Autism rates in the United States have risen dramatically over the past decade. This has put pressure on autism service providers, who have struggled to find a large enough workforce to meet the demands.
In response, autism service operators are using new technologies and training programs to help retain, recruit and optimize staff. At the same time, an influx of private equity funds helped raise salaries to attract more clinical providers.
“We don’t have enough qualified clinicians, [or] licensed or certified clinicians. There just aren’t enough right now,” said Kathleen Bailey Stengel, CEO of NeurAbilities Healthcare, at the Behavioral Health Business INVEST conference. “So as a workforce, we really need to develop them within our company. We have to train them, we have to invest in them.
Based in Voorhees, New Jersey, NeurAbilities Healthcare is a nationally accredited Applied Behavior Analysis treatment provider. It has 10 centers in New Jersey and Pennsylvania.
About 1 in 44 children is identified with autism spectrum disorder, according to the CDC. That’s up from 1 in 69 children in 2012. Additionally, there are also more than 5.4 million adults with autism.
Applied behavior analysis (ABA), a type of individual therapy focused on improving specific behaviors, has become the gold standard for treating autism. Yet there are only 58,345 board-certified behavioral health analysts (BCBAs).
A 2019 study found that 49 states were below the ABA certified provider benchmark per capita supply.
“We have to remember that it’s actually very, very difficult work,” Stengel continued.
To support the pipeline of industry professionals, several autism providers offer registered behavioral health technician training programs. Others support staff through university partnerships that provide opportunities for ongoing education and training.
When it comes to staffing, the first 60 days of employment, in particular, are critical to long-term success, according to Doug Moes, director of clinical development at The Stepping Stones Group. During this time, it’s critical to keep employees engaged through training and immersing them in the culture of a practice.
Offering consistent and flexible schedules is also important, Moes added.
“Where can you access the adults?” Well, a lot of adults that you can access during the day when the younger ones are in school,” he told INVEST. “So [that’s] food for thought when considering how to leverage your workforce.
Boston-based Stepping Stones is a provider of behavioral health and autism services. It operates in 45 states. Its 8,000 employees serve more than 1,000 customers and 300,000 children a year. The supplier was named one of the fastest growing companies by Inc. 5000.
The issue of compensation
While training and non-financial benefits can impact the autistic workforce, there is also a financial element. Staff members generally expect annual raises, Moes said. Yet payor reimbursement rates are slow to keep up with rising wages.
Some operators seek to negotiate with payers and demonstrate the impact of their work.
“It’s not usual and customary for you to get rate increases from your payers every year,” Moes said. “You have to be very strategic and tactical. With our outcome data, [we’re] trying to make the case that we’re worth a rate hike, but [we’re] also trying to trade the annual indexes as a strategy just to mitigate.
Another factor tied to autism clinician salaries is the entry of private equity into the space. Last year, there were 40 deals in the autism subsector. In the first half of 2022, there were 46, a 15% year-over-year increase, according to data from the Braff Group.
“I think it’s also increased compensation for board-certified behavior analysts,” John Hennegan, a partner at Shore Capital Partners, told INVEST. “More and more investors have entered the space and said, ‘Wait, as long as we control the BCBAs, the customers will follow. And so we have seen rampant wage inflation.
Shore Capital Partners, based in Chicago, is a private equity investor. Its behavioral health portfolio includes Behavioral Innovations, BrightView, Column Health and Transformations Care Network.
The role of technology in expanding access, training
Technology could be a driving force to optimize the autism workforce and expand access to care. Digital tools could be used to help monitor, manage and train autism service providers.
“Very early on, we implemented a learning management system. …We’ve used it to gauge how well people are doing on the skills that move them forward [in] their career trajectory and help them move up the food chain,” Moes said.
When it comes to the workforce of the future, it’s a young population that’s coming into the field, Stengel explained. Many employees come from high school or college. Having easy-to-use technology is an expectation.
“They grew up with technology,” she said. “They want things to be easy, so you have to make it easy for them.”
Technology can also help solve the supply and demand problem in autism care. For example, digital tools can help providers reduce administrative tasks like scheduling assignments so they can instead have more time to work with patients.
Virtual reality and AI-powered technology can also improve training or expand access to care in the future.
“[It’s] a kind of ‘uberization’ of deploying behavioral technicians to meet needs,” Moes said. “It’s a different animal because we don’t drive cars; we provide treatment. But certainly we are sophisticated enough to know the kind of severity and acuity profiles of our children, and the kinds of ABA methods we want to use. And then we know our staff…in terms of skills.
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