With autism therapy professionals in high demand and in short supply, organizations are getting creative to hold onto their employees.

From conducting “stay interviews” to glean job satisfaction insights to offering reliable schedules and growth opportunities, providers are pulling out all the stops to prevent clinician burnout and keep top talent on board.

Demand for autism therapy professionals has increased yearly since 2010, according to the Behavior Analyst Certification Board.

But hastily filling open positions may not be the best approach to meeting this rising demand.

Acquiring strong job candidates is crucial, and can even be worth leaving a position open for longer, Fali Sidhva, CEO of Helping Hands Family, said in a recent Autism Business News webinar.  

“If you need [Registered Behavior Technicians] RBTs and you’ve needed them for three months, and this person shows up and you’re not sure, but you think I can make this work,’ don’t do it,” Sidhva said. “It probably will mean you will have to replace his position in a little while.”

King Of Prussia, Pennsylvania-based Helping Hands Family is an applied behavior analysis (ABA) provider with locations in Connecticut, Maryland, New Jersey, New York and Pennsylvania. The provider accepts major insurance plans, including ComPsych, Aetna, Cigna and UnitedHealthcare.

Still, hiring candidates who perform well and are willing to stay with an organization is not the only key to maintaining an autism therapy workforce.

“The quality of your candidates determines your turnover later,” Dallas Star, regional director of behavioral health at BAYADA Home Health Care, said. “But also, the quality of that training and ongoing support program determines whether you can make that hire a good hire or not.”

Moorestown, New Jersey-based BAYADA provides behavioral health, hospice and rehabilitative care, among other specialties, to children, adults and seniors. The nonprofit has approximately 31,500 employees, cares for an average of 44,000 patients weekly and operates in 21 states, according to its site.

Employee retention tactics are widely supported throughout the health care industry at large.

Almost half of hospitals nationwide are making changes because of potential workforce issues, according to a new report published by FTI Consulting. Less than a third of hospital executives expressed concerns about the costs of these changes.

Retention techniques

Executives in the autism field can use surveys and other methods of listening to employees to determine what specific retention tactics to implement.

BAYADA uses “stay interviews,” which Star compared to exit interviews. These discussions involve asking clinicians if they feel supported, how they are coping with their caseload and if they are supplied with necessary technology.

“People sometimes don’t want to complain,” Star said. “So it’s important to go out and ask. In an exit interview, they’ll [say] ‘I was on this client for a really long time. They were frustrating me and I just needed to take a break and move on.’ And we’re [saying], ‘We could have done that for you. We could have taken that extra step.”’

BAYADA also surveys employees twice a year on their experience, asking pointed questions and following up to determine how best to meet clinicians’ needs.

A request that frequently emerges from these employee surveys is the desire for caseload sharing.

“On the business side of things, it’s hard to do those things,” Star said. “From the client’s perspective, you don’t want a bunch of turnover, or to deal with a few different people, or to shift caseloads all the time. But in the long run, if it’s going to help the mental health [of the provider] and the continuity of care overall, I think it’s beneficial.”

Helping Hands Family’s surveys regularly reveal desires for a reliable schedule and a clear career path, Sidhva said.

The provider operates a tiering program called “RBT Rise” in response to these requests. As part of the program, RBTs must pass additional competency tests.

“It’s a very modest program,” Sidhva said. “They come with some leadership roles along with it, too. We think this is a good investment for us because we now have an RBT, who we hope stays longer, but is actually getting more done in the clinic. They’re advising other RBTs, they’re the ones that we use for shadowing and training.”

BAYADA uses BARS, a behavioral activity rating scale, to create tiers for RBTs to have a clear career path. This helps prevent employees from leaving the company around the one-year mark, when RBTs often move on to a different role or a different field altogether. 

Offering payable hours for training and learning opportunities can also help meet the request for reliable hours Helping Hands Family often hears in surveys.

Helping Hands Family utilizes a concept called “dedicated time,” in which providers can use time that would otherwise be lost because of patient cancellations to complete training or attend conferences.

Employees’ time doing non-billable activities, like continuing education, need to be built into an organization’s margins, Star said.

“It takes non-billable time, it takes time away from the client,” Star said. “We’ve got [Board Certified Behavior Analysts] (BCBAs) who need to be working with clients, but we also want them supervising the next set of behavior analysts to come through.”

For the autism industry, training BCBAs is crucial not just for retaining the individual clinician but also for establishing solid leadership throughout an organization.

“Every BCBA is a leader,” Sidhva said. “Having said that, many of them are inexperienced. Training them to be good leaders is just as important. They’re leading a team of five, six RBTs, and we should be training them and the clinic directors as well.”

Ongoing support and training can help young, inexperienced BCBAs expand their caseload, Sidhva said.