HOW TO ETHICALLY ADDRESS PAYING RBTs and BTs for CANCELLATIONS?

I recently had someone reach out to me with this statement:

“People will just expect that financially employers can just pay for canceled sessions when we often cannot. We can’t survive if we pay people when every session is canceled.”

To this, I would respond yes and no. As an entrepreneur, it is up to us to absorb the business risk because we are the beneficiaries of the reward. So developing and implementing risk mitigation strategies become very important when you own your own business. But this means that you have to understand the risk factors.

Given the nature of the ABA Provider business, it’s critically important that a business be well-capitalized to ride out not just the challenges with insurance and payor reimbursement but also competition for talent and competition for clients from larger, much better-funded competitors, particularly those owned by PE-backed companies.

Another way to mitigate the client cancellation risk is to establish clear boundaries, discuss acceptable behavior and explain the consequences to all involved parties (child, parent, agency, BT/RBT, BCBA, and funding sources).

An agency that I consider to be one of the best in the country spends an inordinate amount of time on client selection. Their intake process is extremely thorough and takes into consideration the needs of her staff members as well as the needs of the client. Expectations are covered in detail and frequent reinforcement is provided. All this work is done ahead of time because there is a cost to the business and people when client turnover happens unexpectedly.

A question to agency owners… “Do your parents understand the consequences of unplanned cancellations to your organization and BTs/RBTs? If they did, would their behavior change?” If the answer is a “no” I would consider whether your client selection criteria need to be reevaluated.

On the r/ABA Reddit form, BTs and RBTs are talking among themselves about whether to have these types of conversations directly with parents. But the responsibility to have these uncomfortable conversations shouldn’t fall on the lowest ranking member of the clinical / leadership team.

Client selection and client relationship management should be a workflow that is looked at closely in any organization. Are your clients happy with their child’s progress? Do they know how to measure progress? If they don’t, why not?

There’s an entire section in the 2022 BCBA Ethics Code – Section 2 – Responsibility in Practice and Section 3 – Responsibility to Clients and Stakeholders that addresses these areas but based upon anecdotal evidence, the field seems to be far off the mark.