When we started our ABA practice in 2019, scheduling was easy. We only had 15 clients and our clinical director knew all of our therapists, their schedules, and preferences. However, as we grew, our processes broke down and became unmanageable. We demoed all of the technology we could find that offered scheduling functionality, but everything was either missing some critical features (e.g. incorporating commute time into staffing suggestions) or was not suitable for an ABA practice.

Our solution was to build Teamwork. But, before we started building, we talked to a bunch of other ABA companies to see how they did staffing. The article below is a summary of that research. It turns out, we were not alone in the problems that we faced.

Table of Contents

1. Who did we speak to?
2. Common technology used for staffing
3. Incorporating therapist preference into team decisions
4. Resources (people & time) involved in staffing
5. Biggest pain-points in the current process

Who Did we Speak to?

We surveyed 60 ABA providers throughout the United States. Participants were found in ABA-focused Facebook groups(example) and asked to fill out a Google Form. In some cases, follow-up interviews were conducted with participants so we could learn more about they way they do staffing. Providers offered a variety of care settings and ranged in size from small practices with a few clients to multi-state providers.  

Most Common Technology for Staffing

At Teamwork, we struggled to find an appropriate technology solution to meet our staffing and scheduling needs. We are a fan of and use CentralReach as a practice management solution, but their scheduling capabilities did not meet our needs as an in-home provider. Before creating Teamwork, we utilized a manual process involving post-it notes and Google Sheets with client availability sent to our team. 

We were shocked, but not surprised, that the majority of providers that we spoke to had the same issue. A whopping 72% of providers use Excel or other manual methods (e.g. pen & paper) to staff and schedule providers with clients. Furthermore, only 25% of companies utilize their practice management solution as the one and only scheduling tool. This number drops even further to 18% when looking at companies that provide in-home care. Most companies that used a practice management solution also had to use other tools in combination to meet their scheduling needs. Due to the closed nature of most ABA software, it is no surprise that one of the most common complaints from ABA companies is the lack of integration between their multiple systems. From our conversations, some of the largest ABA companies have spent over $1 million on scheduling software and still felt dissatisfied. We’ll discuss how enterprise-level ABA companies handle their staffing workflows in a future article.  

Incorporating Therapist Preferences

At Teamwork, we believe that giving our therapists a choice on the clients they work with will lead to better continuity of care, and better retention overall. That’s why we built a care-model that encourages therapists to choose their own cases (to be analyzed in a future article). Therefore, we wanted to explore how other providers think about therapist preference when making staffing decisions.

We immediately realized we were alone in running our staffing function this way – no other companies surveyed let therapists be the initial, primary decision maker when it came to selecting the cases they wanted. That’s not to say Teamwork leadership doesn’t review and approve every potential case match, but it means our therapists gain ownership by choosing from our waitlist first. However, most companies (55%) did incorporate some level of therapist input into their staffing process. The most common setup was a “hybrid” model, where a scheduler will propose a draft schedule given therapist preferences captured during onboarding. Therapists then have a final say when it comes to working with clients. In follow-up interviews, we learned this approval process is done in an ad-hoc way via e-mail, and is often viewed as tedious.

Given a significant part of our industry works in this “hybrid” way, we identified an opportunity to put some structure around this process and built a provider portal for Teambuilder where therapists can view an up-to-date waitlist and easily give feedback to schedulers about their preferences with certain clients.

Resources (People & Time) Involved in Staffing

We wanted to learn how many resources are spent staffing at a typical organization, so we asked two questions:

1. How many people are involved operationally to staff a case?
2. How many hours per week does your company spend on staffing?

Unsurprisingly, staffing is an incredibly resource-intensive function. 88% of companies have 3 or more people involved to create a team for a client. Common roles of people involved are: clinical directors, care advocates / client service representatives, recruiters, program managers or admins, and often times someone on the leadership team. Given all the handoffs involved, and that most companies are facilitating this process with Excel, it’s no surprise that most parents spend months on a waitlist before ever receiving care. “Time-to-care” is one of the metrics we’ve spent the most time focusing on when designing Teamwork, and I’m happy to say we’ve managed to reduce our average time spent on the waitlist from 62 to 22 days in our organization.

The other angle we investigated was the hours spent on staffing each week. There is a clear correlation between the size of the company and the number of hours they spend on staffing. A big takeaway here for us is that companies manage to have a part-time resource dedicated to staffing while they are small, but by the time a company reaches 100 clients they should expect to have multiple full-time resources working on their staffing function. This suggests there is an exponential relationship with complexity as you scale. Staffing gets harder and harder to manage as you grow, and it’s worth building scalable processes and procedures now before the problem becomes unmanageable.

Pain-points in the Staffing Process

Finally, we asked participants what their biggest pain-points are when it came to staffing. The results were not surprising to us as we face many of these same challenges ourselves. Managing last-second changes to schedules is hard, particularly for in-home care. We’d love to hear more about how others address this issue, so if you have any learnings you’d like to share on this topic please add them to the comments below.

In regards to the multiple systems, this has also been a pain-point of ours which is why we prioritized making Teamwork as integrated and as open as possible. We connect directly to the most popular CRMs (Hubspot, Salesforce), communication (e.g. Slack, Email) , and scheduling tools (e.g. Google Calendar) our customers use in an effort to reduce the human error and complexity of multiple systems.

Conclusion

In the end, it seems that most ABA practices face similar problems when it comes to scheduling. However, everyone seems to take a different approach to solving these same problems (we hope to cover this in a future article). Because of these varying approaches, there are not industry-wide best practices. Over time, we hope to change this by sharing the tools and workflows that we see successful companies use when it comes to staffing. Equally important, we hope to share what we’ve tried that has been unsuccessful for our organization.

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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 scheduling (e.g. calculating commute times) 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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