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ABA Business Stories with Rick Kubina · ABA Business Leaders

• speaker-0: If you want to have a good outcome, the one thing you can control is the quality of your decisions. speaker-1: There was a study done between AI and BCBAs. They would give the treatment plans to people and say which one was done by AI and which one was done by BCBAs. And they couldn't tell the difference. That to me is scary. speaker-0: But we should have guidance from our organizations that say, look, here's where ABA in the practice is, here's the red lines. And unless we do that, I fear there are going to be some very hard days ahead of us for our field. speaker-1: Welcome to ABA Business Leaders brought to you by 3PiSquared, 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 10 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 podcast brought to you by 3Pi Squared. I'm April. And today with us we have Rick Kabina. Welcome Rick. Yeah, so today we're just going to have a fun conversation about multiple topics, We're going to touch on quite a few things. We met with Rick, you know, leading up to the podcast as we were prepping and speaker-1: I'm Stephen. speaker-0: Thank you for having me. speaker-2: We had a great conversation off air too. So I'm really looking forward to our conversation here. So let's start with the big topic today, AI, right? I think we've had numerous, well, I know we've had numerous conversations about AI and the implications. I'm finding them very fascinating to talk about because I love to see the different perspectives from individuals across our field. So, okay, let's start with Let's start with clinical decision making. How do we all feel about AI being part of that? speaker-1: I could tell you where I'm at. It terrifies me. ⁓ like, and you know, we had a ⁓ Dr. Cox on here talking about AI. And I believe one of the things that he said, I'm probably butchering this, but that there was a study done between AI and BCBAs. And they were like, they would give the, ⁓ the treatment plans to people and say, which one was done by a AI and which one was done by BCBA. So you had to try and figure it out and they couldn't tell the difference. Right. And so like that, that to me is scary. And I just like this is supposed to be. And again, maybe I'm just old and, know, this is my get off my porch phase of life. And I just crabby and I and this is just a new Google. Right. But my concern is when you have a field where BCBA is on average of three years of experience and they're all burnt out. Like the vast majority of BCBAs that we talk to in this space are over... And you know, like the feedback that we've, when we've talked to people in this space with AI, they're like, well, hopefully, you know, they can use this as like a... speaker-2: High keys, limited amount of time. speaker-1: and with oversight and I'm like, no, they're not. No, they're right there. What they're going to do is that the company is now going to say, you could, ⁓ you used to be able to produce 15 treatment plans in six months and now you can do 30, right? Great job. And so like I'm concerned that it's really going to remove the humanity from the field. speaker-0: right to have concerns. When we consider AI, we have to understand, especially in terms of clinical decision-making, I'm drawing a circle for those who can't see me. Imagine in that circle are all the different types of ways that AI can be used. You've hit on one possibility and people can look at that and say like, okay, this is a bad outcome. But AI is being used more and more And good AI tends to be AI where AI is being clerical and it's taking things off your plate that you're not going to get upset about that. For example, in healthcare, doctors will routinely see patients. You could have a human scribe doing it, or you just have this, your phone, it records it, you ask permission, say, hey, can AI do it? AI scribes that all up together. And now, you have this information that can be part of clinical decision making. No one's going to object to that. mean, that's like objecting to just your phone doing it. All the AI is doing it is not taking that strand transcript and doing other things. But again, how far do you push this? If AI is doing certain clerical tasks, that might not be objectionable. But if all of a sudden you go to your doctor and you're like, ⁓ wait, let me check with AI. Hey, my patient said this, what should we do? And the doctor puts all the things in and then says, ⁓ you know what? My AI bot says you should be on penicillin based on these things. That's scary. So there are certain lines that we can cross that in terms of ethical issues that would be very uncomfortable, but there are other things that we're not. That question you asked is very complicated because it gets at how would we use AI to collect data? I love this whole area of decision making because I'm of the belief that if you want to have a good outcome, the one thing you can control is the quality of your decisions. The decisions that we make can help produce good outcomes. It doesn't mean even if you make good decisions, you're always going to get a good outcome, but it's with probability. So the better information you have, the more things that you can look at, the greater likelihood you're going to make a good decision that could lead to a good outcome. if we look at data, what if we are collecting data and we have an AI system that looks at your graph and says, hey, your data are... Like here's the variability, here's the trend, here's the level. I'm to tell you all this right now, from my research, very few people pay attention to all of these hallmarks that we should be. Even in, you go to Java or one of these other things and look at what they're saying, even they're not doing it. Maybe they talk about level, but they're not talking about trend and variability. And again, don't take my word for it. Crack the journal open and look and see what they're saying. So in this instance, If you had AI that was giving you this information, you now have a better chance to make a good decision. So a really good question to lead us with, but I want everyone to think very carefully about how is AI impacting it? What's it doing? And then I feel you could make a better decision on how AI can either hurt or harm us. speaker-1: Yeah, I mean, there was another paper that I just glanced at, right? Again, was that more the they found the more people used AI, the lower their IQ was. And so, yes, you know, like that, again, is my biggest concern. Like I can like I had to remove all AI from my phone because I was just finding how easy it was to paste in a text or an email and say, well, should I respond to that? and I wasn't even thinking about it, I would respond and then I'd get a reply and I wouldn't even remember my response. Did I write that? Did I say that? And so I was just, found like I was, it's almost like when you get in the car and you get to your destination and you park the car and you're like, whoa, I'm here already? And you have no idea of what took place. after you left your house to get to ⁓ your destination. It's like you're on autopilot completely. And so my biggest concern is that we're going to take these amazing tools ⁓ and use them for clinical decisions without having the four, like you're giving the entirety of the field to maybe somebody who hasn't earned the right to have it yet. because they don't have the foresight? speaker-0: Look, I share these concerns. I share these concerns, not just with behavior analysis, but with society in general. 100%. I'm in special ed, I'm a professor in special ed, and we want to teach students. I remember, not just personally, but also when the calculator came out, everyone's like, oh, you don't need to memorize these things, just put it in the calculator. That was a big debate. Now that we have AI, there are people saying, we need to teach kids to read anymore, write anymore, just let AI do it. And what kind of effect do you think that's going to have on our society? what you, you have a very focused, you know, we're talking about AI and ABA, but there's these grand societal issues and it's all connected. And these are all things that we need to really pay attention to because we have these, like the tech companies right now, they don't care. They are barreling to anything that gives them profit. They literally don't care about, they just care about profit. And where's the guardrails on those companies? There are none. There are all of these negative things that are happening. And so we, as a community of practitioners, of scholars, we need to, we should be having panels. We should, I sure, papers are important, but we should have guidance from our organizations that say, look, here's where ABA in the practice is. Here's the red lines, here's the things that it's okay with. And unless we do that, I fear there are gonna be some very hard days ahead of us for our field. speaker-2: But I just did want to go back and touch on what Rick said about how using AI as a tool to help us to capture some of the data and look at the trends. And there again, there's a skill set behind that, right? ⁓ Of knowing, right? Like, okay, well, not to get even bogged down into the data, right? Because I know that's something that just practitioners... ⁓ you know, on the daily, right? We're looking at like, okay, what's important to look at, right? So that we're not taking too much data just for data sake. You know, is it really telling, know, we tracking the right things to tell us what we need to know and then adjusting that as we go. speaker-1: No, I agree. And that's kind of, you know, okay, let's just get an AI system, right? Because I've heard it's there is no and that's my, know, and you could say this for pretty much every field at this point, right? There are companies laying off thousands of people for AI and AI is going to do all of these jobs and reduce all of this admin and bureaucracy, right? And ⁓ isn't that wonderful? And it's just, what are we doing? speaker-2: Easy just to like throw it in. speaker-1: as a society, a high level ⁓ introducing this, right? And I just feel one, because I'm in it, right? I see ⁓ like I'm in ABA every day. I'm talking to BCBAs all the time, but I don't know of a more like direct human to human connected field other than ABA, right? Like there's so many hours and we're working with the family, we're working with speech, we're working with the OT, where we're... working with the school system, right? And like to remove it, remove the humanity from this field, is that really what we want to do? speaker-2: Okay, where can we use this and how can we use this and being mindful to not use it in a way to pile more caseload on. speaker-1: Where is that line of where it can do those things? Shout out to Silna. They're using AI to help with authorizations and benefit checks. No one wants to do that, right? And the amount of hours wasted trying to do that. And so now you can focus more on actual meaningful work. ⁓ And I can totally see the benefit to that with you the billing systems and and and it makes perfect sense that you would do that kind of thing speaker-0: I think this is a good point to double click on, which is the session notes. I also, not only am I a professor at Penn State, I also work for Central Reach. And there's a product that Central Reach has, which is called No Guard. No Guard is AI driven. And what it does is it looks at a session note and can audit it and say, hey, you missed this, you missed this and missed. I don't know if anyone would really object to that because the AI again is being used in a way that's gonna benefit the person. And that to me is a very good tool. if you not only receive that information, your staff can learn to write better notes, you can get paid. This is on the business side. We have to understand that. There's the clinical side, there's the business side, and here we have a very good use case for how AI can be used to help accelerate processes and reduce some of these negative outcomes on the billing side. So I think if we talk about very specific use cases and say, okay, here's how AI could be used as a field and as people who are individual business owners can make their decisions and say yes. This could be a particular product that I don't object to and is going to help me. speaker-1: And then I was talking with April yesterday, right? Like I go down the rabbit hole with AI. We use AI. We're building applications with AI. You know, like when these AI ⁓ integrated robots come out here in the next 18 months or whatever, right? Like everybody's going to have an AI robot in their home and hey, they can do ABA therapy now. Like everybody's glued to their phones already. Can you imagine? the motivation to work with an AI robot at home, right? And ⁓ like, again, what are we doing here? Like, it just seems so disconnected ⁓ from ⁓ what we're trying to strive for, which is better and deeper connections with humans, right? speaker-0: This is a concern that I also have and there are things that I'm very interested in. And what you're talking about is what's called a synthetic relationship. You can have a synthetic relationship with a robot. You can have it with the chat bot. Matter of fact, I just saw a story, was it today, where some guy fell in love with Gemini? So Gemini, and I've seen these stories have been popping up for a while now. And there are, There is a tragic story of a young man like there is a company that creates these avatars and these avatars have personalities and so that synthetic relationship isn't just typing that is you're now looking at something and it turned out when they looked at the transcript that this young man he was a troubled young man and that he was having suicidal ideation in this this chat bot encouraged him to essentially to kill himself. So he died by suicide. And that was just an incredibly tragic story. That company, this is the thing that really bugs me. That company's like, oh no, this isn't a problem. Like just the lack of humanity, the lack of compassion, that this company is like, oh, it's okay. And these are issues that we must address. even if we look at the broader macro and we look at relationships, if we look at, there's a lot of relationship on men and how young men are spending way more time than ever alone. And why are they alone? Because they're having these synthetic relationships. And why go out and be working with another human where you could be rejected and there's I mean, this is how we've all done it for years. This is how society has functioned. But now we have this almost sci-fi stuff that's happening across our entire whoever is accessing this technology in our society. And it's very scary to think about where we can go in. It's really easy to go down that doomer side, but we have to have these conversations. We have to be aware of it. And like I've done research with robotics and one of the things that I did working with children with autism is we looked at can robots help increase attention? And guess what? The answer is yes. If you put robots in front of very young children, then you can increase their attention. Whereas when we looked at how the humans are doing it, they had a way harder time. So if you use robots and you increase the attention and then you transfer that over to human, this is a great instance of how technology can help people. However, if we just kept that whole relationship just with the robot, then you just have a kid that just has a relationship with the robot, doesn't care about people. So having these conversations and understanding what's happening now, and what could happen, we just have to keep talking about it and understanding where this is going because it could be utopia or it could be dystopia. speaker-1: Yeah, I just looked up because I heard this a while back, but there was a certain percentage of the population is now using AI for therapy, right? And the one article said 10 to 15 % of people are now using it for their therapist. like, yeah, it's What are we doing here? ⁓ It's a little concerning for me and drawing those lines of where we can use it and where we can, I think we're going to have to come up with this because like you said, these companies are profit driven and I get it, right? ⁓ But we have to understand that there could be incentives behind these chat bots that we're not aware of. And this again goes, It takes me down another rabbit hole, but let's say you have practice management, ABC, they have an amazing chat pod. ⁓ It helps with treatment plans and session notes and all these great things. It's very accurate and ⁓ better than any human. And then all of sudden, it's kind of like, ⁓ it's very similar to Walmart. So Walmart will come into a community, they'll lower their prices. Everybody goes there because the prices are much better. and then ⁓ they gradually increase their prices, ⁓ But everybody knows Walmart's got the cheapest prices. And so you have ⁓ a practice management software that says, hey, you know what, we could increase our revenue if we just tell that, hey, you should increase your therapy ⁓ by 10%, right? And so now we know, okay, they're gonna... That's gonna mean that they're gonna have more users in our system. They're gonna be billing more through our system. So we'll generate more profit. April and I are so honored to have Margin Keepers sponsor this podcast. speaker-2: Running an ABA business comes with a share of challenges. Managing clients, staff, insurance, the list goes on. speaker-1: One thing you shouldn't add to your stress, bookkeeping. That's where Margin Keepers comes in. speaker-2: or specialists in ABA businesses, which means they understand exactly what we need. speaker-1: With margin keepers handling your finances, you can focus on what really matters, your clients and your practices growth. speaker-2: They're more than just bookkeepers, they're lifesavers in the financial world of ABA. speaker-1: So for peace of mind and expert financial management. speaker-2: Turn to margin keepers. It's a decision that will lift the weight off of your shoulders. speaker-1: Check out Margin Keepers at www.marginkeepers.com and see how they can help your business thrive. speaker-2: There's a, I wasn't going to bring it up because I can't remember the name of it, but I'm going to anyways. There was a toy now or there's probably multiple boys, but it's like a stuffed animal and it has like AI embedded with it. I was listening. was a, it was a, mommy group that I'm in and they were talking about that for, with like the young, like, like toddler. It's like geared towards companion. speaker-1: Wow. and employees is what they're called. speaker-0: Yep. I go to CES every year. That stands for Consumer Electronics Show and it's in Las Vegas. And it is people from around the world that are showcasing what's out there this year. And there's a lot of concepts. I've seen a ton of these toys. They're on the market and they have these other concepts. And I know exactly what you're talking about. Did either of you see Steven Spielberg's AI, that movie? Incredibly depressing movie. And I remember Teddy, that Teddy in that movie was science fiction then, it's gonna be science fact. And it's just gonna get better and better. So these toys that are being created, these toys are gonna be able to interact with our children. We're gonna be able to have agency and do things. Again, you would hope that there's guardrails put around them, but this is happening now. Everyone sees that AI can be used in all these different ways and could be really good, could be really bad. It's hard to understand. So your mom group, I'd love to hear more about what their impressions are. but I have seen these different kinds of toys. And if it's a toy, you can bet people are gonna use this and say like, well, how can we use it for therapy? And like this has been happening for a while in the robotics literature that I've studied, there's something that's called socially assistive robotics, SAR. they have done studies where you have seniors who are very lonely. and they've given them companion robots, again, socially assisted robots, and they've had these synthetic relationships and these people report higher levels of happiness because now they have someone to talk to. speaker-2: I know the big emphasis and like the mom group was I guess there is one of the toys on the market or there again I'm this is new information to me was like bringing up like sexual content or Very young children, right? And that's something that like as a mom of a just turned 11 year old little boy That's something that yes as a parents of him like we've been like deep and trying to figure out how we're going to navigate Raising him and in the world that we're in today knowing that we're all like I didn't even have a computer when I was his age. There was no such thing as cell phones or the internet. I didn't have that at 11. And so this new generation who was just born in the technology, there was always a screen. And I think there was a... I can't remember the stats now, but they were talking about two-year-olds who have their own iPad, their own dedicated amount of two-year-olds. And then there was a, I'm kind of going off on a tangent, but I was, I don't know anything about it other than the headline peaked my interest. And I thought to myself, I'm going to look into that later. I can't handle that right now, but it was about like, like a type of autism or developmental delay that they are determining could potentially be because of like screen use. mean, I know there's already recommendations for how many hours a child should be on the screen and a child under two really should not have screen time. But apparently there was like, I don't know, I'm assuming. Do you know about that, Rick? Have you heard about that like classification of potential like delay and autism type characteristics because of only having excessive screen time? speaker-0: I have, that hasn't hit my radar yet, but I have looked a lot about the recommendations for, and I have grandchildren, they have screens. And it, when you look around all of kids, it's happening. And I've seen other particular studies that look at how that can affect development. And do you all remember baby Einstein? And that came out, maybe I'm dating myself, but Baby Einstein was these video discs. And the idea was you ⁓ watch this and you interact with it and your kid will be smarter because they're receiving access to all of this high quality early childhood content. Well, it turned out that when they did research on it, the kids actually did much worse because they found that Baby Einstein the amount of time that they were spending on that took away from the time they were having these interactions with other people. you're like, ⁓ okay, you think this is a net positive, but it was really a net negative. And I can't imagine that AI, which is the same thing like that, is not having those similar effects with young children. speaker-2: Yeah, I actually had a back in the like early to mid 90s when I'm my clients, their parents actually wanted part of their programming to be around like wanting their kid to watch Baby Einstein. They wanted us to help the kid to attend to this because they were so certain that it was such a good thing for their child, but he wasn't interested in it. And so they wanted us to like, ⁓ like help him to a treasure. to sit longer periods of time to watch this particular show. So I know exactly what you're talking about. But yeah, like those things. So we've learned already so much about screens just and the really short time that we've been able to carry around screen. speaker-1: One question for you, if you, I don't know if you can answer this or not, but like something I've asked on the podcast numerous times is just do an anonymous poll within your company and ask, is anybody using AI for their session notes or treatment plans? Right. ⁓ Cause we don't have one. So I just need to know if you're using one. For a business owner that has come to this realization, ⁓ crap. Okay. People are using a non-secure, non-HIPAA compliant AI. to help with their treatment plans and session notes, what should I do? Is there something that you would recommend? Like, is there a system or what are the questions that you would recommend they start asking themselves? Like, how do they get started into this? speaker-0: putting anything that's sensitive, as you pointed out, adding anything that has PHI into these LLMs is, number one, it's unethical to do that. You should not be doing that. But I understand the allure of doing it because maybe you've talked into something or however, and it's so much more convenient. It speeds up your time. So if you're doing that, there's a lot of risk. that's involved in that type of behavior. If you have, there are several companies out there in the ABA space that do offer HIPAA compliant ways of doing this. And if you're using a company that specializes in this kind of technology, then that's a different story. I would be very concerned in, I think all people that own ABA businesses need to be aware of this because if a staff member is doing that, you're placing the entire business at risk. And there needs to be very clear guidelines and instruction, just having conversations with people to help improve their understanding of what they should do. I am one of the things that I do at Penn State. This also happens at Central Reach. Once a year, you have to take these courses that update you on like internet security and all of these other things. And for the last time, I really dread doing these things, but I gotta tell you this, last time I did it, the information was so good. It was so well produced. I actually found myself taking notes. It's literally the first time I've ever done this because the information was compelling and I wanted to learn. was just, I was just. taken aback by how good this training was. And if we can produce things like that, we're behavior analysts. If we can produce information where it's intriguing and it's also delivering information to the people that need it, then that's gonna help them at least give them the rules better so that they can understand what to do in these types of situations. speaker-2: That's exciting that you got so much out of that training that you're going into thinking, ⁓ this is another, another year. Well, so I think that brings up a kind of a good segue into talking about business owners and kind of just looking at the business side of the field. ⁓ speaker-1: Yeah. Yeah, I mean, I can say like, you know, I often talk about this again, it's a doom and gloom, but, you know, there are a lot of incentives in this space, and this isn't just ABA, right? This is any kind of medical field where you're billing a private insurance, right? And it's paid for services like this. There are so many incentives in this space to have Like you're gonna make more profit with higher turnover, right? Less knowledgeable staff because you don't have to pay them as much. And so that means you're making more profit per hour billed. And if we can increase the number of billable hours that our BCBs are taking, and just make them work on. the non-billable stuff at home, right on their own time, we can increase our profitability. And it's just a same with training, right? If we reduce the amount of training we provide, that means we increase our billables, we decrease our non-billables and we can increase our profit. And you have some of these larger companies, ⁓ I heard it was as high as 105 % churn on their staff. which seems insane to me, but even smaller companies were at around 65 % turnover rate. So there's just a lot of incentive in this space to do the wrong thing. And if you don't go into starting an ABA company, understanding that environment, right? You're just like, I'm gonna provide great services no matter what, right? And I'm gonna take whatever rates I get and I'm just gonna do my own thing. and I'm going to provide better services. If you don't go into it knowing how the incentive structure is, you're going to get a rude awakening in year two and three when you go to your accountant and say, hey, why am I not making any money? Right? Like I have to pay my BCBAs this amount and I'm only making, you know, a very small amount. And then they look at your numbers and it's because, yeah, you accepted rates you shouldn't have taken. You are paying your staff way too much. And then the focus ⁓ switches from providing high quality ethical services to getting those billable hours because I can't afford to pay my mortgage, right? And so we just, talked to so many BCBA business owners ⁓ in that situation. I've heard this statement way too many times is ⁓ the company I left was unethical and they were making me do things I didn't wanna do. And now the only difference between me and them is it's my name on the door, right? And it's such a heartbreaking thing to hear, right? And so, ⁓ you know, I've seen this kind of debate on, you know, the clinician owned is the only way that this can be. ⁓ I just, I kind of stepped back from that and I'm like, but like you can have the best clinician in the world starting an ABA practice, but if they don't know the financial, ⁓ implications of owning a practice and the amount of work behind the scenes ⁓ and they're losing money on every session they're providing, they're not going to be in business very long. And they may do things that they wouldn't necessarily do because of the financial burden and pressures on them. So I just, you know, that's kind of my general ⁓ worldview on this, right. Is A non-clinician owned company with the right morals, the right ethic can be just as good in my opinion as a clinician owned company ⁓ as long as they're focused on the right things. speaker-2: Yeah, but do we all assume though, I think the assumption in the field in these conversations, especially on social media is like that a non clinician owned company automatically means like P like a lot of people are grouping that together. speaker-1: Yeah, yeah, I guess. speaker-0: There's so much to react to based on what you just said. speaker-1: Yeah, yeah. speaker-2: He likes to do that. speaker-0: Many people have probably heard of Warren Buffett. His number two guy was this guy named Charlie Munger. And Charlie Munger was incredible because he read all these books about psychology and he got his hands on some behavior analysis books and he knew about Skinner. And he has this very famous quote and it is, show me the incentive and I'll show you the outcome. And he's just so right when you think about it and it's so profound. And it gets to like a lot of people in business don't understand what we understand as a behavior analyst that when we talk about incentives, we talk about reinforcing behavior. If you look at, if you follow that path, if you understand how you lay out some, any kind of financial contingencies, you're going to get behavior that's going to follow that path. And I have seen as you probably have when you talk with different people and you look across the field, very good examples and very bad examples. A colleague of mine, we did a research project probably three months ago and we traveled down to a place in Texas and this was a mom-owned ⁓ ABA clinic and it was incredible because this mom understood she had had children, but she wasn't a BCBA. And every BCBA we talked to super high retention, no one wanted to leave this place because they had small caseloads, they were given autonomy, they were supported. And this business is thriving in this area. And it was being done right, because this mom understood that she had good clinicians and she wanted to have a center. And she operates under these principles. And I felt very heartened to see what they were all accomplishing there. Their business wasn't failing. Maybe it could make more money if they increased caseloads, but they chose very specifically not to do it. And as a result, all of the staff were very happy there. They were doing good work. And this was just a wonderful case study on how an effective business can be run. Now, I know depending on the state, your funding sources, and there's a lot of variables that come into play. And this one particular place that I saw that I was super impressed with, maybe they're doing things that financially other people couldn't do. I don't know, but it is true. And I've seen other places like that that can manage to succeed. and have successful business, successful outcomes. And certainly you all have run into that as well. speaker-1: Yeah, I think so. And again, it's like, where are your values coming from? And this is something that April is always going on about, Like, but it's true. Like if you don't know your values, like it just, you're going to messed up. You're going to, you have no guard rails at this point. And it's something that, you know, we've done a couple of presentations on. speaker-2: Bye, Wally. speaker-1: But even your red lines, right? And this is something that we've done too for employees, knowing what that red line is, right? Like where I will never go, right? I will never do this. will not like, you know, bill for time that I wasn't there. will, you know, things like that that ⁓ may seem simple, but if you don't ⁓ understand these things going into it, ⁓ you just kind of get lost because of... the incentive structure. ⁓ well, if I get more billables, I get a higher bonus. So yeah, okay, fine. ⁓ Mom doesn't seem to be all that concerned that I'm always 15 minutes late. She says, just bill the whole time. Okay, fine, I'll do it. Right? And so there's just a lot of incentive to look the other way. And so without that why, which it sounds like the mom knew, hey, I know what was good for my child and I'm going to give that to everybody else. And so having that kind of speaker-2: I think too, like also being able to define what quality is for you and for your company, right? You know, ⁓ we want quality services. We want good services. What does that mean? as a field of behavior analysts, like, I think we could kind of dig into that a little bit because we have the knowledge of how to do that. And I think sometimes what I'm seeing more and more over the last few years is like the like the generalization of like how, like how we apply the science to the individuals that were programming for our learners that were providing services for, ⁓ and, and how we apply the science to the, the business end of things and the support and management of staff. Sometimes there's that, there's a there, a disconnect there. ⁓ I've even had some business owners say, I didn't, I didn't learn OBM. I'm like, speaker-1: Like, the ga- speaker-2: Let's step that back a minute and look at what you did learn and how we can apply that in this scenario. So I think being able to define it and know what is this mom sounds like she knew exactly what her vision was and she probably had it clearly defined of what she wanted this to look like and how she wanted it to go. speaker-1: Yeah, there's a Facebook post that I often again ⁓ Someone was reaching ⁓ yeah, this one really bothered me right like but there was this person just genuinely like struggling with with turnover rate and she's like, what do I do? ⁓ I was specifically about text and one of the posters was like just have a robust speaker-2: I really made an impression. speaker-1: a ⁓ hiring process, right? Like there's nothing you can do with these people, right? Like, ⁓ and you know, I often think about like, hey, if we can't ⁓ model behavior or change the behavior of our staff, how can we expect our parents ⁓ to say, okay, you can work with my child, right? And so there has to be something that we can do to provide a higher... Quality of life for our staff, right? There really has to be so yeah speaker-0: I read a lot of books on culture and I am convinced that every business should have some type of culture map or culture plan. That term culture essentially boils down to, if we're gonna talk about this behaviorally, how do we interact and treat one another in a business? And if you have, when you look at these companies that have strong cultures, they explicitly lay out what their values are. One of the most more famous ones and anyone can Google this is Netflix. So there have been books written about Netflix's culture map. And it starts off in this PowerPoint that was given from all these people in Silicon Valley when they shared it. And it's older, but it's still very good. And they say, these are the kind of people we're looking for. This is how we're gonna respond. ⁓ It is embedded in how they treat one another and these culture maps, again, rules for how we interact with people are very important. One of the things that I've learned and this is true too, and you probably can all attest to this, is that your culture is going to become what it becomes if you don't thoughtfully plan for it. And a culture map isn't going to make you money. Having a culture map isn't getting at, How do you succeed in business? But what it does do is it gets at things like retention, the satisfaction that people are gonna have with your job and how you believe people should be treated in your business. So I'm very strongly in favor of people thinking about what the culture is and having a culture map. And if you don't, it's just gonna... proceed based on however it is, you're not planning for it. And it's one of the things that you read in a lot of these case studies is it's very hard and impossible to change a culture once the culture has already taken hold. And you can imagine if you have a business of 40 people, how do you change that culture? And the culture starts at the very top. The business leaders have to live it. They have to make sure that everyone else is following it. and you can't just do this part-time. This is a full-time gig and being able to understand what your culture, and it could be very simple. It doesn't have to be like that Netflix ones that I shared with you, but just having base values and saying, as our business, these are the rules that we're gonna follow. I feel is gonna be very helpful for people starting businesses or even people that do have businesses reflecting on what their culture is and looking at how they could make changes to it. speaker-2: Yeah, absolutely. mean, we talk about we when someone comes to us and they're brand new, like one of the first things is vision. In fact, ⁓ plug, Steven, the first chapter of he just he wrote his book and ⁓ it's he's going to get all bashful. But we just got that he just got the just turned in the final edits for it. And so but his first chapter is speaker-0: to where you speaker-2: Yeah, it's a hard process being here. Like as a supporting role, I'm like, maybe I don't know if I ever want to do that, but he's been doing such a great job. But yeah, your first chapter, right? The first one is about vision, right? And like really sitting with this and looking at what you want, how do you want it to look? I think that that's like in the culture of it. And you walk your readers through like, different questions and kind of help guide what that might look like. There have been several businesses that we've worked with over the years that had to change their culture. had to pretty much let go of most of their staff and kind of restart. had to figure out where the toxicity was, where the change was, where were the individuals that didn't match. the vision that didn't match the direction or the culture. And, you know, there are some things like hiring, hiring even, right? Like hiring for that vision, hiring for the culture is in a lot of ways more important even than hiring for the skills because a lot of these skills can be taught. Whereas like the culture, you know, certain, we're all different people. Some things are going to be the right fit for some people and not the right fit for other people. speaker-1: Yeah, there have been some BCBAs that have come to us and, know, again, ⁓ they're just burnt out, they're frustrated, and so they just feel like they have to start their own thing and not knowing exactly what this is and just winging it. Like, you know, we did that awful idea. It terrible idea. But like a lot of these people just need to find a really good job where they can just be an amazing BCBA and do their own thing. And they don't need to start a business. And so that that you know, we we talked about I was talking to someone yesterday and she was awesome But like I was like, hey, I don't know that you can you know that I wouldn't recommend this I would You know find a really cool company. She told me where she lived. I said I know one right now I'm I can almost guarantee I can get you a job tomorrow if you want one ⁓ and just take three years and just be a BCBA and just enjoy yourself, right? Doing the thing that you went to school for and you love and you don't have to own a business. And so I think it's finding, again, it goes back to those red lines. What will I accept and how do I interview for a company to find my match and not just take the job because, well, they're gonna give me 5K more a year. So obviously I'll take that, right? It has to come down to, finding your place. speaker-0: I would encourage people who are starting businesses to look outside of ABA. was a startup. I had a startup, so I was a co-founder and I lived the journey. Ours was creating a tech company. I lived for years in the ivory tower. I still kind of do. And my baptism by fire was something that the stories that that Steve was mentioning, you gotta make payroll. You have to make payroll. Every single week you have to be ready. That's a serious thing that if you're not bringing in enough revenue, you can't go to the people who you're working and be like, hey, you think we could pay you next week? There's all of this pressure on you. And that's just for one aspect of the business. Then you have people. that you're working with and these people are in these specific roles and they have to do things if they're not. And then if you have other people that have a certain ⁓ direction that they think the company should go in and you have another, how do you have these conversations? There's so much that's involved in creating a business and having a successful business has set me down the path of reading all of these different areas in in business, all these different books in business. There's the financial side, there's the operations side, there's the marketing side, there's the sales side, there's all of these different things that I never really knew a lot about because I had a job as a professor and it's very nice having a professor job because you do research, you do these things, but being the one who's responsible for making sure that all these different components are syncing together and are working, it takes experience. And it also, I've also benefited from looking at what else is out there. And I would just encourage people, like one of the things I've learned about business books, I've read so many, a lot of people who write these books that are very successful, you read something from Bill Gates. You're not going to replicate what Bill Gates did. Reading something about Amazon. These businesses and a lot of these books are case studies and these are people talking about the reflecting on how they got to where they got to. Don't expect that there's some framework in there that you could just take what they did, but there can be many, many valuable lessons. And I would encourage people to start looking at some of these books and exploring outside of behavior analysis. Like, yes, we have people in OBM, but there is just so much information out there. For example, when we were talking about culture, there's a book by a woman named Kim Scott, and she's written this book called Radical Candor. And it's a fascinating book. You know this book? Yeah. So everyone should be reading that book because it gets at something that's very hard. speaker-2: Yeah. speaker-0: as adults to do. And that is deliver feedback in a way that, you know, it's not the, well, what people call the crap sandwich, you know, or whatever you want to call it. Where for years, people like start off with something positive, then say the negative thing and then end with these kind of prosaic formulas that don't work. Understanding that You want to care about people that you truly care about them, but yet you're going to challenge them. That's her thing. Care personally, challenge directly. Those kinds of books, I feel as behavior analysts, when we get more of that information, if we can just take a few things from it and start implementing it and see how does that turn out, there's many resources out there that people can explore to help them run a better ABA business. So that would be my parting comment. speaker-2: Yeah, thank you for that. agree with that. Another is communication, right? That's, ⁓ you know, some books that I'm also reading are falling to like the communication and leadership and like, you know, I think even if you're not a even if you're not a business owner as a BCBA working in a company where you are leading techs and RBT, I think, you know, really being able to lean into those leadership skills and delivering feedback is a lot of your job. So knowing how to do it and how to be comfortable with it, I've worked with many ⁓ owners who really struggle giving feedback and they don't want to hurt anyone's feelings, right? And we can do it without hurting someone's feelings. yeah, Radical Candor is definitely a good book. we have to take... We have no control over their feelings. We can control how we deliver the information. also part of that is being able to... speaker-1: Yeah, yeah speaker-2: to have clear expectations and communicate what you really want from that position or that project or that thing that you're working on. And so that when you do have clear expectations and you communicate that, then that gives you a little bit better starting ground to be able to deliver the feedback. speaker-1: No, totally. And I think that goes again back to the culture map or the values, right? Like if you don't even know what you want in this position, ⁓ how do you give feedback, right? How can you be clear if you don't know what the expectations are? You should just be an RBT. Do what our RBT... No, like we need to really define that. Yeah, yeah. But I mean, even for BCBAs, right? I just do what a BCBA would do. Well, hold on, right? Like how do we, we need to clearly define our expectations? speaker-2: the 40 hour transition. in this particular role in this particular company. yeah, yeah, for sure. Yes. Any anything from you? speaker-1: I a Six Sigma class. think that that could be helpful, right? I think that that is something that I would absolutely recommend. Look into KPI. OBM is great, but I think KPI can be very helpful again. Yeah, so that would be where I'm an engineer. So of course I'm going to say that, right? But I think that those things can be very helpful. speaker-2: This has been a fun conversation. for those of you listening, don't forget, you can find us on YouTube. those of you who are on YouTube, don't forget, you can find us on all the platforms that you could listen to if you're stuck in a long commute. It's a great, great listen. It's great something to listen to, think things to think about. Thank you to all of you listening for your time, for spending time with us today. And what, what reminders do we have, if any, for our listeners? There's so many reminders for our listeners. So. speaker-1: There's too many. We have a new Slack group if you want to join that. speaker-2: Yeah, let's do that. So we do have our support, APA Business Leaders support group. It's free and we're doing it off of social media. So we're doing it within a Slack group. ⁓ the link for that is in our show notes. If you just go to that link and you register and then our coordinator will get you set up. It's growing fast. We just launched it in mid-January and as we record this in March, ⁓ we already have... or getting what 75 or something like that. speaker-1: You can get use it with a free account so you don't have to buy slack. You don't have to get a speaker-2: You don't have to get a subscription. But yeah, so it's really exciting. Not only do we have that many member or users already, we're having the most, and I'm just, you could tell I'm very excited about this. This has been something I've been wanting to put on for a couple of years now, but we're finally here. But the most supportive, accepting, compassionate, kind, BCBAs and ABA business leaders that you could ever find. That's what our hope is, right? Is to have a safe place to be able to talk about all the things that maybe you don't want to share on social media or you don't know what you don't know. And so getting support from those peers has been fantastic. So definitely check that out in the show notes. And then also, if you want to tell us about your experience or your thoughts about AI and and whatnot from this conversation, anything that you want to share or add, or if you have specific questions for us, just don't hesitate to call our hotline and ⁓ we'll put some of those questions and comments together in one of our next podcasts. Don't be shy, just call on it. You don't have to tell us your name. All right. Well, thank you so much. Thanks again, Rick. Thanks for all of you listening and I hope you have a great day. speaker-1: Be shy. See ya. 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 3pi2.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.