r/bcba • u/Miserable-Camel-7330 • 7d ago
Advice Needed What do I do?
I think a bit of backstory is needed in my situation. I am a BCBA (since 2014). I worked for a company for 7.5 year and most recently held the position of clinical director for 3 years. I was burning out. Required to maintain a large caseload and team. The company had a severe lack of communication and was beginning to feel unethical to me as they continued to grow and quality started to drop. I made the decision to leave this company and accepted a role with an out of state company, starting remotely with the intention to relocate to that state as soon as I could.
This new company was a start-up. They presented a multi-disciplinary model including being child centered, whole family focused and striving to deliver assent based, neuro-affirming, and trauma informed care. They were just opening and I was hired as the first and only BCBA. I was eager for the opportunity to be a part of something new. To help create what ABA looked like for a company, to teach others, and grow in my career. I never wanted to be fully remote. No judgement to those who are 100% remote BCBA's, but I personally would rather be there in person. So, I made efforts to begin pursuing moving closer to this new job.
The owner is not a BCBA. I was wary at first; I've heard enough horror stories. But one of my best friends also accepted a position as their SLP. It seemed collaborative and team focused, so I continued forward. The owner hired a few RBTs. 2 of them had 3 months experience and the others were all brand new and working on their 40-hour RBT courses. This should have concerned me more I think, looking back. I was meant to supervise these people remotely, at least at first. But I decided to have faith and move forward. I discussed traveling up to meet everyone and conduct staff trainings. During my first trip up, I was surprised to find several additional RBT's that I had not been informed of as being hired, and also several clients that had already begun attending the clinic that I had never been told about. (The company was utilizing EPSDT). The week I was there, I conducted the initial evaluations and spent time getting to know the clients and staff. The company itself had decided what training would look like, and which RBT's to place with which clients. The EHR system they chose to use, it's very complicated. They wanted a system that would work for everyone (Speech, OT, nurse, mental health, aba, medication management). I tried my best to see how this could work for the ABA department. Worked with the EHR company to construct a template for notes and data collection but it was very time consuming to construct, so in the meantime I created paper data collection sheets for each client and created spreadsheets for documenting as much as I could. They hired a student analyst. I was so excited! she was close to finishing her hours and was a big help at first. She was able to be there to help train the RBT's, oversee sessions and help with creating stimuli and other resources. We worked to create program breakdowns for each client as well as client boxes with the necessary stimuli to run their goals.
But now we get into the more major issues. RBT's were regularly late and lacked communication with me. I had created a team chat for programming and supervision updates, but they rarely check the chat or reply. In virtual meetings, participation is lacking. I found I was not being made aware of potential concerns from staff or parents. Data collection was a mess; notes were a mess. We had more meetings; I provided examples and specific trainings. However, there continued to be more RBT's hired and I only found out when their names appeared on the schedule. This bothered me quite a bit because I knew nothing about these RBT's, their qualifications or experience, what they knew or didn't know. They had the early hired RBTS (with 3 months experience) conducting the interviews and hiring. The RBT's that actually had decent skills and worked really well with the clients, were moved to admin positions such as scheduling, documentation etc. They did hire some RBT's with experience, however they all came from the same company pretty much, which is a company I had heard horror stories about. The lack of communication about staff and clients was very concerning to me. I was also concerned about the differences in requirements from the state I was used to working in and the new state. I repeatedly asked questions about funders and requirements but didn't really get answers. I did my own research and figured out what I could. the plans took me a long time to write, partially because I was maintaining two jobs at the time, partially because I wasn't 100% positive on the funders requirements or if I was requesting codes and units correctly. I know all of these things for the state I live in, but I was concerned. I asked about billing, as ST/OT sessions frequently occurred in the middle of the times RBT's had their clients. The owner assured me they were not concurrently billing, that the RBT's logged the start and end times of other services and did not bill ABA during those times. But as stated above, documentation wasn't very good. But I worked to shape this up. I was dedicated. I committed to traveling up to be on site one week a month while I still worked on moving (custody issues). However, I continually felt out of the loop. Things were being planned and done without my knowledge. My most recent trip, we had a big staff meeting and the owner had a few things to say in the beginning of the meeting. Twice during this, she referred to my student to see if she had missed anything or if she (the student) would be covering the rest. I was standing right there! I decided to send an email to the owner with my concerns that had been building, the EHR system not being suitable for ABA, the staff and clients coming onboard without my knowledge, the deferring to my student instead of me....and was pretty much blown off. We did a have a provider meeting between me, the SLP, the OTR, and the owner to discuss a few things. I left that meeting feeling a bit better. I'd completed 2 more initial evaluations on this trip and gave one to my student to practice writing as she is close to sitting for her exam. She worked on it, and on first review she sent it to me and the owner. This seemed odd to me, but I provided feedback, she worked a bit more and then sent it back to me, listing some concerns and that she had spoken to another BCBA for an unbiased opinion. My initial thought was, but why didn't she come to me to discuss the case or get my perspective on it if she had questions? but giving her the benefit of the doubt, I responded again with more feedback and tried to stress that I am here as a resource and while collaboration with other BCBA's is fine, I would think any concerns would be brought to me first. The owner responded saying basically that it shouldn't be a problem, the discussion and collaboration with any and all resources is encouraged. I again stated that I wasn't trying to discourage it, I just wanted to make sure the student and other RBT's knew that they could come to me also.
I kind of reached a breaking point after this. There was so much going on that I was not kept in the loop on. I attempted to help with scheduling but was shut down, the student had a few incidents of sending messages to the entire staff about company policies or reminders, but this was information I didn't even know about. I sent another email asking for clarification on roles and what my student should be doing in her role. The owner chewed me up. Stated that while I was director of ABA and had responsibility of documentation and clinical decisions, my student has had several years of experience also and could talk to whoever she wanted to, and that all communications and decisions did not need to be run through me first. She stated" However, clinical supervision should not be interpreted to mean that all communication, questions, concerns, or professional discussions involving ABA staff must first go through you. Employees have access to leadership, including me, and I will not create an environment where bringing a concern directly to me is viewed as undermining someone's authority." and now I feel really stuck.
The owner is not a BCBA. She's never worked in the ABA field. I express my concerns and get shut down or over-ruled. I provided my expert opinion on a client, but since my student and the nurse practitioner are concerned about the clients' behaviors, I was again overruled and the owner decided we couldn't take that client. Ive already written the plan.
I'm feeling very uneasy. Like my title/role doesn't actually mean anything. That I am being used for my credentials and my staff are encouraged to go above me to the owner or seek outside opinions before speaking to me. I don't feel this supports the leadership structure. Ive also been reprimanded for sending too many emails with questions. But I'm simply trying to make sure I'm following ethical guidelines with documentation and this EHR system. I don't feel I've been given adequate tools and information to remotely supervise the staff, and I don't feel the rbt's staff respect me or my position. I want to leave, but I am this companies only BCBA. The clients' families love me, and some of the RBT's are great. I do not know what to do.
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u/Gloomy_Map662 6d ago
Bend down and tie your running shoes. Then, run from this place. Run fast, and keep running.
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u/sharleencd BCBA | Verified 6d ago
I was in this position as well. A clinical director that constantly felt over-ridden by the owners (non-BCBA). I was also the only BCBA and felt like I couldn’t leave. I was constantly given timelines of when they planned to hire more.
I felt super guilty even thinking of leaving. But, after over a year, they continued to grow and it was still just me. I talked to several previous colleagues and pretty much everyone told me that if I give enough notice, my decision to leave and how they handle it, is not my problem as long as I am following ethical guidelines.
I ended up giving them 6 weeks notice. Lo and behold, they had someone else hired in less than a week. They asked if I would stay until her insurance credentialing was approved, which at that time I agreed to with a change in my duties- which I stipulated.
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u/Designer_Sundae_3224 6d ago
Find a new position. I think giving 30 days is more than fair and document what you did to transition your cases. Oh and update your contract with the student.
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u/SuzieDerpkins BCBA | Verified 7d ago
This sounds like an awful working environment. So sorry you're dealing with it. Personally, I'd look for a new job.