A Qualitative Analysis of Variables Contributing to Registered Behavior Technicians’ Burnout and Turnover in Florida

Abstract

Despite the increasing number of registered behavior technicians (RBTs) certified yearly, applied behavior-analytic organizations report difficulties in hiring and retaining RBTs in Florida. The current study evaluated RBTs’ work experiences related to the shortage of RBTs in Florida, particularly work concerns that lead to burnout and turnover. Eleven RBTs were interviewed regarding their working conditions and perspectives on the RBT working conditions. A thematic analysis yielded four main themes: (1) challenges establishing and maintaining competency; (2) difficult working conditions; (3) a transient or unheard-of career; and (4) dissatisfaction with pay and benefits. Results suggested that RBTs’ experiences vastly differed across organizations and that a combination of variables impact RBT burnout and turnover, which may contribute to burnout and turnover among RBTs in Florida. Implications for future research on RBT burnout and turnover and recommendations for organizations are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-024-01033-w.

According to the Behavior Analyst Certification Board (BACB), the number of active registered behavior technicians (RBTs) has increased significantly in recent years, with over 168,000 RBTs worldwide as of January 2024 (BACB, 2024a). However, this increase has not been enough to meet the growing demand for applied behavior analysis (ABA) therapy services (Yingling et al., 2022). The BACB has projected that the demand for behavior analysts will continue to outpace the supply, leading to a persistent shortage of qualified professionals (BACB, 2024b). Owing to this shortage, individuals seeking services are placed on increasing waitlists for extended periods, delaying access to necessary services and potentially decreasing quality of life (Heitzman-Powell et al., 2023). In addition to the increasing demand for behavior analysts, the shortage of qualified behavior professionals may be exacerbated by the estimated high turnover rates among behavior technicians (Cymbal et al., 2021). Turnover can be defined as an employee leaving an organization either by resigning or being terminated. Understanding the conditions under which RBT turnover occurs may help inform interventions to address the shortage crisis.

Previous research indicates that work arrangements, pay, job demand, lack of training, and burnout can impact turnover by behavior technicians (Cymbal et al., 2021; Gibson et al., 2009; Hurt et al., 2013; Kazemi et al., 2015; Novack & Dixon, 2019). Some researchers have quantitatively examined variables contributing to behavior technician turnover and burnout across the United States and worldwide (Novack & Dixon, 2019). The World Health Organization (2019) defines burnout as consisting of “feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism to one's job and reduced professional efficacy.” Bottini et al. (2024) conceptualized burnout behaviorally as behaviors that occur in response to work stressors in the environment that result in avoidance of the work stressor or compensation for it. The authors explain that various antecedents and consequences in the work environment might increase or decrease burnout. For example, perceived supervisor support has been associated with or predicted lower burnout among behavior technicians (Gibson et al., 2009; Hurt et al., 2013). Researchers have found that negative implicit attitudes (i.e., negative associations) toward individuals diagnosed with autism spectrum disorder (ASD) might contribute to burnout and suggest hiring individuals who express an explicit preference for working with the population to protect against burnout (Kelly & Barnes-Holmes, 2013). Low job satisfaction and perceived fairness of pay may be related to turnover intention (Kazemi et al., 2015). Furthermore, in a review of BHCOE® accredited companies, Cymbal et al. (2021) found that lower wages and low caregiver satisfaction correlated with higher turnover. Newcomb et al. (2019) found that a competency-based badge system that culminated in a raise reduced behavior technician turnover, suggesting training and advancement might be important tools for improving the working conditions of RBTs.

These data suggest that considering job-employee fit, designing supportive work environments, strong supervision and training systems, and pay may contribute to the recruitment and retention of behavior technicians. More research is needed to identify the variables contributing to a shortage of behavior therapists of all credentials and skill levels, including work factors that lead to providers leaving their jobs. Furthermore, the quantitative research is limited to specific variables selected by the researchers and may miss important factors contributing to turnover. In the current study, a qualitative approach was utilized to evaluate other factors not previously identified by researchers that could be important for reducing turnover and burnout to help address the shortage (Burney et al., 2023).

This study arose as part of a grant to understand the behavior therapist shortage in Florida (Gravina et al., 2023). While Florida boasts the highest number of RBTs in any state by far (BACB, 2024c), the numbers may be inflated owing to examination and billing fraud (ACHA, 2018; BACB, 2022). A county-by-county assessment of Florida revealed that some counties have no Board Certified Behavior Analysts (BCBAs; Yingling et al., 2022) or RBTs (Gravina et al., 2023), and some have less than 1 BCBA per 100,000 people (Deochand et al., 2024), indicative of service deserts in several Florida counties. The Agency for Persons with Disabilities in Florida website reports that more than 23,000 people are waiting for Waiver services (APD, n.d.). Furthermore, a survey administered to caregivers of children diagnosed with ASD in four states (Florida, Delaware, New Jersey, and Pennsylvania), with most respondents from Florida (60%), found that the most common reason children were not receiving ABA services was long wait lists (33.7%; Littman et al., 2023). While Florida has many RBTs compared to other states, expanding its services is still necessary. The aforementioned grant sought to understand the shortage from a variety of perspectives, including understanding the perspective of RBTs who work in the state. As part of that grant, we gathered data through focus groups, surveys, provider information, state agencies, and more. Therefore, the current study sought to expand upon previous research by conducting a qualitative analysis of RBTs’ perceived working conditions to understand some factors that might contribute to burnout and wanting to leave the job. While preliminary results were shared in the technical report associated with the grant (Gravina et al., 2023), we re-analyzed the data using a more rigorous, research-intensive qualitative coding and analysis method for the current paper.

Method

We employed a generic qualitative inquiry (GSI) design to obtain information on participants’ experiences working as registered behavior technicians (Merriam & Tisdell, 2015). A GSI design essentially means that the design incorporated features from different methodologies. This means that the design employed did not fit neatly within an existing qualitative approach (e.g., grounded theory or phenomenological). Instead, the research process included techniques informed by existing qualitative approaches (e.g., open coding, thematic analysis), which were adapted to be more flexible and prescriptive to the current study and consistent with our epistemological behavior analytic framework (Kahlke, 2014). Specifically, data collection, coding, data analysis, and interpretation of results were informed by a behavior-analytic approach to analysis (e.g., objective, parsimonious) and our experience working in ABA. Within GSI, our study could be characterized as descriptive qualitative research (Caelli et al., 2003), meaning that we sought to describe participant experiences within the context of this study rather than interpret them through a specific theoretical model.

Participants

Participants were recruited using convenience and snowballing sampling methods through (a) emails distributed by multi-regional ABA organizations and a state-wide behavior-analytic organization with academic and student members, as well as professional members from a variety of positions such as psychologists, behavior program supervisors, administrators, program directors, and direct care staff, (b) flyers distributed at state conferences, and (c) social media posts by behavior analysis chapters and multi-regional disabilities support organizations (Braun & Clarke, 2013; Patton, 2002). The flyer included a link to a survey that participants completed, and then they were contacted to schedule interviews. Thirty-six people responded to the survey and were contacted to schedule interviews; however, only eleven participants responded to the scheduling requests and attended the interviews. We sought to interview RBTs across multiple regions in Florida who worked with various populations. Participants were included if they were active RBTs providing ABA services in Florida and were not current or former supervisees of the researchers. The participants’ names, state, and regional information were used to verify certification numbers through the BACB Certificant Registry.

Although we intended to collect data using focus groups, the sessions were conducted as individual interviews due to scheduling conflicts (i.e., participants’ availability did not align) and the limited pool of potential participants. Two participants were interviewed in a focus group format and nine participants individually. Participants did not receive compensation. Table 1 includes participant demographics and work information related to gender, race/ethnicity, education, regional location, work setting, reported years in the field, and pay. The demographic information on their patient population was an open-ended question; therefore, discrete categories were not reported. Participants reported working with individuals diagnosed with ASD from age 2–17, other developmental disabilities, children in the foster care system, attention-deficit/hyperactivity disorder, post-traumatic stress disorder, and intellectual disability. Table 1 provides detailed demographic information. We chose not to link participant numbers to quotes to preserve anonymity.

Table 1.

Reported participant demographics & work information

	Gender	Race, ethnicity	Education	Region of work	Work setting	Years in the field	Pay
1	Woman	White, non-Hispanic	Bachelor’s degree	Central Florida	Clinic, university-affiliated	4	Hourly
2	Woman	White, non-Hispanic	High school diploma/GED	Northeast Florida	Home	2	Hourly
3	Woman	White, non-Hispanic	High school diploma/GED	Central Florida	Home, school, and clinic	1	Hourly
4	Woman	White, non-Hispanic	High school diploma/GED	Central Florida	Home, school, and clinic	3	Hourly
5	Woman	White, non-Hispanic	High school diploma/GED	South Florida	Home, school, and clinic	5	Hourly
6	Woman	White, Hispanic	Master’s degree	South Florida	Clinic, no university affiliation	3	Hourly
7	Woman	White, Hispanic	Bachelor’s degree	Central Florida	Chose not to report	4	Hourly
8	Woman	White, Hispanic	Bachelor’s degree	Northeast Florida	Clinic, university affiliated	3	Salary
9	Woman	White, Jewish	High school diploma/GED	Northeast Florida	Home	2	Hourly
10	Woman	Latin American	High school diploma/GED	South Florida	Home, school, and clinic	2	Hourly
11	Woman	Asian	Bachelor’s degree	Central Florida	Clinic, university-affiliated	3	Hourly

Interviews

The second author and an undergraduate research assistant conducted semi-structured interviews via Zoom. The interview questions were developed by the second, third, and last author and informed by prior research focused on causes of employee and behavior technician burnout and turnover, as well as calls to action to study these concerns further (Cymbal et al., 2021; Gibson et al., 2009; Hurt et al., 2013; Jimenez-Gomez et al., 2021; Newcomb et al., 2019; Novack & Dixon, 2019). Interview questions are included in the Supporting Information document. The interviewer instructed participants to use a pseudonym and indicated they could keep their cameras off to preserve anonymity. Zoom meetings were recorded and lasted approximately 30 min for individual interviews and 120 min for small group interviews. Data collection concluded after reaching data saturation. Saturation is a common technique for determining when to conclude data collection based on subjective criteria regarding whether any new information is obtained from interviews or focus groups (Saunders et al., 2018; St. Peter et al., 2023). A review found that saturation is typically met with 9–17 interviews or 4–8 focus groups (Hennink & Kaiser, 2022). In the current study, data saturation was determined collectively by the research team. Specifically, we determined saturation was met when similar, repeated concepts were observed using the codebook, and no new, relevant information was obtained across successive interviews.

Qualitative Coding

Interview transcripts were reviewed, corrected, and uploaded to a qualitative coding application (i.e., Dedoose) after data collection was concluded. An inductive thematic analysis was used to identify, analyze, and organize patterns in participants’ responses during interviews (Braun & Clarke, 2013). Braun and Clarke (2013) described an inductive thematic analysis as a method for producing an analysis from the “bottom (data) up” and is not explicitly tied to existing theory but is nonetheless informed by the epistemology and perspectives of the research team. Specifically, the first and second authors conducted open coding using a random subset of transcripts to determine a preliminary set of coding categories. In other words, those authors scanned each interview and developed preliminary coding categories that seemed to best encompass and represent participants’ verbal behavior. Those preliminary coding categories were reviewed, edited, and organized into themes during meetings with the first and second author and another research assistant who served as the secondary coder. Then, the first author and a secondary coder coded the same transcript subset using the newest iteration of coding categories. This iterative process (i.e., coding, then meeting to discuss emerging themes and edit coding categories with the research team) was repeated three times until acceptable levels of interrater agreement were reached across main themes (Cohen’s Kappa scores of .95, .96, .94, and 1.0 across themes 1–4, respectively). The primary coder then coded the remaining transcripts using the code book shown in Table 2.

Table 2.

Code Book

Theme	Code	Definition
Competency	Supervision	Participants discussed supervision.
	Training
	General	Participants discussed training and it did not fall under the sub codes below.
	Felt unprepared/unsupported	Participants reported feeling unprepared or unsupported during training.
	Continuing education/professional      Development	Participants discussed continuing education or professional development.
	Crisis management Training/challenging behavior	Participants discussed crisis management training or training related to challenging behavior.
	Task List/BACB credentialing	Participants discussed the training required by the task list for BACB credentialing.
Working conditions	Job stress, burnout, turnover	Participants discussed stressors, burnout, and turnover.
	Leadership, culture	Participants discussed leadership or organizational culture.
	Peer support	Participants discussed peer support within their organization or the field.
	Safety	Participants discussed their safety at work.
	Company size	Participants discussed company size.
	Hours, scheduling	Participants discussed hours and scheduling.
	Material conditions	Participants discussed material conditions within their organization.
Transient	General	Participants discussed the transient nature of the RBT position.
	Lack of knowledge	Participants discussed the potential candidates not having knowledge of the existence of the position or field.
	Plan for higher position	Participants discussed how they had goals to work under different positions.
	Easy to turn	Participants discussed the frequency of which people leave the position.
	Career RBTs	Participants discussed conditions an individual might be a career RBT.
Pay and benefits	General	Participants discussed pay and benefits, and it did not fall under the codes.
	Inconsistent or low pay	Participants discussed inconsistent or low pay within their position.
	Initially attractive pay rates	Participants discussed how the RBT pay rate can initially be attractive.
	Benefits	Participants discussed benefits.

Role of the Researchers

Owing to the inherent subjectivity involved in qualitative research, we acknowledge how our positionalities and previous experiences may interact with the development of our method, data analysis, and interpretation. The research team comprised six doctoral-level behavior analysts and academics who have worked in the field for seven to 22 years. All authors had prior experience working in clinical direct care roles. Four authors have or are currently supervising individuals engaged in behavior-analytic assessment and treatment. The first and second authors worked as RBTs previously. Five of the authors identified as women, and one identified as nonbinary. Two authors identified as Latina, and four identified as white and non-Hispanic or Latine. The first and last authors specialize in organizational behavior management. Because our team has experience in clinical ABA in both direct care and supervisory roles, we were intimately familiar with the subject matter, so our development of the questions and first set of coding categories was likely partially influenced by those experiences. Our behavior analysis and OBM background likely resulted in us attending to environmental causes in the data. Because our entire team has published behavior analysis research and some have held faculty and leadership positions in Florida, it is possible that participants were familiar with the researchers, and that could have affected recruitment (either aiding in recruitment or dissuading people from participating). Furthermore, our behavior analysis and quantitative research training influenced the interviewing and coding process. For example, during interviews, we worded questions neutrally and attempted to avoid reinforcing responses so as not to influence them. We also included inter-observer agreement, even though that is not required in qualitative research.

Results

Table 3 shows the four themes that were developed through the coding process: Theme 1: challenges developing and maintaining competency; Theme 2: difficult working conditions; Theme 3: a transient or unheard-of career; and Theme 4: dissatisfaction with pay and benefits. Repeated or filler words were redacted to improve the readability of quotations (e.g., “like” or “um”). The term “challenging behavior” refers to behaviors including, but not limited to, aggression, self-injury, property destruction, or elopement. We recognize the current discourse regarding the social acceptability of the term “challenging behavior” but elected to maintain the verbiage of the participants (Bottema-Beutel et al., 2021).

Table 3.

Main Themes

Theme	Definition
Barriers to developing and maintaining competency	Participants discussed topics related to training, supervision, or the BACB RBT experience standards.
Difficult working conditions	Participants discussed how the difficult working conditions of an RBT may contribute to stress, burnout, or turnover.
A transient or unheard-of career	Participants discussed topics related to short vs. long-term career plans or a lack of knowledge among the general public regarding the RBT position.
Dissatisfaction with pay and benefits	Participants discussed the pros and cons of and difficulties with obtaining desirable rates of pay and benefits.

Theme 1: Challenges Developing and Maintaining Competency

Participants’ experiences with training and supervision varied across supervisors and clinics. Participants who reported positive training and supervision experiences described training for extended periods (e.g., multiple weeks of shadowing), receiving frequent, targeted feedback, and having a supervisor who is actively engaged in problem-solving and providing support in managing challenging behavior and who was “really there for” them. Another participant appreciated that their BCBA tried to match RBTs to clients in terms of preference and skill set and were “with you every step of the way.” One participant shared,

At my first company, I actually really enjoyed on-the-job training. It was two weeks of like basically in vivo training with a peer mentor. So, I got to follow and shadow and really get comfortable.

Participants who were unsatisfied with their training supervision reported that supervision was infrequent, inconsistent, or low quality (i.e., BCBA not attending to their performance, lack of feedback, or little support with challenging behavior). One participant shared that the only learning she did beyond the 40-hour training was through “discussing different techniques and approaches with other RBTs.” A second participant shared that a supervisor would “join me on my first session” but stated, “that was the extent of my training.” Another participant stated,

The only criteria I had to meet was, of course, the 40 hours and pass competency and sit for the test and pass the test and then I could work with clients. But there was no post or follow-up training after that.

One participant reported feeling frustrated that they only received positive feedback, describing an instance during which they intentionally made an error and received no corrective feedback, speculating that their supervisor might be uncomfortable providing feedback. Another participant reported that they initially did not understand that they “had a right to [with] supervision” but eventually advocated for themselves to address their supervision needs. Some participants noted it could be challenging or aversive for both them and their supervisors to obtain supervision due to nonconcurrent billing, stating that pay was sometimes lower during supervision time or that supervisors had caps on how much supervision they could provide per RBT.

Several participants also described feeling unprepared to provide direct services due to insufficient training during their onboarding period. One participant, who was also a mother of a child receiving ABA services, stated,

So, they gave me some courses. I had to be able to take HIPAA courses and all of those things before I actually started. So, it did take a couple of days for me to finish that up, kind of sort of like orientation. And then they gave me my clients. They gave me maybe about two days of supervision, and then let me be with the client. I didn’t really care for that too much because I didn’t know anything about the client. And it was pretty crazy, so I had to come back and be like, can you help me with this? Can you make sure that I’m doing this correctly? I didn’t want to affect anything. It was really a shot to the heart, too, because I thought that I was able to do it. It was very devastating for me.

Similarly, other participants reported that they or their peers received little to no training or supervision before working with clients independently and their corresponding stress and negative emotional experiences. Several participants suggested that they or other RBTs had left organizations because of their dissatisfaction with training or supervision.

Multiple participants discussed feeling unprepared or unsupported in managing challenging behavior. Some participants reported receiving no crisis management training, yet they were expected to manage challenging behavior exhibited by their clients. They suggested that the lack of training and support managing challenging behavior “really takes a toll on RBTs” and that they did not feel like their needs were met. One participant reported that they received little to no support working with their first client, who engaged in aggression and was subsequently injured. Another participant received crisis prevention training in another state and, after moving to Florida, became the only person who could manage aggressive behavior at their company because no crisis training was available to their colleagues. This participant also suggested that RBTs need more training on when or if to perform restraints, the ethics of intrusive care procedures, and trauma-informed care.

In addition, participants also expressed interest in additional training on skill acquisition programs, data collection procedures or technology, and providing feedback. Multiple participants underlined the importance of training in person or in vivo. One participant illustrated this by stating that while the online 40-hour training was helpful, “I felt they just kind of threw me out there. I had absolutely no idea what I was doing, and it was horrible.”

They also suggested conducting training in naturalistic settings and across unique settings (e.g., in homes and schools) and client populations (e.g., adults). Some participants suggested limited opportunities for obtaining ongoing training or continuing education. In contrast, others described attending conferences, organization-sponsored lectures, or networking and learning from their community of RBT peers. A few participants recommended that the BACB or organizations develop more stringent training, supervision, and competency requirements to ensure RBTs feel prepared and able to deliver high-quality services.

Theme 2: Difficult Working Conditions

Participants discussed how job stress and burnout, organizational culture and support, scheduling, and access to tools and materials impacted their experiences at work. Every participant reported that, although their work could be rewarding at times, working as an RBT is a difficult and “taxing” job. Participants specifically discussed feeling burned out due to a lack of training, managing challenging behavior, observing unethical work practices, and feeling unsupported by the organization. When managing challenging behavior, one participant suggested it took time for them to build “stress tolerance.” Others discussed how exposure to challenging behavior throughout the day or week could be “mentally and physically straining” and require “a lot of mental discipline.” Multiple participants suggested burnout and job stress are the most common reasons people leave their jobs. One participant described their difficult work as “not worth the pay.” Another participant indicated that job stress might be higher depending on an RBT’s work setting or client population (e.g., managing challenging behavior among young clients compared to adults).

Despite the difficulties of their work, most RBTs suggested that organizational support and a positive organizational culture could mediate the effects of job stress. One participant stated, “when people feel supported, and that they’re doing something positive—that’s why people stay.” Specifically, participants described the importance of leadership listening to RBT’s concerns and honoring their requests when feasible, frequent communication and support from supervisors, and finding community with their peers. Multiple participants described having varying experiences across organizations, some of which they left due to feeling unsupported or “unappreciated.”

Over half of the participants discussed how an organization’s size corresponded with differing levels of support and quality of services. Specifically, several participants preferred to work for smaller companies, suggesting that larger companies focus on “the bottom line” and taking on as many clients as possible instead of focusing on client progress. One participant who had previously worked in South Florida stated,

I would love ABA companies to stop looking to make a profit off of this and start looking to make a difference in these children. I think it’s very dangerous when clinics start to become almost like a drive-through clinic and try and see as many kids as possible to [impact] the bottom line… and I think we’ve seen a little bit of a shake-up with that, with some of the larger ABA companies and the venture capitalists that have invested in them for that reason. I always think it’s dangerous to blend healthcare and profit.

Similarly, multiple participants discussed concern for the quality of services provided by companies “more focused on profit” but that people also consider the higher compensation and benefits offered by larger companies, which smaller companies may be unable to provide.

Participants frequently discussed the impact of scheduling and working hours on their experience at work. Multiple participants described the importance of having more flexible but consistent schedules, good communication regarding client cancellations, and accessing breaks at work. One participant said they could not take breaks or lunch at a previous clinic, saying this, “kind of grind is exhausting, especially for an older RBT like me.” In contrast, a different participant appreciated that their job had a floater so if you needed a break, you could “tag out” or the floater could “come in and support you” when needed.

Some participants suggested that the hours required to be considered full-time are “exhausting” and difficult, in addition to their commute between clients when working in homes. Specifically, multiple participants described how engaging in over 30 hours of direct work can lead to burnout among RBTs. As one participant stated, “Sometimes clients are there for 8-hour days like a job. This can be mentally straining on the RBT.” They elaborated that when clients are “not having it,” or there is challenging behavior, or “clients are sick,” and “getting everyone else sick,” it can be “taxing.” Another participant who reported extensive work experience as an RBT said they were passed over for jobs because they wanted to work a part-time schedule to avoid burnout and be able to pick up their child from school, but they “were looking for 40 hours.”

Participants also discussed the importance of organizations providing access to the tools and materials needed to provide services safely. One participant described using their money to acquire reinforcers or preferred items for in-home cases, which could be enjoyable but stressful to purchase. Another participant discussed needing personal protective equipment in centers and homes to keep RBTs safe. One participant also desired more health and safety “checks” by outside professionals to maintain appropriate clinic cleanliness levels.

Theme 3: A Transient or Unheard-of Career

Most participants considered the RBT position as short-term and “in-between,” although it may be a long-term career “for some.” They stated that it was a way to “get your feet wet” and a “good learning opportunity” for related, more advanced careers that RBTs might pursue later. One participant noted,

I would personally say that I don’t find it to be a very sustainable career and I think a large part of that is the pay… in my experience, most people that I’ve worked with are working toward a higher degree, but I have worked with some individuals [for whom] this is their career that they have and some of them are about my age and some of them are a lot older… so I do think some people would view it as a lifelong career but I think that’s kind of a more rare occurrence within the position.

Several participants expressed the sentiment that the work of an RBT is unsustainable. Most described that they or their colleagues were planning to move to a higher or different position (i.e., BCBA, teacher, speech-language pathologist, organizational behavior management).

Participants also discussed how the public lacks knowledge regarding ABA and the RBT position. Specifically, participants discussed how the field or organizations should focus on improving dissemination efforts to address the RBT shortage. RBTs expressed that most people had never heard of the position, and those who had heard of it did not understand what the work entailed (e.g., conflating behavior-analytic services with “babysitting”). In addition, participants noted how many new RBTs get into the field with no background in behavior analysis and may not understand the difficulties of the job at the outset. One participant stated,

There’s been instances where I’ve trained five to eight new hires at once in the field, and then they’ll slowly drop off because they’ll see what we actually do as RBTs. Working with aggression, working with biting, working with bodily fluids, all the other stuff. And then they realize it’s not for them.

One participant suggested that companies ask potential hires to observe client sessions before accepting a position to provide a clearer picture of job expectations and address the rapid turnover of new RBTs. Another participant stated that “they don’t realize what it takes” when referring to new hires attracted by the higher pay than some other entry-level jobs. Another RBT indicated that it was easy for RBTs to leave quickly after training and obtain a higher-paying RBT position elsewhere. Each of these variables may impact the organizational tenure of RBTs and exacerbate staff shortages for some organizations.

Theme 4: Dissatisfaction with Pay and Benefits

Finally, participants frequently discussed their desire for higher or more consistent pay. Although some participants were satisfied with their pay, many suggested that most RBTs leave an organization to seek higher and more consistent pay. One participant stated,

I love working as an RBT, and I think it’s very rewarding, so those are positives. I think that I learn a lot from [clients] every day, as much as they learn from me. I mean like the pay is good, but it could be better. And I just think that it is a difficult job for, you know, it is not for the weak of heart. ... I think I should make a little bit more.

Another participant described how several RBTs recently left their clinic due to a lack of client hours. Others cited their frustration with frequent client cancellations or lack of systems to increase pay. One participant stated that their employer “gets away with poor pay because they’re a very well-known and highly regarded center” but that they are learning more and being supervised more frequently, suggesting the “knowledge is compensating with the pay.” One participant shared that they took a large pay cut to work in a clinic with more support after working in-home. Another participant expressed frustration that their organization “did not allow [them] to talk about [their] wages” with their fellow RBTs and suggested their pay determination was unfair because it was not based on education or organizational tenure. Participants also reported wanting access to paid time off and health insurance, although one participant noted that accessing benefits with a larger company may require a sacrifice in pay. They stated,

I’ve seen bigger companies pay less than smaller companies. But smaller companies cannot provide the benefits like PTO, 401ks, medical, dental, and vision insurance like the bigger companies can. So, I think there is a lot of compromise in, do I get paid more and work for a smaller company and just not get those benefits or do I get paid less and work for a bigger company and access those types of benefits?

Despite reports of dissatisfaction with pay, multiple participants acknowledged that RBT pay rates may seem initially attractive to individuals who are young or unfamiliar with ABA. They described how organizations will often hire individuals who recently graduated from high school who may not have comparable opportunities in terms of pay or that it may seem like a “good part-time job.” Some participants also expressed their concern for some of their peers who accessed higher pay, potentially through working as an independent contractor, which the BACB has stated does not comply with the Internal Revenue Service employment rules (Behavior technicians may not be independent contractors in the U.S. 2018, p. 3). Those participants seem to weigh the ethical concerns of providing low-quality services with less support while accessing better wages.

Participants also mentioned incentive systems as part of the discussion of pay. One participant expressed that they would like more social reinforcement for “small moments” when discussing their company’s use of more arbitrary reinforcers (i.e., incentive program). One participant appreciated that their clinic,

Started a shout out board since I started there that was supposed to kind of be social reinforcement and then at every staff meeting, they would pull a card and whoever’s shout out was pulled got a gift card.

In other words, decent pay is necessary but not sufficient to make employees feel appreciated. In contrast, another participant suggested they liked their company’s new token reinforcement system for employees.

Discussion

Despite the increasing number of RBTs in the United States, previous research and anecdotal reports continue to underscore the challenges of managing burnout and turnover, which may contribute to the behavior technician shortage. In the current study, four major themes emerged regarding RBT’s perspective on staff burnout and turnover in Florida: challenges establishing and maintaining competency, difficult working conditions, the RBT career as transient or unheard-of, and pay and benefits. While this research is specific to Florida, similar themes are likely relevant in other locations. These findings support several considerations for future research and practice in understanding and mitigating burnout and turnover among RBTs within the ABA service sector.

Although a 40-hr training is one requirement for RBT credentialing, these results suggest an opportunity to improve training experiences during onboarding and after obtaining the certification. In the current study, participants expressed interest in receiving higher-quality training before delivering services, including training across a greater breadth of stimulus conditions (i.e., participants, settings, behaviors), a preference for in-person training modalities, and explicit training on managing challenging behavior and crisis management. A study by Blackman et al. (2023) found significant variability in the length of training for RBTs, who most often reported training lasted from 1–3 days to 2 weeks. Respondents also reported that verbal training was the most common modality, followed by written instructions. Given that modeling, rehearsal, and feedback are considered best practices for training new skills, these data also suggest a need for improved training practices.

Participants suggested that feeling unprepared or unsupported when working with clients corresponded with negative emotional experiences, which can lead to burnout and turnover. Similarly, a study by Kazemi et al. (2015) reported that satisfaction with training was negatively correlated with turnover intention (i.e., as satisfaction with training increased, turnover intention decreased). To our knowledge, limited research has focused on access to crisis management training or evaluated the quality of those resources. Therefore, further inquiry is needed to assess the availability of crisis management support and general training for behavior technicians and how different training components affect perceived or actual competence and support. In line with the need for more training, the BACB recently released new guidelines for RBTs, which require 12 hours of professional development training in a two-year cycle beginning in 2026 (BACB Newsletter, 2023). If RBTs are required to pay for the training, this could become an additional barrier to staying in the position. Thus, we recommend that organizations provide RBTs with access to training at no cost and pay RBTs for their time. The increased training requirement could increase the amount of training RBTs receive, but attention must be paid to the quality of that training. For example, participants requested more time shadowing and crisis management training before working independently. Thus, there is an opportunity for researchers to evaluate the content, amount, and modality of training that will better prepare and support RBTs in their work and reduce burnout.

Previous research suggested that perceived supervisory support may impact burnout, job satisfaction, and turnover, although reported findings have differed across work settings (Gibson et al., 2009; Griffith et al., 2014; Hurt et al., 2013; Kazemi et al., 2015; Novack & Dixon, 2019). In the current study, participants repeatedly described their desire for improved supervision practices and the relationship between supervisory support and job stress. These results extend previous literature on supervisory support and burnout by more explicitly detailing the aspects of supervision needing improvement (i.e., supervision frequency, provision of corrective feedback, availability to answer questions, and providing support managing challenging behavior). Participants acknowledged that BCBAs may also need additional support (i.e., training) to provide better supervision and may have multiple competing responsibilities (e.g., a high caseload) that could impact the amount of time and effort they can dedicate to their supervisees. We recommend a few strategies to address these concerns. The 40-hour RBT training should explicitly state supervision requirements and explain steps RBTs should take if those requirements are not being met. For example, the training could provide guidance for speaking with their BCBA and how to escalate if the concern is not addressed. The training could also include guidance on how RBTs can advocate for themselves in their role, such as asking for overlapping time with an experienced RBT or requesting a break. We also recommend that both graduate programs and organizations allocate more time and resources toward training and evaluating prospective and current BCBAs’ supervisory competencies (Sellers et al., 2016; Turner et al., 2016). Further, supervisors should also use tools to evaluate and improve their supervisory skills. For example, McElroy et al. (2024) used the Operant Supervisory Taxonomy Index (Komaki, 1986) to evaluate supervisory skills, and Valentino et al. (2024) designed a calculator to score supervision practices. These measurement tools can help supervisors pinpoint opportunities to strengthen their supervision practices.

The difficulties and job stressors associated with providing direct behavior-analytic services were common across participants, yet these results suggest that having access to a supportive work environment may mediate the adverse effects of job stress (Hurt et al., 2013; Gibson et al., 2009). Specifically, participants discussed the importance of having support from supervisors and peers and a positive organizational culture centered around delivering optimal care for their clients while recognizing employees’ needs and concerns. Interestingly, multiple participants described having differing opinions or experiences based on the size of the ABA organizations and explicitly expressed their concern for companies focusing on profit over service quality. Additionally, participants preferred that organizations exercise flexibility in meeting employee scheduling needs. These findings somewhat align with previous research suggesting that job crafting (i.e., aligning work preferences with work tasks) may decrease stress and burnout (Slowiak & DeLongchamp, 2022). Research is needed to understand scheduling (e.g., part-time versus full-time, break and lunch schedules) and rotation systems (e.g., rotating every two hours versus every four) that might reduce RBT burnout. Furthermore, researchers could evaluate whether behavior technicians might benefit from interventions to reduce job stress and burnout, such as acceptance and commitment training (Ragulan et al., 2023) and work-based social support networks (Marby et al., 2018). RBTs could also create a community of practice within or outside of their organization. Local professional organizations could be a starting point for developing a community of practice.

Participants frequently expressed dissatisfaction with the amount and consistency of pay, suggesting that many RBTs will leave an organization to pursue higher wages and more consistent hours. Indeed, previous research supports the relationship between pay and turnover intention (Cymbal et al., 2021; Kazemi et al., 2015). In this study, participants also discussed how RBT wages may be initially attractive to individuals unfamiliar with the field and the work but that some later feel their wages are not worth the difficult job responsibilities of an RBT. Participants described how their pay concerns were weighed with the amount of organizational support and training they received, suggesting that the decision to leave an organization may be impacted by several variables, including, but not limited to, pay. Further research is needed to understand how pay and other workplace conditions simultaneously impact RBT burnout and turnover intention. Researchers should continue to examine the impact of various pay and employment arrangements, such as hourly, contract, salary, etc., in relation to the provided work supports and perceived difficulty of the position.

Despite the importance of accessing adequate training and supervision, desirable workplace conditions, and adequate pay and benefits, most participants suggested that they viewed the RBT position as a short-term career for most individuals, contributing to high turnover. Many participants discussed how the RBT position served as a “stepping stone” between entry- and higher-level jobs in psychology or healthcare. Further research is needed to explore the variables impacting career longevity in RBTs and BCBAs alike. Organizations might consider exploring options for increasing job tenure and decreasing burnout and turnover. Wider adoption and insurance reimbursement for the Board Certified assistant Behavior Analyst position might offer another rung in the career advancement ladder for behavior technicians. Researchers should also explore advancement systems such as badges or RBT levels tied to experience and tenure within a job role that might reduce turnover for RBTs (e.g., Newcomb et al., 2019). In healthcare, strategies such as offering CNAs choices about their patients and work tasks, engaging staff in quality improvement initiatives to fix workplace issues, and educational benefits have been shown to improve retention (Berridge et al., 2022). Researchers and practitioners should consider evaluating these and other strategies that have proved successful in related disciplines such as healthcare and education for improving retention.

Although we contend that these findings make a unique contribution to the literature on behavior therapist burnout and turnover, we recognize that our results represent the perspectives of a select few individuals. Specifically, our participants all worked in Florida and identified as women, and many were planning to or were pursuing a higher degree or BCBA certification. Although this study aimed to evaluate variables that might contribute to the RBT shortage in Florida, it is unclear whether these findings correspond with a larger sample of RBTs across the United States. Our recruitment methods may have yielded RBTs who were more likely to be affiliated with university programs and professional organizations and/or participants who were dissatisfied with their jobs. Although previous research on behavior technician burnout and turnover has presented similar findings, it is also unclear whether these findings would be consistent with the perspectives of RBTs outside of Florida. Future researchers should conduct qualitative and quantitative research to continue to unpack variables that lead to RBT turnover and identify strategies for reducing burnout and improving retention. Additional qualitative studies could provide a more in-depth analysis of some of the topics covered in this research, such as training needs and preferred delivery of content, aspects of working conditions that are most likely to lead to burnout, and factors that make supervision effective. Future qualitative research in this vein should be conducted with purposive sampling (Sandelowski, 1995) of groups of RBTs who work in specific settings (e.g., schools, group homes) and with specific populations (adults, medically complex individuals) to uncover unique factors leading to burnout and turnover in those work contexts.

Like any research, this study has limitations worth mentioning. First, while we did not specifically recruit women, all participants in our sample identified as women. This result is unsurprising, given that the BACB reports that 85% of RBTs identify as women (BACB, 2024a). Still, the reader should remember that women’s experience in the field could differ from those with a different gender identity (e.g., men, nonbinary, or two-spirit). It should also be noted that the goal of qualitative research is to represent the participants’ voices in the sample, and thus, the results should not be generalized to all Florida RBTs. Another limitation was that our sample was likely more educated than the average RBT because several participants reported being in school to obtain certification as a BCBA. The grant did not allow us to allocate funds to paying participants, which might have influenced the types of participants we recruited. It is possible that our sample represented RBTs who care deeply about the field or were more dissatisfied with their jobs because they were willing to volunteer time to participate. Future researchers should consider paying participants but note that identity should be verified because offering pay can increase the likelihood of participant fraud (i.e., saying they meet the inclusion criteria when they do not; Ridge et al., 2023).

We believe this research identifies several opportunities to improve the working conditions of RBTs and address burnout and turnover of behavior technicians in Florida. While many of the findings were consistent with prior research on behavior therapist burnout and turnover, this qualitative inquiry yielded results that more adequately captured the depth and nuance of the RBT experience by providing more specific information about major themes and identifying possible solutions. We hope training programs, organizations, and regulators can use these findings to inform the ways they support and retain behavior-analytic professionals.

Supplementary Information

Below is the link to the electronic supplementary material.

Funding

This project is provided by the Florida Developmental Disabilities Council, Inc., supported in part by grant numbers 2001FLSCDD and 2101FLSCDD from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS or the U.S. Government.

Data Availability

Transcript excerpts are available upon request, provided they do not compromise participant anonymity.

Declarations

Conflict of Interest

The authors declare no conflicts of interest related to this work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants in the study.