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System That Support ABA with Brian Lopez · ABA Business Leaders

• speaker-0: If you don't have the system in place, find resources that can help you implement those systems. If you don't have your ducks in a l in a row from an administrative standpoint, from a billing standpoint, from a training standpoint, it'll be a big problem for you. speaker-1: We talk to a lot of BCBAs that are wanting to start their own thing. The issue I find is for a lot of these, you know, newer BCBAs, they just want to start a business right now. They're like, ⁓ I just graduated, let's go and do it. Why did you become a BCBA? Why didn't you become a business manager? Welcome to ABA Business Leaders, brought to you by Three Pi Squares, 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: We owned a successful ABA practice for over ten years. speaker-2: And now we help other ABA business owners do the same, without all the chaos. speaker-1: Stick around, you're in the right place. speaker-2: Hello everyone, welcome to ABA Business Leaders brought to you by 3Pi Square. I'm April. And today with us, we have Brian Lopez from Jumpstart. speaker-1: I'm Stephen. speaker-0: Thank you very much. I greatly appreciate you guys having me. ⁓ you know, we've had a little bit of time to check in and I look forward to the conversation and sharing kind of a a life's experience that cuts across a variety of professional activities to hopefully support some of the listeners in in their growth and professional development. speaker-2: Thank you so much. Yeah. We ⁓ we all got to we just started our conversation before we press record. And and we were really diving in and really getting to like the get getting into it. And then we're like, Stephen's like, hold on a minute, we're wasting our content. We're like, ⁓ we're not recording. yeah, so today's conversation, we're really going to explore what it looks like to build systems that support the whole. speaker-0: É, é, é. speaker-2: child rather than just treating behavior in isolation. And so that's kind of what's leading our conversation today. And then you know us, we're just starting getting the conversation started. And ⁓ and and Brian is one of us. He's just gonna, he's able to, we're just gonna have this conversation. Brian definitely has a, I guess, a a different perspective ⁓ because he you started out, you did not start out as a BCBA. Tell us about your journey in in into the field. speaker-0: Yeah, and you know, thank you for the introduction. Greatly appreciate it. Yes, my background is in clinical psychology and started years and years and years ago. ⁓ that sounds like a long time, but ⁓ I I put the number out there. It's like twenty five, you know, I know right years ago. It's like ⁓ that is many years ago. ⁓ and really I was involved in a lot of early diagnosis ⁓ work in my clinical ⁓ or my in my ⁓ PhD program. And at that time an early diagnosis in the in the late nineties was kind of seven and eight. and I was lucky enough to work with a team out of UCSD that was looking to push as part of a larger study to push the diagnosis down to age two, which was pretty ⁓ I mean to think at that point that you could diagnose autism that early was was ground shaking. And so, you know, my my training started there, did some treatment in graduate school, some center based treatment, you know, some of the LOVAS stuff was was transitioning down. We had some of our some of the folks trained under the LOVAS program come down and and support. you had ⁓ precision teaching as huge was out there and so that at that point that was really the conversation was precision teaching or I'm sorry not precis ⁓ our PRT, sorry, the PRT group, ⁓ pivotal response training, not precision teaching, pivotal response training. Versus discrete trial. And that was really the kind of the conversation. I always hover or kind of moved over towards the pivotal response training. It really made sense to me. and you know, my early experience was: hey, here's a kiddo, jump in there and figure it out. We're doing treatment. You, you, you know behavioral theory. you you've read all the articles, jump in there. And and it was hard. It was really hard. And Those experiences really stuck with me in terms of what it is that we could do in center based as compared to being out there on your own and struggling. And and someone with a lot of knowledge, you know, what I thought of at that time was a lot of knowledge, which was almost nothing. ⁓ you know, just enough knowledge to do harm is what, you know, I'm I I wasn't even minimally competent. and And just over the years, you know, really seeing ⁓ that those those two experiences weighing on me and and really kind of driving some of the the treatment that I wanted to see, or at least that I had in my mind as the ideal approach. And now how do you make that happen in the real world? ⁓ and you know, I think some of the issues really fall around. How is what are the systems in place? Not only in terms of what you do as a company, but also in terms of how do you make this work with CPT codes? How do you build a business while training? While, you know, a lot of this is unreimbursed, or part of part of just the reimbursement. You have to calculate that. And you know what, I'm not an accountant. I I'm I'm not a financier. I'm ⁓ I'm a psychologist. And so one of those ⁓ along the way, ⁓ you know, when I was in graduate school, there was like one BCBA in Southern California. It was just kind of coming up. And then as as we start services in New Mexico, I'm leaving the School of Medicine to ⁓ start my own practice. And one of the things I find out pretty quickly is that ⁓ they they don't really care if you're a psychologist with a ton of training and they care about a B C BA. And that's how they're gonna build. And that was kind of the initial piece of it. And it's like, ⁓ my goodness. All right. Well, now I gotta go and get my BCBA. And so, ⁓ yeah, and and so I really do think of myself as a psychologist first, with a lot of understanding of behavioral principles and changing behavior. There are tons of people that understand behavior analysis with even within our own practice. ⁓ if there's a behavioral question, behavior modification. Don't ask me yes. So there's tons of people that have better understanding than I do. And so, yeah, i I think it really is, as we we built Jumpstart Autism Collective, it it really has been about knowing my role, where I can excel, to support those teams that are getting built and really giving leeway to those exceptional people that can really fill those deficit areas that I have to then. produce something, you know, where we started, we're nowhere, gosh, where we I can't even envision. And had I had you asked me back then, hey, do you think that this is possible? I've no way. No way. That, you know, and I think that's one of the pieces that I would really encourage a a lot of the leaders is to know that that where you start or where you are today is not going to be where you are ⁓ in a couple of weeks, couple of days. Yes, you may be experiencing similar trends, but the way you handle those trends, the way you handle those instances, vastly changed from the experiences. And it things do get easier. ABA business is really, really hard. Not only are you managing, challenging, you know, trying to provide an excellent service and support those learners, but you're, you know, managing parents, trying to support parents and everything that they're dealing with to then provide a better service to their ⁓ their children. You're managing training, you're managing adults in and their learning differences to acquire skill sets that are sometimes different than how they're parented. And you have to train out the how they were parented to really get good skill sets. And and and so yeah, it has been a process to get there and how we've gone about trying to build this. I've been lucky enough to have fine people. My my skill set is not organization. My skill set is is kind of bigger thinking, addressing bigger issues, and then help people helping me figure out, hey, here's the Stephen kind of here's the engineering that we need to put behind this and here are the systems we need to develop to actually make this run and to make it work systematically. And people know what expectations you have of them so that they can really achieve their best. speaker-1: Yeah, when I when I was managing our ABA practice, it was like, how do I get out of your way? Right. Like how how do I get out of your way so you can thrive, right? What how do I remove the roadblocks and the barriers ⁓ from you enjoying your work and being able to ⁓ provide it, ⁓ do a suc do it successfully and then just let me get out of your way, right? 'Cause I have no business ⁓ telling you how how to do your job. That's why you're here, right? And now ⁓ you know, it That also does take certain skills of the BCBA, right? And something that we often talk about is I think the average B C B A right now is two and a half years experience. So, you know, there is that ⁓ area of I don't even know what I don't know. you know, so ⁓ having some self awareness can be helpful, but then also having those experts in there that can see the gaps, ⁓ even in your your supervision team, right? speaker-0: And and I think, you know, the what what's really challenging, ⁓ and I think this think back to my early years starting clinical service, I I felt like I knew a lot, but I knew I didn't know enough. I knew, you know, i yes, I passed exams and I was licensed, but I I was like, man, I I don't know enough to be licensed. I'm gonna go out and harm people. And and I think, you know, one of the ⁓ again, those early experiences defined how we things we did within Jumpstart. So really one of, you know, kind of knowing that and and this might be, I don't want to make a ⁓ too broad a generalization, but since I still feel like there's times like even sitting here on this podcast, what what business do I have speaking to a national audience about autism treatment and autism and autism systems? Right. And and and you know, I I can think of a bunch of people in our company that would be much better at this. And But it's and so I I think, hey, if I'm still having these concerns about ⁓ people don't want to hear you. I I imagine a lot of folks do. And I do think that there's a little bit of imposture syndrome. And sometimes that imposture syndrome can get, you know, can really take over. And so what we try to do is lift up a lot of our staff in ways that they know that they have support. Right. So if it's a if it's not only you know through the field experience, but post-field experience and ensuring that each of our clinical supervisors, which is basically, you know, as soon as you get your BCBA past the minimum competent both knowledge competencies and behavioral competencies, then you're supervising your own cases. Well, each supervisor then has a senior clinical supervisor that has a number, you know, and and again, this is where we should talk to Ali, our CEO, about what those exact standards for each position are. But thinking about our clinical supervisors, I think each of them have five to seven years of experience to then supervise our entry-level clinical supervisors. And part of that is because you don't know what you don't know. And there's such challenges. And you know, one of the things that that I mentioned earlier when we before we were recording was that in in 2016, Steiner House et al. Published an article looking at outcomes for individuals with autism. And they basically found that 47% of individuals with outcome have ⁓ poor to very poor outcomes. Well, 2016 wasn't too long ago. I mean, yes, it's 10 years ago. Things have drastically changed, I hope. but and so let's say that the research was actually done in 2014, took two years to get published. Not not not that long ago. and hopefully those numbers have changed a little bit, but What that number speaks to me about is that the the treatment models that we had been implementing are missing something because we aren't getting the outcomes that we really want to see. And I would actually, you know, just given my training and what we do at Jumpstart as part of the challenges of addressing and and building systems that that Really ensure we're addressing the whole child and kind of their specific needs, is that I think we're missing some of the medical pieces that we know that 80% of individuals have a co-occurring behavioral health diagnosis. We know that 60% of individuals on the autism spectrum have three co-occurring to minimally be diagnosed with three co-occurring behavioral health diagnoses. And then you start looking at medical. Right. And and I don't know the exact numbers on the medical you know, ⁓ seizures. I think, you know, 12% of our population. ⁓ you know, GI, I I and unfortunately I just don't have those numbers right on top of my head, but it it's pretty significant. And if you're providing ABA services to a neurodiverse population, I guarantee there's some pretty significant medical complications that are impacting your treatment outcomes. A lot of our young BCBAs don't have the experience to identify, you know, they don't have the training nor experience to understand when a medical issue is impacting learning, which creates, in my opinion, and now this is again my training, creates a massive problem in that, as a from a psychologist or even a BCBA perspective, if you're providing behavioral interventions for a known medical condition. That could be considered practicing out practicing out of work scope scope of work, right? So ethical problem minimally. Well, but if you're if you're treating and billing insurance for behavioral health services that are will not make a difference to a medical condition, then that could you know, some insurance is c could consider that fraud. Right. It's a major issue. And unfortunately, the field has done nothing about it. And by the field, I I don't mean ⁓ the board or anything like that. I I mean, you know, the the field of behavioral analysis, the profession of it. And how do we support a lot of young ⁓ BCBAs or even businesses support BCBAs and support to support the medical needs. speaker-2: One of the things I talk about a lot and that was important to me and how I supported my staff when we had ⁓ our own agency was like even even understanding the human development ⁓ and and understanding the stages and the progression and and what what that would look like and and and even being able to look at your goals and saying, is this an appropriate goal? You know, I can't tell you how many a hundred percent compliance and reasonable. speaker-0: Mm-hmm. speaker-2: Yeah, the tantruming. ⁓ a child will tantrum zero out of three occasions across whatever. For a two year old, I'm like, have you met a two-year-old? Right. And and that's just looking at your traditional development, you know, ⁓ norms across you know, across the last decade. Yeah, across the past decades. Yes. Not to mention you throwing in like the different medical. and that also brings us to like medical necessity and and how How well as a field do we really understand medical necessity and what that means? So all of these pieces and bringing them together, which each piece alone is a huge thing. Yes. But like, you know, how do you, you know, how do you ⁓ remedy that? Like how does ⁓ a business owner right now who's like, ⁓ shoot, yeah, I'm a BCBA. I started this business because I want to do better. I I want to provide quality services. I want to fill in those gaps that maybe I didn't have in previous companies that I worked with. and yeah, I I am limited in my knowledge and what I know, but I do want to do better. You know, I know like what where where do we go from here? What do we do? speaker-0: Isn't that a isn't that a great first step? Is kind of the acknowledgement and the awareness. And and yeah, it it it doesn't matter what level you are, but there's kind of those those ⁓ shit moments where you're like, well, I had no idea that this was a problem. An example of that. So probably let's say of 2014, 13, 12, I don't know, somewhere in there, I had to do a prior authorization review with a psychiatrist around ABA. Well, they don't know anything about ABA. And they're going off of the they said, okay, so what's the medical necessity for this service? And I'm like, the the what? What what what are you talking about, Met and and he goes, Nett, yeah, you you should be able to give me the medical necessity. And I'm like, Dr. So and so, I've I've never heard this term. I've been in the field, I've never heard this. What can you please outline them what you mean by medical necessity? And he kind of went down some of the, you know, what are the main symptoms, what are what medical, you know. concerns do you have? What are the safety issues? And I was able to kind of answer those questions in that moment, but I left that medical review thinking, boy, I bombed that. ⁓ we got ⁓ luckily we got what we ⁓ had requested. But I left that meeting thinking, if I don't know this, our entire team doesn't know it. And so we did a I I did a ⁓ deep dive into documentation of medical necessity for our team that we could include and really showed some of the different levels to indicate, you know, no treatment, focused treatment, or comprehensive treatment that we include in our ⁓ treatment plans. That way reviewers can see, you know, from ASD symptoms to medical concerns to adaptive behaviors to you know, self-interest physical behavior, that it really equates over to the level of treatment that we're recommending. So so now you're starting to talk about standardized questionnaires. And none of our staff had training on standardized questionnaires. And I'm kind of like, well, this is the fruit blood of what we talk about and how we communicate to our insurers and diagnoses, right? And and yeah, we've got to convert what it is we do to terms and phrases that the insurance companies understand. I mean, now they're starting to get more BCBAs to help review. But we've got to talk in those terms. And so we had to do a lot of training of our BCBAs on standard scores and understanding what those standard scores are that way they could really communicate effectively around those individuals' needs. And so each one of those steps, it's it's another opportunity. Again, we started where we started is nowhere where we started is nowhere where we are now. And I just kind of thinking about all the steps it takes. And I think it's, you know, how do you eat how do you eat malfin? One bite at a time. Yep. And that you know, I've probably, you know, gotten through maybe it's it's little ⁓ do they have feet, paws? What what what do elephants have? The the the ⁓ barely touched this whole elephant and kind of the the ways that we've we've developed training for our BCBAs and it it it really is a process. It isn't kind of a one and done. And there is, you know, and and luckily you know, thank goodness for ⁓ three Pi Square to Help provide some of the administrative supports, some of the pieces the systems that have to be in place for which a lot of our business owners have never been trained in, myself included. And you know, we even access some of ⁓ three pipe squares materials. Yeah. So ⁓ and and and and you know, it's very helpful. And you know, so it there are, and I guess maybe the lesson from that is if you don't have the system in place. speaker-1: ⁓ I didn't know. speaker-0: Find resources that can help you implement those systems. especially now that we're starting to see more and more scrutiny provided to the field. Yes. And if you don't have your ducks in a in a row from an administrative standpoint, from a billing standpoint, from a training standpoint, it's a problem. Right. And it'll be a big problem for you and the industry. speaker-1: I I don't want to knock anybody, but you know, we we talk to a lot of BCBAs that are wanting to start their own thing and a lot of non-clinician-owned companies that want to start a business. And, you know, and we kind of vet ⁓ those people to make sure that we're all on the right page. They're doing it for the right reasons. They didn't see the tri care numbers and they're like, ⁓ look at how profitable this is. ⁓ but the the issue I find is ⁓ for a lot of these ⁓ You know, newer BCBAs, they just want to start a business right now. They're like, ⁓ I just graduated. I I had let's go and do it. And like, then why why did you become a BCBA? Why didn't you become a business manager? Right. ⁓ because those are different things. And if you think that you can learn how to do a clinical ⁓ role at the same time as building a practice, training staff, working with parents. ⁓ like I'm sorry, right? Not many people can do that, right? Very few can do that. and so and I I wanna say almost zero, right? And so like doing that on a consistent speaker-2: Right. May maybe a team of people that come together in the perfect world, right? You have your clinical, you have your like your systems ⁓ organizational, you have your business, you know, maybe the the trio with each having their their expertise comes together, but even still it does take a lot to learn. speaker-1: Maybe, maybe, right. I I don't remember who told me this, but like one of their issues with ABA in in general was the just the the the surge in new B C B A's and there's not enough experience mentors to guide all of these new B C B A's. And then, you know, they went on and they talked about how the ⁓ you know not every master's ⁓ degree is equal, right? And so that is another issue when you know you have a a 30% pass first pass. I mean, no, no offense to anyone that struggled with this exam. I couldn't pass it. I can tell you that. ⁓ but like if it takes you five times, like that, that's there there's a sign that maybe you need a mentor, right? And I I think that that that is part of the issue. Is that like, is it we We built an industry without a framework. Is that is that what we're seeing? speaker-0: Field of ⁓ applied behavior analysis within autism has grown quickly. And you know, you kind of fill the gaps ⁓ and and plug holes from some of my experiences. You know, some of my best lessons were learned on other people's nickel, meaning through employment. And I learned what it is that I wanted to do. I learned what it is that I would never do. But I think that idea of getting experience and learning, just like ⁓ when you have multiple supervisors. You learn what you really like in a supervisor so you can emulate that. And you learn what you don't like in a supervisor or from supervision you've experienced. And you do everything not to replicate that. And those lessons are terrific life lessons. And I think when when we start a business, and this is one of those kind of crazy things that I look back and I was like, boy, what were you thinking? ⁓ yeah, hey, I want to expand services. Hey, I have this great idea for what all you know I can do, what we can do. And earlier I mentioned that when we started Jumpstart Autism ⁓ in New Mexico, there was two other, maybe three other AVA providers in the state in 2008. I I quickly realized that as I started the company, that I moved out of clinical service and into business management. Yes. For which, you know what, on the clinical service side, I had a lot of training. I I actually went pretty good. on the business administrative, luckily I had a mom that was willing to help me that was an accountant and was managing my dad's pediatric practice. I had no experience. I had no business doing business. I had no idea. No idea about b medical billing. There there weren't a lot of systems for it. And and so I I it it's great to have ⁓ aspirations, to be ambitious, to take what you want to what you've learned and apply that. But no one knows it all. And I think that's one of the critical pieces ⁓ as a business owner and finding those individuals that can really fill in those gaps for your knowledge, your skill set gaps. And everybody has them. And it's okay to have them. It's not finding those people that can fill it. So, you know, ⁓ earlier I mentioned that, you know, I'm really a psychologist first and then BCBA second. And I I should not be training BCPAs. I I don't have that skill set. Well, within Jumpstart and within our ⁓ internal field practice placements, we have a ⁓ so we have a training system or kind of a whole training department. That training department oversees on average, each RBT gets about 140 hours of of training before they sit. with their own client by themselves. Yes, they're working directly with clients, but we have a trainer, kind of a higher level RBT that has been trained that probably has three to four years of experience already, that that's training our staff. and and we have knowledge based our knowledge base testing that they have to pass and skills based testing that they have to pass. You know, again, this kind of goes back to that early conversation that no one wants to deliver bad APA. No one wants to struggle in kind of, I don't know what to do. And so creating those opportunities for supervision, providing up ⁓ you know, from people that are really knowledgeable and can do that training, because I didn't have that. And that's what builds a terrific foundation to then build quality treatment and then fill the gaps. speaker-2: Yes. And I I just I just I could just sit here and and and listen to you talk all afternoon because all of what you're saying, like what what I'm hearing is that like support and trust and collaborating and working together and that like just one person, one professional, one individual isn't going to be able to make the difference in the same way that a group of individuals, a group working together, a group of professionals. professionals who all who each have their own strength and knowledge base and understanding and experience levels. And, you know, back earlier when you were talking about medal we were talking about medical needs and like being able to rule out ⁓ dual diagnoses or just other situations going on outside of just ⁓ if you know the treatment of one behavior. ⁓ you know, and and I was Had a question that I was going to bring up to you, but you ⁓ you've kind of answered that in how you guys are handling that with being able to have a psychologist on on board, someone who is able to to diagnose. And and so that that yearly diagnosis, that psych con that that psych consult, excuse me, yearly site consult, and then as emergencies happen, because that was one thing I was gonna say is like, okay, we talk about you don't know what you don't know. So, you know, if you're a BCBA ⁓ providing treatment for a learner and you know, maybe signs come up where they have an ear infection. You know, a lot of times that's especially if you've been around children, if you if you have, you know, if you've been around children for any amount of years, even if even if you haven't been at B C B A for very long, there are certain symptoms, certain signs that can kind of lead to that, use that. ⁓ they're tugging on their ear or they're hitting their ear, or you know, maybe they're not swallowing as much. ⁓ now if you if you haven't had a lot of ⁓ experience with with a young child, you may not know. You may think, ⁓ there's a sense of like the self injurious behavior is coming out of nowhere. Like let's do a let's you know, let's take data, let's do a functional analysis, let's figure out are they escaping work? Are they whatever, whatever? You know. and when really it could be something simple as an ear infection and they need antibiotics and then sh you know, blah blah blah. But then you they well, I just want to say one more thing, but then like that's something that you can c we kind of have a little bit of understanding. Understanding of that. But then you add in these other major diagnoses and ⁓ like dual diagnosis, ⁓ like how would I even know that, ⁓ maybe that's speaker-0: Yeah. speaker-2: I'm just gonna pull some rand O C D or how you know, or some other thing and and I'm treating it as like a very basic autism trait. Anyways, yeah. So so I love that you brought that all in. speaker-0: Yeah, no, and and I love the example and kind of that idea of OCD kind of it makes me think of a couple of different examples of of how working with psychologists improve outcomes. And so at Jumpstart, we have kind of three levels of of programming. ⁓ the early learner, we have a transition readiness kind of getting kiddo, kind of going from the early learner to getting kiddos ready to enter kindergarten ⁓ or school services. And and being able to learn in group settings, things like that. And then we also have an intensive skills ⁓ program where it's individuals with ⁓ challenging behaviors, different ⁓ acquisition rates, and ⁓ you know, typically a range of complex behaviors. And ⁓ and and many of them are already di ⁓ diagnosed with profound autism. And so one of the things that comes up at at Every single one of these levels is this idea of maybe not the the experience of and we get it in consults all time, you know, the the the rule-bound behaviors just trigger everything, right? They want to play with their one toy and you remove that toy and they just melt down. ⁓ and they can go on and on about different triggers. And it it starts to look like OCD, right? Where they're hyper focused on it, they can't shift. They they check to make sure it's there. It's interfering with all learning opportunities. And so through that site consult, we really do start talking about other coexisting conditions and how we can think about medical interventions to support ⁓ and how I frame it is it's a positive behavioral support, right? If we can find the right medication for a known condition that's impacting an ⁓ another. Learner's ability to acquire new skills and reduce that rule-bound perseverative behavior, which some medications can also reduce significant sensory ⁓ processing differences. And we can just take the edge off. That way, if and and there's different medications that can do that, for which after the consult, you know, I'll call this, I'll call the PCP or I'll call the psychiatrist. And sometimes the child's on specific meds that's trying to reduce severe behavior. And I'll talk to the psychiatrist, like, yeah, I get that this is designed to reduce challenging behavior, but that's not getting at the core the cause of it. Here's the cause, and here's the kind of medication we would look to to have positive outcomes given the types of behaviors. And we we just see astronomical changes when you help a child get their neurochemistry right so that. They can then be at a place where they're ready to learn. I think that that's kind of one example. You take sleep and trying to figure out sleep, right? That that there can be neurological reasons why a child's not sleeping at night and and it just goes unidentified. And working with PCPs to get into neurologists to then talk with neurologists around some of the subtle differences and why we need a sleep study and and identifying. know hey yet sleep's impacted but here are the differences we're seeing in their learning profile and i've even had a neurologist say yeah but that's autism i'm like and i i can guarantee you ⁓ i've been in this field forever i'll say this this this way but i've been in it forever listen to me you're the i'm the pro no i don't say it quite that way but but it's like no i i can guarantee you that this is not an autism symptom this is caused kind of from a neurological standpoint that we do not see in the population and here's how it's impacting their learning and go through the very specific changes of behavior that autism wouldn't count for. And as to why I'm saying, ⁓ this is possibly a seizure. You know, and and so, you know, we had a a client ⁓ that was bow trained, toilet trained, fully toilet trained, and started having accidents. And someone said something to me in passing and I was kind of like, ⁓ hey, let's get together and let's talk about this. And looked at all their data and you could see across the data ⁓ the the the toileting voiding was the biggest issue, but you could see slight downturns in other kind of sequent or kind of along those same timestamps. And so then talking with mom and kind of, hey, I I think that he's probably having some kind of seizure. She ended up taking she saw the seizure, took him to the hospital, nothing happened. You know, they couldn't get find anything on the ⁓ on the EEG. And I kept on talking to mom and supporting mom. She was going through it. I mean, it was It was really challenging. And you know, the y she's going through a divorce at the time. ⁓ and she kept on trying to get her child seen by a neurologist. And so she had, you know, probably three times over the next 18 months had him in the ER. And finally I said, Hey, when the doctor shows up at your bedside, call me. I will answer. And I need to talk to that pediatrician or that that hospitalist. And so kind of gave them the full background and told them what I thought needed to happen. And then the child's admitted and I said, hey, when the neurologist shows up, calm. So had the conversation with the neurologist and she said, you know, we aren't seeing it, but I am hearing what you're saying, Brian. And yeah, let's start some prophylactic ⁓ neuroleptics. And I seizure and I convulsive medication and see what happens. Literally within a week we see the same kid and he's accelerating. Just night and day difference. And so that's one of those kind of pieces that we wouldn't expect even seasoned BCBAs, even parents that have ⁓ you know, ⁓ that are BCBAs to to really understand. And that's where the the interdisciplinary or the collaborative approach really makes a difference in improving these, you know, the the you know, 47 to 50 percent of poor outcomes. And changing that. That that's what insurance is paying us to do. That's what Medicaid is paying us to do. And it's really, you know, and as a provider, you know, as an RBT, as a BCBA, it's it's frustrating not knowing why you're getting regressions, why, why you aren't making progress. Having that those kind of outside eyes and considerations when you aren't in the weeds really can be helpful to make massive changes. speaker-1: Yeah. I I I think that and you know, I mean we we talked about the imposter syndrome. I think that was all off off the recording, but you know, there is that ⁓ I mean I have it pretty bad at times. I can imagine that there are a lot of BCBAs out there in the similar situation where they feel like ⁓ I shouldn't be doing this anyway. I'm not gonna ask anybody. ⁓ and and on some of those Facebook groups. ⁓ you know, when when someone asks a question, it's why they're all anonymous now. Everybody's anonymous. ⁓ there is some pretty ⁓ you know, not so nice responses, I guess, right? And so like as a field, it it does seem like the some of those harsher voices are kind of coming to the top. And I don't know how helpful that is when, you know, we're we need to be able to collaborate, right? We need different perspectives. and you have to be able to ask perceived stupid questions, right? Like I asked stupid questions all day long, right? Like that's the only way that I can learn. so if if anybody knows a different way, I gladly take that, right? ⁓ and I'll try it. ⁓ but yeah, so I think that that is is something that, you know, we could maybe do a little bit better as a field is allow those questions And be open and vulnerable, I think w speaker-2: Yeah, for sure. And by the way, I think the I think the imposter on the frame because he I was sitting here thinking, Yes, I feel that same way every time we hit record. yes, there there's a lot. There there is so there's so many pieces here too, so many different threads we can pull. And so yeah, so much here. But I do and that is like one of our main missions of of this podcast. speaker-1: ⁓ yeah. speaker-2: is to have the conversations, is to ask the questions, is to be curious and and and even model that we don't know everything. And and I don't think a single guest that we have had on the podcast to discuss has all has even said, ⁓ I am the expert. I know it all most of our guests pose questions too, right? and I do think that whether it's multi, you know, interdisciplinary, whether you have You know, even if it's not, even if you don't have a psychologist on board, which like after talk after this conversation we've had so far, I'm I'm thinking, wow, like we we need to make changes here. We we need to have more access to not only speech and PT and OT, because that's a whole those are all other conversations that we could be having. Maybe there's a a f maybe there's a fine motor issue that could be You just do this one little thing and tweak it and voila, the outcomes are gonna be are gonna like skyrocket, right? but but even even a group of B C B A's to be able to sit down and talk about, you know, ⁓ well have you thought about driving around the back door? Yeah I mean it's not groundbreaking. ⁓ but yeah, but I I think just that that ability to be able to have that collaborative approach, even to reach out to the other business owner across town and say, hey, I've said this before. I've gone scrutiny for it. But like, hey, you want to have a cup you want to meet for a cup of coffee? Do you like I I would love to hear what's working for you and what's not working for you. And I want to share what's working with me and what's not working for me. speaker-0: You know, April kind of one of the kind of a story along those lines. I I'd been in New Mexico for years, and a newer company had come in and started offering services. And we happened to be at the same conference, a local conference, and had booths kind of catacorner from each other. And and I had never met them before. And I had heard their name and I just walked over and introduced myself. And you know, hey, I know you guys are new. You know, we do diagnostic work, we're always looking for referrals. ⁓ happy to refer folk families over to you. And if there's anything that we can do to kind of support you in ⁓ building a service here in New Mexico, happy to support. And from that one introduction and just being willing to kind of have a conversation, ⁓ over the years have developed an amazing relationship. And kind of every time the the owner, if one of the owners introduces me, she's like, Brian's one of the nicest people. The first time we ever met, we were struggling, and he walked up and just offered any assistance possible. And and it's hard. Clinical service is extremely hard because you have so much governance and so many regulations, and you don't know what you don't know. You know, as a as you know, kind of on not only on the clinical side, but now on the business side and the the contracts, you know, there there's a lot of legal jargon that you have to follow. And, you know, you have to have an avenue to be able to ask that. So if it's it, you know, kind of like what Steven mentioned, if it's one of the then are one of the groups on social media, or it's finding a mentor, or if it's joining a professional association through, you know, your local ABA state association or something like CASP, Council for Autism Service Providers. And and I'll tell you, the we joined CASP I think it was in 2018, 2017. And we were going through we we had just opened up another clin two clinics at the same time, one in a second clinic in Albuquerque and a third clinic in Denver, ⁓ where I am now. And it it was a financial struggle. It was a challenge on all of our skill sets because we were training. First time I mean we had trained BCBA ⁓ or some interns before. And at this point we have 12. We're trained and and the amount of money it takes to train 12 people, it puts the entire system, you know, kind of in stress. And and the first time we attended CASP, I was like, wait, I'm not ⁓ I'm not the only one experiencing this. ⁓ my gosh, that here are my people. Here's people. And it it's a place that you can ask questions. And they are You know, CASP was built around sharing information because it is hard. And ⁓ you know, if if you're looking for kind of a little more anonymous opportunity to get feedback and find support and find kind of a group, I'd recommend looking into CASP for sure as an opportunity. speaker-1: Yeah, I I think, you know, we had an experience with our practice where, you know, we didn't accept Medicaid at the time and we were transferring a client to a Medicaid provider and we were trying to transition out and they just they didn't even want to talk to us, right? And it's like that's like it does such a disservice, right? You can say our treatment plant's terrible, but at least have a conversation with us, right? ⁓ and and so I I think that that is something ⁓ again, it just goes to that like ⁓ scarcity ⁓ mindset. And you know, there is enough like there's such a high demand for B C B A's right now. ⁓ speaker-2: I mean, we were just talking in or asked me anything yesterday ⁓ about wait list. How do I manage my wait list? I mean, so that tells you something right there. Everyone has a very long wait list that's that's years long. and so that that right there tells us that there's a there were there are enough people to go around that need our help and need, you know, services. speaker-1: And y you all are helpers, right? Like ⁓ help each other. So And I have a question for you. I'm curious about ⁓ I I knew I saw it somewhere and I looked it up. AI diagnosing ⁓ for autism. speaker-0: Exactly. I love that. So I think that, you know, AI presents challenges in in all areas, right? And and if you go in blindly, it's a major problem. I I I think in some ways, if you look at AI from a distance and fear it, you you're kind of you you're you're just gonna get consumed and you won't understand. And ultimately AI is there, ⁓ should be there to be able to support ⁓ work that you're doing. And so with that in mind, ⁓ you know, we do diagnostic work and we were funded through a rural health care grant in New Mexico to expand autism screening and diagnosis into rural areas of New Mexico. And so we were able to hire psychologists from outside of the state because New Mexico is not part of one of the compacts that allow priv the psychologists to practice via telehealth into the state. So we hired psychologists outside of the state. licensed them in New Mexico. That way they provide telehealth diagnostic services. Great model, works terrific. It has been a massive success in creating access ⁓ of services, ⁓ diagnostic services. And you know, in in in New Mexico as many rural areas. If you're in a rural area, it's going to take you two to three years longer to get a diagnosis just because of accessibility. And we found that families even in metropolitan areas are going to prefer a telehealth eval over a in-person eval. You you you contextually you see the behaviors that you need to see diagnostically, it makes a massive difference. As a psychologist, anymore I much prefer a telehealth diagnosis than a doing a telehealth avow, than doing an in-person avow because you see a different client in in an office than you do at home. I think that's important also for treatment, but that's kind of a different piece. So the AI, so so speaker-1: Yeah. speaker-0: We had thir we have 13 psychologists working with us at Jumpstart to expand the services. And part of the thinking now is, hey, you know, we have a limited resource of of diagnostic work. What can AI do to support us? And over the last two years, trying to figure it out, trying to figure it out. And ⁓ I was eventually approached by a group, and it might be the very group that you're talking about, Steven, I don't know. ⁓ about hey, can can AI work to support psychologists? To remove some of the administrative responsibility, that way we can get the avows done quicker and make that one psychologist more effective. And over a course of a year in talking with them, ⁓ and ⁓ the ⁓ I finally agreed. I said, hey, you know what? And and kind of initially I'm like, Yeah, Jumpstart would be willing to collaborate with you guys and and look at this. And they're like, no, we aren't interested in Jumpstart. We're interested in you supporting us. I see. I'm like, I'm like, uh-uh. Not I'm I'm comfortable where I'm at. It's taken me years to kind of get right now. I have a system. And then six months later, I'm like, hey, you know what? Yeah, I'll support you guys. And and through telehealth, okay, hey, just simply using AI as voice to text and ⁓ not even thinking about. It than getting parsed out. Right. But once you can parse it into specific areas, right? So if we go through the medical history, it it's talking about birth, you know, it'll parse all the conversation into birth history, into, you know, hearing, vision concerns, dental concerns, toileting, sleep, medical in terms of genetic history, if there's any, if it's, you know, behavioral health history. And and so it's all right there. I don't have to now go and type that. speaker-2: the clinicians who don't have as much experience are like is there are there safeguards in place for things like this or should we have safeguards in place so that they're not easily swayed, right? Because if they're being given specific information speaker-1: Yeah, that's where like I'm the you know, I'm the Amish guy, ⁓ riding my horse and buggy on the side of the road, I'm watching all the cars. Like you say don't fear it, I'm fearing it, right? And and like so and we use it. We use it, we're building with it, right? And I'm still speaker-2: I use it for my console to take my notes for the same very reset, right? Yeah. speaker-1: But like my concern is okay, you have all of applied behavior analysis at at at your fingertips. And even diagnosing. But like this is where I go with it. And and it it it applies to this too, right? Yes. And so you have a brand new BCBA that now has the like all they have to do is just type what do I do for this? And they don't have that experience, right? And now we're giving them speaker-2: This is like for diagnosis. speaker-1: all of this. I'm my concern is that inexperienced people will rely on this more than than they should. And and so like that that's kind of where I go with this. I don't know where this goes. speaker-0: story here that I want to get to. But I think the first piece to kind of realize you know having a ⁓ strong skepticism for everything everything AI produces is a solid approach. And no, and and I think if you're going to do anything clinical, you have to vet on top of that to make sure that any clinical information you're putting in is secure. So that you're using like a bastion.com or Bastion GPT or something that you aren't using the big LLMs. And they're they're vetting everything before it goes out to the LLMs and de identifying and then pulling it back in. ⁓ and and I guess the the big thing that I'd say is have skepticism about everything produced because all LM do all LLMs do is provide best predictive next port. That's all they're doing. speaker-1: Yes. speaker-0: It sounds great. And so just kind of and and and again, I'm I have a BCDA. This gives you a better idea of where my behavior analytics skills are. one of our good friends who's the director of training, ⁓ was wanting to do a bark. They just moved to a new house and her dog's barking and it's like, ⁓ well, I know it's when I'm in meetings, I just need him not to bark. And I'm thinking about a bark collar. And so I put into into Chat or whomever, ⁓ but good bark callers on there. And chat comes back. That's a great question. And what you want to do for a bark collar is one that actually slowly increases, you know, shocks over time. And I'm kind of, yeah, that sounds good. And and and my wife, who's our CEO and the BCBA, look at me and they're like, what the hell are you talking about? speaker-1: Right. ⁓ speaker-0: Yeah, you just kind of want to warn it and you know so to say Yeah exactly and and and my wife looks at me and she goes, Do you not know anything about behavior analysis? I'm like, I know a little. What am I missing? You tell me what I'm missing. And and she's like, That doesn't work for punishment. I'm like, duh. Right. And and and so that's a great example. And so then so then they put into the LLM, you know, hey, what about this? And I thought, You are a hundred percent correct. speaker-1: That's ⁓ yes. Yeah. speaker-0: So so and and and I say this in all humility, right? I I don't know everything. I probably could have probably had to answer that question correctly on the exam, but then deep six to it, right? Whatever. But but it gets to that idea of hey, you know, psychologist, 25 years of experience in the field of beh of diagnosis and behavior modification, ask a simple, relevant question to an LLM, take it as yeah, that makes sense. And you don't have that skepticism, you're going to fall for it every time. Yes. And I think that's just a great example of it is very easy. And whatever information you get, make sure it makes sense. Because you're going to put it out there and it's going to represent the work you do. And all of a sudden, it's going to get in front of people that know and they'll be like, hey, this is AI slot. Or you're incompetent. Which one is it? speaker-1: No, and you know, I I was I don't know where ⁓ I heard this, but there are ⁓ like a lot of court cases are now getting thrown out because like lawyers are just like a hundred percent AI and they're like this doesn't even this this court case doesn't exist. You're citing this as part of your case. It's not even a real thing. And so like they're just throwing these cases out and and they're getting overwhelmed, you know, like The the other like so when I put my tinfoil hat on, right, where where I take this is you have a large practice management software that has incorporated AI into the support of treatment planning, diagnosing, whatever it may be. ⁓ and you have a ⁓ like ⁓ maybe a BCBA uses a system, they vet it, it's a hundred percent accurate, like it's great, right? Perfect. Everything's right. And then they rely on it very similar to like Tesla's ⁓ whatever, what is it? ⁓ crew. Yeah, self-driving thing. and and then, you know, and then they get into a huge car accident because they're s asleep at the wheel. Like you can't do that, right? And so like is are we ⁓ are we the frog in the pot that we're gradually warming up to get used to it? And then, you know, then this practice management software says, ⁓ you know what? We can ⁓ r we can recommend maybe 10% more treatment, you know. And and then, you know, we also get we get the revenue on the billing side. Yeah, that's you know what I mean? So like that's where I kind of go. And so this is my worry, right? Like that's just my worry. I don't know if it's like crazy, but that's just where I'm at, right? speaker-0: Yeah, I don't know that you should take your take the full tinfoil cap off, but maybe kind of adjust it just a little bit. No, but I I think that good skepticism is is warranted. And the the systems if I'm not gonna say if as an AI owner, when you're using or allowing your staff to use AI, ⁓ be sure you have a policy in place around the use of AI. And Make sure that every staff member knows that the AI is an assistant. It's not replacing what we expect of you. Right. and never never allowed to take the clinical, ⁓ the clinician or the clinical judgment out of the decisions being made. Right. It can support, but it it it's not there to replace. And in in and sometimes in the cut and paste world that we have around document development. It's easy to cut and paste and let it just kind of take the pathway of least resistance. ⁓ What AI is going to do for us is you're going to be paid to review what AI generates and make sure it's accurate. That's where your big bucks are going to come in. Right. And and how it applies. And and I don't know how close that is, but that's no different than what we do right now. Sure. Minus you have to type everything. And and I think it's it it's holding all of our staff accountable. It isn't about seeing more clients. It's about producing what's accurate and and what leads to change, behavioral change for that learner and better outcomes. AI can get it right or get it wrong, just like what I the example I gave around the shock collar. Yep. And and if you don't know, you're gonna actually do harm. Yes. And yeah, I I I keep on kind of talking to my staff about or my teams about it it it's a matter of time until a and and actually I think it happened with in Florida where public sued an ABA provider for not only overbilling them but not having the outcomes that they said they were getting. And that's gonna happen more and more, I think, where ⁓ insurance companies are really trying to recoup ⁓ significant money for poor outcomes. Yes. And and and and so I think we just have to be on top of anything. If it's diagnostic work, you know, ⁓ I I I would definitely say the companies that I'm involved with in are designed as the primary mission to support the clinician. Right. And ⁓ not to replace. And so if you're trying to develop AI systems that replace, that's a problem. Yeah. And I would fully put that tinfoil hat, I'd have you make me a tinfoil hat. I will I would get on that soapbox. speaker-1: Yeah. Yeah. And and like I agree it is this that that is the intended purpose. I hope, right? Like that that has to be my hope. But I I feel as though, and I'm sure you're well aware, there are some pretty awful companies out there that will use this as a pro a productivity gaining machine, right? ⁓ and so, you know, I think you said this earlier, right? But you have these lines that you won't cross. Like you you've thought about this in your vision. What will we not do? And that kind of brings me back to that. Like how do you train your staff on building that moral compass inside like because the ethics is great, right? The the I I but like you have to have some kind of internal navigation system that says, I won't do this, right? Like that's not what I'm willing to do. And and I'm wondering how you build that into your system. speaker-0: That that is a terrific question. I guess my initial response is it isn't any one thing. It's everything. it just kinda no one's ever asked me that question. And it it it kind of gets it I know you guys have talked about culture. I know and how important that is and how do you develop it? It's kind of the same thing. I think it really starts it starts at the top and what that vision is and how you speaker-1: You do. speaker-0: where where you invest to ensure that that vision is being implemented. And so for example, one of the one of the driving goals initially for Jumpstart was to change a child's developmental trajectory. That's that's a massive goal. Right? We aren't talking one-to-one learning for a child, you know, ⁓ for a child that's taking, you know, four months to learn one skill. We're talking like a week to learn Three new skills, right? It's exponential, ideally. and and everybody has to be on the same page. And so the training has to be on point. And it really does kind of come down to you have to I ⁓ the only word that's coming to mind that's the wrong word, indoctrinate everybody on the team in the same way of thinking and putting that client's learning. First and foremost, at every step of the way. Yeah. Even if it ev even if it doesn't necessarily make financial sense, how do you now make that one decision financial sense? The the the there there's tons of spin-offs that we can do as business owners that can help generate other revenue. ⁓ as you guys have found out in terms of podcasting, potentially it's to support other pieces. ⁓ there there's ⁓ Ford companies, they were starting to develop their ⁓ cars. They had a massive ⁓ si, you know, kind of through the furnaces that they had to generate, all the steel, they had a ton of just coal developed. Well, they then take that byproduct and start Stanford Coal, the the charcoal business, right? So now they created their whole other industry. Well, it's kind of same thing that comes up with with this in in the practice that you are the services that you develop. ⁓ some of the stuff in terms of our training, the the extensive training that we have, it's like, hey, let's start, let's start. you know, it it doesn't make sense for any one person, but as a system, it really starts to make sense. Now, how is it that these decisions we started with from changing a child's developmental trajectory, all the different side things that we've had to do to accomplish that, how can we now think about those as supporting a larger community for educational purposes? Or what are those systems that we have that we can start training or s offering as kind of ⁓ a a a low cost kind of monetary thing? ⁓ I I think very much like what you guys have done and saw a need and been able to fill it. It isn't any one thing that develops that ethical and clinical fiber to do the right thing in the moment. It's everything that you do as you train a staff. So if you're just offering forty hours, what does that tell the staff? That tells the staff doesn't matter. Yeah. Right. ⁓ and and and we've had BCBAs leave jumpstart because they don't like they excuse me, they feel the the ⁓ quality assurance verifications and the ongoing ⁓ consultation supervision. impacts their individuality and being able to develop ⁓ true. I get it. At jumpstart, here's how we do things and here's how we collaborate and and this is what we do. At jump if it doesn't work for you, it doesn't work for you. And that's fine. Yeah. You can go on other places and kind of do whatever. and and that's okay, but this is what we value. And as long and and I think that is, you know, it it not to get too act based, but speaker-1: Yeah. speaker-0: It it it is that idea of what is your value as a company and how are you living those values? ⁓ another example. ⁓ so ⁓ two of our psychologists are gonna ⁓ do a training later this month with all of our BCBAs on motivational interviewing. And motivational interviewing is something that came out of the substance abuse service model around understanding where. someone is in kind of the the process of change, of behavior change. And the reason we're doing this is to help our staff better understand where parents are in supporting their child because we know that one of the biggest outcome indicators is having a parent engaged and being able to implement you know to to support their child in their everyday activities. And As our staff are more aware of how to assess some of that stuff to be a better collaborator with parents, you get better outcomes. And you know, I I I know a little bit about motivational interviewing. I can't do a training on it, but sure one of our psychologists knows a lot about it. Yeah, let's do it. I love it. Yeah. And and again, it it isn't any one thing, it's everything that you do. Yeah. and everything in little steps, right? So If a supervisor says, ⁓ I gotta get this new program impl implemented, let me throw it into AI or let me just copy what I did over at Johnny and not modify it. Okay, you you're sending a message. speaker-1: Yeah. speaker-0: And it it's everything that we do. and it's taking time. But also if if if as a business we just say, hey, you know, the the brand new B C B A that just got her B C B A, his her B C B A two days ago can now carry a full caseload, just like my seasoned B C B A, you know what? That's sending a message. And that message is it doesn't matter what the outcomes are, it matters that we're making money. Yeah. Your your professional of development doesn't matter to me. It matter what matters to me as my employee is that you're making money. And and and so if if as an employer I can say, hey, your professional development is just as valuable to me as our clients' outcomes, and they serve the same purpose, right? That the it's this the money I invest in you and improves our clients' outcomes, which lifts jump starts, branding or awareness in the community, it's a win-win. It's a long term win and not just playing the short term games. speaker-1: Yeah, I think it goes back to that conversation you had with the the family, right? We broke your trust. I I think that that is where this comes from, right? Your values are embedded in this company. And I think if you have a lack of value or a lack of intention or a lack of vision, that will show, right. And I think that that is what's missing from a lot of well meaning ABA businesses. speaker-0: know kind of if we get back to systems and what systems do you have in place. I I think that having that vision or and maybe not, but but what are the values that you're trying to implement through the through the practice that you're working at or the practice that you're developing as a small business owner? What are those guiding values? Those values will dictate the systems that you have to implement. Now you aren't going to know every system that you're going need. And Once those once once those facts kind of come about or you hear what someone else is doing and try to replicate, then you know replicate that to how it matches your values. You aren't gonna necessarily be able to cut and paste everything that someone else is doing. You can do a lot, absolutely. It might be able to get you 80% there. Sure. But that extra 20% is the individualization for the value you have for your company. Or as an employee at a B at an ABA program, the you know, what you're implementing is matching the value for that company that then actually is the beacon for younger BCBAs to s to replicate, for the RBTs to aspire to become future BCBAs. and and and it just it really makes a difference. And it's not aspirational. But what I'm saying is is not aspirational at all. It it's people get into this field to make a difference. Yes. They they want to grasp on to your values that are making a difference and they want to live them. Help them live them by creating the systems to really make that difference. What I just said, we have to run that through the filter of adult learners, of different life experiences and different, you know. People just see the same thing and experience it a little bit differently and have different interpretations. And and so it's messy, it's hard, it it it it's a challenge. It that this is not, you know, developing and ⁓ running a a company i i is extremely challenging at every level. But if you can fall back on those values and use that as your beacon and it it makes it sustainable, right? ⁓ it not it it's not forever, but Of that is just my own personal story is after COVID, you know, we we trained 12 ⁓ interns to become BCPAs, and that was a huge financial burden. And we finished that process kind of the right as COVID was starting. Then you have this monster of financial burden, and now you're building out of it. And ⁓ in Denver, we you know, we had our center in Denver and our lease was up in 2003. And we started running numbers and we were looking at kind of expanding. And as we were running numbers, it's like it it doesn't matter how many kids we serve, our model's not going to work here. Right. And it was a hard decision to say, hey, we're going to have to close our center. We weren't w willing to move to a ⁓ home base. And so we looked at actually selling our Denver operations, went through that process with some great consultants that we still stay in touch with to help us kind of continue ⁓ to refine our systems. and and after we ended up closing, which which was a big deal. It I mean, we ended up terminating, you know, stopping service for I think 50 kids. We ended up ⁓ having to terminate about 70 staff. One of them was my son that was finding his stride within behavior analysis. One of them was my cousin. It was heartbreaking. And at that point, I told our wife and my wife then and now CEO. ⁓ I said, you know, I can't do this anymore. I I ⁓ I'm I'm done. I'm I I can't. This is too brutal. And we were able to shift my role from CEO back into clinical site to support our teams even more and thriving within that and kind of got me back to the clinical service that that I was trained to do, that I had stopped doing for years. And and it's just w and and so I think along the lines, you know, we do as leaders of a business and as leaders in an industry. you you can go down paths that you say, Hey, for me, this is now a dead end. speaker-2: Thank you. Like thank you so much for sharing your story and for sharing just now what you shared because it helps to normalize, right? Because we have we we started ⁓ this year at the beginning of the year, we started a support group for BCBA business owners completely free, no charge. It's it's just you go on to ⁓ you can ⁓ the link will be in the show notes actually if if anyone's interested. ⁓ But that is as we're growing that and as more and more people are joining and we have we have meetings we ⁓ monthly and then we support each other through the Discord platform like throughout the the month. That's been the biggest feedback I think that I've received in that community is wow, I don't feel alone. Right. And I'm not the only one. And ⁓ maybe I'm not doing anything wrong. This is just part of This is just a challenge ⁓ that's before us, right? And and then also the building that community of of reaching out to ask for help from each other or you know, and I I think it's really ⁓ it's a beautiful thing that when professionals, especially professionals in the helping field, can come together and each other. speaker-0: Yep. Absolutely. Well, and and kind of on a similar note, ⁓ you know, we are looking to expand some business to business opportunities for Psych to support ⁓ ABA companies. ⁓ it it's not only from ⁓ an autism, you know, kind of to potentially offer kind of a white glove autism screening and diagnosis where you don't have to find you don't have to hire a psychologist. Psychologists are squirrely bunch. I like this put it out there. Not all psych just like, you know, kind of i any profession, not all psychs are created equal and nor are s you know that Hurting cats, right? speaker-2: Right. We all have our quirks. speaker-0: Absolutely. And and you know, it it can be hard to manage, especially to try to incorporate psychol psychologist diagnostics ⁓ consultation into a practice. And so if folks are interested, ⁓ I'll you know, my email will be in the show notes. ⁓ reach out to me, happy to have those conversations and what those look like and what that, you know, where we've had success. ⁓ you know, one of the challenges with with diagnostic work is is really ⁓ or just autism services is how do you penetrate the referral field. And through diagnostic work, you know, that that's one of the easiest ways to generate referrals for that company. And so, you know, it's not that when you do an avow and avows that we've done all over the ⁓ with other providers, it's like, hey, we'll refer, we'll talk to the family about your company, but they can they have the option to go anywhere. First and foremost. Right. As long as we're clear on that, then yep, good. Provide this. And and so really helping companies address the medical needs of their clients is what our goal is. But also being able to help companies, if they chose, to implement diag or offer diagnostic services, to do it in an ethical way that really not only supports their business, but ⁓ for referral that also supports the community. And brings value in in so many different roles that people are welcome to reach out to me and happy to talk with what that would look like. speaker-2: Great. Absolutely. We can provide your information on the show notes for sure. Well, as much as I want to continue this conversation, and we will actually be continuing the conversation, we ⁓ we have ⁓ arranged at least one more, maybe even more conversations with Brian. And ⁓ so we're we're really looking forward to that. And and Brian, we thank you so much for your time and thank you so much for all of your Your story and your wisdom that you've shared with us today. It's very much appreciated. speaker-0: Well, thank very much for having me. I greatly appreciate it. And you know, to be to have a platform and to support co owners, to support those that are in the field to continue to deliver best services possible and and meet your own personal goals through value based kind of ⁓ life. And you know, it it it's a hard profession, but people are out there that want to support you to do the best you can. Yes. Yeah. Find your tribe, for which I think ⁓ three Pi Square is part of that tribe to help you do better. speaker-2: Thank for that. I really appreciate that. Everyone who is listening, we appreciate your time and we appreciate you joining us. And ⁓ if you want to ⁓ reach out to Brian, those that his information will be in the show notes. The support group will be in the the show notes. And yeah, we would also love to hear what you have to say. ⁓ and if you wa if you have any questions about today's episode, we would love for you to call the hotline and leave your question, leave your story, leave leave any information that you that you have for us about the podcast, good or bad. We'll take it all. All right. Well, thank you everyone for today and we'll see you next week. 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 threepiesquar.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.