One of my favorite comedians, Brian Regan, has a bit about playing baseball as a kid. He didn't love the game, but every kid got a snow cone afterward.
He figured out that it didn't matter whether he sat in right field playing with the grass or worked his tail off and hit a home run. Snow cone either way. So he sat in the grass.
I think about that bit constantly when I look at how ABA organizations support, or don't support, treatment integrity.
Where the snow cone shows up
If your organization reinforces only billable hours or time spent with a client, you may be reinforcing the wrong thing without meaning to.
When the pay, the bonus, and the recognition are the same for a straightforward case as for a client who is hitting, scratching, and kicking all session, nobody is reinforced for doing the hard thing.
I'm not saying bonus structures are bad, or that tying them to billable time is inappropriate. I'm saying that if you stop there, the system quietly rewards showing up and not doing the difficult part well.
Three kinds of fit
That is organizational fit, one of three areas I look at when I check whether a plan can survive in the real world:
Environmental fit: the time, space, competing demands, and routines. A plan could work if the child were alone in a quiet room, but he isn't.
Implementer fit: the skills, training, supervision, and buy-in of the person carrying it out.
Organizational fit: the feedback, reinforcement, accountability, policy alignment, and sustainability over time that keep the plan alive.
The math of supervision
A technician is alone with a client for most of the therapeutic hours. Say a client receives 30 hours a week. Insurers commonly expect somewhere between 5% and 20% supervision, which is anywhere from an hour and a half to six hours.
Even at the high end, 24 or more hours a week are delivered by a technician, often a newly trained one, who is effectively unsupervised.
That means most of the therapy happens when you aren't there. A plan that only works with a BCBA in the room has not been designed for most of the hours it will actually be used.
Four questions to ask about your organization
Who gives feedback, and how often does it really happen? Compare how often feedback is supposed to happen with how often it does.
Is effort acknowledged, not only corrected? Has anyone asked the technician or the caregiver what acknowledgment would be meaningful to them?
Does the organization act on resource requests? If a technician flags a missing material or a safety concern, what happens next?
Are barriers handled collaboratively or punitively? If a plan isn't working, is the first move to blame the technician or the parent?
Each one has a scheduled, proactive version. Standing time to review data and feedback with a technician or caregiver does more than a plan to check in when someone has time.
Reinforcement isn't one-size-fits-all
What reinforces you may not reinforce the people you supervise. Many technicians early in their careers are less moved by a retirement plan or a heavy benefits package than by pay, the feel of the workplace, and the value they see in the work. Even within a group of people the same age, preferences differ.
So ask them. You can run a preference assessment on your own team.
Systems, not heroics
Organizational behavior management has a long history of tools for finding barriers and building feedback loops, and contextual fit work sits comfortably inside it. A few practical moves:
Put a recurring supervision touchpoint on the calendar for every plan, and treat it as a requirement, not a favor.
Track whether the plan was followed, and make sure the person who followed it is acknowledged.
Plan for staff turnover. If a technician leaves, what keeps the plan consistent?
Check whether the authorization actually matches what the plan needs. If you need more supervision, parent training, or direct BCBA time, ask for it.
It's also not all on you. If you've built a plan that fits, trained and supported the people carrying it out, and still don't see change, the other party has a part to play. It's rarely 50/50, but it isn't 100/0 either, and carrying all of it is where burnout and "I'm not good enough" come from.
If you remember one thing: people do what the system reinforces, so build a system that reinforces the hard, important work.
You can see where your own plans stand with the free B-FIT Clinical tool on our Clinical Tools page, which scores environmental, implementer, and organizational fit for technicians and caregivers.
If you're leading a team and want help building the supervision, feedback, and reinforcement systems that keep plans going, learn about Clinical and Agency Consulting. I offer a free 15-minute consultation if you want to talk it through.
Casey Gressmen, MBA, MEd, BCBA, LBA, is a licensed special education teacher and board certified behavior analyst and the founder of Phoenix Rising Behavior and Academic Consulting.
