present these as competing rather than valid in their own right.

I feel like this is representative of a trend. A trend to invoke scientific research and findings for personal agendas over the interest of pursuing scientific advancement and the interest of others.

This seems to be, at least in part, the result of greater occurrence and acceptance of inconsistent and subjective interpretation and critical analysis of these and other factors related to research and findings.

I believe the items listed here can contribute meaningfully to the anti-science and pseudoscience movement and ideology.

I’m not suggesting the better part of our community is doing this intentionally, or that motives are bad.

Maybe it’s lack of, or inconsistency in, education.

We are all susceptible to this.

Before we address this, however, we need to have collective shared value around whether this matters and our standards around it.

What do you think?

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Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

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ABA has a lot to offer when it comes to understanding and helping people, and positively impacting the world around us. Our science is evidence based, it works, and our practitioners care deeply about the people we support.

Many people have demonstrated significant improvements in quality of life as a result of ABA services, but some have been hurt in the evolution of our practice.

The former in no way justifies the latter, but understanding and addressing the issues at hand in a vacuum has problematic implications looking forward.

The purpose of this article is to provide context for some common critiques of ABA and strategies for overcoming them.

WERE/ARE THE VALUES OF ABA PRACTITIONERS COMPARABLY WORSE, BY TODAY’S STANDARDS, THAN OTHERS?

As times change, healthcare and educational standards change with it. What we consider as “best practices” and socially acceptable practices change over time. Some therapeutic or medical procedures, language, and ideology that once prevailed are no longer acceptable.

Across all aspects of life (religion, medicine, education, parenting) normalization was a common goal, punishment was an accepted practice, and the concept of patient-centered care, at least as interpreted by today’s standards, was relatively foreign.

The actions and belief systems being called into question today are part of a broader cultural ideology from a time and mentality that’s fading from popular culture. These things are not, and were not, specific to ABA.

One could look to psychiatry, medicine, psychology for analogues in healthcare. In education, teachers, principles, psychologists, and others were all part of the same value system. It wasn’t uncommon in schools for educators and administrators to implore behavior analysts to prioritize aversive procedures such as extinction, time out, and punishment procedures, where those same behavior analysts sometimes advocated instead for reinforcement based procedures. In fact, this was an important part of positive behavior support’s history.

I strongly encourage behavior analysts who’ve only started practicing in the last 10 years or so to speak to parents and a variety of professionals if they question this claim. (Be sure to approach this systematically!)

“TODAY’S ABA”

Dr. Hanley provided context for “Today’s ABA” in his post “A Perspective on Today’s ABA From Greg Hanley” (linked below). He elaborated on that in a Behavioral Observations podcast (Session 160, also linked below).

I thought Dr. Hanley very nicely characterized the evolution we’re seeing in collective ideologies, values, and practices.

That said, I believe the manner in which some members of our community have carried that forward may prove counterproductive.

My concern is with the rebranding of our discipline around this terminology, and how some who embrace this rebranding contextualize it relative to our practice and history in the broader context.

The defining characteristics of ‘Today’s ABA’ aren’t the product of some cladogenesis, or some sudden shift away from yesterday’s practices by today’s enlightened professionals. They also aren’t specific to ABA, despite anti-ABA propaganda embraced and perpetuated by some people in and outside of our field, that would suggest otherwise. They are the result of our science and practitioners knowing more and therefore doing better. That’s an ongoing learning process and part of any discipline’s evolution.

These changes may be due in part to advances in evidence based science/research, change in collective societal values, and feedback from various stakeholder communities.

Messaging to suggest values or standards now being called into question were specific to ABA are misleading, and have adverse implications.

Specifically, impacts are erosion of trust in our science, our discipline, and our colleagues, and subsequently steers prospective beneficiaries of ABA services away from effective, validated, evidence-based services that can positively impact their quality of life.

FURTHER CONSIDERATIONS OF ALTERNATIVE TERMINOLOGY FOR A DISCIPLINE DISTINCT FROM ABA

For those embracing the concept of a new ABA as a means to address the segment of autistic adults who harbor anti-ABA sentiment due to personal experiences, consider how this approach may seem insincere. It might present as a public relations stunt to disassociate from outdated and hurtful practices, and draw effort and attention away from more actionable alternatives.

Treating “Today’s ABA” as some terminus rather than just where we are in our discipline’s timeline risks drawing focus away from “tomorrow’s ABA” and the wonderful science yet to come that will make what we’re doing today appear as going the way of the dinosaurs.

Johnston, Jacobson, Green, & Mulick (2006) discuss what I see as a comparable ‘campaign’: Positive Behavior Support (PBS). They also discuss some of its movement’s implications – pros and cons – which can apply here as well.

There is still work to do and there always will be. Surface level rebranding efforts don’t equate to real action, and even risk dismantling and therefore minimizing the collective historical and potential future impact of behavior analysis for the short term gain to any one generation of practitioners and businesses.

Science and practice are ever changing and improving. When tomorrow comes (i.e. as we learn and improve), today’s ABA will inevitably become yesterday’s ABA.

There will always be stragglers. Those who fall into this category won’t realize it. Nobody says “hit me up if you want 80’s style therapy”. People will inevitably assume they are offering the highest quality and most current practices. It would make sense that over time, the newly adopted language will lose its meaning.

NECESSARY ACTION

In my view, we need to play the long game, and the long game ain’t always easy. We need to accept responsibility when applicable, learn, and improve. As the saying goes, ‘when you know better, you do better’.

Quality will be demonstrated by engaging in practices that are based on the best and most current scientific evidence and also prioritizing and reporting out on measures that align with client/patient standards. The prevailing community of autism service providers have evolved with our culture’s predominant ideology to prioritize concepts of patient-centered, value-based, and compassionate care, (regardless whether they use that terminology), but we’ll continue to do even better as we learn more. “The proof is in the pudding”.

This doesn’t mean we don’t focus on our ‘brand’ and effective marketing of our science and discipline. Just that we are more thoughtful in doing so. Perhaps a greater shift in emphasis to patient-centered outcomes. Not at the expense of, but in addition to other clinical outcomes.

Consider your website’s landing page highlighting “clients meet x percent of their treatment goals and report a 5 out of 5 on their experience and satisfaction with our team! Their parents report the same!”.

I believe that keeping ethics and client/patient values, experience, and satisfaction as guiding beacons for our research and practice, and central to all that we do and all that we are, is bound to best reflect our sincerity and achieve the best long term outcomes all around.

SUMMARY

As I reflect back knowing what I do now, there are extinction bursts I would have avoided, autistic client voices (including those who were non-verbal) I would have weighed so much more heavily, and treatment plans I would have approached differently. I don’t say this lightly. I remember, and so I’m confident my clients do too.

But there are also people who I know have good memories. People who are doing things now, it was said they’d never do. People living safer and healthier lives and having opportunities and successes they’d have otherwise not had. Autistic adults and parents I’ve spoken to who praise their therapists from years ago.

I have memories of schools whose policies and practices I was able to help shift toward more appetitive and reinforcement based practices. I did this working with, not against, district educators and administrators.

This isn’t justification for any outdated, hurtful practices. It’s a basis for a more balanced historical context.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health supports ABA practice leaders and advocates for our discipline.

REFERENCES

Johnston JM, Foxx RM, Jacobson JW, Green G, Mulick JA. Positive behavior support and applied behavior analysis. Behav Anal. 2006 Spring;29(1):51-74. doi: 10.1007/BF03392117. PMID: 22478452; PMCID: PMC2223172.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223172

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Partners Behavioral Health: improving standards in the discipline of ABA.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

The post Is applied behavior analysis (ABA) a woman dominated field? appeared first on Partners Behavioral Health.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

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I’ll start with the problem. This question as asked in the title, just doesn’t provide enough context.

The reality is, it depends on various factors.

👉 Client treatment dosages and treatment model: The number of clients you can reasonably manage will be directly and meaningfully impacted by service dosage of those clients.

👉 Job responsibilities: What other roles or expectations do you have beyond client time?

👉 Location: Are those services delivered in person or via telehealth? Are they center, home, school, or some combination. If it’s not all at one location, don’t forget to factor in drive time.

👉 Business mission/model: Different businesses may be set up to meet the different needs of their community and target population based on their available resources.

👉 Funder type (and funder expectations): School? Waiver? Insurance? Grants? Different funders may have different expectations or obligations.

👉 Total job time expectations by employer/employee: Whether expectations are for 20 hours, 40 hours, or more or less, will impact the total client caseload.

👉 “Intensity”, or effort relative to compensation: In the past, I’ve had employees who would rather work more hours, or have a more dense schedule, and get paid more. Others preferred a less stressful schedule, and would be fine with a lower but still fair base compensation. Obviously compensation structure comes into play here, but again, it’s an important factor in doing a fair comparison.

There definitely are some commonalities as you narrow down these factors. For example, one can make more informed assumptions looking at center based insurance funded comprehensive service models as compared to school based/funded IEP driven caseloads. Obviously these are two extremes but you get the point.

It’s nice to know others’ assumptions, but it’s just as important to do an apples to apples comparison, and ultimately base your decisions on your specific situation.

What factors do you feel I’ve left out?
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Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about. 

The post “What’s a regular caseload for a BCBA”? ➕ ➖ ➗ ✖ appeared first on Partners Behavioral Health.

Partners Behavioral Health – higher standards, brighter futures.

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For clarity, none of the following is to be considered investment advice.  

The Role of a Bank Line of Credit in Funding an ABA Practice

One of the most common options for financing an ABA practice is through a bank line of credit. This revolving credit option offers businesses the flexibility only to pay interest on the portion of the utilized loan. Not only does this lower interest payments, but it also provides your ABA practice with the necessary liquidity to keep operating. A bank line of credit often serves as a bridge between receivables and unforeseen expenses that may arise in the day-to-day operations of your practice. Each bank will have different requirements to qualify based on income, personal net worth, and more. If you qualify this can be a tremendous founder-friendly financing option that allows you to keep more ownership in your practice. Lines of credit can vary in size between $10k-250K (or more) and can be approved in as little as one month. 

SBA Loans: A Low-Cost Alternative for Financing ABA Practice

Next up on the list of financial options for ABA practices is SBA loans. They come with a long and detailed underwriting process as a low-cost alternative. The US government backs a meaningful percentage of SBA loans allowing the bank to increase their risk profile, making it possible to get funded. The downside is that the loans typically have strict protocols, limiting flexibility on the use of the proceeds. If you need a long-term loan, an SBA loan can be an excellent option for your ABA practice. Lastly, please note if your loan is over $350K the SBA and bank fees may add up, negating the low-cost advantage. 

Friends and Family Capital: A Classic Source of Small Business Lending

Turning to friends and family for financial support is a time-tested strategy for small businesses, including ABA practices. Given the personal ties, terms are often flexible. However, these relationships might be strained if the company encounters difficulties. Before accepting money from friends and family, it’s critical to imagine the stress that could come if things don’t go well. For many, it’s too much responsibility and can be detrimental. On the other hand, many of the best companies in America were founded with investment from support from family. If you go this route, communicate frequently, give monthly updates, and distribute dividends on time. The key to success here is communication, clarity, and honesty. 

Factoring: Flexible and Fast, but at a Cost

Factoring financing is another avenue for ABA practices that refers to factoring companies paying outstanding invoices quickly to limit receivables and give you cash now. The factoring company makes money by charging a fee of 2-10% (or more) of the invoice when the customer actually pays. The advantage here is the speed of underwriting and the flexibility in negotiation and expansion options. The downside is that these benefits come at a higher cost. Despite the price, factoring remains an attractive choice due to its extensive advantages, and it’s essential to consider that the term “expensive” should be viewed in context; if you need cash quickly, paying a higher rate might be worth it. 

Merchant Cash Advances (MCAs): A High-Cost, High-Risk Solution

Lastly, we have Merchant Cash Advances (MCAs). This financing option comes with very quick underwriting and funding. Yet, MCAs come with prohibitively high costs. They can be dangerously addictive, with the risk of the business potentially going under. As such, it’s difficult to recommend an ABA practice to secure an MCA.

Equity Financing

Equity financing involves the exchange of a portion of your company (shares) for capital – it’s the partial sale of your company. It may be a good option if you need cash but also can offer strategic advantages. Equity financing may come from different sources such as investors or family or friends. Aligning yourself with investors who share your personal and professional values is essential. Preparing in advance for this arrangement can help maximize your financial value. (Let me know if you have questions about this).

Final Thoughts

Financing an ABA practice is no small task, and choosing the right financing option cannot be overstated. Whether it’s a bank line of credit, SBA loan, friends and family capital, factoring financing, MCAs, or equity financing, each has its pros and cons. Therefore, it is vital to analyze the needs and capacity of your ABA practice before selecting the best funding option.

Very importantly, working with a professional you trust cannot be overstated!

Remember, you aim to secure a financial solution that addresses your immediate needs and provides the stability and growth potential that your ABA practice deserves.

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Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Financing an ABA Practice: Exploring Your Options appeared first on Partners Behavioral Health.

Fortunately, there are numerous experts available who have successfully navigated this path. When seeking guidance, select professionals who have relevant experience and collaborate with diverse industry peers. These professionals can provide valuable insights readily accessible to those closely involved with different providers in various markets.

Remember, by tapping into the wisdom of these experts, you can gain a competitive edge, avoid common pitfalls, and make informed decisions that contribute to the long-term success of your ABA practice.

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Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health offers business services, resources, and advocacy. Our team includes leaders with demonstrated success in ABA as well as more established healthcare disciplines.…let’s chat!

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Autism is heterogeneous, and for some autistic people, aspects of their autism experience are disabling. 

Anti-disability narrative, efforts to distance autism from disability, and perpetuating use of the term disability in a pejorative manner, can have unintended and undesirable consequences for some people. It can:

• Lead to others minimizing or invalidating the experience and needs of those who identify with that aspect of their autism experience. 
• Create barriers to accessing supports or services for those with disabilities.
• Build unproductive or problematic stigma around disability.
• Shame those who identify with disability, which has other implications for health and wellbeing. 

For others who either by legal or medical definitions or based on their own experiences do identify with autism as a disability, it’s important we respect, validate, and support them and their autism experience, even if it’s not reflective of others’. Similarly, those who have different experiences deserve the same respect and validation.

A label of disability affords certain rights and protections to people who need them. A great deal of time and effort has been invested in improving rights and protections for people with disabilities, and it would be sad to create additional barriers or strip autistic people who share those needs of those rights and protections.

There is no shame in disability. Let’s not make it a bad word.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post An anti-disability narrative around autism can be harmful appeared first on Partners Behavioral Health.