Starting From Scratch: What I Learned Opening the First ABA Clinic in Our Rural Community

ABA therapy compliance is one of the most complex areas in behavioral healthcare. Providers must navigate a web of payor-specific requirements, state regulations, and BACB ethical standards — all while delivering high-quality care to their patients. This guide breaks down everything you need to know.

1. Documentation Requirements

Every ABA session must include specific documentation elements: treatment plan goals addressed, data collection methods used, patient response to interventions, and session duration. Missing any of these elements puts you at risk of denied claims and clawbacks.

2. Payor-Specific Requirements

Each payor has unique requirements for ABA documentation. Some require specific CPT codes for different service types, while others have strict guidelines around session duration and supervision ratios. Understanding these nuances is critical for maintaining clean claims.

Your story captures exactly what it looks like to build something mission-driven from the ground up in a community that truly needs it.

A few things stand out powerfully:

1. Calling over convenience

You didn’t move for a job or a market opportunity; you moved because there were kids going without life-changing services. That sense of calling comes through in every part of your story and is likely a big reason you grew from 2 clients to 25–30 families and a 30-person team in such a short time.

1. Building a workforce from scratch

In a county where ABA was virtually unknown, you weren’t just recruiting—you were educating, training, and shaping what ABA even means to the community. That’s a much heavier lift than hiring into an established market, and it makes your current team’s commitment even more meaningful.

1. Values that actually drive behavior

Generosity, integrity, honor, connection, and respect aren’t just slogans for you; you’ve operationalized them. Using Bonusly and tying points to specific, observable behaviors is very ABA-consistent: you’re reinforcing the culture you want. Integrating Brellium audit scores into that system is a smart way to align clinical quality with recognition.

1. Taking care of your people in a hard field

Guaranteed hours, 100% employer-paid health insurance, 13 paid holidays, 10 PTO days, and a paid Christmas week off—especially in a rural, high–cost-of-living beach town—send a clear message: your staff are not expendable. The annual staff fun day and focus on connection reinforce that this is a community, not just a workplace.

1. Practical, grounded advice for others

• Getting in network with as many funders as possible is critical in rural areas where volume is lower and payer mix is limited.
• Prioritizing people over profits is not just ethical; it’s strategic. Retention and culture are everything in a service-based, relationship-driven field.
• Your mantra of “communicate with consistency and clarity” is spot on—uncertainty and mixed messages are huge drivers of burnout.

1. A vision that sees the whole family

Your long-term goal of a multi-specialty clinic—ABA, mental health, speech, OT, diagnostics—reflects a deep understanding that autism affects the entire family system, not just the child. The name ENC Family Services and the idea that “ABA is just the beginning” beautifully capture that broader mission.

Overall, your story is a powerful model for:

• How to launch in a rural area with little existing infrastructure.
• How to translate values into daily practices and reinforcement systems.
• How to protect staff well-being in a demanding field.

If you ever decide to turn this into a full blog post, talk, or guide for new rural clinic owners, you already have the backbone: origin story, challenges, systems you built (hiring, culture, benefits, QA), practical advice, and future vision. It’s compelling, honest, and deeply encouraging for anyone considering a similar path.