How to Scale Clinical Excellence in a Multi-State ABA Organization

By Sam Blanco, PhD, LBA, BCBA (Chief Clinical Officer, BK Behavior Ventures) and Zach Rosen (CEO, Brellium)

Sam Armstrong Blanco is the Chief Clinical Officer of BK Behavior Ventures, a multi-state ABA therapy group. Sam has taught BCBAs for over a decade and is a leading expert on ABA clinical excellence. Sam holds a PhD in Applied Behavior Analysis from Endicott College.

Zach Rosen is the CEO of Brellium, which helps dozens of ABA agencies across the country, from 10-RBT startup agencies up through the largest ABA center in the country with 5,000+ providers, automate their note auditing with AI.

In this guide, we'll outline how to most efficiently set up your clinical quality process for your ABA center so it's prepared to scale as your organization grows. This guide is most helpful for Clinical Directors at small-to-mid size organizations who are looking to build and maintain clinical excellence.

Why Striving for Clinical Excellence is Important

1. To make sure that every client leaves your care in a better place than when they came in.
2. To make sure both your office staff and clinical staff know how to maintain a high standard.
3. If you're known for high quality care, you'll be able to attract more clients and better quality providers.

In short, clinical excellence means your clients, your providers, and your business are all better off.

Step 1: How to Outline Clear Policies for Your RBTs and BCBAs

Attaining clinical excellence requires a clear vision for the values of your organization, setting up proper policies and procedures, hiring staff whose values align, and training your staff to understand and implement the policies and procedures.

The key for your organization is to have:

1. A go-to clinical excellence expert within your organization that your providers can ask questions to while providing services.
2. Values-based hiring practices for both in-office staff and practitioners working in the field.
3. Clear, objective, and all-inclusive expectations on how your RBTs and BCBAs should handle day-to-day services as well as unexpected situations.
4. Goals clearly set, individualized, and monitored per client with ongoing changes as needed.

Your providers will need easy access to either your clinical leader or an experienced member of your clinical team. They should be able to respond quickly to questions or concerns and deeply understand the day-to-day of providing services and academic best-practices.

An additional support you should provide your RBTs and BCBAs is an Ethical Officer or Ethics Committee that providers can reach out to in order to safely report ethical concerns.

Taking the time to hire the right staff is the most important thing you can do after setting clear values-based policies and procedures. No matter how much experience an RBT or BCBA comes in with, you need to conduct training prior to placing them on cases.

Step 2: How to Select Your Clinical Excellence Leader

A critical part of scaling clinical excellence is ensuring you have the right clinical leader.

We usually see the most successful clinical leaders include very experienced BCBAs who understand the operations side of the business. They have context on therapy, working conditions, and can "speak the language" of the RBT and BCBA sessions they're overseeing. They've also lived and breathed the operations/managerial side of the business.

If you have a few experienced BCBAs on your team who are natural leaders and drawn towards operations, they can be GREAT candidates to scale (and potentially lead) your clinical excellence program.

Step 3: How to Set Up Your Clinical Excellence Program

You need a strong team in the office that includes:

1. Office staff who understand the mission and how their role relates to clinical excellence. Ensure they know how their role connects to the larger mission so they can support clinical excellence within their daily tasks.
2. A motivated, personable, and knowledgeable clinical leader. If your organization has one clinical leader and one operational leader, it is imperative that they work together and coordinate both long term and short term goals.
3. A strong quality assurance team. While your goal is that policies, procedures, and ongoing training set your clinicians up for success, a strong QA team allows you to catch errors, identify individual training needs, and identify larger patterns or gaps.

Step 4: How to Scale Your Clinical Excellence Program

As your organization expands, processes begin to break. One Clinical Director may be able to oversee a few locations. But, once you've expanded to a certain point they'll be overwhelmed, stressed, and things will inevitably begin to fall through the cracks.

We recommend selecting one clinical leader per location to oversee the day-to-day. They should consistently monitor the clinical excellence metrics you've set, and funnel the information up to your clinical leader. As your organization grows even larger, you may look to promote your high-performing Site Leaders to Regional Leaders overseeing multiple locations.

Brellium helps monitoring clinical excellence scale quicker. Instead of needing to consistently aggregate and de-aggregate data to view trends, Brellium analyzes all of your clients' sessions on your clinical quality metrics and gives you custom insights into where your organization is excelling and what needs improvement.

Step 5: How to Balance Clinical Excellence with Operations

As your agency scales, it becomes more resource-intensive to maintain clinical excellence. We recommend maintaining regular meetings between clinical and operations leadership, with specific time allocated to discussing clinical excellence.

Both sides should agree on clinical excellence Key Performance Indicators (KPIs) that remain static, so changes are observable. These KPI metrics should be reviewed on a regular cadence, with achievable goals pre-set.

When goals are met/exceeded, both clinical and operations leadership should make a point to commend the entire organization on quality of service. Taking a moment to praise your team for achieving goals also promotes continued excellence by making your staff feel even more valued.