Starting an ABA practice involves five areas of activity.
1. Planning. Some people have an idea and jump at it with their wallet and both feet. That’s their plan; they figure they’ll learn the rest as they go. Others want to plan everything to the last detail before beginning.
Both extremes have their pros and cons. Wisdom is about discerning the most appropriate target spot on the spectrum between planning and action—architect and building contractor.
You can effectively start building the house before every last detail of the architectural work is complete, but only if you are intricately aware of where flexibility exists or doesn’t, where risks are high or low, what the likely timeframes are for each aspect of the building process, how long it takes to acquire each of the necessary materials, how to manage the cost of capital tied up in the project, etc.
In short, the more you want to take action while still developing the plans, the more complex the effort becomes and the more mathematics and highly developed expertise are required.
2. Credentialing. There are self-pay clients and those with PPO insurance policies for whom a licensed BCBA can offer services without the lengthy credentialing process (often 2-6 months) generally applicable to Medicaid and in-network insurer relationships. But most practices depend primarily upon Medicaid/in-network contracts. And many new practices engage in magical thinking—imagining that their credentialing will happen faster than it does. Wishing does not make it so.
3. Training. Whether you are a novice or expert, a franchisee or independent practice, opening a large clinic or starting tiny, you must allocate time and resources toward training and staff/team development. Team cohesion requires dedicated time regularly invested to create strong, healthy lines of communication and mutual understanding. Expect key employees to require at least 12-24 months to come up to speed, and plan accordingly.
4. Recruiting. Yes, you can start recruiting before credentialing is complete. New techs take time to interview and select and can then easily require another 30-60 days to finish a 40-hour course and become ready for clients. But manage expectations! Watch your timelines. Give them a realistic projection for when they will likely begin work so that you don’t find yourself under pressure from staff for client assignments before you have all the other pieces in place.
5. Accepting Clients. The new practice is naturally sensitive to any potential clients which may happen along. In some geographic areas, 6-12-month waitlists are common. You may well be able to let prospects know that you anticipate readiness to offer services within, say, 30-60 days. But again—manage expectations. And remember that industry ethics rules forbid utilizing a waitlist when alternative adequate services are available from another provider.
Balance resource allocation between all five areas from the beginning, prioritizing them in the order listed.
Planning is first because your plan orders everything else.
Credentialing is second because most business cannot happen without it and there is typically no way to rush it. And many insurers and Medicaid officials will kill applications many weeks into the process for the sake of even a small error—even a typo! So, make certain to take your time up front to do it right. Restarting the process from scratch two months in is painful, and oh so common.
Training is where to live while you wait for credentialing. There is so much to learn in this business. My wife Stephanie and daughter Rebecca Gonzales, both with ABA doctorate degrees and long dynamic careers, are learning every day. Your ultimate value proposition to your team and clients is excellence, and excellence is a lifetime pursuit—always worthy of your time when waiting for some other necessary aspect of your business to ripen.
4. Recruiting should generally wait until you have a very good handle on Planning, Credentialing and Training. Otherwise, your prospective staff will sense that the concrete in your foundation is still wet. And how people see you when they join your organization tends to frame their longer-term perspectives of who you are.
The cleaner and crisper your practice’s initial development, the more confidence and gravitas you will have with your new personnel. And their impressions get shared among themselves, which leads to a fairly accurate group assessment of you pretty fast. If your preparation is insufficiently ahead of their needs, that initial impression of your startup as deficient is tough to shake off.
5. Clients. In most areas clients are easier to come by than clinicians. Clients are also, on average, onboarded much more quickly than techs or BCBAs. This is why adding clients is the lowest priority area among the five.
For those readers who are naturally patient, this outline is likely comfortable and clarifying.
For those who might be patient but put a premium upon collapsing timeframes—perhaps in order to redeem the value of a substantial ongoing expense for a building or existing personnel—I encourage you to consider drilling down on all five simultaneously while nevertheless remaining highly cognizant of the prioritization sequence. If you keep your priorities straight, you won’t lose your peace.
For those who are not patient—particularly those who might be attempting too much with too little capital (which includes the need to draw an income before a stable practice is established), I urge you to park in Planning until your plan allows you the time and patience necessary for success. Skipping sufficient planning, which includes provision of sufficient capitalization, guarantees failure and regret. As soon as action outpaces planning, stuff will go wrong. Don’t take a broken car out onto the highway.
ABA is a business requiring practitioners to patiently develop order within the lives of chaotic families. One cannot resolve chaos from chaos. The lifeguard cannot afford to drown along with the swimmer she seeks to rescue.
So, when chaos is encountered, it’s a signal to back up as many steps as necessary to find good footing again—a posture from which you can methodically proceed to advance into the chaos from a position of strength—continuously providing, to both clients and personnel, the sense of peace and balance which they themselves require.