Autism therapy providers have described workforce trends with out-of-character positivity when analyzing the year that was in 2024.

That’s not to say that it was all peaches and cream.

Sky-high turnover and workforce-driven margin degradation keep their dominating positions as the industry’s chief concerns. However, several executives Autism Business News contacted for this story described varied improvements via workforce initiatives launched and reiterated since the onset of COVID-19 and its world-changing impact. 

But beyond specific initiatives, environmental factors have lent a touch of breathing room to the industry to allow such initiatives to have an effect in the first place.

Dennis May, CEO of Indianapolis-based holistic autism therapy provider Hopebridge, noted that unemployment figures in 2024 ticked up slightly — 4% in 2024 compared to 3.6% in 2023 — adding more people to the potential job candidate pool. Plus, Americans have settled into roles at a more typical rate. People quit jobs at a lower rate in 2024 after quitting reached an all-time high in 2022. The rate at which people quit jobs in 2024 compared to 2022 is down 22%. 

“We have definitely seen improving trends in ’24 over ’23,” May said. “There’s just a lot more stability in the workforce.”

Collectively, Hopebridge and other autism therapy providers have to build infrastructure that the public sector has built for other segments of the health care system.

Over the course of 2024, Hopebridge either rolled out or brought up to speed several initiatives. This led to a double-digit percentage improvement in retaining clinicians. May declined to share a specific number.

Turnover in the autism therapy space is staggering compared to other industries. But the data shows a varied landscape, largely depending on the providers sampled. The Behavioral Health Center of Excellence, the accreditation arm of Jade Health, previously reported that median turnover across the industry was 65%. According to data from the autism therapy and human services software provider CentralReach, the top-performing large organization had an employee turnover of about 49%. Across all deciles, large autism therapy providers saw a 104% turnover rate. 

By comparison, one staffing group found that hospital staff turnover was about 21% in 2023. 

Funding educational initiatives 

At Hopebridge, the company offers a pathway of progress from prospective registered behavior technicians (RBT) to senior board-certified behavioral analysts (BCBA) and leadership roles within each. This year, the company invested in and leaned on its fellowship program, which enables graduate students to become RBTs and work while studying and preparing for the BCBA competency exams.

“So many more of our clinicians have come up through … the fellowship program and we find that those clinicians are just better equipped to understand the job and understand the mission of what we do,” May said. “And we find that those clinicians that come to our fellowship program have better retention and better clinical outcomes.”

The company rolled out a “bridge program” to support early-career BCBAs with more local clinical leadership. It also gives them and more advanced clinicians additional opportunities to step into assistant clinical director and clinical director roles.

Programs like this are essential for the industry to address systemic issues in the workforce. Most BCBAs would be considered early in their careers: 47% of BCBAs are 34 years or younger. Based on the latest data from the Behavior Analyst Certification Board (BACB), 56% of BCBA certifications were awarded in the last five years.

The company also partners with colleges and universities to help give clinicians and their families more direct and affordable access to higher education. In November, Hopebridge announced partnerships with nine higher learning institutions. These partnerships include various discounts and incentives.

“Because we have such a comprehensive fellowship program and bridge training program, we’re really a great place for those universities to partner,” May said.

Another more dramatic approach to getting more BCBAs into the field is simpler in concept and in execution. Fort Lauderdale, Florida-based autism therapy company ABA Centers of America funded 20 full-ride scholarships for prospective BCBAs to get master’s degrees with Temple University. The organization has the goal of enrolling 60 more in 2025.

“Increasing access to higher education for all fulfills a demand and ensures those with autism have access to clinicians that can provide the life-changing care they need,” Jason Barker, CEO of ABA Centers of America, previously told ABN.

Van Nuys, California-based 360 Behavioral Health also sponsors the education of certain staffers. The company has also invested heavily in discrete internal skills training to aid in the everyday development of those that engage with patients. Similar to Hopebridge, 360 Behavioral Health also hopes to draw people closer to the company by laying out a path for education, development and career advancement.

Also, 360 Behavioral Health’s hiring and retention strategies have been reworked to ensure that people feel a connection to the purpose of clinical work in autism therapy: helping patients and families live better. A lot of this starts with hiring the right people.

“We put a lot of thought into the type of candidate that will be the most committed to providing great care, and we found that those front-line technicians were really choosing our field over alternate opportunities because they want to make a difference,” Kate Sheldon, CEO of 360 Behavioral Health, told ABN.

The “mission” of management is to ensure that clinicians feel they have an impact on the lives of patients and their families.

Part of that has been reducing administrative burdens that often make clinicians feel disconnected from their purpose and (more practically speaking) take time away from actual care activities. 360 Behavioral Health leaned into technologies “wherever possible,” Sheldon said. This includes data aggregation for report writing and eliminating writing redundancies.

These and other tactics led to what Sheldon called a record-breaking year in terms of growth and retention at 360 Behavioral Health. Overall, the company hired 40% more clinicians in 2024 than the year before and improved retention rates by 20%. Specifically, it increased BCBA hiring by 25%.

Sheldon noted that ensuring a clear company-wide hiring and retention strategy can be difficult when expanding beyond core markets. The company, which for most of its existence has operated only in California, expanded into Nebraska.

“If you look at the populations and the communities that we serve, each has a separate set of needs. There are times when we’re going in and we’re partnering closely with the universities and the colleges and bringing on board individuals who may be early in their careers,” Sheldon said. “Then there may be other communities where it’s not a university community. We’re enabling individuals to access the next rung on their professional ladder.”

Still, some things that influence the workforce that are well beyond addressing with strategy. Sheldon pointed to increases in minimum wages, specifically highlighting a law in California that increased health care minimum wages for many facility-based workers. The other is stagnant and shrinking reimbursement from health plans.

“You naturally see market margin deterioration if rates from payers are stagnant but your wages are increasing,” Prince said.

That means that some markets aren’t tenable for some providers to operate in, despite need or demand.

“Not surprising, but some markets in the U.S. continue to be very challenging for ABA therapy operations through combinations of low payer rates, BCBA scarcity and RBT turnover,” Krista Boe, chief clinical officer of Acorn Health, previously told ABN. “We saw the result of that in 2024 with providers closing up shop.

“This degradation of networks only exacerbates the problems of access to care for children with ASD and there is a need to continue to advocate for and overcome these obstacles for clients and their care.”