🚀 Mastering ABA Business & Technology: Practice Management, Data Collection, & Growth Strategies with Suzanne Juzwik, BCBA | ABA on Tap (Part II)

The landscape of Applied Behavior Analysis has transformed dramatically over the last decade—from how we collect data to how we run our businesses. In this illuminating conversation, Dan and Mike welcome Suzanne Juzwick, BCBA and founder of Innovation Moon, who shares her unique perspective on the technological evolution reshaping our field.

Suzanne's journey from special education teacher to ABA technology consultant offers a fascinating window into how the profession has grown. After witnessing the significant impact of ABA in her classroom, she pursued more education and her board certification,  and eventually found her niche at the intersection of clinical quality and technology innovation. Today, she helps ABA businesses navigate the complex world of practice management platforms, offering insights that can mean the difference between struggling and thriving.

Whether you're considering opening your own practice, struggling with technology decisions, or simply trying to balance clinical excellence with business sustainability, this episode offers practical wisdom from someone who's been in the trenches. Tune in to gain insights that could transform how you approach the business side of behavior analysis.

And always analyze responsibly.

To learn more about Suzanne Juzwik, click the link below:

https://www.innovationmoon.com/

*This is part 2 of 2. 

Transcript

SPEAKER_00: 0:00

Welcome to ABA on Tap, where our goal is to find the best recipe to brew the smoothest, coldest, and best tasting ABA around. I'm Dan Lowry with Mike Rubio, and join us on our journey as we look back into the ingredients to form the best concoction of ABA on tap. In this podcast, we will talk about the history of the ABA brew, how much to consume to achieve the optimum buzz while not getting too drunk, and the recommended pairings to bring to the table. So without further ado, sit back, relax, and always analyze responsibly.

SPEAKER_02: 0:54

All right, all right, all right. And welcome back to part two with Suzanne Juswick. I am your co-host, Mike Rubio. Enjoy.

SPEAKER_00: 1:04

So, Mike, I remember at the CPABA conference, remember they talked about, I think it was at the CPABA conference, talked about TRICARE. It might have been in one of our podcasts, but I think it was CPABA conference. Somebody mentioned that TRICARE recouped, it was like 60 or 70% of the money they paid out back, it was like, I forget how many years ago, back in... in audits and how they were like kind of proud about it. So speaking to what you were saying that they were kind of proud of, which I mean, maybe that people were billing fraudulently. It'll put you

SPEAKER_03: 1:38

out of

SPEAKER_00: 1:40

business. Yeah. At the end of the day, I mean, that is going to put somebody out of business. I mean, people aren't going to get paid. And so there's, there's both sides of it, but that was a crazy stat. I heard 60 or 70% of the money that they paid out. They were cooped by the end of the year. I

SPEAKER_02: 1:54

don't even know what to say about that. I mean, I, I would believe that it was TRICARE, sure. That would be easy to believe. So we've spent a good amount of time talking about sort of the business end, and then we've alluded to the clinical end of things. I'm going to shift gears, unless there's anything else anybody wants to bring up. But as we were starting to record and we were chatting a little bit, you said the word Reddit. which leads us immediately to think about the backlash that ABA is facing from a more social validity perspective. I wouldn't say it's widespread that it's It's very particular to the neurodivergent community, I would say. Dan and I both agree that actually very early on in the podcast, we started looking for those voices. The Chloe Everett, that was the first person we ever featured on the podcast. Because one of the reasons we started this was to say, hey, there's no way we bet$1,000. There's no way we get everything right. So let's start talking about this. Let's get better at this. But that's something that is also... quite a challenge, has to be a challenge for funding sources who are mandated to reimburse for these empirically validated, you know, evidence-based services. We spent a lot of time talking about that here and the differences there. But then to hear such strong detractors, such strong voices out there saying, hey, man, this stuff is no good. This stuff is evil. This stuff is abusive. You know, obviously for Us as clinicians, as a board certified behavior analyst, that can be very challenging to hear. That can be downright unnerving, frustrating. And then sometimes you take a listen to those voices and you kind of have to go, yeah, I hear what you're saying. That was something that I Once Upon a Time did, and I'm glad to be able to say that I stopped doing that for these reasons, and those are the very reasons you're kind of pointing out right now. So I packed a lot into that comment there. Suzanne, help us unpack it.

SPEAKER_04: 4:13

Yeah, actually, so it's interesting, and I'll try to keep this short because my reasoning for bringing up Reddit was more on the BCBA side

SPEAKER_02: 4:24

or RBT side. But

SPEAKER_04: 4:26

that being said, I mean, I'm new to Reddit. I have a really big following on LinkedIn. I'm very active on LinkedIn. I have been active, inactive on Facebook. I kind of just do a check-in a couple times a month. But now my favorite social medias are up there with TikTok and LinkedIn for professional, which I think it's hilarious that I love TikTok, but

UNKNOWN: 4:52

I'm good there.

SPEAKER_04: 4:53

So Reddit, I just one day was like, I think I did a Google search because I love doing Google searches. Somebody I love from the past used to call it Google University. I learned a lot of information from doing random Google searches. And I probably typed in like ABA outside of autism therapy. And one of the things that pops up is a Reddit comments. And I was like, you know what, I've never really hung out on Reddit. Let me let me check it out. So So I hop on and I type in OBM because I love OBM, right? So let's see what's on here. And I was shocked by what I found. There wasn't a lot of good information. And one of the issues with Reddit that I have is everyone's anonymous. And so that kind of adds to a whole new level of you're going to get a lot of unprofessional behavior versus LinkedIn where everyone can read and see who you are. Okay. So take that. So there are a lot of trolls on Reddit. And some people who may be pretending like they're BCBAs, but they are not. And so there's that issue too. But whatever. That piece aside, when we're talking about the autism community, I will always validate someone's personal experience. I am an autism advocate. I do help parents advocate at IEP meetings and I have friends who are autistic that have grown up with ABA therapy and some have had great experiences and some did not. And I personally even remember my own, I mean, I have trauma personally at when I was in RBT being asked to do things from the person who was above me that kind of just felt wrong, right? Like, And I hate this, but I was told as a BT, we didn't have our BTs back then, to ignore someone crying and this kid would tantrum and this session would be two hours and he literally would be crying and tantruming the entire two hours. And all I was supposed to do was record it.

SPEAKER_02: 7:12

Like

SPEAKER_04: 7:13

document the duration. Yeah.

SPEAKER_02: 7:14

I would never do that to a four-year-old. This entire podcast right there, what you just talked about, the blanket ignoring, the extinction is blanket ignoring. Probably, I would say it's the biggest atrocity anybody's ever committed in the name of ABA.

SPEAKER_00: 7:29

And we've all done it. I agree. Absolutely.

SPEAKER_02: 7:33

The only reason I know it's wrong is because I went through it. All of us that are old

SPEAKER_04: 7:36

school, yeah, anyone who's old school ABA, this is what we were taught in We were taught to do these things. And then when I became a BCBA, I started telling my staff to do things differently. Cause I just didn't feel right with that. I was like, we do not pick up children when they're laying on the ground tantruming. We do not forcibly move anyone. We don't touch their faces to have them face you or look at you. And like, I was like, I was the BCBA that they were like, wait, why? Cause everyone else tells me I should do this. And I was like, well, let me tell you, I'm going to grab your face and tell you to look at me. How does that feel? And they're pulling away. Like you're pulling away. You don't want me to touch you. How do you think you're going to feel if you're a kid and you have no autonomy over your own body? Like, of course they grow up to have trauma. Right. And so, yes, I mean, at the end of the day, if you're practicing ABA and you're training other people, you need to be doing trauma informed ABA, compassionate care ABA. And to me, if you're not, you have no business doing ABA anymore. Like that's just, that's why ABA has a bad name, right?

SPEAKER_02: 8:48

That is, I agree a thousand percent with what you're saying. I recently took a little bit of a deep dive into some of the older literature, you know, seven dimensions and, You think it's difficult because there's some language in there that is very archaic. And then. Oh, yeah. Street has

SPEAKER_04: 9:09

run in Fox toilet training.

SPEAKER_02: 9:10

So so you get it. And then and then you you know, I guess I bring it up because it's it's not to say that. That. That isn't compassionate or informed ABA, but. I would say that somewhere we went awry, somewhere this sort of authoritarian feel that we're working with a quote unquote disabled population. So whatever I tell you to do is the correct thing to do. And if something you do annoys me, then I've got a reason to correct it. And because I can go back and read some of the other literature and it's like, well, it's not like this stuff isn't compassionate. Again, there's words that I won't repeat in there that really-

SPEAKER_04: 9:56

It's clearly not compassionate. Okay. But I think it depends on which articles you're reading.

SPEAKER_03: 10:01

Yeah.

SPEAKER_04: 10:03

And who the population was. And I know I already threw out Asrin and Fox. But if you read that article, it is a hard article to get through. It is. They worked with adults. And they were trying to teach adults in an institution how to be toilet trained. The wording that they use, I would never...

SPEAKER_03: 10:24

Oh, that's completely, yeah.

SPEAKER_04: 10:27

And then some of the procedures that they use, like overcorrection, you know, again, I would never use overcorrection.

SPEAKER_03: 10:34

And

SPEAKER_04: 10:36

so I do think it depends on which article you're looking at. And again, call me back anytime. I'd love to talk about this, but it's a big thing. And I do think, like I said, you have to, value and understand someone's personal experience.

SPEAKER_02: 10:54

Absolutely. Absolutely.

SPEAKER_04: 10:57

If someone with autism is complaining about their personal experience with ABA, don't argue with them. Like that does no good.

SPEAKER_02: 11:03

That's their experience.

SPEAKER_04: 11:07

You can just say, I actually have a funny story. One of my friends now, we met at an advocacy leadership meeting. conference for parents um it was actually like a several months training and we would go every like one or two times a month and on day one of this training that i attended in wisconsin i'm sitting at a table and you know you kind of turn to your right turn to your left introduce yourself talk about what you do and i i the woman says to me she's a speech path and an autism mom i'm also an autism mom because everyone there was some kind of parent of a disabled person. And so, because it was an advocacy training for parents. And then I got excited because she said she's a speech path. And I was like, I'm a BCBA. And she says to me right away, I'm sorry. I was like, oh, this is loaded. I was like, okay, well, how do I come back from this? And it's, I mean, I probably didn't do it great back then. But I said, like, I'm not that kind of BCBA. Let me try to explain myself. Like, like, and unfortunately, you know, every state's a little different. Like, I live in work in Wisconsin. Now, Wisconsin's really low boss heavy. I grew up in ABA in California. I quote unquote grew up doing ABA in California. So everything there was very PRT, play-based therapy, natural environment. I'd still learn structured teaching. And like I said, still learn some practices I would never do today. But yeah. having that mindset versus like what majority of people do here in Wisconsin, it was like, kind of like a, I stepped back into the past when I first moved here and had to really fight and, and navigate like as a practitioner, I fully believe in natural environment teaching. I fully believe in, you know, ascent consent and like, how do I work this through, you know?

SPEAKER_00: 13:23

Yeah. I mean, he was obviously, you know, the father of ABA. But I even think, like you said, you always say, Mike, if Lovaas, you know, he'd be turning in his grave. I think so. It's kind of like the Wright brothers, like the Wright that's being like, oh, well, and please, I'm not disagreeing with you at all. Hopefully it doesn't seem like I'm disagreeing with you. I'm actually very much. You guys don't know what

SPEAKER_04: 13:48

Lovaas is. because you're in California. Sorry. I am telling you straight up, like, if you were to come out to the Midwest where a lot of low-blast replication sites are, it's like a night and day difference of how ABA is done.

SPEAKER_02: 14:04

You're scaring me.

SPEAKER_04: 14:07

Oh, you should be scared.

SPEAKER_00: 14:10

You really are. If aviation was still the Wright brothers, like, I feel like we're like on biplanes and pushing planes off a cliff. Like, I feel like that's what people like, like you're saying, that's like, it's like, yeah, that was good. That was good back in the day. Can we progress a little bit?

SPEAKER_02: 14:25

Well, and that's, that's, I think that's what we're talking about. Right. So the idea that you take something foundational or fundamental, um, and then you, you take it out of, uh, uh, you know, a chronological context, right. It's like, the idea that you go to the airport and you're about to board your flight and you've got you know some guy on a bicycle on the front and these you know two large wings like wait a minute where's the new where's the airplane we you know but again without that very uh rudimentary machine we wouldn't have these bigger things that we have and i so i think that we've we've done a good job of sort of talking around that point right so the idea that that is it is it the science that faulty is that is faulty or is it the application of the science given the practical practitioner or the purveyor. And I think we can make arguments on both sides of that. But, you know, to sort of wrap up my point on that is, is it does it does frustrate me to to have to look at the decontextualized science and then have it be disparaged and going, well, wait a minute, if you're not if you're not moving this forward from 1971 or even 1987, you know, that Lobos article, if you haven't done anything to progress it, then it's really not on Lobos necessarily. I know he's got the name and he's the one that put it out there. But, you know, like Dan said, I love saying that to people. Man, if Lobos knew you were still doing it that way, he would turn over in his grave, I'm pretty sure. Because as a scientist, he would have wanted us, I firmly believe, to say, here's this. go do something else with it. Go evolve it. Go make a difference after, you know, a 1964 Civil Rights Act and then in 1971, take some of those new monies and set up a young autism project in a huge university and actually progress it. Now, I do agree that when we don't recontextualize those things from the past, they can run a very horrible risk and they can look very archaic and they can be very detrimental despite some good intention. So I really appreciate the way we talked through that because we covered a lot of ground there. So thank you. Pass

SPEAKER_00: 16:38

it back to

SPEAKER_02: 16:38

you. Yeah.

SPEAKER_04: 16:39

Yeah, no worries. And I mean, at the end of the day, that's where like, you know, like you said, you really should be looking at like, what is current best practice for this age group for this diagnosis, whatever, right? And even outside of our science, I know that we're not supposed to, you know, use pseudosciences. But if, you know, people who study child development are saying that you shouldn't be working on tying shoes at age three, that the that's typically not a skill that's even developed until five or six, then why are we working on it at four with someone who has a developmental delay or autism? And same like with children who are two, why are we making them sit for 30 minutes at a table, you know, and requiring them to stay there? Like that is not developmentally appropriate. And that's to me where our science is, Unfortunately, you go to school as a BCBA to become a practitioner of the science of ABA,

SPEAKER_03: 17:49

right?

SPEAKER_04: 17:50

You do not go to school to learn about child development unless you also had maybe education as your undergrad or part of your master's. You're not learning child development. And so we're taking these people who are learning the science and expecting them to automatically know how to apply it to humans and children, and they have no idea anything about child development. That's just faulty. I

SPEAKER_02: 18:19

love talking about how you can go through a 40-hour training as an RBT. You can pass your 40-hour competency exam. And you will still not know squat about how to engage a child or run a session. Man, we have to close that gap. I'm actually a developmental psychologist by training first, converted to behavior analysis. So you're speaking my language. And I think that, I mean, we've done episodes on it. I could sit and talk for another two hours about so many other examples that you're really hitting the nail here on the head. and saying, we do things just based on this linear application of, well, the violin said this was a zero, and now I'm going to turn this line item on a behavior scale into an all-encompassing goal. And it's like, are you sure? That's probably why you have 30 goals on your treatment plan, and you're probably only running about 10 of those procedures if you're lucky, but it looks really nice on paper, good for you. And it really ties back into the assessment. Those are all good things. Where is the pragmatism? Where is the actual practical application of it? So I think you're right, whether it's utensil use, brushing teeth, tying shoes, all these things that developmentally from a treatment perspective, of course, it's going to be very helpful as an access skill for somebody to be able to tie their shoes. And then the idea that you're going to beat that horse into a pulp just because you know go get shoes that don't have laces. I don't know. There's a million others. Yeah, I was going

SPEAKER_04: 19:55

to say,

SPEAKER_02: 19:55

that's my thing, too. Right. I mean, Skechers has a whole campaign right now, and the fact, you don't even have to bend down to put your shoes on anymore. There's shoes

SPEAKER_04: 20:04

that you can just step into. Exactly. And, like, the heel fixes itself. You don't have to

SPEAKER_02: 20:07

do anything. I don't want to say it's the ultimate answer, because it could still be very useful for you to learn how to tie something. But the idea that we're going to get stuck on that continually because some assessment, you know, again,

SPEAKER_00: 20:18

yeah. That's, like, what we were talking about. And what you were saying, too Suzanne I think is interesting because one of the presentations at the conference they talked about our arbitrary 80 percent of opportunities number and they talked about how neurotypical people typically don't hit that level of achievement and where did we come up with that and they came up you know they talked about the shoe tying the toilet and things like that and we just arbitrarily work on this goal not having any idea what the if we're trying to teach to neurotypical levels what the actual neurotypical level is of if they're doing it and then what percentage of the opportunity they're doing it. But back to what you were, oh, sorry. Back to what you were saying, Mike. Oh, go ahead, Suzanne.

SPEAKER_04: 20:59

I was going to say that's a whole nother topic too. I mean, just goal writing in general. Yeah. Yeah. A whole nother day.

SPEAKER_02: 21:09

After moderating that conference, and we've had this discussion several times, but we, and again, I won't get too far into it, but I think it's a whole... three-part series on ABA on Tap, to say the least, because we adopt these conventions and then technology to, you know, to your point, really helpful tool, this cut and paste thing we do. And it makes things a lot more, you know, quick and you can get your report done. And then all of a sudden your individualization is eroding and going out the window because, I mean, again, we've talked about all these things today already in terms of how much work you actually have to do. And that's, you know, that can be difficult. That can be very, very challenging to get it all, to make it all fit. But yeah, goal writing in terms of percentage of opportunities versus a certain level of accuracy versus, I mean, it's almost like we just replicate this language. And at some point, yeah, it doesn't mean anything anymore.

SPEAKER_00: 22:06

Mike, I do want to go back though. Yeah. So something, kind of going back to something we all talked about earlier, and then we definitely, this will probably be a two-part episode. We'll record it all today, but we'll split it up because We've had a lot of discussions. I want to get to your kind of the new direction of Innovation Moon. But before we get there, Mike, you mentioned about having goal writing basically based on the Vineland and to eliminate line items on the Vineland, turns those zeros into ones and twos and threes. That's an interesting, again, juxtaposition with, as we talked about earlier, and you mentioned values-based ABA, Suzanne, and standardized assessments. What... How are we defining success in ABA and what are we teaching to? Because I know like my girlfriend, who's a special ed teacher in California, education is based around standardized assessments. So you basically teach to those standardized assessments because if you get better scores, your school gets better money and things like that. So you're teaching to the standardized assessment, which for a special ed individual, that may be a whole different discussion. But my question to both of you is, So Mike, you mentioned about having programming that is more holistic than a line item on a Vineland. But if that's a standardized assessment that we're teaching to, that insurance is going to compensate us for, whether it's us or the general ABA public, they're going to come back to that because that's what compensation's for. I don't know if that made sense, and I'll open it up to any of you all, but that's where my mind went.

SPEAKER_04: 23:37

So it does. It makes a

SPEAKER_03: 23:39

lot of sense.

SPEAKER_04: 23:41

Yeah, it's less that... I mean, yes, your teacher, you said wife, I think.

SPEAKER_00: 23:49

Domestic partner, technically.

SPEAKER_04: 23:52

Domestic partner, teacher. They do end up right now having to do a lot of that teaching to the test. And I would say that ABA, some people, because again, they don't have that bigger picture of child development, that's where you'll see us teaching to our tests too. And not just the Vineland, but like the VB MAP. I mean, how many goals or programs have you looked at that literally are like, they will say, you know, 25 words on the EESA level one at whatever accuracy. And then the targets are like, goodness gracious. What are the, like, dippity dog, like, I don't know, whatever those are, right? Zimbabwe. And they're directly working to that test. That test was never meant to be worked directly to. We're not supposed to be teaching to any of the items directly. We're supposed to be doing our normal everyday incorporation of those skills in natural environment, natural play, and or structured teaching, but we're not supposed to directly be teaching to any test. And so Again, that does take some finesse and some knowledge on the part of the clinician. And hopefully the company is providing enrichment for their BCBAs so that they know how to not do goals that are straight from an assessment. And that they're then teaching, you know, this is like a little bit of like RFT, right? Like we're going to do some incidental learning, right? all children have the ability to have incidental learning. And so if we're doing that, we're enriching the environment, we're using as many teaching examples as we can, then ideally when you go to do the standardized assessment in the six months, year, whatever the schedule is, that child's gonna make progress, ideally. If not, that's a whole nother subject. And as a parent of someone who does have profound autism, to me, You know, maintenance is also progress. I know that that's a hard line with some insurance companies that if they're not seeing progress, they're going to do, you know, it's not medically necessary anymore because the child's not making progress. But I would appeal that and I would fight that because, you know, there are some children are never going to surpass whatever that level is. Are they going to make gains? Are they going to be small incremental gains? Yes. Do they have the ability to learn? Yes. But Are they going to make enough gains that the insurance company says, yeah, that's great? Probably not. Like some of us, our children grow up to be adults and they still need services and support. I know that's not what insurance wants to hear because that's going to cost them millions of dollars, but hopefully that's a small percentage. I think it's one in every four persons with autism has profound autism. And I am, I'm starting more, more on that advocacy journey. I've joined the Profound Autism Alliance. I'm a state chapter leader here, but I'm still very much learning about that and how to advocate for our profoundly autistic adults and children. So,

SPEAKER_02: 27:23

yeah. That is an interesting, I guess an interesting ethical quandary that I was discussing recently with a colleague. We were going through a report and trying to address some comments from the funding source And it was this whole question of the levels, right? That the violence spits out. And this whole idea that the reviewer was saying something along the lines of, well, this client or this person isn't gonna, make any more progress along these lines or the idea that my exit criterion was when that reaches a moderately low as opposed to a lower and adequate level from an ethical perspective, if there's a need that I can identify and the person's willing to work on it, then we can provide it. But of course, you have to draw some lines to your point. So it's an interesting ethical quandary for me to say, or to think of the prospect of having a funding source, tell me number one, No, there's no more progress going to be made. Well, I beg to differ if you just give me the time. And then the idea that if you give me enough time, I don't know that it's necessarily the objective to hit that new level on the Vineland as much as ensuring that the person has as much access as possible. is reasonable that they actually desire to have. So it's, again, I don't wanna, it's easy to beat up on the funding sources based on all these rules. I do understand where they're coming from. And then at the same time for us as behavior analysts, the idea that we might have to accept the notion that no, there's no more progress gonna be made. So you're no longer medically necessary. That's a tough pill to swallow to say the least.

SPEAKER_04: 29:10

I do think, yeah. I mean, that's at the end of the day, That's where advocacy, you have to ask, who would be responsible for this thing? And if the medical model isn't responsible for it, so insurance-funded ABA, then who is? And then is it our state and our federal government who's responsible to provide these types of services? And if they are, then we need to advocate to make sure that they continue to do so. And at the end of the day, we can't just say, well, that's not my problem. That's not my problem. I mean, that's what everyone's doing right now. They're saying like, you know, this, Okay, well, you come to me and you say you want to work on adaptive skills. Well, guess what? Adaptive skills aren't in the medical model. So we're not going to work. We're not going to approve any adaptive skill goals. We're seeing a lot of insurance companies do that. We're not going to approve any educational goals, right? So who then is responsible for educational goals? The school. Who then is responsible for adaptive goals? I would argue it could be the school, but they might say, no, it's not us. It's somebody else. It's somebody else's problem. Well, everybody pushes people away saying that's somebody else's problem. So then at the end of the day, this is where advocacy is so important. And if more BCBAs want to do advocacy, please contact me. State level is very important because we need parents and providers to advocate together to make sure that it does become someone's problem. Because somebody needs to pay for it. These services are needed. They're needed long term. They're needed into life or like throughout the life of some individuals, not all.

SPEAKER_02: 31:00

Recently had a discussion on fine motor skills. With the same thing, well, they're going to kick this back. Well, I didn't take this out of thin air. In fact, it's under the physical development section of the very behavior scale you're asking me to use. And yes, I do see how these skills would be relevant to the educational setting. But guess what? A pencil is also relevant to the home, as is a crayon, as is any of these other things that now get regarded as fine motor and then educational. And it's like, wait a minute. These are life skills that are going to be relevant. So again, I do understand. why the lines are attempted or why the boundaries are created. And then at the same time, I, as a clinician, I face a lot more frustration at those limitations because it's like, well, this doesn't make any sense. You're really, it feels like excuse making continually. You're just finding a way. pigeonhole my practice, and I don't like it. I don't appreciate it.

SPEAKER_04: 31:59

Well, I think we don't like it because we want to be able to work on skills across the entire person, right?

SPEAKER_03: 32:08

And

SPEAKER_04: 32:08

as behavior analysts, We feel like we can do that because, you know, we look at behavior and we know how to break it down and we know how to apply whatever we need to to make progress. So but at the end of the day, if you're working with insurance and you're doing a medical model ABA, they're going to tell you no, because guess what? Somebody else that is in their purview. So OT. So that's where you either bring in an OT to your practice or you collaborate once one and you do parent training so that the parent is, you know, providing those opportunities outside of the OT. The OT only see the client one hour once a week, which we all know is not going to help long-term, but you can do collaboration. And so that's where, again, that's your purview if you're doing medical model. So we can say that, don't like it but you're getting paid to like it by the funder

SPEAKER_00: 33:10

not to conflict what either of you are saying but just to pose the opposite so absolutely you know like give us the time and we could make this uh you know make this achievable for this individual medical insurance might be like well how much time and how achievable and at what point do we say any level of achievement is appropriate because that is somebody's life? Is that what we're saying is if we can get a little, or does there need to be a statistically or medically significant? And then how much time? I think that's what they're saying. Historically in ABA, we haven't really done a great job of saying that. We

SPEAKER_04: 33:43

haven't. I would say this is where if you're working with someone with level three autism, maybe level two, someone who would fall under like, severe, profound kind of diagnosis. Maybe they have Down syndrome as well, or some other clinical diagnosis on top of autism. This is where I... I would say that you should be using the Essentials for Living assessment for your skills-based assessment. That one focuses on those, I think it's Essential 8 or Essential 9. I'm terrible. It's been a while since I've personally used it. But it says, here are the basic skills that any human needs through adulthood. If they don't have these basic eight skills or I think it's eight, then they're going to rely on someone for the rest of their life for everything. Those basic eight skills, I think three of them or four of them are communication based. And then the others are things like being able to change their clothing or handle some simple like feeding themselves, acquiring food. So again, if you're looking at the autism population aging, if they can't you know, use the toilet independently. They can't find food, access food, or communicate that they need food. They're going to need someone 24 hours a day to take care of them. And so to me, if you want to get insurance on board, you're going to do the violin, you're going to do whatever the required standardized assessment is, and you can use the AFLS, or not AFLS, I apologize, E-F-L-S, Essentials for Living.

SPEAKER_02: 35:26

Yeah. Okay.

SPEAKER_00: 35:27

Mike, anything you wanted to add?

SPEAKER_02: 35:29

No, I mean, I think, again, I think that it's quite a dance that we're describing, and it's good to get good at it. And I certainly agree with the need for those definitions, those boundaries to be set. But it's ever interesting, right? So the notion that you can get exited from services for being too successful, and at the same time for not being successful, it's a Again, I get their point. And then at the same time, it's like, well, can we define those timelines? Can we achieve a standard mode of treatment in ABA and still have it be individualized? That can be a little different if you're giving somebody a dosage of antibiotic based on your height, weight. that's going to be much more easily quantifiable. But I mean, I think you made that point, Suzanne. And I think that's the hard part here is that, that we are trying to fit a very individualized model into a system that otherwise needs to generalize across a larger population. And that's, that is proving a very formidable challenge.

SPEAKER_04: 36:40

Yeah, definitely. And, and that, You know, again, like I said, I do think ultimately you have to ask yourself who's paying for the service. If back in the day, it was a parent that paid for it out of pocket. And so of course you would do whatever they wanted, you know, because they'd say, well, it's really important to us that they know how to stand in line at Disneyland. Well, guess what? The medical model isn't going to approve that. So, you know, you have to, again, if you don't like it, then do private pay. You don't like it, be a solopreneur. Like if you don't want to work in the medical model and you don't want to work towards whatever box that they have, because again, they're going to say that's not our responsibility to fund you for that, then your options to not, not bill insurance. You just would have to, you know, totally change your model. And there are lots of BCBAs that do that and still do private pay or, you know, work with regional centers only or work with, you know, you know reimbursement from the state because every not all states have regional centers so yeah

SPEAKER_02: 37:50

i'm gonna um guide us into we've had a lovely discussion um this is probably the first time

SPEAKER_04: 37:57

uh

SPEAKER_02: 37:58

We go past our time limit and I actually feel like we can fill two episodes worth. But I do know that at the start of our conversation, you were alluding to ABA outside of autism treatment and some of your new projects. So I want to make sure we get to that. Tell us a little bit about what you're thinking.

SPEAKER_04: 38:20

So I kind of call myself like a serial entrepreneur. I always joke that if I had money, I'd be like, you know, the owner of Virgin, right? Like he just has like so many ideas and does so many things. I don't have money. So, you know, I'm limited with what I can do. One of the things that I have in the last couple of years been doing, again, is, you know, building communities, working on, you you know, providing mentorship and doing coaching, as well as doing the business consultation. And so I started Launchpad, which is a private community currently for business owners, not limited to BCBA business owners or ABA business owners. So I invite anyone who's basically, I like to call ABA adjacent. And so I've got, you know, women who are who own their own billing companies and contracting companies that are a part of the group. I've got, you know, someone who that does financial coaching to people who want to learn about their finance, personal finances. So she, you know, she's a consultant or a coach for personal finances, but she uses ABA because she's a BCBA in that business. And so she, I've just been kind of collecting and networking with all these people who do different things. Some people that do ABA in sports. And kind of what I fell into when I stepped into Reddit was I started realizing that a lot of people were posting posts, BCBAs, who were looking for something else to do outside of the behavioral health treatment for autism right so be outside of ABA therapy for autism they're burnt out they don't want to maybe they're recognizing that was never really for them but they love ABA and I think that that's appropriate like that's okay to say not all of us should work with children right like when you become a teacher you get to decide if you want to work with young children or adults or if you want to work with high school students you know when you become a doctor you get to specialize in whatever type of practice you are going to specialize once you hit that doctorate level in your degree. And so finding a specialization, it's kind of I get it. And as an autism parent and, you know, having my own kid be on waitlist, that's, again, a whole nother conversation. Of course, there's a need for people to go into autism or behavioral health treatment for autism. Or even education, like be a BCBA in schools. 100%, please do it. But if you're finding yourself burnt out, you're unhappy, you hate your life, and you're questioning if you should even be doing ABA, I think that what you're really questioning is, should I be working with children in this intensive therapy model with these people as my boss? And maybe I should look at something else that I'm passionate about. Can I apply ABA to that and how? It's so again, like we pay a lot of money to become BCBAs, right? You have to go to grad school, you have to pay someone typically for supervision, you know, fieldwork, not everybody pays, but a lot of people do. And so to just walk away from a science, I mean, I'm guessing that if you went through that process, you love the science of ABA, like I do.

UNKNOWN: 42:03

Yeah.

SPEAKER_04: 42:04

Maybe you don't. Maybe then it is time to reevaluate and change your life. But if you're one of those people who's just, I'm just tired of working in this model. And then you think to yourself, well, what are my options? My options are I could start my own company. Again, don't do it unless you're really prepared to do because you're going to get burnt out from that. also, and you're going to become one of those angry owners who's always mad at their employees and their clients. If you don't love autism therapy, don't do autism therapy. So, but, you know, the other thing is sometimes people become solopreneurs and they just do one-to-one contracts. They don't do anything with insurance. You know, I've got I think one of the first episodes I ever listened to you guys, you did Kendall Rendak Samuel. I don't know how to say her name. I loved that episode. I reached out to her. She and I are friends now. And like she does.

SPEAKER_02: 43:03

Your neighbors.

SPEAKER_04: 43:08

We found that out. So yeah, someday we're going to meet in person, but she is in Chicago and I'm in Wisconsin.

SPEAKER_03: 43:15

So

SPEAKER_04: 43:16

yeah, but it's, it is huge. And yeah, So I just am starting to recognize and I, like I said, I love networking. I like to think of myself kind of like as a cheerleader. I do personally have a lot of anxiety and that's why it's been very hard for me to do public speaking like this. But this last month or quarter, Thank you. This last month or quarter, I've been pushing myself to actually like become a speaker at conferences. I've got a couple things lined up. And one of the things I've recognized that I'm good at is networking and being a people connector, like helping people find other people so that either they can get mentorship or experiences. You know, there's so many BCBAs that are doing new, exciting applications of ABA or, you know, they've been doing it. People just don't know about them. Right. You know, we've got BCBAs who are doing health and wellness. We've got BCBAs that are working with gerontology or the elderly, dementia. We've got BCBAs who, like I said, personal finance programs. Just regular coaching. There's so many other applications. So just looking at like, well, how do you take the work experience you already have and then go and apply for a position or or forge your own? Right. Like you might not be able to find a position like we always kind of joke that there's no. there's no jobs that are looking for OBM specialists. That title doesn't exist. I would beg to say that I have seen a few when I'm looking at what jobs there are in ABA. Sometimes I'll see OBM in a title of a position, but it is rare. And so you're not putting that you do, you're basically having to look at what are the types of things that I can do And rewrite your resume so that it really fits that job that you're hoping to get. You want to be a BCBA and work in tech? There's definitely an avenue to do that. So, you know, whatever it is, that's kind of what I'm coming to this road of. We, as a field, need a way to... really just expose what else we can do, right? Like we always joke, ABA can save the world. Well, we can, maybe. We just have to figure out how to do it in practice. So

SPEAKER_00: 45:59

what have you found with, so you talked about some of the different fields, health and wellness, even finances, and you kind of alluded to it. Have you found that you're advising people more to apply to companies and say, hey, I'm a BC, are you finding more, people to like private pay or to like kind of create their own entity within that field? Or do they need to sign up for Innovation Moon to figure out, I don't want to give away paid secrets for free? What can you speak to

SPEAKER_04: 46:31

on that? I mean, that's kind of the funny thing. So when I started doing Reddit and I started seeing all these people who are so sad and like, just ready to throw in the towel. Or maybe they had already thrown in the towel, but then they were like, what do I do now for work? I just started saying like, hey, here's my booking link, book with me, let's talk. So I have been giving away coaching for free. That being said, now I'm recognizing that because like I'll look at my calendar and I've got like 10 coaching calls that I'm not getting paid anything for. So I am going to still offer like a free coaching, like a discovery call, but it's going to be 30 minutes or less. And then if people want to continue to work with me, then they can sign a contract and get mentorship. That's one way. The other way is they can join my community. And again, it is a private community, so there is a fee, but they're going to have more access to me and to other BCBAs who are doing unique things, you know, readily within kind of like, it's almost like having a private Facebook group, but cooler because it's more. app and all of that and no one's anonymous so there's no trolls like we get to moderate it we get to make sure people are actually who they say they are that they're actually supportive of each other and they're providing value to the community so there's two options one is to work with me or another I can connect them to another BCBA who's doing something different or they could join the community. So definitely go to my website because you said we're going to launch this in the new year. So by then my website will have links and everything. So if they go to innovationmoon.com, they'll be able to find the different options. Follow me on LinkedIn. That's definitely another way to get in contact with me because my name is who I am. So they can also DM me privately that way.

SPEAKER_00: 48:44

I personally... We'll put your name in the

SPEAKER_02: 48:49

description.

SPEAKER_00: 48:49

We'll

SPEAKER_02: 48:49

put

SPEAKER_00: 48:49

all these

SPEAKER_02: 48:50

links in the description, too. So make sure people know how to get a hold of you. I think you've got a ton of very valuable resources, and this is very exciting. What you're describing there in terms of almost throwing in the towel, I mean, that was... That was Dan and myself 10 months ago kind of going. Yeah. The way you pitched it, the way you quoted it too was, I mean, it was like you were in my head. I love this work. I don't know what else I want to do for work. This is what I'm good at. And this is what I've been doing for 28 years now. I don't want to put all that experience aside. So we're really, really glad to have connected with you. Really glad that you're doing this for other VCBAs. Glad to hear that you know people we know. I think that the community needs to become a little stronger and start sharing more of those ideas and start taking care of each other. You know, even in terms of just coming together to create that lobby with the insurance company and saying, hey, can you help us out here? What else can you do for us? We're trying to do good service and some of these constraints are making it very difficult to maintain that clinical quality. So Dan, we're at a good stopping point here. We don't want to cut anything off too early, but we've covered a lot of ground. Anything else we want to discuss here in wrapping up?

SPEAKER_00: 50:07

No, this is a banger. Start the new year with them. Yeah, thank

SPEAKER_02: 50:09

you.

SPEAKER_00: 50:09

Thank you, Suzanne, for your time. And we'll hope to have you with Jennifer and some other of our regular guests back on the podcast more regularly.

SPEAKER_02: 50:18

Yeah,

SPEAKER_00: 50:19

definitely.

SPEAKER_02: 50:20

Go ahead. Go ahead.

SPEAKER_04: 50:21

Oh, one other plug. I am hosting every what first Wednesday of every quarter. So every three months, a net networking night, and that's free. So Just look again, follow me on LinkedIn, you can find the registration, you do have to register for it. Right now, it'll be limited to 100 people. But that those networking nights, you know, again, are a great way to just get out there and meet different people and learn about how other people are doing ABA.

SPEAKER_02: 50:53

Cool. So that's a good closing point right there. Get out there, meet other people, see what other people are doing. Certainly find new avenues for ABA and its application. And then we'd like to close by saying, always analyze responsibly. Cheers. Thank you, Suzanne. Thank you so much for your time.

SPEAKER_04: 51:11

Thank you.

SPEAKER_01: 51:12

ABA on Tap is recorded live and unfiltered. We're done for today. You don't have to go home, but you can't stay here. See you next time.