The Next Generation of ABA Providers

Abstract

The imbalance of supply and demand for behavior analytic services will change in the near future. Behavior analysts, who want to survive in an increasing competitive marketplace, will need to show quality results and better results than the next behavior analyst. Trumpet Behavioral Health is a company designed to infuse scientific research with clinical practices. In the years ahead, look to companies like Trumpet as role models of the next generation of autism service providers.

For a little over a decade, our field of behavior analysts has seen a radical boom in employment opportunities for recent graduates. Most of these jobs are rooted in the service delivery for persons with autism and were created via state and national legislation mandating behavioral care. The demand for services far exceeded the supply, and as a result, the few providers that were in place could charge large fees and not be too concerned with outcomes. The competition was few and far between. The metaphor of “Get your degree on Saturday, hang a shingle with your name on Monday” was literally true. I myself have seen many individuals do just this, and as a result, reap huge rewards. But shingle owners beware—the competition is coming.

I see the decade ahead as one whereby the imbalance of supply and demand for services will start to level off. As this occurs, providers will need to be focused more on quality than quantity of service. Clients are becoming more savvy about the behavioral marketplace, and will expect more outcome. Furthermore, as behavior analysts continue to enter the world of insurance billing, those Fortune 500 companies will treat us with a critical eye. Managed care is, for better or worse, managed. In other words, behavior analysts will need to show results, show quality results, and show results better than the next behavior analyst. Personally, I welcome the competition because it will create the evolution of sophistication. And let the selection by consequences begin.

Trumpet Behavioral Health was established in (2009) by Lani Fritts and Chris Miller. These two innovative individuals realized very quickly that fragmented care, ineffective care, and lack of access to care were keeping hundreds of children with autism at a major disadvantage. To solve the problem, Lani and Chris acquired two small companies that were providing school-based and in-home services in the San Francisco Bay area and Hawaii and began the process of creating operational infrastructure to grow. What started off in those two states has grown into a presence in 10 states, which now serves almost 1,500 individuals across the USA. Growth can be rapid and easy, but sustained quality is always risked as new staff, new locations, and new clients are brought into a well-running system. To ensure that growth never would compromise service, Dr. Linda LeBlanc was hired in 2012 as the Executive Director of Research and Clinical Services for the organization. For Linda to walk away from a tenure line academic faculty position as a professor, Trumpet must have proved itself to be something different than a shiny shingle business. When you see the vision Trumpet has crafted, the difference is clear.

Any Board Certified Behavior Analyst (BCBA) that has spent some time emerged in the clinical care for persons with disabilities can come to master the science of applied behavior analysis, and the various differential reinforcement schedules, preference assessments, functional assessments, and treatment plan writing, However, it takes a rather rare BCBA that can figure out how to turn day-to-day work into world-leading research. If anyone can accomplish this vision, it would be Linda. She has already become a household name among the top behavior analysts in the world. Her 80 plus publication record, various editorial board positions, and leadership roles within our discipline have prepared her well for the journey ahead. As Trumpet solidifies itself as the forerunner of the next generation of treatment providers, they can rest comfortably on the shoulders of Leblanc.

Trumpet currently provides services to children in their homes, in schools, in center-based early intervention programs, in alternative school settings, and soon in residential programs for adolescents with autism and severe problem behavior. Trumpet is in the middle of a multiyear effort to create comprehensive clinical standards and resources to ensure consistent quality of care and positive outcomes for consumers. Each clinical process is carefully mapped with synthesized best practices guidelines, carefully designed e-learning modules for training, and downloadable resources to make programming, data collection and outcomes monitoring, and quality assurance a seamless process. Each new service center experiences the same training and resourcing and all clinical teams benefit from the integration of ongoing research efforts and literature review into updated clinical standards.

As we move forward into the next generation of sophistication of behavior analytic services, it seems predictable that the single “shingle” providers will face increased competition from well-developed organizations like Trumpet. In our culture of capitalism, anything is possible, and it has been for many years in the treatment of children with autism. While many people balk at the notion of managed health care, it does contain some exciting challenges and opportunities for comprehensive system design. The demand for quality will come as the market gets more saturated with BCBAs. While such a forecast could appear callus, in my opinion, it is fantastic. Persons suffering from the global autism epidemic will have more choices and more beneficial outcomes as services improve. The future looks very bright with organizations such as Trumpet Behavioral Health leading the way.