Autism service providers have the unique challenge of helping the individuals they work with achieve meaningful and sometimes life-changing outcomes while managing their own mental and physical exhaustion. The burnout rate among Registered Behavior Technicians (RBTs) and Board Certified Behavior Analysts (BCBAs) in the field is high. Direct care staff working with individuals with developmental disabilities have burnout rates as high as 70.7%-77% per year (Mitchell and Braddock 1994; Seniger and Traci 2002). Combating staff turnover through support programs within Autism provider organizations is paramount for retaining good staff while providing quality and effective services. Burnout among direct care staff is due to several factors, including inconsistent hours, complexity of caseloads, family dynamics, or a lack of support and training. Autism service providers often recruit and hire staff with varying degrees of experience. For some, it may be their first time in the field. Regardless of experience, all staff should receive continued training and support from their organization. Training should be ongoing to ensure providers stay updated with the most effective and ethical practices when delivering autism services. Support from within one’s Autism services provider organization is essential to retaining quality staff.
Different organizations in our field support providers. Those providing ABA-related services, such as Board-Certified Behavior Analysts (BCBAs) and Registered Behavior Technicians (RBTs), have guidelines for supervision that must be followed. These can be found in the Ethics Code for Behavior Analysts and the RBT Ethics Code. These guidelines come from the Behavior Analyst Certification Board, founded in 1998 (Sellers et al., 2023). It is a certifying body for credentialing all BCBAs and RBTs. Shortly after the Board was founded, they put out the Guidelines for Responsible Conduct for Behavior Analysts in 2001 (Sellers et al., 2023). It was from there that our Ethics Code evolved.
ABA practitioners are held to standards stated in our ethics code, including our responsibility in practice, responsibility as a professional, responsibility to serve our clients in a meaningful way, responsibility to adhere to our research, responsibility as supervisees, and more (Behavior Analyst Certification Board, 2020). Behavior Analysts assess skills and create goals for clients to make a meaningful change in their lives and those of their caregivers and loved ones. The Behavior Analyst Certification Board supports behavior analysts by giving free access to peer-reviewed publications and academic journals to ensure we are up to date on research and knowledgeable about best practices in ABA. Additionally, BCBAs are required to provide consistent and ongoing supervision, train RBTs and stakeholders in best practices, and ensure interventions are being implemented with fidelity. The aim is to promote autonomy for our clients.
Along with the BACB providing resources to support practitioners, BCBAs and RBTs support each other within the field. BCBAs have gotten together to create organizations such as Applied Behavior Analysis International (ABAI), the Association of Professional Behavior Analysts (APBA), state organizations, and more. These organizations hold conferences where practitioners from different areas of the field can collaborate, share their work and research, and offer tools to help increase the quality of direct services. They also provide continuing education units, which BCBAs must obtain to ensure they stay up to date on research and best practices in the field.
Supervisors within ABA provider groups should meet with BCBAs weekly to provide support in areas such as case reviews, RBT supervision tasks, and data-based intervention decisions. They should also provide guidance and advice when staff are taxed from productivity requirements and caseload complexity. Providers can also survey their employees periodically to ask what additional support they feel will be helpful as they carry out their services daily. As supervisors create schedules, they should consider details such as drive time, staff preferences in setting, and appropriateness of staff-to-client ratio. This all contributes to minimizing burnout and cultivating a group of professionals who feel supported, motivated, and passionate about their profession.
In addition, professional development opportunities are the greatest resource for our Autism providing partners. Staff from a behavior technician level all the way up to a director should have access to professional development opportunities. This helps providers keep up with the research, data, and developments in ABA. Compassionate and trauma-informed care have surfaced as priorities in our field and should be at the forefront of treatment. Assuring that our Autism providers are fully versed in these domains should be standard practice. It helps provide and encourage staff to be more empathetic providers.
It is also especially important that staff have opportunities to share their interest in training topics they would like to explore. School districts and clinic-based providers can especially use this as a tool for gearing training toward specific topics. It also enables the staff to find time to share their experiences on what is working and what they need more support with. By providing staff with opportunities to share and learn, we can assess and work towards reducing staff burnout and turnover. When we reduce burnout, we are cultivating a work environment geared towards effective services that are ethical and compassionate.
Providers can also benefit from mentorship opportunities and peer review of their direct and indirect work. Having access to a peer to provide feedback encourages flexibility in a permanent product of work and the ability to gain new experiences in thought processes and strategic development of treatment. This ensures the quality of services and creates meaningful goals for the clients we serve.
Georgia Efthimiou, MA, BCBA, is Sr. Director of School Based Services, Lisa Radil, MA, BCBA, is Assistant Director of School Based Services, Brandon Sierchio, MA, BCBA, is Director of Quality and Training, and Howard Savin, PhD, is Clinical Advisor at First Children Services.
References
Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://bacb.com/wp-content/ethics-code-for-behavior-analysts/
Behavior Analyst Certification Board. (n.d.-b). U.S. licensure of behavior analysts.https://www.bacb.com/u-s-licensure-of-behavior-analysts/. Accessed 27 Apr 2023
Mitchell, D., & Braddock, D. (1994). Compensation and turnover of direct care staff in developmental disabilities. Ment. Retard, 32, 34-42. https://www.researchgate.net/profile/David-Braddock-2/publication/15022295_Compensation_and_turnover_of_direct-care_staff_in_developmental_disabilities_residential_facilities_in_the_United_States_II_Turnover/links/57993bec08aec89db7bb9b9b/Compensation-and-turnover-of-direct-care-staff-in-developmental-disabilities-residential-facilities-in-the-United-States-II-Turnover.pdf
Sellers, T.P., Seniuk, H.A., Lichtenberger, S.N. et al. The History of the Behavior Analyst Certification Board’s Ethics Codes. Behavior Analysis Practice (2023). https://doi.org/10.1007/s40617-023-00803-2
Seninger, S., & Traci, M. A. (2002). Direct service staff turnover in supported living arrangements: preliminary results and observations (rural disability and rehabilitation research progress report no. 17). University of Montana Bureau of Business and Economic Research.
