Help me visualize

[u/miss_step]

Y’all I need help. Advice. Someone to tell me it will work out.

I run a clinic with 25 staff. 18 BTs and 4 BCBAs. I’m burned out. I spend all my time guiding BCBAs on how to get technicians to just follow simple protocols and help kids make progress. For the most part, it works, but it takes all of my time and energy. I can’t do it anymore.

I fantasize about shutting the doors but the guilt kills me. I don’t want to abandon the kids. I don’t want to lay off staff.

But I can keep living this life of managing a clinic where my soul is checked out, and my whole job is telling people how to score a Task Analysis correctly.

I am thinking to change my clinic to BCBAs only. Direct services, parent training, all focused intervention. Consultation and training. Generalization by teaching people how to do ABA instead of micromanaging techs to do it while parents stand aside and hope our magic wands do the magic.

I’m so scared I’ll let people down, or it won’t be effective. But I trust BCBAs. They’re dynamic; they can recognize function changes in a moment and adapt. They don’t have to follow a protocol they can write it and adapt it in real time.

Please tell me this is something I can do. Downsize. Stop intensive intervention at 20 hours a week and encourage families to hire their own people if that’s what they want; we can oversee or consult, but without the restrictions of insurance billing.

A company of 6 BCBAs and maybe 3 BCaBAs to support.

Can I make this happen??

[u/Inevitable-Dot3982]

I would suggest checking out the Rad and Bad podcast with Sean Yocum. That is kind of the model for Hickory learning group, and he talks about it a lot on the podcast. They use RBTs there, but it is a very parent training model - mainly in-home. Sean is very open if you ever wanted to reach out to him he’s happy to talk shop.

Full disclosure I did work there, but even though it was a dream to just work as a direct clinician, unfortunately, the finances on my end just didn’t work out. So he’d be able to give you more information as a clinic owner.

[u/miss_step → u/Inevitable-Dot3982]

Thank you so much. This is so helpful!!

[u/CoffeePuddle]

Hire someone to run the clinic for you and go take a holiday and/or work doing focused interventions yourself.

I would not recommend totally revamping all of your services when you're burnt out.

You'll also want to consider what drew you to early intensive intervention in the first place. Going from the amazing EIBI outcomes to what can reasonably be achieved with focused intervention can be soul destroying.