The role of a Registered Behavior Technician (RBT) is pivotal In the field of Applied Behavior Analysis (ABA). Although the BCBAs are responsible for developing treatment plans, skill acquisition programming, and standardized assessments, RBTs are their eyes on the ground. Given this direct care position is the entry point into the ABA field for most, their working relationship with families and insight into the day-to-day workings of their clients can be one of the strongest influencers on a client’s progress while in care. However, by nature of being an entry level position, that makes it all the more challenging when RBT turnover rates are estimated to be between 30-75%. 

Table of Contents

1. How Much Does RBT Turnover Cost?
2. How Teamwork Took Steps for Improvement
3. Conclusion

How Large is the Impact of RBT Turnover? 

Knowing the difficulties ABA organizations face with retaining RBT-level employees, including internally, Teamwork undertook an analysis with Christie Lau at Token Data Lab to quantify the exact cost this turnover was having on our own clients’ clinical progress. We don’t know anyone else in the field who has expertise combining data on outcomes, rates, and operational metrics. To perform this analysis, our Chief Clinical Officer and Christie grouped our clients into three buckets: we defined low turnover as no change in therapy team, medium turnover as one change in therapy team, and high turnover as two or more changes to the therapy team.

The results of the study were dishearteningly huge, yet unsurprising. We observed a direct relationship between the amount of staff turnover clients experienced and the number of skill acquisition targets mastered by those respective clients within the first 12 months in therapy. The gaps in care created while restaffing, retraining, and pairing with a new RBT meant critically less time for the client to spend learning.  Sadly, we see well over a 50% reduction in skills acquired for teams with turnover!

The RBT turnover not only impacted clinical outcomes but had a ripple effect into revenue and sunk costs. Between the signing bonus, background checks, time spent recruiting and training, as well as potential loss in the client, we internally calculated each RBT lost as at least $5,000! We had the desire to invest more into competitive staff wages but the loss in cash flow was making it difficult to reinvest capital into the business where it was most urgently needed.

Lastly, constantly training new RBTs was putting an understandable strain on our hardworking BCBAs. Burnout is all too common in the ABA field, and if we didn’t act to change our current predicament, we could be facing similar turnover issues with our clinical supervisors.

We had to adapt to our realities, and fast.

How We’re Improving RBT Retention

Ensured Adequate Training and Clinical Supervision

RBTs require training and guidance. We invested in our TeamUp training program before our RBTs began working with a client to ensure they have a strong foundation before their feet even hit the ground. We also tracked each case closely to ensure that each RBT received the necessary percentage of clinical supervision from BCBAs.

Provided Non-Clinical Pathways for Growth and Development

We recognized that direct care may not be the perfect fit for every individual long-term. However, when we identified high-quality clinicians that we wanted to retain, we created part-time opportunities for our RBTs to join our Care Advocacy or Recruiting team to help our organization forge ahead in non-clinical capacities, while still making a monumental impact for Teamwork families.  

We Invested in Better Staffing and Scheduling Tech to Empower RBT Choice

Our scheduling and matching platform utilizes experience matching, which only pairs our RBTs with cases that match their skill sets. Teamwork’s platform also empowers our RBTs to make their own decision on which cases they are staffed. RBTs are no longer forced into unmanageably long commute times, and can select the schedules that work best for them. Using Teamwork’s platform dramatically sped up staffing RBTs with existing clients, finding replacements and increased therapist utilization, meaning they were paid more. As a result, Teamwork’s RBT full year retention rate improved by 8% from 2021 (41%) to 2022 (49%) with the introduction to our staffing platform. Neither 41% nor 49% is close to perfect, but ignoring the improvement would be missing the point: more of our therapists were paid more by choosing to work more hours, commuted less and stayed with their clients.

In the image below, we’re showing what it’s like for our therapists to see the relevant clients they could work with and apply to join extra cases.   

Conclusion: Quantifying the pain helps to address it

It’s felt as though most of the field has just accepted turnover. We think it’s simply too painful to push the issue of RBT turnover under the carpet. Truly recognizing the care quality and financial implications of high turnover is the first step to tackling the problem. Only when we proactively invested in strategies to support and retain RBTs did we see a change. We encourage other agencies to recognize they too can move the needle to ensure continuity, effectiveness, and quality in the ABA services they provide. Teamwork is committed to the mission to support our RBTs and help other organizations do the same. There’s no reason for organizations to work through the same problems alone. If you’re interested in learning what staffing and scheduling solutions are available for ABA providers, we’d love for you to reach out by scheduling a demo!

Interested in Teamwork? Schedule a Demo!

At Teamwork, we pride ourselves on being different from our competition. Teamwork is built specifically for ABA providers with a focus on clinical quality. We automate manual work associated with matching, staffing and scheduling so your team can focus on what’s important: delivering quality care to your patients.

Interested? Fill out the form below to sign-up for a demo of our tool!

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