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Writer's pictureMary Ellen Beliveau

A More Targeted Lens on Community Health: Applied Behavior Analysis Therapy

Recently, someone reached out to me with a request to delve deeper into the intersection of Autism Spectrum Disorder (ASD) and Diversity, Equity, and Inclusion (DEI) as it relates to Community Based Health. This topic intrigued me, and as I explored it further, I discovered a wealth of fascinating and essential information. I am grateful for this opportunity to share my findings and shed light on this critical issue.


The Growing Demand for RBTs and BABC Certified Managers in the Face of Increasing Autism Diagnoses: A Call for Compassion and Change



In recent years, autism diagnoses have surged by 78%, reflecting a significant shift in our understanding and recognition of this condition. This increase has heightened the demand for Registered Behavior Technicians (RBTs) and Board Certified Behavior Analysts (BCBAs), who play a crucial role in supporting individuals with autism. However, despite the critical nature of their work, these professionals face numerous challenges, including inadequate pay, demanding job requirements, and high turnover rates.


A Day in the Life of an RBT: A Journey of Compassion and Resilience

Imagine waking up each day with the knowledge that your work can transform a child's life. As an RBT, your morning begins at the home of a young child with autism. You help them navigate their morning routine, using patience and specific behavioral techniques to teach and reinforce essential skills. Your day is filled with structured activities and therapy sessions, each moment a blend of science and empathy. You witness small victories—moments of eye contact, a newly learned word, a meltdown avoided—and each of these moments fuels your commitment. The emotional demands are high, but the reward lies in the progress you see, however incremental.


The BCBA's Challenge: Balancing Many Roles

Now, step into the shoes of a BCBA and their role in designing and supporting Applied Behavior Analysis Therapy (ABA. Your day is a mosaic of clinical supervision, direct intervention, and administrative tasks. You start by reviewing data and adjusting treatment plans based on your clients' progress. You mentor RBTs, ensuring they have the guidance needed to implement effective interventions. Afternoons are often dedicated to meeting with families and caregivers, educating them on supporting their child's development at home. You balance these responsibilities while maintaining a high standard of care, navigating the complexities of insurance and regulatory requirements. The work is challenging, but the impact you have on families keeps you going.


Workplace Requirements and Emotional Demands for ABA Therapy

The job requirements for RBTs and BCBAs are rigorous. RBTs must have at least a high school diploma and complete a 40-hour training program before passing a competency assessment. BCBAs, on the other hand, must hold a master’s degree in psychology, social work, or a related field, complete 2,000 hours of supervised fieldwork, and pass a challenging certification exam with a 56% pass rate on the first attempt, and only 23% on retakes.


The Pay Discrepancy

Despite their critical roles, RBTs and BCBAs are often underpaid. An RBT earns an average hourly rate of $16-18, comparable to entry-level positions at companies like Amazon or Starbucks. Yet, the emotional and physical demands of the job are far greater. BCBAs, who undergo extensive education and training, face significant financial challenges. The total cost for education and credentialing can exceed $230,000, yet the compensation does not always reflect this investment.


Educational and Financial Investment
  • Bachelor’s Degree in Psychology or Social Work: ~$180,000

  • Master’s Degree in Psychology or Social Work: ~$50,000

  • RBT Work (2,000 hours at $16-18/hr): ~$32,000 - $36,000

  • Total Investment: ~$230,000


Given these figures, an RBT earning $16 per hour would make approximately $33,280 per year, assuming full-time work (40 hours per week). After accounting for basic living expenses (estimated at $25,000 per year), an RBT might only have around $8,280 left annually. If this amount were used solely to pay off student loans, it would take many years to repay even a fraction of the debt incurred.


Example:

  • Annual Earnings: ~$33,280

  • Basic Living Expenses: ~$25,000

  • Remaining for Loan Repayment: ~$8,280

  • Percentage of Loans Paid Off Annually: ~3.6% of $230,000


In this scenario, it would take an RBT approximately 28 years to pay off their educational debt, assuming no interest accrual and no changes in income or living expenses. This highlights the significant financial burden placed on these professionals despite the essential nature of their work.


Comparisons to Other Professions

To highlight the disparity, consider the pay and credentialing requirements for roles like baristas, babysitters, or marketing managers. While these positions are important, they do not demand the same level of training, emotional resilience, or financial investment as RBTs and BCBAs. Yet, the compensation does not reflect this difference.


Community-Based Health and DEI: A Broader Perspective

The need for support extends beyond direct therapy. Community-based health initiatives, DEI programs, and educational tools are essential for fostering a supportive environment for individuals with autism. This involves educating community service providers, such as teachers, healthcare providers, first responders, and those involved in after-school programs and recreational activities.


Empowering the Community

Imagine a community where everyone, from the local barista to the school teacher, understands the basics of autism and knows how to support individuals with autism. This vision includes inclusive after-school programs, sports coaches who can adapt activities to be more accessible, and first responders trained to handle emergencies involving individuals with autism with sensitivity and care.


Furthermore, gender can be confusing for children with ASD, who may not experience romantic love as others do. This underscores the need for gender-neutral professionals who can better relate to and support these children. Creating an environment where these children feel understood and supported is crucial for their development.


Opportunities for High School Students

This field also presents an excellent opportunity to engage diverse high school students and expose them to career paths in behavioral therapy and autism support. By integrating STEM-focused programs in schools and offering hands-on experiences, we can inspire young students from various backgrounds to consider careers in this field while developing awareness, empathy and support. Community-based initiatives can provide these students with valuable skills, mentorship, and the motivation to pursue higher education and professional roles in autism support, ultimately contributing to a more diverse and empathetic workforce.


Post-High School Development

One of the significant gaps in the current system is the support for individuals with autism after high school. Developing skills for appropriate careers and working with employers to create supportive job opportunities is crucial. This requires dedicated professionals who can identify the strengths and interests of individuals with autism, helping them to pursue meaningful careers. This is where DEI initiatives can make a substantial impact, ensuring that everyone, regardless of their neurodiversity, has the opportunity to thrive.


Post-Graduate Development

Beyond degree, certificate programs, and research efforts what role should Health Systems and Academic Medical Systems play? What is their role in supporting the communities they service relative to education and support of families with ASD children and adults.


A Call for Change

With the expected 22-25% job growth rate for BCBAs over the next decade, the demand for skilled RBTs and BCBAs will only increase. Yet, the field cannot sustain this growth without addressing the high turnover rates and inadequate compensation.


Notable Statistics:

  • In 2023, 18,705 BCBA candidates were tested, with a first-time pass rate of 56% and a retake pass rate of 23%.

  • The turnover rate for ABA therapists ranges from 30-75%. Assuming a 30% turnover rate of the 60,000 total therapists in the US, about 18,000 therapists leave the profession annually, while only 7,000 are newly certified.


This discrepancy highlights a significant gap in the workforce, exacerbated by the high costs and rigorous demands of entering and remaining in the field. Universities are beginning to address this by offering more specific Applied Behavior Analysis Therapy masters and certificate programs, which could help streamline the path to certification and reduce some of the barriers.


However, more needs to be done to ensure that these changes lead to tangible improvements in the workforce.


Conclusion: A Compassionate Future

This is not just about restructuring pay scales or revising job requirements—it's about recognizing the immense value these professionals bring to our communities. It's about creating a world where individuals with autism are supported and understood by everyone they encounter. It's about building a future where empathy and equity are at the heart of our healthcare system. We owe it to those with autism, their families, and the dedicated professionals who support them every day. Let's make this vision a reality.

Is this how we want our workforce structured? And we wonder why healthcare is so challenged. Let's strive for a compassionate future, where those who care are cared for, and every individual has the opportunity to thrive.


Yours in Health,

Mary Ellen



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