Latest / ABA Business Leaders / What Does Quality ABA Really Look Like? Building Better Systems with Jumpstart Autism

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What Does Quality ABA Really Look Like? Building Better Systems with Jumpstart Autism · ABA Business Leaders

• speaker-0: And this is a critical understanding and doing business, probably any business, is that where you start is not where you're gonna end up. And and in my opinion, that's the definition of quality. If we aren't gonna have audacious, challenging visions that change quality of life, that change an individual's and a family's entire life, then what am I doing here? speaker-1: Welcome to ABA Business Leaders, brought to you by 3Pie Square, where we discuss topics on how to create and grow an ethical and sustainable ABA practice. speaker-2: Whether you're starting, scaling, or thinking about selling your business, we're here to share insights, stories, and strategies to help you on the journey. speaker-1: He owned a successful ABA practice for over 10 years. speaker-2: And now we help other ABA business owners do the same without all the chaos. speaker-1: around, you're in the right place. speaker-2: Welcome to AVA Business Leaders Podcast brought to you by 35 Squared. I am April. And today with us we have Kara and Brian. Kara, they are they are both from Jumpstart Autism Collective. And Kara is the director of professional development. And Brian is the director of psychological services and research. And ⁓ those of you who have listened to us for a while now, will speaker-1: ⁓ I'm Stephen. speaker-2: already know Brian a little bit. He came on ⁓ recently and we d we discussed it we talked a lot, but I guess so some of it would be about like the systems and whatnot within autism services. So or ABA. So ⁓ you know, Brian brings definitely a wide variety of perspective, ⁓ being that he's a psychologist a law as well as a B C B A. And so if you ⁓ if after you listen to this episode, if you haven't already heard the episode that we had with Brian a few episodes ago, I would recommend ⁓ giving that a listen. so welcome, Brian and Kara. I'm so glad to have you here today. speaker-0: Thank you for having us. speaker-3: Yeah, thanks for inviting us. speaker-2: ⁓ there's so much to cover. There are so many things that we want to talk about. but I think what where we're going to try to focus this conversation a bit is really diving into quality. What does quality look like? ⁓ we like to ask other providers what what's your definition of quality? How do you know you're providing quality services? And it's a loaded question. It's really, really hard to define that. And so ⁓ here we go, talking about it again and from a different perspective. Where do we want to go, guys? How do we wanna jump into this? speaker-0: remember when when I was starting Jumpstart back in 2008, ⁓ you know, a little bit ago. And it was me as a sole provider trying to figure it out. I I think like many listeners have experienced, trying to figure out what everything means and how to do it and how to do it to the best best of my ability. How do I get people to support to build to a vision. And it was one of those moments where I s we started as home based services and it was one of those moments where I'm sitting in a family's home outside of their their house and I'm the the trainer was there or the other RBT though I'll call them trainer. They they had the RBT wasn't even a thing there. Right. I had trained them on the you know, the gist of what we were gonna do. So by trainer what I mean is is they had been working with me for probably about two months. Right. On the ABA side, they had done some diagnostic work. She was a postdoc or she was a pre doc ⁓ in psychology. And we're sitting there waiting for the new hire. And it's kinda like waiting, waiting, waiting. I think that new hire had already been with us maybe for two sessions, so four hours. New hire doesn't show up. Ugh son of one. Okay, well let's go do this session. ⁓ the the greater Albuquerque area where we were is is a pretty metropolitan area. But ⁓ it is it ⁓ it At that time there was very little known about ABA, very little funding for ABA. And so it it was boy, kinda trying to build a plane while it was flying at nine what at that time felt nine hundred miles an hour. Now I get that at at looking back, I look back, well that plane wasn't even out of the hangar yet. And so it but but it was that I I think I went home and I'm just like i i it was just like this is gonna be effing impossible. There's there's no effing way I can get this done. Now I probably threw in a couple more F-bombs in my own mind, but it and and I'm just like, well, I gotta go back to what I know. And what I knew was center-based services. Now where we were, and I think this is a critical understanding and doing business, ⁓ probably any business, is that where you start is not where you're gonna end up. And And in my opinion, that's the definition of quality. Is one actually I'll say is one part of quality, that where you start is where is not where you'll end up. And so let let's fast forward the story to two thousand and sixteen, eight years later, of the struggle. We now have a one center in Albuquerque, about forty five hundred square feet. We're serving probably let's call it twenty-five kids, ⁓ twenty-five learners. And the one of the clinical supervisors at that time, and I was happy to have clinical supervisors who were actually moving into this idea of of a director role. And at that time she said, Hey, I think we really should look at a different model of intervention that can really support all of our staff and make expectations clear. I'm like, where is this? Where is this holy Bible that just kinda can drop down and help me s help me solve all of my angst, all of my worries, all of my stress? How do we build this? How does it increase? You know, ⁓ yeah. And and so we started down the path of precision teaching. And and this isn't a precision teaching qual, you know, but but it it gets at where we started is not where we ended up. Let let's fast forward. Kara, you joined us in seventeen? Seventeen seventeen, yeah, twenty seventeen. speaker-3: twenty seven. speaker-0: And Kara joined us in our Denver location, which we have ha since had to shut down, which heartbreak as hard as that decision is, it made a massive impact to the quality that we could deliver to other providers. ⁓ because more you know, more season when I say more I mean we were able to bring staff from Denver down to Color or down to New Mexico via telehealth. that have a wealth of experience in administration, have a wealth of experience in and years of experience in the field. And from there we were able to continue the vision of providing ⁓ you know, ensuring everybody's on the same page when delivering services from top to bottom, ⁓ because initially one of our goals was to change a child's developmental trajectory. And if we are able the the quickest way not to change a child's development, I know that's horrible in English, but the the quickest way to fail, let me say, is to have people doing their own thing. And so consistency, predictability, and good expectations through and through. And Kara, ⁓ as she as as we closed down our Denver site for which she was one of the two BCBAs basically running it, she was the assistant director then, came down and started our internship, basically, our formalized internship. And so where we are now is nowhere near. speaker-2: Yeah. speaker-0: So everything we talk about today, please understand it has been a struggle. It has been tooth and nail. There's been many many challenges, many stressful nights, sleepless nights, but finding the right people and getting out of their way as an owner and as a founder and as a wanting to have some sanity ⁓ in one's life, getting out of the way of good people's skills with support and and still providing a vision. And some guardrails, right? No, can't but hey, y Kara, we gotta get an internship. Go for it. And consultation and support from there. And and so I know that's a long story, but I hope it resonates. And I I can imagine it resonates with a lot of a lot of founders and and executives that that where they started in the field of ABA is nowhere near where they are. And that for a company is the is one piece of the indicators of quality, I think. And just having that vision and staying true to that vision. speaker-1: Yeah, I I think that's great. And and something, you know, people will often ask me, what does a clinical director even do or not a clinical, ⁓ operations director even do? And I I said when I was doing it, my job was to remove barriers. And like that's it. Like that was my whole focus. If I can make it easier for you to do your job, then ⁓ w we're we're doing better. And and yeah, like you said with guardrails, with support, but the idea is that I get out of their way, I I I ⁓ make it so that they can do the thing that they love to do. speaker-0: And and I think you're probably coming at it from an engineer standpoint, which I love, and that is nowhere near what my how my brain was trained or thinks. And so finding folks that can help create administrative and clinical systems that take your vision and put it into everyday implementable activities. And and this is for anything and everything from what Cara does around the the training of interns and our RBTs. All the way down to or all the way up to ⁓ you know, what what's our system for intake? What's our system for discharge? What's our system for ⁓ critical incidence? What's you know, i all of those as long as there are and and the word systems used to drive me baddie. Just because that's not how my brain thinks. Sure. And then I'm like What is this thing that that like helps everybody know what to ex you know, has sets everybody's expectations and keeps us all in the same and people have good expectations of me. That way I'm not getting rate crazy phone calls in the middle of the night. ⁓ this is a system. Yeah. ⁓ I like these systems. Okay. I have no idea how to develop them. Here's a bit let's sit down and let's talk about how to get from point A to point B that ends up in a in a predictable system. speaker-1: And those are rough to build too, right? It takes a long time to well, ⁓ depending on the system, but like it it can take a long time. You know, you paint the picture of the vision and then we start i inputting that system. And a lot of times you what do this doesn't do anything to what I want, right? ⁓ when when I'm working with companies on on KPI, even it's like, okay, we started measuring this, we thought it was going to tell us something. It it does nothing, right? It's just another number that we're collecting. It's a waste of time. So how do we actually know the numbers that we're tracking are going to answer the question that that we we started with, right? So ⁓ it can get so part of when you're building these, I would ⁓ I don't know. I enjoy it, right? Like I I I love breaking things and saying, ⁓ okay, how do we actually put it back together the right way? And and so If you are hoping for perfection on your first run through on this, I'm sorry. Right? ⁓ this this can be difficult. speaker-0: No and and one of the most difficult pieces is a lot of the the learning and improvement comes from failure. speaker-1: Yeah. Yeah. speaker-0: And you know, one of the things I think, you know, I I I still don't think about quality in terms of numbers. I know that's there and I know that's important. I was lucky enough to be able to hand that over to our director of quality assurance. But I think where I still come at it and where our discussions, ⁓ if it's Kara and I or anybody, i it's around processes and and supports. And so for example, as a clinical psychologist in an interdisciplinary team. My goal and and even back back when we first started this, because I've always come at it from psychology's gonna be involved. As a psychologist, starting this practice, psych's gonna be involved. And at at the time our our then director of our Albuquerque location, who's now our CEO, is was just like Brian, I mean you y what you're asking people to do, they don't even know how to do it. You gotta come up with some guidelines on when is a clinical are or what we call now a a site consult, we also call them a medical necessity review or kind of a an emergency site consult. W you know our our B C BAs have no idea how to ask for that. And so we came up with some clinical practice guidelines around that. And so the idea of from my perspective in defining quality is having having a means to address one one aspect is having the means to address medical concerns that come up in our complex learners. And when should those ⁓ requests be made? And so really what we've done and I know that this isn't necessarily implementable widely, but it is one way we defined quality and want to ensure that that we're implementing it. And so we have ⁓ every one of our clients gets an annual psych consult to look at medical concerns, talk to families, make sure we're kind of on target, raise concerns with the BCBA, hear, hear what the BCBA's concerns are and communicate that to the parents for some funny reason when it comes from a psychologist, they just happen to hear it a little bit differently. Kara has many stories of that. Brian, I need the parents, I need you to tell the parents this. speaker-3: If you know, if we've had ⁓ any immediate hospitalizations, you know, if we have any ⁓ injuries, if we've had an injury or a situation in which we've needed to either consider restraint or use restraint, that's gonna be a situation where ⁓ we have a site consult and we get that second opinion. And really, I mean the the second set of eyes is not only invaluable to our clinicians because While we do kind of have a cascade of experience, a lot of our clinicians are less than two years old in BCBA years, right? And so they're still learning the ropes, they're still very in there's they're still very much an entry-level practitioner. So to have a second set of eyes to say, No, you're not that far off. That behavioral procedure that you're implementing that protocol isn't working because not because you aren't implementing the fidelity. There's something else in the mix here. ⁓ as somebody that works pretty closely with families too, I think the other really comforting piece of that is like we have a medical or a you know, a provider that can give eyes on, often faster than a pediatrician or a specialist. So, ⁓ you know, I'm thinking of learners that we have discovered seizure disorders with and we've got a plan that if we have another seizure and we ⁓ you know, are waiting to get in with a neurologist, sometimes these poor families are waiting Months and months and months to get in with their specialist, we've got some on site in practice people that can drop everything and within, I mean, a day if needed, at least get eyes on so as a team we have a plan while we're waiting ⁓ for their specialist appointment or something like that. So it really does provide comfort, resource, and is really the through line in that collaboration between both the practitioners and the families. speaker-1: you talk a lot about vision and in the last podcast we talked a lot. Was this something that you just inherently had right? You knew what you wanted to build right from the start, or was this something that you You failed miserably and you're like, wait, wait, wait, I have to step back and actually get a clear picture of what I wanna build and how I wanna do this. Because you seem very it it's like an obvious natural step that we would take our vision, we turn it into a quality benchmark, and then we'll go do it. We'll execute. And so just is that something just innate innate in you or or did you get taught that in psychology? speaker-0: Yeah, I don't know. That's a good question. I we we weren't taught that in psychology. I don't think maybe it's a way of thinking. I don't know. I I think it's I I do a lot of diagnosis, so I understand how delayed and disordered many of our early learners are, as well as our profound ⁓ population. Intervention, ⁓ the the goal should be supporting that person to it at least where insurance is now particularly. Not insurance. Let me redefine that. This is not insurance's goal by any means. ⁓ I I guess from my perspective, doing everything possible to ensure that we can maximize that individual's quality of life. I think when I first had the vision of of develop changing developmental trajectory, it was a little naive, it was a little ambitious, and it it may not have been ⁓ as as aware around some of the ⁓ neurodiversity neuroaffirming kind of perspective right ⁓ that that that there's more of that now i think that how we've done it is very much a neuroaffirming excuse me approach but i if if we aren't gonna have audacious challenging visions that change quality of life that change an individual's and a family's entire life Then what am I doing here? speaker-1: Yeah, I just think it's really important for owners that are wanting to start and they come in with the idea that I want to do this better than the last company or I want to provide good services to really just get curious about what it is that you're wanting to build and and maybe a lot of people do, I don't know, I just wanna provide good services. Well what do you not wanna build ⁓ if you can't, you know, visualize exactly what you wanna build ⁓ can be very helpful. ⁓ so yeah. speaker-2: Shape of plug from from a proud wife. in Steven's new book. He he does walk through like the first chapter is walking you through. speaker-1: I did not see that coming. speaker-2: No, but seriously, he he does walk through like helping you to like asking you questions and telling stories to help guide you in coming up with that vision and the workbook that goes with it will also help you because I do think that sometimes we need something a little concrete. We're not we we all feel think differently. I'm very much a creative and an idea person. I've got all kinds of visions. ⁓ but then coming up with the parameters and the guidelines and like the the the the Guide rails and stuff it can be a little bit more difficult for me because I want all the things. So anyway, so i if i the the link is in the show notes if you want to check that out to kind of have, you know, a way to help you go through your vision, whether you have one or you're trying to develop one. So just speaker-3: And I would say from the employee side, right? Like being a clinical supervisor throughout the last like nine years at Jumpstart, I would s I would argue, Brian, too, that your commitment to what just what you said, where we started is not where we're ending at you know where we're ending up. And Jumpstart in particular employs a constantly iterative practice. And I think that that commitment to not only where we started isn't where we're ending up, but evaluating where we are and making the changes to be somewhere different, right? That it's this constant, we're going to employ, we're going to iterate, and then we're going to reevaluate and say what's working and what's not. And are we actually getting towards being different than what we were before? The left turn to employ or to use P T in twenty what was that? It was right before COVID, I think, for the Denver Center, twenty nineteen, twenty eighteen. The full conversion. I mean it I have never seen a company take a left turn like that. And it was a commitment to philosophy, resources. I mean, it a lot was put into that and it was all at that crux of we can't be where we started because we have to be better. ⁓ and I so I think that, you know, to that point of that vision is like I don't know that any I know the the guiding vision of we want to help kids and we wanna make their lives better, right? Like that that that's there. But, you know, I think if you're not constantly evaluating that and I've just seen that in my time at Jumpstart. I was not a part of the Roach Motel years. ⁓ but for this kind of like back half, you know, the back nine that I've been a part of, you know, I think that that has shown through in all of those decisions. So I think it's not also necessarily an adherence to a vision or a value that is that concrete, but to that iterative piece that we are going to change and we are going to do what we need to do to make sure that where we end up is not where we started and that each iteration is just one click better. speaker-2: So I think that's really important anytime you're looking at growth, right? Is having a that growth mindset to, you know, we're not there yet and and knowing being able to this topic has also come up a lot, like self awareness, right? Self awareness for your yourself as an owner or a leader within the company and and self awareness of of the health of the company and understanding where you currently are, where you want to be. what you need to get there, what barriers, as you were talking about earlier, need to be removed, how you're gonna remove those and and what to what to add in and the growth process is not linear no matter in no matter what growth we're looking at, it's never linear. That's something that's talked about so often is because it's true. speaker-0: Yeah. Well, and one thing that the and I I can't pinpoint what you ⁓ said, April, but one one thing that really resonates with me is how do we get a team to embrace the vision and really move forward in a systematic way. And and I think some of the stuff that Kara just mentioned really is about setting setting standards early. And it really is setting those expectations around those clinic or around those company values. And being a value based or value driven company really makes a difference. Because then at the very onset of training to talk about your values and you know one of them really is kind of that extreme candor and and openness to feedback and that, hey, everybody gets feedback. Brian gets feedback. But when a when a family meeting went well or went really bad and you know, th he gets feedback. speaker-3: the personality of every center is very different. So kind of at the peak of Jumpstart having three different centers across two different states, ⁓ one of the things that was really important in driving that culture was making sure that each, you know, we have policies and values that ⁓ are company wide, but each center kind of took on their own personality and what that looked like. And so I think, you know, again, you know, to Brian's point of like he gets the right people and he gets out of the way. He gets so out of the way that before this conversation he was like, Can you remind me what your title is? I was like, I I you probably should know it if you company like so far out of the way. He was like, What do you do here? speaker-0: She she self-titled herself as director of fun and was it good time? speaker-3: Good times, yeah. ⁓ you know, I think that th to that to the point of that candor ⁓ is making sure that we had a lot of bi-directional feedback systems. I think that was a huge piece because ⁓ the idea of intent versus impact is something that I see drag leadership down, drag centers down. Well I'm doing all this stuff. You know, I've talked with clinical directors within Jumpstart ⁓ and you know, colleagues in the field. I'm doing all the stuff I'm doing and speaker-2: Yeah. speaker-3: The the vibes aren't better, the culture isn't better, we still have, you know, li high turnover and I'm I'm at my wit's end. I can't do anymore. I don't have any more resources to give. And just the simple question of like, have you asked if they even like that? Or are you spinning your wheels? And sometimes that is just enough of a light bulb. So I think, you one of the things that I really value at Jumpstart and is a really big culture driver is we have a lot of different modalities of bi-directional feedback. What do you like that I'm doing? A lot of this comes from Ken Scott's radical candor work. Like what do you like what I'm do you what do you like that we're doing? What do you not like? If you could wave a magic wand, what would you change about Jumpstart? You know, looking at those, ⁓ looking at the RBT at and we have other clinicians and other leadership levels and really valuing that feedback and integrating it where possible, being transparent where it's like, ooh That's a big change. That's a one to two year change you're talking about versus like, absolutely, we could get a few more snacks in the break room. That's an e that's a low lift change. And so I think that that bi-directional feedback allows each center to be shaped by the culture of their staff. And as somebody that, you know, again left the Denver Center, came down to our ⁓ two New Mexico centers, it was so interesting to see how the same values looked a little different in practice, center by center. But we're absolutely shaped by the people that were there, right? And we have people that are looking forward to coming to work. That's one of our questions. You know, what if I can maybe what's the most difficult part of your day? What's the hardest thing? And sometimes it's something really big and that's good to have it on our radar. And sometimes it's really small, like the line's really long for the kids to get to the bathroom. Okay, that's good that's good for us to know. And so I think that that commitment to candor, like Brian was talking about, both in terms of the feedback, but then also soliciting ⁓ ways that we can be better again just goes back to that like where we started isn't where we're ending up. If I could be one click better tomorrow, if there could just be one thing that we do better tomorrow, what would that look like for you? speaker-1: Yeah, there's a level of trust there that you you all must have, ⁓ because There like yeah. I I mean I have worked in many different companies just as like an engineer and okay, w our door is always open, right? You get that that okay, sure. I I'm I'm in your door. Why are you even here? You're wasting right like that. That's the feedback you get when you go in the open door. So like there is a level there has to be a level of trust and you gotta do what you say and say what you do. You know, and and ⁓ yeah, I think it goes back to what you said, Brian. Like, what are we even doing here if we're not doing that? speaker-2: I guess we assume all workers come with is like the ability to communicate. So there's there's all of these ⁓ soft skills and in with communication and then you know, also the not to go off on a change of a little bit is like the executive functioning skills of like the you know, time management and and prioritization, just to name a couple of the many, right? So I think that especially with a newer workforce, right? And you know, with the with the ⁓ speaker-3: That that ⁓ speaker-2: B C B A's themselves being two like the j the average is two to three years, right? And and then RBTs, a lot of times they're coming, we're hiring them fresh into the field with with no prior knowledge. speaker-1: I built a lot of systems and trainings for engineering, right? Like and those can be these are simple machines, right? Like and like you know, okay, this is broke, you fix it this way, right? Now we're dealing with like the complexity of developmental and and and different humans. Right. Like it's just like, ⁓ my goodness. And so like how does one go and build a training system that allows you to Bring in those systems that you get consistency and also allow for flexibility because everybody's a little bit different and your your kids need different skills. And so h how do you even start? speaker-0: It it does come from leadership and it comes from what is what are those values that you're trying to instill and how you go about it that and then learning I think where your gaps are in addressing your own gaps over time. ⁓ you know, it's funny, there there's times ⁓ th some of the jokes when when we first started ⁓ and before we had our first official dress code, right? It it's hot in New Mexico in the summer and people would violate dress code in very many ways. And even talking about this I can already start feeling myself cringe. And so, you know, women coming in with ⁓ spaghetti strap tops. speaker-1: And speaker-0: And it's just like, ⁓ my goodness. I I all right it and and at that point is like, hey Allie, I I need you to go in and talk to so and so about, you know, kind of a shirt and you know, kind of what the appropri 'cause I just couldn't talk about cleavage. I was just like so uncomfortable about it. But still and Kara's probably laughing like you're still very look at you, Brian, you're like squirt but But ⁓ and and and I think that there are pieces where we need to know our own limits. ⁓ and then really trying to fill those those holes for us personally, but also leaning on each other. speaker-1: Yeah. speaker-0: to to kind of build that vision. speaker-3: Yeah. And so you know, my experience is more so within the the field work, right? Right. Our field work experience. And I think it's absolutely that being objective about your own gaps, looking at what you're doing and saying what's working, what's not, how can we be one click better? We don't want it start, you know, end up where we started and just kind of having that mindset. So for us, our initial iteration of the internship is what I lovingly call our whackable internship. And I think it's what a lot of providers do, that it's like, ⁓ you need an FA experience. Like someone's doing an FA. Just like run over there and you know do it and like hope you get everything that you need. ⁓ and so we really had an internship that was all you know, whackamole or a la carte. I don't know, either one of those sounds better. ⁓ and as we started to move into ⁓ more instructional design, getting more ⁓ experience with PT and then with the Denver closure and this being able to be something that I get to do full time and very, very thankful and lucky, ⁓ getting to t take a step back from that and say, Okay, what's working and what's not because It wasn't totally bad. It wasn't great. It wasn't totally bad. Like what repertoires are we getting from this type of instruction, from this a la carte whack-a-mole instruction that we want to maintain? And what are we not getting? We're not getting a lot of problem solving. We're not getting a lot of self-reflection or self-monitoring. How do we program better for that? And we're getting a lot of one-track repertoires. They can do it one way with one learner because that was the one learner that they learned it with. And we've, you know, holding both our contingency-shaped behaviors and our contingency-shaped repertoires. you know, in one hand and rule governed in the other. So we had people that were learning very specific examples of a skill and were generalizing that as the rule. And they had a really hard time building those flexible repertoires because they didn't have the critical underpinnings. So the first thing that we took a look at with any great system is going to be like, how are we going to monitor this? I know where we're at. I know that we need to go somewhere, but if I don't have a data collection system that indicates quality How will I know that we're moving in the right direction? So we kind of started with the initial pillars of improving the competency of our clinicians. And that's something that we pull directly from our pass rates, right? That's kind of an easy easy thing to pull down. I think it's most salient to most providers. We also wanted to be efficient though, because we had a lot of variability in terms of how long people were taking to accrue their hours and how long it took them to subsequently get certified. So we needed a system that improved competency, improved efficiency. with that certification and also was an enjoyable experience, right? We wanted people to come out of their field work and say, like, wow, I'm really glad that I did my field work at Jumpstart. And that was a little bit more of that anecdotal piece. So we had those pillars of both data driven, okay, I can pull these metrics down and make sure that we're on track. ⁓ and then the experience piece that is again a bit more anecdotal at the end. speaker-1: I think a lot of business owners, they can't even and again, no offense to business owners, like they don't they can't even identify the the skills to do their job. Like a lot of people will come to me and say, Okay, I need a list of all the regulations and and like how how do I ensure that my treatment plans will pass the ⁓ funder requirements and I'm like, Okay, we can do that today, right? But tomorrow I'm not there. And I can guarantee it's gonna change. Right. And so like you have to have the ability. I that's what I am trying to build in you is the ability to change and update your systems to reflect the current standards because these things are gonna change. And so I it's a disservice to to me and to you if I just say, Okay, this is it. I I painted you the picture and now you go and do whatever. Right. And so I think that skill is something that a lot of these business owners don't have the ability to do. So, like, how do you how do you even build that? Does that make sense? speaker-2: too. Like also where where it shows up is is, you know, like let's say you're a one or two person, you know, of founder, you're you're starting this thing and then, you know, at some point, some quicker than others, you get you you have to start delegating, right? Whether you're forced to speaker-1: Well it's forced delegation, yeah. speaker-2: And so then you're just throwing things off to different people and then you're growing at a massive speed and then you turn around and you're like, there is a mess here. and so there's there's something in also breaking down like the the even the general job responsibility, job job expectations, job responsibility. speaker-3: But you know, I don't mean to show the end of our marathon and and it's not even the end of our marathon, right? Like I can't say that our internship isn't I mean we're working on the next iteration, right? It's that constant commitment. So I don't want to show you like a cake and not all the like dirty dishes that are piled in the sink because the first iteration was a yes-no checklist, right? Like these markers were here and we have the critical features that we needed to detect. Were we making progress towards again just being one click better? Were we a little bit different and a little bit better? Along those values that we wanted. We wanted efficiency, we wanted competency, and we wanted people to be able to finish their field work with Jumpstart and say that was a great internship. ⁓ and so once we had those in, then what we started with was kind of this whack-a-mole, right? Did you do it? Did you not do it? It was a yes-no checklist. Like, did you complete FA? Yes, no. That's all we had. We had a front and back list. I think mine is still in my HR file somewhere because I came in as a B C B A. So I was like, I could do all these, but I still I you I did a checkout on all of And it could be something as simple as that, right? It's not, I don't mean to show again that end product. That's how it started. And what we realized was that even that's a great data point. ⁓ my gosh, everyone's having a really hard time with FA. Let's let's start there. And so I think to your point of like, yes, it's this huge, daunting thing. We didn't get there overnight. We started with something as simple as a yes-no checklist and then looked at that data. And I think it's just that iterative process of having those data collection systems. knowing where you need to go and just picking one thing. We started with one thing. We started with FA. We started with treatment plans, right? And operationalized it. And so I think that, you know, yes, at the end we have this really sparkly, awesome internship that I'm very, very proud of. But at the same time, it we didn't start there. And this is a result of many small clicks up over time over the last seven years. speaker-0: Kara presents what Kara presented as kind of the the checklist, you know, she has the ingredients in the kitchen to make a cake. That's where she's starting. Right. Really where a lot of this started was as I was driving to the grocery store to figure out what ingredients we needed to be able to build all the different cakes. And and and I say that as an analogy to the decisions you make from a business standpoint will impact what you can do. speaker-1: Yes. speaker-0: From a quality standpoint. And I'll give you a great example. We've we have been ⁓ gosh, this is probably six years ago. So let's call it right before it's probably right before COVID. you know, we're we're jammed, we're we're kicking ass, taking names, feeling like we're, you know, cats meow. And all of a sudden, you know, some of the quality some of the the supervision checks that we had implemented at that time and and some of the outcomes for a a specific B C B A were just kind of like, What is going on? Why Why is why are these cases not showing progress? And the after kind of a couple of months of analyzing it, it really was, you know what? We're trying to serve too broad of a population. The goal of being in and very early on, I was okay making the decision. We cannot serve everybody. Even though there is a hard push, and the longer you know the longer you serve a family, the harder it is to have some hard Of criteria for discharge in terms of where your clinical expertise is. But in making those decisions, it allowed us to focus not only the kind of programs that we were developing so a couple of things, programs in terms of overarching types of clients we can serve and developing general service models for certain profiles across certain ages. That way, again, we're pulling in the same direction. So, okay, now I'm starting to drive, you know, I might have gotten to the grocery store at this point. And now I can actually go and start pulling specific ingredients for an early learner program and start pulling those ingredients so the the people that are running that can, you know, I've made those decisions. They could probably join me at the grocery store and start picking out ingredients they want to implement. ⁓ for our transition readiness, which is kind of the between the early learner and getting them into school age, or our intensive skill program. Right. Those are three very different client populations and and and profiles that we have to address very specifically. And building each one of those up has been based on the single foundational decision for our business that hey, we aren't going to serve everybody. Here are the populations we need to start with because I can train up that. This is my expertise. I need to start here. speaker-1: There are gonna be a lot of desperate parents out there, right? And it it breaks your heart to not help every human. ⁓ but you know, you're used to working with two to four year olds ⁓ in a specific area, and then you know, a mom says, I can't get into any clinic, my son's fifteen. Well, please, please just help. Right. And then you're learning how to ⁓ to provide this service while you're building a business and trying to train them. Like that doesn't work. I'm sorry. speaker-2: factor like developmental appropriateness, right? And so like you could teach human like the whole lifespan of development if you're if you're serving birth and like adults as well. Yeah. Or or you could really focus in on, I don't know, two to eight and really or or eighteen to twenty four. I don't know, whatever, right? But like really focus in and be able to really train to that very specific. And that's just one little example of of all of the factors, right? speaker-1: Yeah. What I see with a lot of companies that are adding a training ⁓ role is it's you can be our trainer as long as you have a full caseload. And so like ⁓ can you like can you maybe maybe summarize or talk about the like the role of a trainer? How do you do it? Like could you do it effectively with a full caseload? How does how would that even work? speaker-3: And I think, you know, from the business side, jump Brian, jump in for like those back end pieces. But there have been seasons like right now I'm overseeing two caseloads. I have some supervisors that are out on MATLEAVE and so I'm covering down on those. So my position is flexible and our head trainer positions are flexible in the sense that ⁓ they can cover down on all of those things, but as a standalone, ⁓ we're designing the instruction, we're monitoring the instruction, and we're making sure that the training is effective. And that holds true at both the RBT level and our internship level. The apprenticeship model, their training with a full caseload, right? So that apprenticeship model is a BCBA. They are the proverbial trainer for our interns and they are maintaining a full caseload that is built into that position and the requirements for that candidate to progress. So we start with a lower caseload, we build that caseload. So by the end of their supervised clinical experience, they have an entire caseload that BCBA is trained off. And then we're kind of rinsing and repeating from an operational standpoint. My role in designing the instruction doesn't I don't have a caseload as a requirement of my position, so I'm very lucky. Maybe I don't know, Brian, don't get any ideas. I do have a case two right now. I'm okay. He's like, wait a second, I didn't even know it was an option. But I do in the sense that I have, you know, anywhere between three to five senior CSs that I'm supporting with that quality. I'm designing that instruction. ⁓ I do a lot of clinical case consultation, so I wouldn't say that my position is entirely like not billable. ⁓ and so we do have both again at the internship level and then, you know, some commiserate positions at the RBT level that serve that same purpose that they're not necessarily responsible for learners, but they're overseeing our training department to make sure that that quality is there and they can support in those ways. So I think it's having kind of like Ryan said, the right people in the right positions that can oversee and make sure that all of those systems are running smoothly, but can cover down when needed. speaker-1: one other thing like that you you mentioned Brian is like that's above your prey grade. Well hold on. Like I know a lot of people are going to be say, you're the owner. You make all those decisions, right? And so the fact that you have allowed You have the tr again, this is a trust thing. The values have been implemented. The vision is there. The trust is there. That feedback and communication is there. And that's what happens when these things are in place. You can say, okay, I'm done. Right. Like and I don't have to make that decision. That's not my job. And I think that that is a wonderful thing for all owners. That's where we're I mean, most owners should be striving for that. The day when they can just say, I'm not involved. This is not my job. I put the people in place to do that job. So Yeah. speaker-0: Yeah, read turn the ship around. Is a great roadmap to being able to let go. And then you have to let go. speaker-1: Yeah, that's a hard thing to do. speaker-3: You have to forget their titles. You have to f what does this person do here? That's how you that's a good marker. What's your title? What do you do? speaker-0: Truly l let's rephrase that. That is a true compliment to the Jack of All Traits and the exceptionality that you bring to this company. Hey, hey, hey, hey. Hear it for the truth. Don't discount the truth. It's okay. And and she's held at so many titles and I've moved away from any involvement, right? And okay, you know, I I know what she does, kinda, but ⁓ what's the t what's the title to the general, you know, gestalt of what it is you do now? speaker-3: You dressed that up well. You dressed it up well. speaker-1: Would ya? speaker-0: 'Cause you can step in and you even heard kind of her role. She can step in and you know be a clinical supervisor again. Right. At a drop of a hat. And so yeah, what what is that? Okay, yeah. Just give me your title. I know that you yeah, and what it is I know most of what you do, but again, above my pay. speaker-1: Great. And so do you think Kara like is that the first step is like do a self assessment of your staff and just see where they speaker-3: Yes, and I think speaker-1: I guess there was some assessment of your speaker-3: Start with yourself. That's the easiest, you know, and detect like do I have those self monitoring skills? I think you know, I and then I think one of the other things that I really value at Jumpstart with that candor candor and something that I think really contributes to that culture is that sense of humility. Like if I'm ever thinking I'm doing something perfect, like that's the first red flag that I really like if you if you sit down and you're like, What could I be doing better? and you're like nothing, then self monitoring skills should probably be the first thing that you work on. speaker-1: Yes, I need some self-moderating skills. speaker-3: But I think you know taking that task analysis, you know, and and I think what can get hard with some of this is you're looking at people's repertoires is it ki it it's hard to be objective. It's hard to say, you know, what what trends are you seeing. And so ask your clinical directors like what are the repertoires that you're that you feel like your clinical supervisors are missing? And if it's like, you know, hey, ⁓ they're not coming in, right? Anything that kind of feels like a pressure or a pain point, that would be something to lean into and say, Okay, well What is the what's behind that? There's something behind that because if the door is open and you said you got an office hour but they're not coming in, lean into that. Hey, what would make you know, do that assessment? That's what we do as behavior anal analysts, right? We detect an issue and then we assess it. So I think that initial step of just detecting where those issues are, you know, where do you need to grow? Where are those pain points? And then assessing, leaning into it. Is it a time management issue? Yeah, your office hours are right in the middle of when all my kids are whiling out. And so it's right when all the kids are eight in the morning. It's when all my kids get here. Is it something like that, or is it I don't know how to approach you? And so I think treating it like we would any other behavior that we're looking to change, identify it and assess it. So absolutely that first step of just identification, ⁓ looking for those commonalities in the repertoires of your clinicians. Is everyone having a hard time with authorizations and getting them in on time? Is everyone having an issue with behavior reduction? That was one we had to go back and take a look at. We consistently had clinicians that were Not passing our QAs relative to which it serves as another great metric for us with behavior reduction. And anecdotally, they were telling us, I'm having a really hard time with this. Okay, then we need to we need to assess and work back and figure out where is this a systems issue or a training issue. ⁓ and so I think absolutely that inventory of just kind of getting it all done on down on paper, to Brian's point, get it all down and then you can start working with it. So get it all down and pick one. speaker-2: Yeah. And we thank you for sharing. Journey and and what's working, what's not working, and and being open to have these conversations because that's what it's all about. Just get ⁓ just getting these conversations started and and and and helping to model like collaborating and working together. And and I think these are these are all great great things that we all could could embrace. speaker-1: Yeah, yeah. Yeah, it's wonderful to see them in practice too, right? Like, ⁓ wow, this can really be done, you know, and and people are doing it. I think that's so helpful. speaker-0: Yeah, and I was gonna say that, Steven, is is that I hope this conversation helps to be inspirational, not daunting. Right. That where you start, everybody starts somewhere, and that's fine. And you're gonna make lots of mistakes, and that's okay, it's gonna hurt, but those will make you better. They'll and and you know, just one click better. I'm as Kara Batson would say, one click better. I'm gonna start citing you on that, Kara. Kara Kara Batson says as Kara Batson sa speaker-3: One click better. speaker-2: See one of the one of our speaker-1: Yeah. speaker-2: There you go. Love it. Love it. Love it. Love it. All right. Well to all thank you guys for coming. And thank you for those who have been hanging out with us for the for the past ⁓ almost couple of hours. And and and we would love to hear your feedback. ⁓ to those of you who are listening, if ⁓ you know, comment on social media, ⁓ YouTube, socials, all the places where you see us or ⁓ call our speaker-0: Thank you guys very much. speaker-2: Our ⁓ podcast hotline. The number is in the show notes. We'd love to hear from you. We'd love to hear any feedback. We'd love to hear any questions. We'd love to hear your story. Yeah. What's working for you? What's not working for you? We'd love to hear your failures, right? We would love to to explore and and chat with you. And if we can help you in any way, feel free to reach out. There's a link of our free consults in the show notes as well. And we would love to ⁓ to chat with you. So Alright, well we hope to see everyone here next year next year. Next year. Next speaker-1: All right, see ya. speaker-3: you next week. speaker-2: Thanks for joining us on ABA Business Leaders. speaker-1: We provide mentorship, courses, handbooks, billing support, credentialing, HIPAA support, web design, and more. Everything you need to build an ethical and sustainable ABA practice. speaker-2: You can find all of our resources at threepiesquare.com. speaker-1: Don't forget to subscribe and share this podcast with other ABA business owners. speaker-2: We'll see you next time, and remember, you don't have to build your practice alone. Okay.