The High Cost of Stress in the ABA Workplace

https://flic.kr/p/9MVtGQ

By Dan Sundberg, PhD

bSci21 Contributing Writer

As a planet full of workers, we are getting increasingly stressed out. According to a recent article in the Huffington Post levels of stress in the workplace are reportedly 18% – 24% higher now than they were 30 years ago. Why? Potential culprits include unreasonable workloads, and an increasingly blurred line between work and personal life.

Are those behavior analysts working in the ABA clinical world immune to this? After all, Behavior Analyst was recently rated as one of the top 10 jobs for do-gooders, with most individuals reporting their job as being highly meaningful.

Yet, clinical behavior analysts may well be positioned for high levels of stress on the job. This point was recently highlighted when my colleague, Jane, quit her job at her ABA company.

Jane started work a few years back at a company, doing exactly what she wanted to be doing – clinical behavior analysis.  She had clients she adored, families who loved her, and coworkers she enjoyed. But she quickly found she needed to put in more time than she was allocated to do the job the right way. She spent many late nights writing funding reports, creating stimuli for her clients, or programming iPads. 

At first this was OK, because she loved the work she did, and the people she did it for. Plus, she was used to late nights, fresh out of grad school. Yet, this constant assault on her personal time started to take its toll. She rarely took time off because all of her work would simply pile up, creating a nightmare when she got back. When she did take time, Jane always remained connected via e-mail and would sometimes spend hours a day working, while on “vacation”.

Now we may look at this and think we see a dedicated worker, which may well be true. But in fact Jane was stuck between a rock and a hard place.

At an ABA conference, a presenter once made the point that we behavior analysts tend to be very “rule-governed” people. This is something our field and our culture encourages. We seek out the function of behavior using data and analysis, rather than intuition or guess work. We look to research first when trying to solve a problem, and know how critical it is to follow the behavior plan. We create task analyses, job aids, and process maps to make sure the work gets done just as it should. And we strictly adhere to our code of ethics.

And these are, indeed, good behaviors for our culture to support.

Yet, when these cultural norms come against organizational practices that don’t support them, we see situations like Jane’s. Jane had, on one hand, her responsibility to provide effective services in adherence to the culture of the field and the code of ethics. On the other, she had a responsibility to her employer.

After all, an employer has the responsibility of providing effective services, but also the responsibility of generating revenue and minimizing expenses, making the best use of resources, and navigating an often treacherous landscape of regulations and requirements. For some, these constraints are met by increasing caseloads, and billable hour requirements, decreasing the availability of professional development, training, and supervision activities.

All of this came together for Jane and forced her into two choices:

1) Take on the extra case load, and follow the cultural and ethical codes of our field by providing the right services, regardless of the fact that this required her to dip deeply into personal time.

-OR-

2) Take on the extra case load, but risk breaking the ethics code by lower the quality of services to preserve her personal time.

In other words: to have a reasonable work/life balance she had to violate her code of ethics and personal values.

Six months in, she was still putting in full effort in all aspects of the organization, hoping to get faster at meeting the case requirements and completing reports. 18 months later things had not changed much, but her stress levels were constantly building, pushing her down the path to burnout. All things associated with the company had become aversive, and she was becoming cynical. Nonetheless, she continued to sacrifice the time needed to provide exceptional service for her clients.

Finally, 3 years after starting she threw in the towel and quit. Despite her efforts, things had not changed, and she finally had to prioritize her own mental and physical health.

While from an organization’s perspective, adding to the caseload of BCBAs, and limiting the time spent on non-billable activities are logical steps to keeping the organization afloat. However, this does not come without a cost. Research has shown stress, burnout, and management practices to be directly associated with turnover, which can in turn cost organizations heavily (Arshadi & Damiri, 2013; Mor Barak, Nissly, & Levin, 2001).

In a past bSci21.org article on how organizations can deal with turnover, the costs at the behavior technician level were estimated to be around $5,000 per turnover. For the BCBA level, those costs skyrocket, nearing 30% – 100% of that individual’s yearly salary. Some fields can support turnover at such a high cost; for example, in fields like finance, law, or business consulting where there are people lining up waiting for a position to open.

Yet this is not the case in the ABA clinical world, where profit margins are narrower and the jobs are plentiful.

For example, in California alone, you can find hundreds of job postings per month for BCBA positions on sites like Monster.com, craigslist.com, indeed.com, and the ABAI job board. Yet, according to the BACB, there are just 3,700 BCBAs in the whole state. While this is not the case in every state or location, by and large this is not an employer’s market. Which makes practices and policies that create a stressful work environment, even more toxic to the organization’s success.

While many companies do work to enact policies to prevent stress, burnout, and turnover, as the Huffington Post article pointed out “If policy changes aren’t supported by cultural shifts, employees won’t feel comfortable following the new policies — so for any real change to take place, leaders and managers have to model these new behavioral norms.” This means leaders must not only talk the talk, but must also walk the walk – and reinforce the behavior of others who walk the walk as well. For example organizations may support cultural changes by supporting policies that:

1) Take into account the true time requirements for non-billable tasks

2) Allow employees to engage in preferred, non-billable activities that still add value to the organization, such as research, professional events, or continuing education.

3) Support reasonable supervision limits

4) Recognize the fact that individual stress management strategies do not address the root cause of stress.

Additionally, other articles on bSci21 and other blog sites provide additional insights into creating a more positive and effective work environment. 

While this may paint an unattractive image, there are, in fact, many organizations out there dedicated to creating a culture that supports BCBAs and embraces the values of the field of behavior analysis. And as the field moves forward and grows, organizations that create a work environment that supports the culture of our field, while reducing stress in an already stressful job, are likely to be the ones that succeed.

Let us know about your experiences with work overload in the comments below, and be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

References:

Arshadi, N., & Damiri, H. (2013). The relationship of job stress with turnover intention and job performance: moderating role of OBSE. Procedia – Social and Behavioral Sciences, 84(2003), 706–710. http://doi.org/10.1016/j.sbspro.2013.06.631

Mor Barak, M. E., Nissly, J. A., & Levin, A. (2001). Antecedents to retention and turnover among child welfare, social work, and other human service wmployees: what can we learn from past research? A review and metanalysis. Social Service Review, 75(4), 625–661. http://doi.org/10.1086/323166

Dan SundbergDaniel B. Sundberg, PhD, is a behavior analyst dedicated to creating meaningful change for individuals and organizations using the science of human behavior. Dan has worked in a variety of organizations, including non-profits. Additionally, Dan spent two years as a university lecturer, teaching undergraduate students how to improve the workplace with behavior analysis

Dan earned his B.A. in Psychology at the University of California at Berkeley, M.S. in Organizational Behavior Management from Florida Institute of Technology, and Ph. D. in Industrial/ Organizational Behavior Management from Western Michigan University. During this time, some of the best thinkers in behavior analysis and OBM mentored Dr. Sundberg as an academician and business professional.

Dan is currently Regional Manager of Consulting Services at ABA Technologies, where he helps to develop and deliver OBM consulting services. Dan is also a guest reviewer for the Journal of Organizational Behavior Management, and in his spare time he creates behavior-based products that allow people to manage their time and accomplish their goals. He also has a special interest in building effective work practices and cultures for start-up companies, and increasing the positive effects of organizations working towards an environmentally sustainable future.  You can contact him at dan@abatechnologies.com.

28 Comments on "The High Cost of Stress in the ABA Workplace"

  1. Mary Ferrell | April 26, 2016 at 6:20 am | Reply

    This article could have been written by me. Only difference is that I am only at the 2 years, 4 months mark. Non-billable hours to complete my job is tough. Being a sub-contractor with unpaid travel and hours in between not paid for, add significantly to unpaid hours and working on nights and weekends. Plus it takes unpaid time to write up professional Daily Reports that are essential for getting paid for hours worked, and most importantly providing effective treatment! Whew! Ready to move on to another career at first opportunity. But I do love the application of ABA to bring about positive change.

  2. Jan Montgomery | April 26, 2016 at 8:30 am | Reply

    Excellent article on a very relevant topic! Thanks!

  3. Kudos to ‘Jane’ for practicing self-reliant skills and changing her environment.
    How can we help others if we come ‘walking basket cases’ ourselves?

    Dr. B. F. Skinner wrote over 50 years ago about the plight of ‘human service’ employees. He had observed many young people who started out enthusiastically and proud of the work they were doing.
    After a while however, due to the environment provided by employers, these dedicated individuals became, “…careless, then callous and finally cruel.” in the way they interacted with their client.

    Perhaps we need an “Employer Certification Process” which is granted to employers in the human services field who are seeking to hire BCBAs.
    Considering those ‘hundreds of job postings’ for behaviorally oriented clinicians, and the supply/demand curve that appears to exist, at least in California, only ‘enlightened’ employers deserve to be rewarded with a supply of confident and competent employees.

    • Hi Paul, I agree. I think such a thing is a great idea!

    • Hi Paul,
      I believe that this is needed over on the east coast as well, in this Golden Age of Behavior Analysis. If you would like to act on your brilliant idea, please reach out! I am eager to address this issue.

  4. Great article! I had a experience similar to Jane’s and I left my job to work for a school district where I do not have to worry about compromising my ethics to meet billable hours. I feel like I’m just standing by watching our field become watered down with companies that are only concerned with billable hours.

  5. Clelia Sigaud | April 26, 2016 at 8:50 pm | Reply

    Thank for this truly excellent article! I can relate to everything you describe.

  6. I agree that the balance between the billable hour and client responsibility is not easy. My previous employer has lost many really hardworking and talented BCBAs due to this lack of understanding. The sponge is squeezed dry, so to speak. I believe that the owner/operator of an organization should do the job alongside of the BCBA for a week or even a day before deciding what a caseload should look like. There are more “Janes” than not in this field and that is why I am privileged to be in it. But employers take advantage of that dedication and commitment to the client.

  7. As true as it may be, this article is depressing. It makes sense why so many of my supervisors have appeared to be cold and overworked. Everyone thinking of becoming a behavior analyst should read this article or be familiar with the politics of becoming one before they choose to do so. Most individuals do not have experiences with these issues until they already went through all the schooling and are in the field as a behavior analyst . It’s truly sad..going into a field to help others and having to deal with this.

  8. Danielle Virnelson, M.S., BCBA | April 27, 2016 at 9:17 am | Reply

    This is hitting really close to home right now. I’ve put in several late nights this week, and even made a comment that it was bringing on flashbacks from grad school. I often work on the weekends and put in 10nto 1e hour days. I know that this is common practice at my agency and others access SoCal. There needs to be a culture shift and we all need to accept it before any change is made. Great article.

  9. Yes. It is about time that we face the reality. Many agencies do not understand that we strive to provide real changes and quality services. They are just concerned about the billable hours. I call these agencies “billing mills”. I contracted with one of these agencies and they right away started setting up evaluations for me to conduct without any orientation or supervision. When I asked for assistance they basically said “we have no one to assist you”. Also, they were not honest during the interview and was intentionally misleading. They also was not forthcoming with the clients. Their mentality was “a lot of individuals need ABA, we can sign them up, hire a BCBA, and make money”. As a BCBA we can not involve ourselves with such agencies. Yes, we want to serve the clients but not under these conditions. So in the final analysis I had to take a pay cut and move on.

    It is time that we start promoting that a BCBA work for themselves or as a team with another BCBA. In other professional fields the top level professionals are encouraged to work solo or start their own agency. However, in ABA we are encouraged to work for an agency and yet their are no requirements for ABA agencies. Some of these “billing mills” are owned by BCBA but most are not BCBA owned.
    Thanks for the article.

  10. Excellent article, Daniel! As opposed to throwing in the towel, I, too, have tossed my hat into the air, Mary Tyler Moore style, and walked away from unreasonable and exorbitant company demands. This came with many frightening feelings at the time, but in the end it was/is all about the practice of good self-care. Those of us with experience under our collective belts have likely seen the costly ramifications of blurred boundaries between work and home, often at great expense to both. Unreasonable caseloads with whip-cracking billable hours can leave BCBAs with little time/energy for the ‘behind the scenes’ hours required when providing a quality service. As is so often the case, this situation exponentially magnifies when management is unaware of what our practice entails.

    I enjoyed the reminder about our rule-governed behavior—it’s true! We are in these positions large in part to our tendencies lean toward continually improved outcomes. However, as we know all too well, consequences often rule. Recently, I listened to a co-worker express disdain at our purchasing small items to aid in working with clients. “The company has the money, but doesn’t want to spend it. We need to stop buying and force their financial hands.” Within the same conversation, there was a matter-of-fact declaration of an entire weekend spent hunkered over a computer in an effort to complete an assessment that ran well in excess of allotted hours. Later, the parent smilingly complimented the same colleague who was “…up well past midnight…” working on her child’s report. If we are willing to donate so many of our own hours, giving the consequential impression that the allotment was sufficient and doable, isn’t it all within the same ultimately costly realm?

    While we have all experienced the lost hours of dedication we’ll never get back, making this the norm sends the message that this is an accepted and even admirable method of our practice. While doing good work, at work, is the gold standard, we must be diligent in caring for ourselves… leaving enough of ‘us’ to be effective and efficient—an increasingly overlooked challenge in our field. I donate the occasional hour or two to my clients, at times staying later than paid to see a situation through or making sure the ‘t’ is crossed. However, I know now that I am not at my best on Monday morning when I donate my evenings and weekends to fulfilling a company’s ultimately self-harming demands. Jane had responsibilities to her clients and her employer, but neglected those to her self. Today, closing the laptop is just as important as opening it.

    • I agree with everything said here! As a new behavior analyst who is fresh out of an intensive program, I am starting to experience the consequences of allowing the line to be blurred between providing top quality work and dipping into so much of my personal time to do so. Being counseled by supervisors to improve my time management skills is only so helpful when so many of my rule governed behaviors stem around being trained to dedicate my all to my clients’ well-being. I’m struggling to find that sweet spot where I feel like I am providing high quality services without running out of hours in my work day.

  11. Like so many already shared, I am experiencing every environmental contingency Jane is experiencing. I do hope that there will be a culture shift as this truth is exposed.
    I agree with Bevy, we need to put agency overwork on extinction for this change to occur.
    feeling compromised every day is not going to contribute to the meaningful change I set out to do. Sometimes we need BCBA’s like Dr Dan Sundberg to give agencies feedback from a purely organizational standpoint. -I also think it starts with legislation, insurance requirements, etc.
    I’m not too confident we will actually get there.

  12. Daniel B. Sundberg | May 3, 2016 at 11:42 am | Reply

    Thank you all for the comments, it is great to hear such good discussion around this topic.

    It is an unfortunate so many of you can relate to this situation. And it is sad to hear there are many “bill-mills” out there, but I can certainly say from experience there are also many excellent ABA companies out there, very concerned with doing the right thing. The challenge for all companies is balancing the most obvious and near term contingencies (billing, and keeping costs down) against the longer term contingencies (retention, company reputation, morale, discretionary effort).

    This is a constant struggle for the company as well, and it is challenging to get right all the time.

    I am, however, optimistic that we will see this issue getting better with time. In many ways, we are still in the “wild-west” period for ABA treatment companies, as new companies are opened every day, and the regulatory landscape is constantly changing. As Paul Brown noted, the supply/demand situation creates contingencies that will support the survival of “enlightened” companies in the long run. In the short run, however, I will paraphrase Lori in saying that learning the behavior of “closing the laptop” is very important for each individual.

  13. This is exactly why I have a billable cap for all my staff. Some people will want more hours and we’ll experiment with it, but I have no problem telling them “No, I don’t think you should add more.” We also don’t set requirements on the times you have to work. If you want early morning, great. If you prefer late day, great. It’s a little extra work creating treatment teams for clients, but it’s worth it. Work/life balance is absolutely key for me.

    I also think a slightly lower billable allows the team to actually have time to sit and brainstorm/learn/meet together. Some of my RBT’s who are students independently formed a study group, treatment teams often independently set up non-billable meetings with each other and my staff looks forward to trainings. We’re not perfect, but I think setting upper limits on caseloads has made a giant difference for our staff’s job satisfaction.

    • Sounds like you’re running a company that any of us would be lucky to work for! Keep up the thoughtful leadership!

    • Daniel B. Sundberg | May 22, 2016 at 11:46 am | Reply

      Gabi, it does sound like you are doing an excellent job working to balance these contingencies. Please do keep it up, as you well know it is worth the work.

  14. I would love to hear other business owners view of this. It is a very hard balance to keep between wanting to continue pay rates as high as we can but also take on the insurance rate cuts. I wonder how many companies have a reasonable billing requirement by also do not pay their people well or lower average range of pay. It’s a trade off sometimes and something we struggle with on a daily basis. Keeping the lights on and also creating an environment where people feel the reimbursement is fair is difficult.

  15. I am thinking of going back to school to become a BCBA. Is this advisable? After reading this article and your comments, I am now a bit concerned. I am 40 years old, so I am not wanting a “high stress” job, and I do value a good work-life balance. PLEASE HELP!!!

    • Daniel B. Sundberg | May 22, 2016 at 11:50 am | Reply

      TIffany, if you’d like a wide range of responses on this, I’d recommend posting to this facebook page: https://www.facebook.com/groups/2558390057/

      This page is very active, and you will no doubt get a lot of people chiming in on this.

      I hope this article doesn’t paint a negative picture of the field for you – it is really a wonderful area to get into. Many people are wonderfully happy with this as their chosen field, and have very happy work-life balances. But as with everything, there are always two sides to the coin.

  16. One of the many reasons that I am leaving the field of ABA. As someone who has been an employee of an agency as well as an owner of an agency, I can no longer handle the stressors of this industry. The amount of regulations being placed on businesses without actually thinking how it may impact services is ridiculous. I’m the first one who believes we should have stronger standards in our practice, but those standards should be developed in conjunction with agency owners and stakeholders. Our folks need indirect time if they are being asked for lengthy reports or agencies need higher rates to support what’s being asked. The constant questioning from insurance companies, excessive staff turnover, parent complaints, disrespect from other healthcare providers, no standardization in treatment…I could go on. Perhaps this industry is for certain people, but I can no longer take it.

  17. I am a BCBA owner of a newer company. I still carry a caseload and provide supervision alongside my other supervisor staff. I really liked the idea of putting a cap on billable hours. Right now we have a minimum in place, and incentive for going beyond the minimum. We keep caseloads low, and supervision hours at the 2 for every 10 ratio. The highest caseload a supervisor has is 8, and 10 will be the max ever. We do out best to encourage non billable meetings, all staff outings provided by the company, professional development and competitive pay. Sometimes we miss the mark, but starting our own agency and doing my best to make sure that staff liked their job and turnover was low was, is and will always be high on my list of priorities.

  18. Natalie Savage, BCBA | September 10, 2017 at 4:23 am | Reply

    fab article! Would be interesting to have a UK spin on this considering a large portion of ABA professionals in the UK are in some capacity self-employed! Where if you don’t put in the hours and do the work, you don’t get paid!

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