Addressing the staffing shortage among autism service providers will likely require a multi-pronged approach.
As rates of autism diagnosis have rapidly increased over the past few years, providers have struggled to keep up with the demand. Still, operators have successfully retained talent by building new career pathways for employees, increasing pay, and creating a meaningful work environment. Some providers have taken it a step further and added innovative ownership models and geographical flexibility.
While recruitment is essential to staffing applied behavior analysis (ABA) and autism services, providers prioritize retaining existing staff.
“It’s cheaper to keep people than it is to go find someone new and train them,” Pete Tedesco, managing director at Avesi Partners, said at Behavioral Health Business’ INVEST event.” You put a lot of time and resources into recruiting and training someone to be a care provider, particularly in the ABA space.”
Avesi Partners is a Stamford, Connecticut-based private equity firm. Its portfolio includes Point Quest, an adolescent behavioral health and special education service provider, and Muir Wood, an adolescent residential behavioral health service.
Initially, the ABA field had a shortage of Board Certified Behavior Analysts, which are master’s level clinicians who come up with ABA care plans for individuals with autism and other neurodiversities. But recently, providers’ pain point has been filling and retaining entry-level positions like behavior technicians (BTs).
Career advancement
Creating growth pathways for entry-level employees is one way operators incentivize staff members to stay with the organization.
“We have a career trajectory for [behavior technicians] where they can advance both through competency, skill sets and tenure, and there are pay increases that go along with that. We do that on our BCBA side as well,” David McIntosh, CEO of Hopebridge, said at INVEST. “But the other thing we have is a pretty high support system of operational leaders. For those who come in as BTs and may not want to become a BCBA, we have a track for them to lead through operations, whether on a unit side or region side.”
Hopebridge is an Indianapolis, Indiana-based autism service provider with over 100 centers. The provider offers outpatient ABA, occupational, speech and feeding therapies to children with autism, and other social and communication challenges. It is backed by private equity firm Arsenal Capital.
In addition to creating career pathways, some providers also offer free tuition to employees as a retention incentive.
Even if a provider can’t pay more than competitors, the ability to grow at a company can help curb employee turnover.
“One thing that we have learned is that we could increase the pay rates of everybody at Hopebridge, and it does not make retention better at all,” McIntosh said. “Having the other components that really matter in terms of growth and career trajectory are imperative. And just the pay alone is not going to solve [retention], but it is a component of it and it’s meaningful.”
Money matters
While career growth is important, money also matters. Still, operators’ ability to increase pay for clinicians and support staff largely depends on reimbursement rates.
McIntosh noted that reimbursement trends for autism services are going in a positive direction. Historically, this has enabled providers to pay staff more, which has resulted in a direct correlation to staff retention.
Yet, these favorable rate increases may not be able to keep up with the rising costs of living.
“Rates haven’t increased as fast as wage inflation has,” Tedesco said. “[We have to consider] what other things we can do to keep our staff happy while ensuring that the economic model makes sense and we have a business to run.”
Operators and private equity firms sometimes use innovative ownership structures, like equity in the company, to incentivize staff to stay.
However, Tedesco noted that outside of the world of finance, employees may not see the value in these models.
“There’s a bit of an education process around it, and [the staff] understanding what it means and why it is a benefit is the linchpin to making it successful,” Tedesco said. “When folks don’t understand it, or don’t value it, it’s not going to work.”
Workplace incentives
In addition to financial incentives, workplace culture is also a big part of retention. Many employees want to work with a mission-driven organization.
“People want to feel like they’re working for a company that they identify with, that has the same values as they do and that they fit in with,” Tedesco said. “So, being thoughtful about the way you build that culture and that identification within the company and its mission is really important.”
Companies can also provide other perks to staffers. For example, if an ABA provider has a large national footprint, this could allow staff to change locations.
For example, in June, Hopebridge announced a new travel BCBA position. In this role, a BCBA can travel to Hopebridge’s sites across the 12 states they serve.
Providers could also make their care staff’s lives easier with technology to help with mundane tasks.
“I think there are workflow technologies that we’ve been able to find and invest in to make folks’ lives a tiny bit easier,” Tedesco said.
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