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I wanted to share this exchange I’m having with a BCBA on Reddit…


Part of the reason for the tiered model is that the bulk of direct work in an EIBI program takes very little skill. I can train someone to implement one of my programs to high-fidelity in an afternoon. I’ve been practicing for over a decade and sometimes parents or new techs are genuinely better at direct services than I am. In terms of learning outcomes, the actual difference between an excellent tech and an average tech is pretty low.

It’s difficult to measure outcomes, they can be easily fudged, and reimbursement linked to outcomes would only encourage client pre-selection.

Also, client pre-selection and “cookie cutter” approaches is typically good for the field and the consumer. If a standard cookie is what 80% of your clients need you can pump out standard cookies and have a separate kitchen/refer out the other 20% for bespoke cookies.


Certainly, for any business, standardization is the goal because it drives efficiency, which reduces costs. But in our field, when we’re dealing with people, how do we make sure that the outliers – i.e. difficult cases – are also getting services when the profitability model clearly favors standardization?

You mention referring out. Maybe that’s the model that the field needs to move to – agencies that specialize in difficult cases, reimbursed at higher rates to compensate for the greater degree of specialization. Similar to the medical model.

But since our field isn’t currently set up this way, how do we make sure that the “difficult cases” are not being passed over for the easier EIBI cases? Incidentally, this seems to be the trend, especially in many large agencies.


QUESTION… Do you think it’s unethical for a business to cherry-pick cases? In any other industry, it’s the prerogative of a business to decide to whom they want to provide services.

But in the field of ABA, with an existing system with ABA organizations that were previously set up to treat all levels of challenges across the board, what impact will this bias towards EIBI cases (i.e. cherry picking) have on the lives of clients who fall outside the norm?

Whose responsibility is it to ensure that consumers with challenging cases are getting access to services they need in a timely manner, without being discriminated against when the economics of the business clearly favor standardization?


Parent Waitlist Program


November 02, 2023 | 12pm-1pm PDT

Journey to Independence

Community-based program designed to support families on waitlist

Being an RBT for me was extremely fun because where were you going to find a place where you can be completely silly without having to worry what people thought about you? This was the only job that made me feel like I could make a dramatic difference while being myself.

I also liked to be surrounded by people that had the same goals of wanting to help kids and the teamwork made the job much easier and more enjoyable.

Change and progress was the ultimate goal for our kiddos. The early intervention program was seriously only a miracle because I saw changes in the kiddos that from day one, you wouldn’t even recognize who they were.

Changes from being able to utter 3-4 words where they can only make a syllable from when they started, the behavior decreases in which kiddo that used to engage in 30-40 0 self-harm to only half, learning how to wait during games, table work where they use to swipe and drop to the floor if they had to.

My favorite was when the parents would tell us what amazing progress they were making at home. I used to tear up and felt for these parents so much because it was already difficult for them and now, they can trust and rely on ABA and the therapists knowing their goal was ours.

By Emma Rogers, BA, RBT

Mother Child
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