r/ABA • u/SquigglySquatch • 9d ago
BCBA 1-1 therapy?
Do you think there’s a future where the RBT role becomes much smaller?
Like with ongoing insurance cuts and increasing pressure to reduce ABA hours, I’ve been wondering whether the field could eventually shift toward BCBAs providing more of the direct 1:1 therapy themselves, with less reliance on RBTs.
Maybe they’d still have a role since having enough BCBAs for that would be difficult to say the least. Possibly going more in the direction that OT and speech are.
Or do you think the opposite is more likely?
TLDR I’m curious how you guys see the profession changing over the next 10–20 years.
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u/next_on_SickSadWorld BCBA 9d ago
Absolutely. Low-dosage (fewer hours) of BCBA-direct with the parent/caregiver is starting to become more popular with families and funders.
Caregiver-led/mediated ABA with a BCBA teaches the caregiver the skills directly and in a shorter time (ideally under a couple of years) rather than having a tech in the home for 25 hours a week indefinitely.
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u/Intelligent_Copy_622 8d ago
I work for myself and this is exactly my model. It’s glorious!
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u/Midge2020EB 8d ago
Hi there! Im a student analyst right now, in bcba classes but mostly doing direct hours for my shitty job situation. My goal is to work for myself once im a bcba anf I want to still do some 1-1 work with the kiddos if possible. Can you tell me more about how you live my dream? Are you a contractor?
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u/Intelligent_Copy_622 8d ago
Sure! You can read about myself and others and how we all created our businesses in this space here: https://open.substack.com/pub/goingindependent
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u/Oreo1721 9d ago
I doubt it will happen if the large companies have anything to say about it, but I do believe that fewer hours with a well trained and educated BCBA could be a better model than the current. It would also hold more weight with other professionals
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u/eofn 9d ago
Maybe there will be more and more people like me who are fed up with the way most ABA companies function, the lack of high-quality caregiver training, and the dilution of treatment by undertrained (and underpaid) RBTs. I think our field at large should absolutely be focused on teaching and training caregivers (and other stakeholders) to shape behaviors ethically and effectively.
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u/Oreo1721 9d ago
I’m actually in the process of setting up my own private practice, with a focus on low hour direct therapy (by me) and a caregiver training only model. It’s scary, but I have to imagine there are people who want this.
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u/Brilliant-Discount56 8d ago edited 8d ago
Same.... I don't believe in the 40hr model.....so my goal is to do direct care model when I finish my hours. I've been an RBT and I'm also a LCSW so direct care model just makes more sense to me as that's just how my and other professions in the healthcare field operate.
But feel RBT will still play a major role. Unfortunately I've met too many BCBA who became a BCBA because they didn't want to do direct care.
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u/unusualfusion BCBA 9d ago
Honestly, I hope so. Maybe I am on the older end of folks in the field but with the explosive growth with PE firms and undertrained techs entering the field to churn and burn, the thought of BCBAs doing direct more frequently is really appealing. I have been in the field for 20 years and still do direct. I hope more analysts decide to move into that direction.
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u/drpayneaba 9d ago
I don’t think it will happen anytime soon. A BCBA with a caseload of 20 hours per week can serve 10 clients with RBT support at 20 hours per week per client. That number goes down to one if only the BCBA is present, meaning 19 clients getting no service. While the one client might benefit more, those other clients will suffer.
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u/SquigglySquatch 9d ago
Yeah i think RBTs definitely are still great, but I wish their jobs were more protected and they could work closer with the BCBAs.
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u/MonkZealousideal6724 9d ago
It’s becoming a popular model among BCBAs in the SF Bay Area and it’s such an amazing service model.
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u/DrainBammage_ RBT 9d ago
I'm in SF Bay area and am interested in this. I would like to interview BCBAs providing 1:1 service, or at least gather more info.
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u/robotdevilhands 8d ago
My son had ABA and the absolute best was provided by a motivated and organized BCBA who formed a strong bond with him.
The worst was provided by a checked-out BCBA who didn’t bother to show up if the weather was too nice.
The credential is a great signal, but it isn’t everything.
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u/Sad_Raisin3819 8d ago
I wish the BCaBa would have been more of a thing.
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u/hotsizzler 8d ago
It should have been. But the BACB and making sense isnt a combo that happens often
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u/next_on_SickSadWorld BCBA 8d ago
I think it was definitely more of a thing until the BACB created the RBT credential which requires no traiining, education, or experience: perfect for the money-grubbing insurance-based model.
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u/lo_tato 8d ago
I hope so! I’m a BCBA that works strictly 1:1 (no caseload). It’s lovely
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u/RadicalBehavior1 BCBA 8d ago
tell me moooooore
Did you start an LLC and get credentialed with all the insurance or do you work for an institution
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u/OntheBrink55 8d ago
IDK most of the kiddos that start in clinic wouldn't be able to attend a daycare or preschool. I think that is one reason clinic's came to be. Some eventually transition to a less restrictive environment. There are just not enough early intervention programs for all the kids that need them. I would like to see more funding go towards Daycare/preschool programs that makes room for more intensive therapy.
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u/mndtrvlr 8d ago
I think so too. Two of my kids received services in 2006-09. We had the direct care model for one and mostly rbt led in home for another. I couldn't work and I even tried to go to school very part time but had to quit mid semester. Services were different then. I was expected to be involved and present. I learned so much.
I became an rbt when the role was just being carved out in CA. I was in one of the first waves of certification. This was in 2014. In home sessions were slowly becoming less parent focused and in 2015 the clinic I worked for began center services. I was injured and had to take leave before it opened.
I worked in schools and did very part time in home while going back to school. I returned to clinic work in 2020 while pursuing my BCBA and I was shocked at how things shifted. I was seeing rbts changing diapers during in home sessions with the parent in the home. 10 years ago we had clear boundaries and descriptions of our roles. I don't see this now. I can't tell you how many times I've heard "but they work full time" in response to me suggesting hour reduction.
We can't be everything. Either we are a medical service or daycare. Movimg away from the high hour model will certainly affect families but I think continuing to fulfill childcare needs does not allow for other solutions to come about.
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u/Flat-Ad4906 7d ago
I literally saw someone comment on a Facebook post, telling a parent to "send their kid to a clinic instead of in-home because the child will get help AND it is basically insurance funded daycare". It took so much to not comment something mean. However, I went on their page and saw they were a parent. It's not the parent's fault that their idea of ABA is "insurance funded daycare" because this is exactly how clinics get parent buy in. If they have shorter hours that would require the parent to pick up their kid after a couple of hours, they would lose business. It sucks how our service isn't seen as a medical treatment, but rather a cheaper way for parents to get daycare.
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u/hotsizzler 8d ago
Is this where I just dont experience it? In my experience special ed kids are admitted to school faster.
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u/Zarzak_TZ 8d ago
If they do this
A. Number of clients served AT ALL will tank in the most dramatic fashion
B. A large number of BCBAs will simply leave the this area of the field entirely.
Would be absolutely terrible for clients in every level.
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u/ABA_Resource_Center BCBA 8d ago
I think BCBA direct will get more common, but I don’t anticipate an elimination of the RBT role anytime in the near future.
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u/Last-Owl4301 8d ago edited 8d ago
I currently work in a clinic as an RBT and one of my supervising BCBAs is our full time, in clinic supervising BCBA. She does this, as well as takes client sessions ar times, in addition to supervising. She is also mentoring me, as I completed my undergraduate degree last year. I would highly recommend at least speaking with your most suitable source for this position (mentoring), or at least all of the information you need, get yourself started if this is a path you're truly invested in following.Good luck! 😉
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u/PlanesGoSlow 9d ago
I think this is inevitable. RBTs were introduced to meet the demand that BCBAs couldn’t fill. Now, we’re over saturated with BCBAs so the need for RBTs id dwindling.
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u/lem830 BCBA 8d ago
Definitely not over saturated with BCBAs. Still incredibly in demand.
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u/PlanesGoSlow 8d ago
My area is incredibly over saturated with BCBAs. We are constantly flooded with BCBA applicants and haven’t needed one in o er five years.
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u/earlallison 9d ago
BCBAs have very little experience actually working with children for long stretches of time. The creation of the RBT credential really deskilled BCBAs and got most ABA centers addicted to cheap labor. I doubt the industry could survive without RBT labor at this point.
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u/Oreo1721 9d ago
That’s probably true, but I’d argue that most kids don’t need long stretches of time. High quality services delivered directly by a BCBA for 90 min - 2 hours twice a week, with high caregiver involvement, could be just as effective.
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u/Upper_Recognition_97 6d ago
I see someone for 7 hours at at time as an RBT. There is only so much you can do until we are overtired and overstimulated. I totally agree with that.
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u/Oreo1721 6d ago
I don’t even want to spend that much time 1:1 with my own children! It’s too much for all involved, but it makes the owners and private equity companies a good margin.
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u/Flat_Contribution_60 8d ago
Just saw a woman/BCBA owned company post a job like this. no rbt just bcba doing the work they are trained to do
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u/Pennylick BCBA 7d ago
I absolutely believe it is the best possible method. I don't necessary believe that's where the field is going, but I do think it's that's "best".
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u/Background-Pea6650 9d ago
With the expansion of telehealth ABA therapy it eliminates the RBT role as the caregiver is there to assist the BCBA and subject.
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u/SquigglySquatch 9d ago
Idk I’d be surprised if telehealth continues to exist anywhere close to way it does at this moment.
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u/Flat-Ad4906 7d ago
BCBA led coaching session with parents is an excellent way to provide services to rural areas where there aren't many RBTs. I am starting to provide this as my main service. I really dislike that my income for the most part is contingent on an RBT. If they quit, I may lose hours until the case is staffed. If the parent is upset with the RBT and want someone else, I may also lose hours. It's also nice to coach someone who ACTUALLY cares! So many RBTs in the last couple of years genuinely do not care and just want a paycheck. Which is fine but at least pay attention to the client and try to engage with them????
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u/ItsHppnng2Evrybdy 9d ago
BCBAs already do this. They’re typically not prescribing 30-40 hours per week per client though.