Transforming Applied Behavior Analysis Through AI-Powered Tools with Adam Ventura (Part I)

ABA on Tap is proud to present Mr. Adam Ventura. (Part 1 of 2)

Adam Ventura, MS, BCBA, is a leader in the integration of artificial intelligence and behavior science. He is the Founder and CEO of Intraverbal AI, a company dedicated to transforming applied behavior analysis (ABA) through AI-powered tools that support ethical decision-making, supervision, and clinical efficiency. Adam's current focus is on leveraging technology to make data-driven insights and innovative systems more accessible to behavior analysts across settings. A graduate of Florida International University (FIU) and a long-standing adjunct professor, Adam blends academic rigor with cutting-edge application. Adam is an established author and speaker, he has contributed extensively to the literature on ethical practices, leadership, and now the responsible integration of AI in behavior analysis.

Adam speaks eloquently about his past experiences leading to his current project and heart work at Intraverbal AI. He has done it all in the field of ABA, and he forges forward with the most modern of technologies at hand. This is an innovative and refreshing brew you can enjoy over and over again, and it's only the first of two full pours. Sit back, enjoy this. tall, cold one, and always analyze responsibly. 

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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_03: 0:53

all right and welcome yet again to another installment of aba on tap i am your ever grateful co-host mike rubio along with mr daniel lowry mr dan how you doing today sir

SPEAKER_00: 1:05

great great doing great excited to have another guest on today

SPEAKER_03: 1:08

yeah it's been a couple weeks since our last guest it was a great conversation with dr scott o'donnell and i i think that uh today's conversation will will be uh just as promising and interesting we're going to be talking about Something that, quite frankly, I've been a little fearful of, and I think I've admitted it on the podcast, and I think that our guest is going to help me work through that fear today. So I'm excited to welcome Adam Ventura. Let me talk a little bit about Adam. He is a leader in the integration of artificial intelligence and behavior science. He's the founder and CEO of Intraverbal AI, a company that's dedicated to transforming applied behavior analysis through AI-powered tools that support ethical decision-making supervision and clinical efficiency. So without further ado. Mr. Adam Ventura

SPEAKER_01: 2:23

Thank you guys so much for the invite and for that great entrance music as well. I remember that you guys just told me a few minutes ago before we went live that you're looking for names for your virtual band. So I am going to take some time after this podcast to come up with a couple of names and I'm going to use AI to do it and then send it over to you guys. That is

SPEAKER_03: 2:44

perfect. That is perfect. For whatever it's worth, I believe it would be Gemini that helped me with your introduction. So I hope it got it right. AI-powered Gemini I got it right there on Google. That's, again, me overcoming my fears slowly and gradually. Obviously, you punch it into the search, it does it for you. I hope it's that easy looking forward to the tools that you'll be talking about. Before we get to that, we love the origin story here on ABA on Tap. We like to talk about the brew, basic ingredients, how everybody brings them together to present something palatable, something that's functional, that works for individuals. Please, kick us off. Tell us a little bit about your background. I think you've done everything that Dan and I have, and now you're pushing the field forward in some new directions. So tell us all about what got Mr. Adam Ventura started and what keeps you going.

SPEAKER_01: 3:36

Sure, absolutely. It's interesting that you asked about my origin story here because I've been in the field now for 20 years. And I was having a discussion with somebody the other day and they're like, how long have you been in the field? I've been in the field for two decades. And then I had one of those take a pause moments and I'm like, wow, I've been in behavior analysis for 20 years. But I feel like so many people in the field specialize in one thing and that's kind of their claim to fame. Where with me, I never really specialized in anything in particular, I feel like my thing that makes me unique is I've worked in just about every setting doing everything. So when I started in the field, I started working with adults. I was working in group homes. I was working in adult day training facilities. Then I moved over to doing foster care. I did that for a few years. And then I started working with kids. And somewhere around 2010, 2011, I ended up starting my own company, my own ABA therapy company in Miami. And I ran that for almost 10 years before I sold to private equity. And during that time, our company grew and flourished. By the time I sold the company, we were in three states. We had just under 300 employees. Good Lord. Yeah, yeah. It was way more than I ever expected. I was very fortunate to work with a lot of great people. And we worked in a variety of different settings. So like I was saying, we worked in schools, homes. I continued doing group homes for a little while after I started my company. Then after I sold the company, I did a lot of different things. I wasn't sure what I wanted to do next. So I did some OBM consulting for a while. I started an OBM practice management software system and I wrote a few books during that time as well. So I had a lot of different things going on and I feel like I've been very fortunate in that my experience in ADA has been very diverse. I've worked in the private sector a lot. I worked in academia. I taught at Florida International University in the behavior analysis department for 12 years.

SPEAKER_00: 6:06

RIP Jose Martinez.

SPEAKER_01: 6:09

Actually, he was FIT. Oh,

SPEAKER_00: 6:12

good

SPEAKER_01: 6:12

guess. Yeah, so Florida Institute of Technology.

SPEAKER_00: 6:18

Oh, sorry, sorry.

SPEAKER_01: 6:20

No, no, yeah, no problem, no problem. We actually worked with him a great deal and... mad respect to him i mean he's he contributed so much to our field but yeah fit is in like the center of florida like the melbourne area fiu is in like the miami area

SPEAKER_00: 6:36

gotcha

SPEAKER_01: 6:38

but um yeah so uh i i think that's uh uh my elevator speech for my origin story here is that i've worked in a variety of different settings i've been really fortunate in in that area and I know a lot of people in a lot of different domains of behavior analysis. And that's something that's really professionally reinforcing for me is I have the opportunity whenever somebody comes to me and says, you know, I really need somebody that works in schools that can help BCBAs get started. No problem. I know like five people. I need somebody that does OBM consulting and manufacturing plants. No problem. I know somebody. So I'm really fortunate in that I know a lot of different people in a lot of areas. guys. Yeah, I would say that's my origin story here, and happy to dive into any of those details.

SPEAKER_00: 7:31

Awesome. That's so exciting. I feel like, not the mission of the podcast, but it's almost changed over the last little bit. We started talking about ABA and the partition of that with individuals with autism, but over the last, especially with the guests that we've had, we've talked about the diversity, and I think that's really special, because ABA so often gets, like we talk about, pigeonholed into autism, right? but kids with autism specifically. So it's so cool to have somebody like yourself, Adam. We've had a few, Dr. Scott O'Connell, the last guest, not just with kids with autism, in fact, working with adults. So also the organizational behavioral management piece. So it's just so cool to have the diversity from ABA. Yeah,

SPEAKER_03: 8:12

yeah. Tell us a little bit. So you said foster care and group homes. Those can be very diverse, very interesting, very challenging settings. Tell us a little bit about your experience there. And again, that's certainly now dealing with behavioral challenges outside of spectrum disorders, maybe within. Tell us a little bit about your experience in those settings.

SPEAKER_01: 8:35

Yeah, I worked in, I only did foster care, I would say for about a year and a half, but I did, I worked with adults in group homes and ADTs for really the first like seven years of my career, six, seven years, something

SPEAKER_00: 8:47

like that.

SPEAKER_01: 8:48

And it's really hard work in the sense that if you don't work at the right place, and I worked in a lot of different places, you end up becoming a paper pusher. instead of somebody that is actively making the lives of the individuals that you work with better. And I worked in really tough group homes. Like I'm thinking about a couple of group homes that I worked in where we got clients out of jail. So they came out of prison and we dealt with the hardest behaviors Um, you can imagine, um, really difficult behaviors, not just physically aggressive behaviors, but property destruction, uh, sexual aggression behaviors, um, severe, severe self injurious behavior. So it was, I, I was. uh good at navigating the system but i never really felt like i was making the difference that i think our science can and i was moments away from leaving the field and going and doing something else and then i ended up transitioning over to work with kids and you know when you're working with kids you have you're working with a shorter history of conditioning you know so if you're like if you go start a client that's 50 years old and it's been in the system in a group home for 30 years they've been doing the same things the same way um changing behavior is really difficult but you know if you're working with a four-year-old or a five-year-old you know their history of conditioning is much shorter so it's easier to make uh changes and um so yeah it's Working in group homes was challenging. It was tough. It was physically demanding. I've had everything happen to me. I've gotten poached, kicked, bitten, burned, hit with chairs, you name it. We've had everything happen to us. It's challenging work and I wish the system was set up because they're usually run through state or federal money. And I wish private insurance were more involved with this to shake things up a little bit. And I wish the system worked a little bit differently because you just don't see a lot of movement, a lot of improvement with the clients that are there. breaks your heart in a sense you know and it kind of makes your job aversive and i got to that point when i hit like year six i was like i don't want to do this anymore i'm not making a difference you know i'm just pushing paperwork i was involved in audits three four times a year because i was contracting out to different companies they're constantly auditing those places it's really stressful um so it just It wasn't the best time in my professional career. I worked with great people. I think there's a lot of people there that want to make a difference, but it's not really why I got into the field.

SPEAKER_00: 11:58

That makes a lot of sense. Yeah. Have you heard of a PROACT, PROACT Crisis Management at all? What's it called? PROACT.

SPEAKER_01: 12:06

No, the one that we used was, um, PCM professional crisis

SPEAKER_00: 12:11

management. Yeah. There's also CPI. Um, but yeah, the company I work for is product. So we work with a lot of people that do group homes and residential facilities and, uh, definitely a different, um, demographic than the, you know, in home ABA. Um, and it's interesting too, because we get a lot of people that are coming and starting their own, um, group home and, um, I don't think they realize, kind of like you were saying, Adam, what they are signing up for. Because it is a lot. The people are a lot. And sometimes the support that you get isn't a lot, but the expectations are. Here in California, a lot of them are funded by the regional centers and the Department of Developmental Services here in California. And yeah, it's a lot. It's just thinking about that as you were talking that... Yeah, that history of reinforcement. Even when we deal with 18 year olds, 15 year olds, it's so much harder than it is a three or four or five year old. I can't imagine a 50 year old expecting any sort of behavior change. And then like you're saying, it's paper pushing and then probably just going to work and trying not to get hit because you're not really making a whole lot of meaningful changes probably at that age without a lot of intensive support. So,

SPEAKER_01: 13:22

yeah. Yeah, and the other thing I would say too about working with adults is especially within those state-run facilities, is that the behavioral contingencies that the state oftentimes, and I'm not an expert on other states, I did most of that work in Florida, the way they set up those behavioral contingencies, it doesn't reinforce client improvement. It reinforces audits and paperwork and you know and behavior goes where reinforcement flows so i ended up doing uh the tasks that the state wanted which is and they it may not be what they state that they want but it's the contingencies contingencies that they set up which were make sure that your paperwork is in order make sure that you're checking off all of these boxes and you know there wasn't you know they weren't doing like in-depth analysis of how how much the clients were improving and they didn't reward the providers um that got these improvements with the clients either so i i think and again there's a lot of great people working at the state and a lot of great providers out there it's just I feel like some

SPEAKER_00: 14:44

structural changes would do that system a lot of good. these funders want, whether it's private insurance, state, whatever. And it's like, do the people even know the procedures? That doesn't matter. Can we just make sure that the notes look right so we don't fail an audit? So I even see that in the private sector of not failing an audit being the motive and the reinforcement for success.

SPEAKER_03: 15:18

Yeah, it takes focus away from the real work, right? Yeah, it takes the focus away from what you're trying to do. So was there any level of, you know, was there any level of measurable success rate for that work? I would imagine that they're looking at the paperwork, but at some point they have to look at some rate of success and say, well, this isn't working. What are we going to change? Or it's just kind of a system that rolls on. That's what it sounds like.

SPEAKER_01: 15:42

It was my experience that it was a system that just rolls on. And I found myself jumping from job to job a lot, trying to find more meaning in my work. And we were just talking. about, I think Dan, you brought up crisis management. And I became a PCM instructor. I was like, let me try something new. Let me see if I can get some more success here. And I started moving into the realm of staff training a little bit more. And that included becoming a PCM instructor. And I found a little bit more meaning with that. And I started moving into supervision and working with younger behavior analysts. So that was a little bit more reinforcing And then in 2010, 2011, maybe it was 2009, I forget the year, but the insurance mandate came out. And when the insurance mandate came out as, you know, for anybody that's been in the field this long, that was the game changer. And I'll identify something in specific. When I was working, I worked Medicaid waiver. I know you all have an equivalent out in California, but in Florida, it's Medicaid waiver. I would get... two hours a week to work with the client with no what we called back then behavior assistant help so obviously this is in like i would say 2005 six seven there was no such thing as an rbt there was no such thing as a behavior technician if you wanted what we called back then a behavior assistant um you would have to submit a lengthy behavior program. And when I say lengthy, I'm talking 25, 30 pages, not a reauthorization report, like a lengthy behavior program to the local review committee. They would have to approve it, and then you would have to get the state to approve it as well. And those were few and far between. So if you were a behavior analyst back then, you had two hours a week to work with the client. And with a client that has, let's say, a 30-year history of conditioning living in or existing within the system, two hours a week you're just not going to make progress you know no matter how hard you try so i i try different creative things i'm like instead of working with the client directly we focus on staff training then i was like well let me start working with the group home managers a little bit and i just kept throwing jello at the wall trying to make it work and it wasn't and it was demoralized

SPEAKER_03: 18:11

Yeah, that's a lot. Or did you see a lot of people have one incident and then have to go right back in?

SPEAKER_01: 18:47

You know, one of the experiences that I had that was very lightning positive, I would say, is I did a lot of IDT meetings, so interdisciplinary team meetings, and I learned a lot from that because we had I feel like we should do so much more of that now. I feel like that happens sometimes with IEP meetings in schools, but for the most part, we don't do that. But we did a lot of that back then. And we would have a psychiatrist there, a speech person there, OT, PT, the group home managers there. We would have like an hour and a half long meeting with like 10 people in the room about one client. And it was really cool, actually. I remember learning so much about medication, how these facilities were run, how we could make environmental changes that would impact the behavior of the client. But to answer your question, a lot of what was done was med changes um to these clients again one of the saddest parts is when these clients exist in the system for so long they end up getting prescribed a lot of psychotropic medication and we were doing our best to be good behavior analysts in changing one thing at a time putting in the phase change on the graph phase change line on the graph and then observing what happened with those clients afterwards, and then jumping back into the IDT meeting, having an interaction with the psychiatrist and said, here's the data. This is what that med change did. So we did a lot of that. We worked with, I testified in court a few different times, which was an experience. which was kind of an exciting, I'm going to be honest with you, it was kind of an exciting thing to do. And when you get in there, you take it very seriously. So I remember dressing up in a suit. Nobody else was in a suit, but I took it very seriously. I dressed up in a suit. I came in, I had notes. I said, this is what's going on. And so to answer your question, I would say it was a combination of, it was really an interdisciplinary discussion. And we talked a lot about um their behavior versus the outcome of maybe sending them back to prison or making a recommendation because that wasn't our job to make that decision but we would make a recommendation and we would we would oftentimes sit down and say okay yes he had a really bad behavior this client he attacked another client that's not good but in the broader picture here we think that this was just an isolated incident and that we can make some changes with him with just some tweaks or he's been making so much progress this was just like one bad day and nobody wants to get judged on their worst day you know so uh we took a lot of that stuff into consideration before we made recommendations sometimes it happened you know we had to um have to make some hard choices sometimes you know some of them would you know attack other clients i worked at a place um i'm sure you all have an equivalent out there was called an intermediate care facility in icf and it was basically like a six-story apartment building and in this six-story apartment building we had about 60 adults that worked uh that lived in there and you know, if you had one that maybe had an incident, a serious incident once every few months or something like that, and the injuries weren't that bad, it was more just kind of a scuffle, you know, that's one thing versus, you know, we had serious incidents where, you know, a client pretty badly attacked another client. And I won't go into details unless you guys really want it, but some of them are pretty horrifying. So long story short, we would try our best to make interdisciplinary decisions and recommendations based on all of the factors involved. So I would say that that was one positive part of my experience working with adults is you get to work with other professionals and see different perspectives. And I thought that those were pretty positive.

SPEAKER_03: 23:06

So from that angle, these individuals were getting a second chance. It wasn't like one mishap, one assault within the facility, and then they were going back. You all had the opportunity to say, no, wait a minute, they're doing better. This is an isolated incident, as you were saying. And now, I mean, I guess that's different from now being out in the community where if they're doing that out there and they get picked back up, it's almost a sure thing. I'm guessing that they're getting back, you know, thrown back in. So that's really neat that at least it seems like the system was working in that way, that within that isolated facility, home or that facility, you all had the jurisdiction to say, no, this is an assault and it would be illegal anywhere else. And it would probably put their parole at risk. However, we're working to change that behavior. I mean, that just sounds, despite all the challenges you're talking about, that seems somewhat positive that people are getting more than a second or third chance to try and change those behaviors.

SPEAKER_01: 24:05

Yeah, absolutely. And I will say one more thing, not to bring it to a negative thing. But again, if we're looking at the behavioral contingencies, if we recommend based on a client's behavior for them to be placed back into a prison type facility, the facility that we're working in loses money for the client that are there. So I hate to say it, but if we're just being honest here, that was always a factor. It shouldn't have been. We did our best to focus just on the behavior. But if you're working in an organization and the folks that are in charge of the organization make it clear that if we lose too many clients, that impacts the revenue here and then that impacts jobs. So unfortunately, those decisions weren't made in a vacuum. We tried our best, like I said, when we get to those IDT meetings to make decisions based on what's best for the consumer. but we had to work within reality. And if we made, that happened to me a lot when I was a young behavior analyst, I was just like, you know, this is what's in the best interest of the client. And then I'd get pushed back from some of the organizations that I worked at. And they said, well, you know, and you know, they would make excuses and say, well, if they just go somewhere else, they're going to have the same problem. So it's just best to keep them here. So you deal with a little bit of that. And just like ABA companies now, there was good facilities and there was not so great facilities and you just do your best. Yes. do your best within those organizations.

SPEAKER_03: 25:41

What a fascinating experience. And again, I think for our listeners, cool to hear the presence of behavior analysis within that circumstance. I don't know how that plays out here in California, but I'm certainly going to look into it because that seems like an important forum where we would be able to make a change. And despite some of the systemic challenges that you faced in Florida, which I'm sure are prevalent in any given state with that particular population, Just another angle for us as behavior analysts to consider where our work could be of good contribution and where it's clearly still needed. I mean, that sounds like a very challenging experience you went through. Thanks for sharing that.

SPEAKER_00: 26:20

Okay. You were talking, you kind of made a segue there to ABA companies, and you mentioned earlier that you started your own ABA company. So can you tell us a little bit about that? Maybe what made you want to start your ABA company and how that came about?

SPEAKER_01: 26:35

Yeah, absolutely. I actually had no interest in starting an ABA company. I was an independent contractor. It's interesting because I know that most states don't have a culture of independent contractors like Florida does. In Florida, we had a big independent contractor culture for a long time, and I was one. contracted out to, I remember before I started my company, I was contracted out to four different agencies. So I was doing work for four different agencies. I was working six days a week. I was driving around to different group homes and agencies. And I occasionally took or did some work with um card so um there's two different cards though and i always have to explain this there's the private enterprise card and then there's the not private enterprise card i work with the not private enterprise card and they're fantastic they're still in existence and thriving here in florida they really act as I would say support coordinators or service facilitators. And I have a good relationship with them. And the director at the time, I developed a reputation over the years for dealing with severe cases of like aggression, self-injury, property destruction, just kind of became my professional specialty for a few years. So I remember the director of CARD sent me one client and he said, hey, listen, you know, this is... It was a younger kid. At the time, I believe he was like eight or nine. And he said, hey, do you think you could take on this client? I said, sure. And it was right when TRICARE, interestingly enough, started the I don't know if it was the echo program or the autism demonstration. It was one or the other. It was one or the other. It was like 2009, 2010. Sounds about right. Okay. Yeah. And I took the client on and I said, okay, you know, no problem. And I started working with the client and then this person contacted me again. He said, I might have another client for you. And I already had a full slate of clients across the different places that I was working. And I'm like, okay, I'll take it. But then it was maxed out. And then he came to me again and he said, you know, Adam, I've got some more clients for you. I'm like, listen, I can't take out any more clients. And then he looked at me, he's like, just hire somebody. And it was just this kind of direct moment and like crystallizing moment. I'm like, I can hire people? How does that work? So I was like, okay, so I can hire somebody. So I had just started teaching at FIU. And there was a student that got through my first couple of courses really well. So I just went to her and I was like, hey, are you interested in doing this sort of work? And she said yes. And we didn't have the formalized RBT training back then that we do now. you just kind of made up your own training and you did your best. So I created a training, trained her for months. She started working with some of the clients. Things started going really well. By the way, that first client that I'm mentioning, um i heard a few years ago graduated college wow and when i first started working with that client yeah it was it's just so rewarding because when i first started working with that client um he was maybe eight or nine years old um he was um it was a military family obviously through tricare he had zero communication skills at eight years old um engaging in severe tantrums severe um property destruction And then he graduated college. And it was just such a great moment. So yeah, so I brought on this one person. She started working with me. And then I got another phone call from somebody else at Card. And I'm like, listen, the person that I hired is already maxed out. And they're like, well, we have more clients. And I said, I don't have any more hands. There's only so many of us. There's only so many hours in the day. And then the same person got on the phone with me again and said, Adam, just hire more people. And then I got the message after the second instruction, and I just started hiring more people. And in 2011, I went from two clients through insurance, two, three, something like that, to about 60. Wow. Because, yeah, yeah, the insurance mandate just came rushing in. and all of these kids that needed services. And I was really fortunate because when I taught at FIU, there were so many students in my courses that were interested in doing this sort of work. So it kind of became a feeder system for us and we set up training programs and we just grew really quick.

SPEAKER_00: 31:33

Did you find it hard to meet the demand? Because that's a really quick growth.

SPEAKER_01: 31:38

Oh yeah, 100%. I think... If I knew then what I knew now about growing an ABA agency, we would have grown to 200 clients in that first year. There was just so much I didn't know. I had no understanding about how employment law works or how to start and run a company. And you have to do payroll. And the biggest thing that I didn't understand, I'll say this really quick, is I didn't understand how medical billing worked. Neither did the insurance companies with ADA. When we got started, I didn't get paid for the first six months. Yikes. Not because we didn't know how to do it. We were actually doing things correctly. I had to send someone that I hired to do billing to sit with people at the insurance company for about two months to explain to them how we should fill out the CMS 1500 form. Oh,

SPEAKER_00: 32:36

man. Yeah, we just started our own ABA company, so I feel you on the billing side of things for sure.

SPEAKER_01: 32:43

Oh, my gosh. And I'll never forget, I had to have a really comfortable meeting with my staff at the time, and I said, I'm sorry, but you're all going to have to be independent contractors and I'm going to have to pay you 30 days in arrears. So they would work, let's say from January 1st to January 31st and get paid March 1st. And having that discussion with folks, I'll never forget that day. That was a hard talk. You know, telling people that they're not going to get paid for a month or two because as I'm sure you guys are going through right now, the insurance companies don't, when people work, they don't

SPEAKER_00: 33:21

pay the next day. Yep. Did you lose a lot of people during that conversation?

SPEAKER_01: 33:25

No, you know what? I didn't lose anybody. And I remember having that talk. It was with about 25 of my staff and I'll never forget, we were having this discussion in my very first office. I just brought them all in there and I just laid it out straight. And I said, listen, you know, if some of you want to leave, I'll understand, but you know, this is our mission here and we're trying to help out these kids. I promise I'm doing everything that I can. was one of those believe in us believe in me i promise i won't let you down um and it just it took years for everybody on both sides the insurance side and the provider side to figure out how to build aba nobody really understood it you know the the the laws just came down and they said well you have to cover this service and the insurance companies were like okay how do you do that So we there was a lot of providers working with insurance companies. It was a completely different time than it is now We met with them regularly and said folks, you know, this is how you need to build these services This is why you need to do this and you need to pay us Yeah,

SPEAKER_00: 34:36

it's the wild wild west now I can't imagine what it was like in its infancy I remember and I probably talked about this in the podcast, but the company we worked for originally, that was the one I worked for at that time, there were like no regulations or anything. So originally it had to be a licensed staff. So it either had to be like a nurse practitioner or an OT supervised because there was in California, there was, certification but no licensing we still don't have licensure yeah insurance said you had to be licensed so we were being supervised in our aba programs by occupational therapists because that's what insurance said that we had to do yeah those were the days those were the days i mean

SPEAKER_03: 35:15

it's changed a little bit i think it's gotten a little bit easier from what you're describing um and and one of the things that's very interesting you sound very clinically oriented i think You know, I identify with that right away, meaning you put me to do administrative tasks. You're going to lose me. You're going to lose my content expertise. It's not my cup of tea. I need to be out in the field. I need to be with clients. And it sounds like at the beginning you had to face that transition. Tell us a little bit about that. You know, it sounds like you're very passionate about the direct work. All of a sudden, you're having to hire people. You're having to learn employment law. You're having to deal with billing and deal with insurance companies. Clearly, that takes you away from the hands-on work. How did you deal with that? What was that experience like for you?

SPEAKER_01: 35:59

Yeah, that's a great question. Thank you for asking. I would say I did like the clinical work. I like behavior analysis. I think a lot of people... get into the field because they want to work with kids. I like working with people, but my first love, my first passion was the science. I connected with the science. I relate to that. Oh, can you? Yeah. And I feel like that doesn't happen as often. And that's sad to me. I love the science. I like learning more about the science, expanding the boundaries of the science. Um, so that was kind of my first love. Um, I, I did do a lot of the clinical work. I enjoy the business aspect of things. I really enjoy businesses. Um, I've opened since then I've opened a ton of businesses in different aspects of, um, in different, uh, business industries, a lot in, uh, behavior analysis. So I like the business part. I absolutely hate ABA admin, scheduling, medical billing, reauthorization reports, HR stuff related to that. I hate that stuff. I went to school for behavior analysis and psychology. I did not go to school to learn how billing codes work and audits and the rest of that. The business side of things, leadership, management, coaching, that sort of thing, making deals. I love making deals. I love connecting people, setting up business partnerships. I really enjoy that. That's really reinforcing for me, but I need to survive and flourish in a business endeavor, I need folks that I can work with, that I can lean on, that can take care of that day-to-day scheduling or billing or keeping the books organized. Those are not my strengths, and I lean on people to do those things.

SPEAKER_03: 37:54

That's good advice for us, for sure. I'm very grateful for this guy who does a lot of the admin stuff for us and will sit on the phone with insurance companies. And like I say, I'd rather be kicked, scratched, and spit on than sit on the phone for two hours waiting to discuss some denied claims. Anyway, we'll see if that changes. I think as I learn more, I agree with you. As I learn more in terms of the leadership aspects and I guess how to explain to younger professionals the nature of the business so that they can value their clinical work but also understand its monetary value, it's something that we're really trying to delve into so that we're out to save the RBT I don't know that anybody Yeah, logistically, yeah. there's a lot that we can employ from our constant expertise. For example, working with kids. There's a lot to negotiate in working with kids that can transfer over.

SPEAKER_00: 39:45

Do you have any thoughts on that, actually, as a multiple business owner yourself? Any thoughts on that, trying to incentivize RBTs to looking at the reimbursement rate that we get from insurances that are going to be compensated somewhere around that in California, that fast food rate, but then they're going to have a much more fluid schedule and presumably a much more challenging job description. Any thoughts on that?

SPEAKER_01: 40:12

I have a lot of thoughts on that, but I'll try to focus my thoughts. Take your time, sir. Take your time. So it's interesting, Dan, you mentioned FIT over here. And with my aviation therapy company years ago, we set up the first hybrid program with FIT. And what that meant was we got a fantastic FIT professor to work on our campus at our clinic. we set up the fit masters program there so our rbts at the time they were behavior technicians actually did their master's degree at our clinic with the professor there so the reason i'm bringing this up is because the way that we worked around this was i had two feeder systems i taught at fiu i recruited students there and then once they were in doing that kind of rbt back then role Then we convinced them to do the FIT program to get their master's degree. And the idea was, I live my professional life with a simple credo, keep moving forward, keep moving forward. And I would stress that to my staff all the time. And if they were moving forward with their career, then we found that there was a lot less burnout. There was a lot less turnover if they were focused on that. And those two setups with those two universities made such a difference. And I remember with the first cohort of the master's program through FIT, I covered the cost of it for them. just to get people excited about it because I knew that it would work well. And so many of the people that graduated through especially those first cohorts are fantastic behavior analysts now and run their own companies. So I really look back on that as something that I feel positive that I contributed to the field is encouraging people to get excited about our field not just working with kids but also about the science and fit does such a great job of sticking to the science not kind of venturing off and they along with our work experience i think we created a lot of great behavior analysts and that would be my advice to folks out there you can do Everybody tries to get clever. Oh, let's do performance scorecards. Let's pay them more money. Let's give them more time off. The way that I like solving that turnover problem is give them purpose. Give them direction. Say, you know what? Here is this goal. It's out in the distance. It's three years out, but you can become a BCBA one day. You can do this. You can do that. And then here's a whole bunch of short-term objectives along the way. Let's hit one at a time. You know, and something I used to always say to my staff is, I'm not sure, do you guys know how to eat an elephant?

SPEAKER_00: 43:20

One bite at a time. There you go. One bite at

SPEAKER_01: 43:24

a time. I find that eating an elephant is one bite at a time. And I said, the elephant is getting your BCBA and being a supervisor. Because back then, everybody wanted to move. You get worn out from doing direct one-to-one care because you can only get spit on and kicked and punched and scratched and the rest of that so many times. So I would give them this goal and say, listen, get through three months and then six months and then a year. And you just keep stacking accomplishments, one on top of the other. And then you hit supervision. And what I tried to do at my organization was create keep creating those benchmarks so even if they hit became dcbas something that we set up back then that didn't always work out well but we set up special projects and say hey what are you interested in in behavior analysis um besides therapy and some people would be interested in technology or research or something like that so we tried to create avenues for people so that they can keep moving forward and if they're moving forward if you're busy you're not thinking about some of the hardships in your life because you're busy i remember that was something that i learned from my grandmother when i was a kid um you know that people i think are most content with their life when they're purposeful when they're working towards something so i tried to take that credo and pass it on to the people that I worked with. Not sure if that makes sense.

SPEAKER_00: 44:55

No, it absolutely does. And that's amazing. I've been a trainer at my various companies for probably the last 15 years. And I've put, I don't know how many people through the ASU program for ABA. And I've definitely noticed that the turnover rate is much less for people that are moving forward in their career. So kind of to what you're saying then and to what Mike said earlier, if you are trying to set your staff goals as you bring on more staff, then you're becoming kind of more of a staff manager than the direct client. Working with direct clients, is that kind of what it became? You were using your ABA more for your staff than the clients and then outsourcing the client work directly to the staff that you were training?

SPEAKER_01: 45:36

Yeah, you nailed it, absolutely. So when you start a business, I mean, you guys know you're going through it now, but when you start a business, especially if you do it by yourself, That was, by the way, one of the mistakes that I made in the beginning was I started by myself. But when you start by yourself, you wear all the hats. And then as you hire people, the idea is you take hats off and you give the hats to somebody else. And as the company grew, I wore less and less hats. And then you start wearing different hats and you start having to learn how to, I got so used to in the beginning, leading and motivating people directly. Like I told you when I had to have that tough conversation with my staff in the very beginning, hey, you're not going to get paid for 45 days. I had it directly. And even after the meeting, I talked to key people in that group individually. And I talked to them about the importance of what we're trying to do. And I had a direct impact. But as your company grows and you get people underneath you, There's a great book, if you guys are ever interested. It's called The Leadership Pipeline, one of the most fantastic books I've ever read about leadership. And as you grow as a professional and as you climb, let's say, the corporate ladder, you have to pick up new skill sets. Because if you keep doing the other skill set, you what they call in the book you clog up the leadership pipeline you have to teach other people how to do what you were doing and then back off and lead them and as your organization grows you lead fewer and fewer people but the leadership you engage in has bigger and bigger impact and it took me nobody really ever masters that i mean the Greatest CEOs in the world are still learning every day how to do that better. But that was one of the big aha moments that I had is as that pyramid, let's say, grows and you take off hats, the things that you do every day, the interactions that you have with your direct reports, who for me in the end were clinical directors, executive team members, those sorts of people, every word that you say matters because it gets amplified throughout the course of the company. And that, that was something I think all CEOs struggle with. And I certainly did.

SPEAKER_00: 48:12

That's so hard to like, even just with like admin, you know, a lot of times people just don't do it the way you want it to be done. And, you know, that gets magnified as you get higher and higher. And when you're talking about a company vision, like to make sure that your vision is still manifested as you're adding layers to that direct line employee. And the vision is something you spend years and years and we spent countless hours creating with the company and you did as well. Um, that's a lot of faith and a lot of trust. And I'm sure that's, I mean, that's even challenging now just in one layer. Sometimes it's like, you know, I'll do the Excel spreadsheet because I just, I don't, I, it'll be quicker and it'll get done the way you, I want it to be done.

SPEAKER_03: 48:52

And learning to allow that too. For my end, for example, you take on that and I don't care what it looks like as long as it makes sense and it gives us the information we need. I really appreciate you talked, you've used this phrasing about sort of preserving the science. I don't know if that's the exact verb you used, but the partnership that you had set up with academia to then be able to train your staff or to do things concurrently, that's ideal. I know that's something that we're looking for. One thing I like to say is you can provide training say to a prospect of rbt to pass that rbt competency exam and by passing that exam you can then throw them into a session and and you may not have taught them how to do that in other words they don't know how to apply those things that allowed them to pass that exam

SPEAKER_00: 49:38

they know the differential reinforcement definition but not what it looks like

SPEAKER_03: 49:42

right or what are the the different things that can be done and i know that you know long uh long storied career that i've had in this seen a lot of changes remember creating treatment plans and program books that looked like unabridged dictionaries back in the day when we were using paper. And we somehow had this vision that you were going to plan out the entire session from beginning to end, and this is the way it was going to look. And then you would get younger professionals out there, and the first five minutes, that plan would go out the window. And now they had their RBT competency, but they don't know what to do next. What's been your experience in... kind of reconciling those two sides of putting out a super well-trained professional. And again, starting with the idea that you want to preserve the science, you want them to know what these terms mean on paper from an academic perspective. You want them to be able to translate those into action that now looks good in somebody's living room with their four-year-old who's been having a tantrum for the past 45 minutes. That's a big translation. What's been your... know your go-to what's been your success uh in that realm and making that translation for younger pros

SPEAKER_01: 50:55

yeah that's that's always a big challenge um you know it's interesting you talked about um creating a behavior plan and i'll use a couple of old sayings here um so i'll use two um because i think they're both relevant so i don't think a uh business plan or behavior plan survive first contact with a consumer

SPEAKER_03: 51:17

nice

SPEAKER_01: 51:18

so and the other saying that i'll say here i'll quote mike tyson because i think mike once once said that everybody's got a plan until they get punched in the face there you go i'm sure you heard it oh i love it love it And I think both of them apply here, because literally sometimes you will get punched in the face. And it's certainly a challenge, I think, I mean, there's so many specific things you can do. I think shadowing is absolutely mandatory. And every ABA therapy company faces the same challenge. You know, it's getting people in to do this work. And a lot of people cut corners. And I'm going to be honest with you guys. There were some times when I had my ABA therapy company before that I cut corners. And then I paid for it later. And one of the lessons that I learned is you never ever get away with anything, ever. And people may think you do if you're running a company or just in life in general, no one ever gets away with anything. Because if you do something that you're not supposed to, even if you don't get caught in that moment, you're still impacting your own behavioral repertoire and you think you can do that again, you do it again and then something really bad happens. Unfortunately, the contingencies are not ideal in our industry right now, and they haven't been for a long time. And if you don't have proper training, and we can have a whole discussion about what proper training means. Are you using behavior analysis to teach behavior analysis? Are you using PSI? Are you using precision instruction? Are you training to fluency? Are you even training to competency? Forget fluency. Are you even training to competency, or are you just training to the exam? And not everyone is doing that. And we're all vulnerable, I would say, to some of the contingencies that are out there, some of the financial contingencies, some of the status contingencies. We don't talk about status enough. And that, you know, a behavioral perspective money is a generalized condition reinforcer but status and social praise falls under that generalized social reinforcer um category as well and you know i think that's something that we don't talk about enough as well and i think we're all vulnerable to those different contingencies and end up doing things that we shouldn't and i think it's a I think it's a day-to-day grind. I think we have to do a good job to make sure that we... And we were talking about the ripple effect earlier of the CEO throughout the company. As a CEO, I think probably the most important skillset, probably in life as well, but for a CEO is self-control, self-discipline. If you make impulsive choices as a CEO, and I've made so many of them myself, that has a ripple effect in your company. And if you choose in that moment, you know what? Somebody comes to you and says, well, this new RBT hasn't had a proper training or hasn't had enough time to shadow. And then you make that one decision in that one moment and say, it'll be okay. I've met with them. I've seen them. They'll be fine. I don't know, I didn't do a lot, but those times when I made those really bad decisions, it always ended in problems. And so I would say, do your best to have a good training program that's built on a foundation of behavior analysis. Train at the very least to competency, at least. And if you have the opportunity, train to fluency and then use behavioral skills training for the love of God. Make sure that people are getting regular feedback and make sure that your company is set up so that you set up a culture of feedback. So many people... Talk about, oh, well, I had a meeting, and I gave them feedback. No. Create a culture of feedback where people are regularly giving people feedback in the moment or right after performance occurs, those sorts of things. So I would say, from a CEO perspective, make those self-control, self-discipline decisions as many of the moments of your workday as you can. And you'll see that over time it builds. You know who does a great job describing this is James Clear and his book, Atomic Habits. And he talks about every self-control decision you make is an investment in your individual future. And I think that that happens at your organization as well. If you decide to live a professionally self-disciplined life, After six months, nine months, 12 months, you're going to see that ripple across your business and you'll provide better care for the clients that you're with. You're going to raise better behavior analysts and make no mistake, if you're a CEO, you are raising professionals. They're listening and they're watching every single thing that you do and I think As CEOs, you need to realize that and make decisions accordingly.

SPEAKER_03: 56:57

I love what you just explained there. In the short term, people might take it as a loss to invest that extra time to cultivating that younger professional. They see it as a monetary loss. You're saying, no, that's your investment. That's going to pay off. And in fact, if you don't do it, you might end up with a real loss.

SPEAKER_00: 57:17

Yes. And I talked to the higher management and like, look, we're having turnover, like probably 50% of the staff is leaving within six months. This has got to be costing you a ton of money because you're investing time. And they're like, yeah, the RBT is just a revolving door. Like it's not a long term position anyway. And I was like, is this really what? And this is kind of what we're talking about with saving the RBT. Is this? Is this really how we're going to look at it? Because at the end of the day, yeah, the RBT suffers, but the client suffers as well because they're not getting competent, consistent care. So then we left. But I think that, again, really talks to what you're talking about, about having competent staff that is hopefully fluent, but at least competent. And I feel like a lot of times because of maybe the level of whether it's reimbursement or credentials that a lot of companies now are not looking at the RBT as needing that level of competency. It's just like get them in and get them out and start billing and then we'll higher and just create this cycle, which seems defeating in the long run.

SPEAKER_03: 58:38

Oh, and Dan leaves us with a couple of good questions there for Adam, so you'll have to make sure and tune in for part two of our interview with Adam Ventura. In the meantime,

SPEAKER_02: 58:48

always analyze responsibly.

SPEAKER_03: 58:52

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.