Transforming Applied Behavior Analysis Through AI-Powered Tools with Adam Ventura (Part I)

Episode Transcript
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SPEAKER_00 (00:00):
Welcome to ABA on Tap, where our goal is to find

(00:14):
the best recipe to brew thesmoothest, coldest, and best
tasting ABA around.
I'm Dan Lowry with Mike Rubio,and join us on our journey as we
look back into the ingredientsto form the best concoction of
ABA on tap.
In this podcast, we will talkabout the history of the ABA

(00:35):
brew, how much to consume toachieve the optimum buzz while
not getting too drunk, and therecommended pairings to bring to
the table.
So without further ado, sitback, relax, and always analyze
responsibly.

SPEAKER_03 (00:53):
all right and welcome yet again to another
installment of aba on tap i amyour ever grateful co-host mike
rubio along with mr daniel lowrymr dan how you doing today sir

SPEAKER_00 (01:05):
great great doing great excited to have another
guest on today

SPEAKER_03 (01:08):
yeah it's been a couple weeks since our last
guest it was a greatconversation with dr scott
o'donnell and i i think that uhtoday's conversation will will
be uh just as promising andinteresting we're going to be
talking about Something that,quite frankly, I've been a
little fearful of, and I thinkI've admitted it on the podcast,
and I think that our guest isgoing to help me work through
that fear today.

(01:30):
So I'm excited to welcome AdamVentura.
Let me talk a little bit aboutAdam.
He is a leader in theintegration of artificial
intelligence and behaviorscience.
He's the founder and CEO ofIntraverbal AI, a company that's
dedicated to transformingapplied behavior analysis
through AI-powered tools thatsupport ethical decision-making

(01:50):
supervision and clinicalefficiency.
So without further ado.
Mr.
Adam Ventura

SPEAKER_01 (02:23):
Thank you guys so much for the invite and for that
great entrance music as well.
I remember that you guys justtold me a few minutes ago before
we went live that you're lookingfor names for your virtual band.
So I am going to take some timeafter this podcast to come up
with a couple of names and I'mgoing to use AI to do it and
then send it over to you guys.

(02:44):
That is

SPEAKER_03 (02:44):
perfect.
That is perfect.
For whatever it's worth, Ibelieve it would be Gemini that
helped me with yourintroduction.
So I hope it got it right.
AI-powered Gemini I got it rightthere on Google.
That's, again, me overcoming myfears slowly and gradually.
Obviously, you punch it into thesearch, it does it for you.
I hope it's that easy lookingforward to the tools that you'll

(03:06):
be talking about.
Before we get to that, we lovethe origin story here on ABA on
Tap.
We like to talk about the brew,basic ingredients, how everybody
brings them together to presentsomething palatable, something
that's functional, that worksfor individuals.
Please, kick us off.
Tell us a little bit about yourbackground.
I think you've done everythingthat Dan and I have, and now

(03:27):
you're pushing the field forwardin some new directions.
So tell us all about what gotMr.
Adam Ventura started and whatkeeps you going.

SPEAKER_01 (03:36):
Sure, absolutely.
It's interesting that you askedabout my origin story here
because I've been in the fieldnow for 20 years.
And I was having a discussionwith somebody the other day and
they're like, how long have youbeen in the field?
I've been in the field for twodecades.
And then I had one of those takea pause moments and I'm like,
wow, I've been in behavioranalysis for 20 years.

(03:57):
But I feel like so many peoplein the field specialize in one
thing and that's kind of theirclaim to fame.
Where with me, I never reallyspecialized in anything in
particular, I feel like my thingthat makes me unique is I've
worked in just about everysetting doing everything.

(04:19):
So when I started in the field,I started working with adults.
I was working in group homes.
I was working in adult daytraining facilities.
Then I moved over to doingfoster care.
I did that for a few years.
And then I started working withkids.
And somewhere around 2010, 2011,I ended up starting my own

(04:41):
company, my own ABA therapycompany in Miami.
And I ran that for almost 10years before I sold to private
equity.
And during that time, ourcompany grew and flourished.
By the time I sold the company,we were in three states.
We had just under 300 employees.

(05:04):
Good Lord.
Yeah, yeah.
It was way more than I everexpected.
I was very fortunate to workwith a lot of great people.
And we worked in a variety ofdifferent settings.
So like I was saying, we workedin schools, homes.
I continued doing group homesfor a little while after I

(05:24):
started my company.
Then after I sold the company, Idid a lot of different things.
I wasn't sure what I wanted todo next.
So I did some OBM consulting fora while.
I started an OBM practicemanagement software system and I
wrote a few books during thattime as well.
So I had a lot of differentthings going on and I feel like

(05:46):
I've been very fortunate in thatmy experience in ADA has been
very diverse.
I've worked in the privatesector a lot.
I worked in academia.
I taught at FloridaInternational University in the
behavior analysis department for12 years.

SPEAKER_00 (06:06):
RIP Jose Martinez.

SPEAKER_01 (06:09):
Actually, he was FIT.
Oh,

SPEAKER_00 (06:12):
good

SPEAKER_01 (06:12):
guess.
Yeah, so Florida Institute ofTechnology.

SPEAKER_00 (06:18):
Oh, sorry, sorry.

SPEAKER_01 (06:20):
No, no, yeah, no problem, no problem.
We actually worked with him agreat deal and...
mad respect to him i mean he'she contributed so much to our
field but yeah fit is in likethe center of florida like the
melbourne area fiu is in likethe miami area

SPEAKER_00 (06:36):
gotcha

SPEAKER_01 (06:38):
but um yeah so uh i i think that's uh uh my elevator
speech for my origin story hereis that i've worked in a variety
of different settings i've beenreally fortunate in in that area
and I know a lot of people in alot of different domains of
behavior analysis.
And that's something that'sreally professionally

(07:00):
reinforcing for me is I have theopportunity whenever somebody
comes to me and says, you know,I really need somebody that
works in schools that can helpBCBAs get started.
No problem.
I know like five people.
I need somebody that does OBMconsulting and manufacturing
plants.
No problem.
I know somebody.
So I'm really fortunate in thatI know a lot of different people

(07:22):
in a lot of areas.
guys.
Yeah, I would say that's myorigin story here, and happy to
dive into any of those details.

SPEAKER_00 (07:31):
Awesome.
That's so exciting.
I feel like, not the mission ofthe podcast, but it's almost
changed over the last littlebit.
We started talking about ABA andthe partition of that with
individuals with autism, butover the last, especially with
the guests that we've had, we'vetalked about the diversity, and
I think that's really special,because ABA so often gets, like
we talk about, pigeonholed intoautism, right?

(07:53):
but kids with autismspecifically.
So it's so cool to have somebodylike yourself, Adam.
We've had a few, Dr.
Scott O'Connell, the last guest,not just with kids with autism,
in fact, working with adults.
So also the organizationalbehavioral management piece.
So it's just so cool to have thediversity from ABA.
Yeah,

SPEAKER_03 (08:12):
yeah.
Tell us a little bit.
So you said foster care andgroup homes.
Those can be very diverse, veryinteresting, very challenging
settings.
Tell us a little bit about yourexperience there.
And again, that's certainly nowdealing with behavioral
challenges outside of spectrumdisorders, maybe within.

(08:32):
Tell us a little bit about yourexperience in those settings.

SPEAKER_01 (08:35):
Yeah, I worked in, I only did foster care, I would
say for about a year and a half,but I did, I worked with adults
in group homes and ADTs forreally the first like seven
years of my career, six, sevenyears, something

SPEAKER_00 (08:47):
like that.

SPEAKER_01 (08:48):
And it's really hard work in the sense that if you
don't work at the right place,and I worked in a lot of
different places, you end upbecoming a paper pusher.
instead of somebody that isactively making the lives of the
individuals that you work withbetter.
And I worked in really toughgroup homes.

(09:10):
Like I'm thinking about a coupleof group homes that I worked in
where we got clients out ofjail.
So they came out of prison andwe dealt with the hardest
behaviors Um, you can imagine,um, really difficult behaviors,
not just physically aggressivebehaviors, but property
destruction, uh, sexualaggression behaviors, um,

(09:32):
severe, severe self injuriousbehavior.
So it was, I, I was.
uh good at navigating the systembut i never really felt like i
was making the difference that ithink our science can and i was
moments away from leaving thefield and going and doing
something else and then i endedup transitioning over to work

(09:56):
with kids and you know whenyou're working with kids you
have you're working with ashorter history of conditioning
you know so if you're like ifyou go start a client that's 50
years old and it's been in thesystem in a group home for 30
years they've been doing thesame things the same way um
changing behavior is reallydifficult but you know if you're

(10:17):
working with a four-year-old ora five-year-old you know their
history of conditioning is muchshorter so it's easier to make
uh changes and um so yeah it'sWorking in group homes was
challenging.
It was tough.
It was physically demanding.
I've had everything happen tome.

(10:38):
I've gotten poached, kicked,bitten, burned, hit with chairs,
you name it.
We've had everything happen tous.
It's challenging work and I wishthe system was set up because
they're usually run throughstate or federal money.

(11:00):
And I wish private insurancewere more involved with this to
shake things up a little bit.
And I wish the system worked alittle bit differently because
you just don't see a lot ofmovement, a lot of improvement
with the clients that are there.

(11:21):
breaks your heart in a sense youknow and it kind of makes your
job aversive and i got to thatpoint when i hit like year six i
was like i don't want to do thisanymore i'm not making a
difference you know i'm justpushing paperwork i was involved
in audits three four times ayear because i was contracting
out to different companiesthey're constantly auditing

(11:42):
those places it's reallystressful um so it just It
wasn't the best time in myprofessional career.
I worked with great people.
I think there's a lot of peoplethere that want to make a
difference, but it's not reallywhy I got into the field.

SPEAKER_00 (11:58):
That makes a lot of sense.
Yeah.
Have you heard of a PROACT,PROACT Crisis Management at all?
What's it called?
PROACT.

SPEAKER_01 (12:06):
No, the one that we used was, um, PCM professional
crisis

SPEAKER_00 (12:11):
management.
Yeah.
There's also CPI.
Um, but yeah, the company I workfor is product.
So we work with a lot of peoplethat do group homes and
residential facilities and, uh,definitely a different, um,
demographic than the, you know,in home ABA.
Um, and it's interesting too,because we get a lot of people
that are coming and startingtheir own, um, group home and,

(12:33):
um, I don't think they realize,kind of like you were saying,
Adam, what they are signing upfor.
Because it is a lot.
The people are a lot.
And sometimes the support thatyou get isn't a lot, but the
expectations are.
Here in California, a lot ofthem are funded by the regional
centers and the Department ofDevelopmental Services here in
California.

(12:53):
And yeah, it's a lot.
It's just thinking about that asyou were talking that...
Yeah, that history ofreinforcement.
Even when we deal with 18 yearolds, 15 year olds, it's so much
harder than it is a three orfour or five year old.
I can't imagine a 50 year oldexpecting any sort of behavior
change.
And then like you're saying,it's paper pushing and then
probably just going to work andtrying not to get hit because

(13:14):
you're not really making a wholelot of meaningful changes
probably at that age without alot of intensive support.
So,

SPEAKER_01 (13:22):
yeah.
Yeah, and the other thing Iwould say too about working with
adults is especially withinthose state-run facilities, is
that the behavioralcontingencies that the state
oftentimes, and I'm not anexpert on other states, I did
most of that work in Florida,the way they set up those

(13:43):
behavioral contingencies, itdoesn't reinforce client
improvement.
It reinforces audits andpaperwork and you know and
behavior goes wherereinforcement flows so i ended
up doing uh the tasks that thestate wanted which is and they

(14:03):
it may not be what they statethat they want but it's the
contingencies contingencies thatthey set up which were make sure
that your paperwork is in ordermake sure that you're checking
off all of these boxes and youknow there wasn't you know they
weren't doing like in-depthanalysis of how how much the
clients were improving and theydidn't reward the providers um

(14:28):
that got these improvements withthe clients either so i i think
and again there's a lot of greatpeople working at the state and
a lot of great providers outthere it's just I feel like some

SPEAKER_00 (14:44):
structural changes would do that system a lot of
good.
these funders want, whether it'sprivate insurance, state,
whatever.
And it's like, do the peopleeven know the procedures?

(15:06):
That doesn't matter.
Can we just make sure that thenotes look right so we don't
fail an audit?
So I even see that in theprivate sector of not failing an
audit being the motive and thereinforcement for success.

SPEAKER_03 (15:18):
Yeah, it takes focus away from the real work, right?
Yeah, it takes the focus awayfrom what you're trying to do.
So was there any level of, youknow, was there any level of
measurable success rate for thatwork?
I would imagine that they'relooking at the paperwork, but at
some point they have to look atsome rate of success and say,
well, this isn't working.
What are we going to change?
Or it's just kind of a systemthat rolls on.

(15:40):
That's what it sounds like.

SPEAKER_01 (15:42):
It was my experience that it was a system that just
rolls on.
And I found myself jumping fromjob to job a lot, trying to find
more meaning in my work.
And we were just talking.
about, I think Dan, you broughtup crisis management.
And I became a PCM instructor.

(16:04):
I was like, let me try somethingnew.
Let me see if I can get somemore success here.
And I started moving into therealm of staff training a little
bit more.
And that included becoming a PCMinstructor.
And I found a little bit moremeaning with that.
And I started moving intosupervision and working with
younger behavior analysts.

(16:25):
So that was a little bit morereinforcing And then in 2010,
2011, maybe it was 2009, Iforget the year, but the
insurance mandate came out.
And when the insurance mandatecame out as, you know, for
anybody that's been in the fieldthis long, that was the game
changer.
And I'll identify something inspecific.

(16:46):
When I was working, I workedMedicaid waiver.
I know you all have anequivalent out in California,
but in Florida, it's Medicaidwaiver.
I would get...
two hours a week to work withthe client with no what we
called back then behaviorassistant help so obviously this
is in like i would say 2005 sixseven there was no such thing as

(17:08):
an rbt there was no such thingas a behavior technician if you
wanted what we called back thena behavior assistant um you
would have to submit a lengthybehavior program.
And when I say lengthy, I'mtalking 25, 30 pages, not a
reauthorization report, like alengthy behavior program to the
local review committee.
They would have to approve it,and then you would have to get

(17:30):
the state to approve it as well.
And those were few and farbetween.
So if you were a behavioranalyst back then, you had two
hours a week to work with theclient.
And with a client that has,let's say, a 30-year history of
conditioning living in orexisting within the system, two
hours a week you're just notgoing to make progress you know

(17:52):
no matter how hard you try so ii try different creative things
i'm like instead of working withthe client directly we focus on
staff training then i was likewell let me start working with
the group home managers a littlebit and i just kept throwing
jello at the wall trying to makeit work and it wasn't and it was
demoralized

SPEAKER_03 (18:11):
Yeah, that's a lot.

(18:41):
Or did you see a lot of peoplehave one incident and then have
to go right back in?

SPEAKER_01 (18:47):
You know, one of the experiences that I had that was
very lightning positive, I wouldsay, is I did a lot of IDT
meetings, so interdisciplinaryteam meetings, and I learned a
lot from that because we had Ifeel like we should do so much
more of that now.
I feel like that happenssometimes with IEP meetings in
schools, but for the most part,we don't do that.

(19:09):
But we did a lot of that backthen.
And we would have a psychiatristthere, a speech person there,
OT, PT, the group home managersthere.
We would have like an hour and ahalf long meeting with like 10
people in the room about oneclient.
And it was really cool,actually.
I remember learning so muchabout medication, how these
facilities were run, how wecould make environmental changes

(19:32):
that would impact the behaviorof the client.
But to answer your question, alot of what was done was med
changes um to these clientsagain one of the saddest parts
is when these clients exist inthe system for so long they end
up getting prescribed a lot ofpsychotropic medication and we

(19:53):
were doing our best to be goodbehavior analysts in changing
one thing at a time putting inthe phase change on the graph
phase change line on the graphand then observing what happened
with those clients afterwards,and then jumping back into the
IDT meeting, having aninteraction with the
psychiatrist and said, here'sthe data.

(20:14):
This is what that med changedid.
So we did a lot of that.
We worked with, I testified incourt a few different times,
which was an experience.
which was kind of an exciting,I'm going to be honest with you,
it was kind of an exciting thingto do.
And when you get in there, youtake it very seriously.

(20:35):
So I remember dressing up in asuit.
Nobody else was in a suit, but Itook it very seriously.
I dressed up in a suit.
I came in, I had notes.
I said, this is what's going on.
And so to answer your question,I would say it was a combination
of, it was really aninterdisciplinary discussion.
And we talked a lot about umtheir behavior versus the

(21:03):
outcome of maybe sending themback to prison or making a
recommendation because thatwasn't our job to make that
decision but we would make arecommendation and we would we
would oftentimes sit down andsay okay yes he had a really bad
behavior this client he attackedanother client that's not good
but in the broader picture herewe think that this was just an

(21:27):
isolated incident and that wecan make some changes with him
with just some tweaks or he'sbeen making so much progress
this was just like one bad dayand nobody wants to get judged
on their worst day you know souh we took a lot of that stuff
into consideration before wemade recommendations sometimes

(21:48):
it happened you know we had toum have to make some hard
choices sometimes you know someof them would you know attack
other clients i worked at aplace um i'm sure you all have
an equivalent out there wascalled an intermediate care
facility in icf and it wasbasically like a six-story
apartment building and in thissix-story apartment building we

(22:11):
had about 60 adults that workeduh that lived in there and you
know, if you had one that maybehad an incident, a serious
incident once every few monthsor something like that, and the
injuries weren't that bad, itwas more just kind of a scuffle,
you know, that's one thingversus, you know, we had serious

(22:33):
incidents where, you know, aclient pretty badly attacked
another client.
And I won't go into detailsunless you guys really want it,
but some of them are prettyhorrifying.
So long story short, we wouldtry our best to make
interdisciplinary decisions andrecommendations based on all of
the factors involved.

(22:54):
So I would say that that was onepositive part of my experience
working with adults is you getto work with other professionals
and see different perspectives.
And I thought that those werepretty positive.

SPEAKER_03 (23:06):
So from that angle, these individuals were getting a
second chance.
It wasn't like one mishap, oneassault within the facility, and
then they were going back.
You all had the opportunity tosay, no, wait a minute, they're
doing better.
This is an isolated incident, asyou were saying.
And now, I mean, I guess that'sdifferent from now being out in
the community where if they'redoing that out there and they

(23:27):
get picked back up, it's almosta sure thing.
I'm guessing that they'regetting back, you know, thrown
back in.
So that's really neat that atleast it seems like the system
was working in that way, thatwithin that isolated facility,
home or that facility, you allhad the jurisdiction to say, no,
this is an assault and it wouldbe illegal anywhere else.
And it would probably put theirparole at risk.

(23:51):
However, we're working to changethat behavior.
I mean, that just sounds,despite all the challenges
you're talking about, that seemssomewhat positive that people
are getting more than a secondor third chance to try and
change those behaviors.

SPEAKER_01 (24:05):
Yeah, absolutely.
And I will say one more thing,not to bring it to a negative
thing.
But again, if we're looking atthe behavioral contingencies, if
we recommend based on a client'sbehavior for them to be placed
back into a prison typefacility, the facility that
we're working in loses money forthe client that are there.

(24:28):
So I hate to say it, but ifwe're just being honest here,
that was always a factor.
It shouldn't have been.
We did our best to focus just onthe behavior.
But if you're working in anorganization and the folks that
are in charge of theorganization make it clear that
if we lose too many clients,that impacts the revenue here

(24:51):
and then that impacts jobs.
So unfortunately, thosedecisions weren't made in a
vacuum.
We tried our best, like I said,when we get to those IDT
meetings to make decisions basedon what's best for the consumer.
but we had to work withinreality.
And if we made, that happened tome a lot when I was a young

(25:12):
behavior analyst, I was justlike, you know, this is what's
in the best interest of theclient.
And then I'd get pushed backfrom some of the organizations
that I worked at.
And they said, well, you know,and you know, they would make
excuses and say, well, if theyjust go somewhere else, they're
going to have the same problem.
So it's just best to keep themhere.
So you deal with a little bit ofthat.
And just like ABA companies now,there was good facilities and

(25:33):
there was not so greatfacilities and you just do your
best.
Yes.
do your best within thoseorganizations.

SPEAKER_03 (25:41):
What a fascinating experience.
And again, I think for ourlisteners, cool to hear the
presence of behavior analysiswithin that circumstance.
I don't know how that plays outhere in California, but I'm
certainly going to look into itbecause that seems like an
important forum where we wouldbe able to make a change.
And despite some of the systemicchallenges that you faced in

(26:02):
Florida, which I'm sure areprevalent in any given state
with that particular population,Just another angle for us as
behavior analysts to considerwhere our work could be of good
contribution and where it'sclearly still needed.
I mean, that sounds like a verychallenging experience you went
through.
Thanks for sharing that.

SPEAKER_00 (26:20):
Okay.
You were talking, you kind ofmade a segue there to ABA
companies, and you mentionedearlier that you started your
own ABA company.
So can you tell us a little bitabout that?
Maybe what made you want tostart your ABA company and how
that came about?

SPEAKER_01 (26:35):
Yeah, absolutely.
I actually had no interest instarting an ABA company.
I was an independent contractor.
It's interesting because I knowthat most states don't have a
culture of independentcontractors like Florida does.
In Florida, we had a bigindependent contractor culture
for a long time, and I was one.

(26:58):
contracted out to, I rememberbefore I started my company, I
was contracted out to fourdifferent agencies.
So I was doing work for fourdifferent agencies.
I was working six days a week.
I was driving around todifferent group homes and
agencies.
And I occasionally took or didsome work with um card so um

(27:19):
there's two different cardsthough and i always have to
explain this there's the privateenterprise card and then there's
the not private enterprise cardi work with the not private
enterprise card and they'refantastic they're still in
existence and thriving here inflorida they really act as I
would say support coordinatorsor service facilitators.

(27:43):
And I have a good relationshipwith them.
And the director at the time, Ideveloped a reputation over the
years for dealing with severecases of like aggression,
self-injury, propertydestruction, just kind of became
my professional specialty for afew years.
So I remember the director ofCARD sent me one client and he

(28:07):
said, hey, listen, you know,this is...
It was a younger kid.
At the time, I believe he waslike eight or nine.
And he said, hey, do you thinkyou could take on this client?
I said, sure.
And it was right when TRICARE,interestingly enough, started
the I don't know if it was theecho program or the autism
demonstration.
It was one or the other.

(28:29):
It was one or the other.
It was like 2009, 2010.
Sounds about right.
Okay.
Yeah.
And I took the client on and Isaid, okay, you know, no
problem.
And I started working with theclient and then this person
contacted me again.
He said, I might have anotherclient for you.
And I already had a full slateof clients across the different
places that I was working.
And I'm like, okay, I'll takeit.

(28:50):
But then it was maxed out.
And then he came to me again andhe said, you know, Adam, I've
got some more clients for you.
I'm like, listen, I can't takeout any more clients.
And then he looked at me, he'slike, just hire somebody.
And it was just this kind ofdirect moment and like
crystallizing moment.
I'm like, I can hire people?
How does that work?

(29:11):
So I was like, okay, so I canhire somebody.
So I had just started teachingat FIU.
And there was a student that gotthrough my first couple of
courses really well.
So I just went to her and I waslike, hey, are you interested in
doing this sort of work?
And she said yes.
And we didn't have theformalized RBT training back

(29:32):
then that we do now.
you just kind of made up yourown training and you did your
best.
So I created a training, trainedher for months.
She started working with some ofthe clients.
Things started going reallywell.
By the way, that first clientthat I'm mentioning, um i heard
a few years ago graduatedcollege wow and when i first

(29:55):
started working with that clientyeah it was it's just so
rewarding because when i firststarted working with that client
um he was maybe eight or nineyears old um he was um it was a
military family obviouslythrough tricare he had zero
communication skills at eightyears old um engaging in severe
tantrums severe um propertydestruction And then he

(30:17):
graduated college.
And it was just such a greatmoment.
So yeah, so I brought on thisone person.
She started working with me.
And then I got another phonecall from somebody else at Card.
And I'm like, listen, the personthat I hired is already maxed
out.
And they're like, well, we havemore clients.
And I said, I don't have anymore hands.
There's only so many of us.

(30:38):
There's only so many hours inthe day.
And then the same person got onthe phone with me again and
said, Adam, just hire morepeople.
And then I got the message afterthe second instruction, and I
just started hiring more people.
And in 2011, I went from twoclients through insurance, two,

(31:02):
three, something like that, toabout 60.
Wow.
Because, yeah, yeah, theinsurance mandate just came
rushing in.
and all of these kids thatneeded services.
And I was really fortunatebecause when I taught at FIU,
there were so many students inmy courses that were interested

(31:22):
in doing this sort of work.
So it kind of became a feedersystem for us and we set up
training programs and we justgrew really quick.

SPEAKER_00 (31:33):
Did you find it hard to meet the demand?
Because that's a really quickgrowth.

SPEAKER_01 (31:38):
Oh yeah, 100%.
I think...
If I knew then what I knew nowabout growing an ABA agency, we
would have grown to 200 clientsin that first year.
There was just so much I didn'tknow.
I had no understanding about howemployment law works or how to
start and run a company.
And you have to do payroll.

(31:59):
And the biggest thing that Ididn't understand, I'll say this
really quick, is I didn'tunderstand how medical billing
worked.
Neither did the insurancecompanies with ADA.
When we got started, I didn'tget paid for the first six
months.
Yikes.
Not because we didn't know howto do it.
We were actually doing thingscorrectly.

(32:23):
I had to send someone that Ihired to do billing to sit with
people at the insurance companyfor about two months to explain
to them how we should fill outthe CMS 1500 form.
Oh,

SPEAKER_00 (32:36):
man.
Yeah, we just started our ownABA company, so I feel you on
the billing side of things forsure.

SPEAKER_01 (32:43):
Oh, my gosh.
And I'll never forget, I had tohave a really comfortable
meeting with my staff at thetime, and I said, I'm sorry, but
you're all going to have to beindependent contractors and I'm
going to have to pay you 30 daysin arrears.
So they would work, let's sayfrom January 1st to January 31st
and get paid March 1st.

(33:03):
And having that discussion withfolks, I'll never forget that
day.
That was a hard talk.
You know, telling people thatthey're not going to get paid
for a month or two because asI'm sure you guys are going
through right now, the insurancecompanies don't, when people
work, they don't

SPEAKER_00 (33:21):
pay the next day.
Yep.
Did you lose a lot of peopleduring that conversation?

SPEAKER_01 (33:25):
No, you know what?
I didn't lose anybody.
And I remember having that talk.
It was with about 25 of my staffand I'll never forget, we were
having this discussion in myvery first office.
I just brought them all in thereand I just laid it out straight.
And I said, listen, you know, ifsome of you want to leave, I'll
understand, but you know, thisis our mission here and we're

(33:49):
trying to help out these kids.
I promise I'm doing everythingthat I can.
was one of those believe in usbelieve in me i promise i won't
let you down um and it just ittook years for everybody on both
sides the insurance side and theprovider side to figure out how
to build aba nobody reallyunderstood it you know the the

(34:11):
the laws just came down and theysaid well you have to cover this
service and the insurancecompanies were like okay how do
you do that So we there was alot of providers working with
insurance companies.
It was a completely differenttime than it is now We met with
them regularly and said folks,you know, this is how you need
to build these services This iswhy you need to do this and you

(34:33):
need to pay us Yeah,

SPEAKER_00 (34:36):
it's the wild wild west now I can't imagine what it
was like in its infancy Iremember and I probably talked
about this in the podcast, butthe company we worked for
originally, that was the one Iworked for at that time, there
were like no regulations oranything.
So originally it had to be alicensed staff.
So it either had to be like anurse practitioner or an OT

(34:58):
supervised because there was inCalifornia, there was,
certification but no licensingwe still don't have licensure
yeah insurance said you had tobe licensed so we were being
supervised in our aba programsby occupational therapists
because that's what insurancesaid that we had to do yeah
those were the days those werethe days i mean

SPEAKER_03 (35:15):
it's changed a little bit i think it's gotten a
little bit easier from whatyou're describing um and and one
of the things that's veryinteresting you sound very
clinically oriented i think Youknow, I identify with that right
away, meaning you put me to doadministrative tasks.
You're going to lose me.
You're going to lose my contentexpertise.
It's not my cup of tea.
I need to be out in the field.
I need to be with clients.

(35:37):
And it sounds like at thebeginning you had to face that
transition.
Tell us a little bit about that.
You know, it sounds like you'revery passionate about the direct
work.
All of a sudden, you're havingto hire people.
You're having to learnemployment law.
You're having to deal withbilling and deal with insurance
companies.
Clearly, that takes you awayfrom the hands-on work.
How did you deal with that?
What was that experience likefor you?

SPEAKER_01 (35:59):
Yeah, that's a great question.
Thank you for asking.
I would say I did like theclinical work.
I like behavior analysis.
I think a lot of people...
get into the field because theywant to work with kids.
I like working with people, butmy first love, my first passion
was the science.
I connected with the science.

(36:20):
I relate to that.
Oh, can you?
Yeah.
And I feel like that doesn'thappen as often.
And that's sad to me.
I love the science.
I like learning more about thescience, expanding the
boundaries of the science.
Um, so that was kind of my firstlove.
Um, I, I did do a lot of theclinical work.
I enjoy the business aspect ofthings.

(36:42):
I really enjoy businesses.
Um, I've opened since then I'veopened a ton of businesses in
different aspects of, um, indifferent, uh, business
industries, a lot in, uh,behavior analysis.
So I like the business part.
I absolutely hate ABA admin,scheduling, medical billing,

(37:04):
reauthorization reports, HRstuff related to that.
I hate that stuff.
I went to school for behavioranalysis and psychology.
I did not go to school to learnhow billing codes work and
audits and the rest of that.
The business side of things,leadership, management,
coaching, that sort of thing,making deals.

(37:26):
I love making deals.
I love connecting people,setting up business
partnerships.
I really enjoy that.
That's really reinforcing forme, but I need to survive and
flourish in a business endeavor,I need folks that I can work
with, that I can lean on, thatcan take care of that day-to-day

(37:46):
scheduling or billing or keepingthe books organized.
Those are not my strengths, andI lean on people to do those
things.

SPEAKER_03 (37:54):
That's good advice for us, for sure.
I'm very grateful for this guywho does a lot of the admin
stuff for us and will sit on thephone with insurance companies.
And like I say, I'd rather bekicked, scratched, and spit on
than sit on the phone for twohours waiting to discuss some
denied claims.
Anyway, we'll see if thatchanges.

(38:15):
I think as I learn more, I agreewith you.
As I learn more in terms of theleadership aspects and I guess
how to explain to youngerprofessionals the nature of the
business so that they can valuetheir clinical work but also
understand its monetary value,it's something that we're really
trying to delve into so thatwe're out to save the RBT I

(38:37):
don't know that anybody Yeah,logistically, yeah.

(39:36):
there's a lot that we can employfrom our constant expertise.
For example, working with kids.
There's a lot to negotiate inworking with kids that can
transfer over.

SPEAKER_00 (39:45):
Do you have any thoughts on that, actually, as a
multiple business owneryourself?
Any thoughts on that, trying toincentivize RBTs to looking at
the reimbursement rate that weget from insurances that are
going to be compensatedsomewhere around that in
California, that fast food rate,but then they're going to have a
much more fluid schedule andpresumably a much more

(40:07):
challenging job description.
Any thoughts on that?

SPEAKER_01 (40:12):
I have a lot of thoughts on that, but I'll try
to focus my thoughts.
Take your time, sir.
Take your time.
So it's interesting, Dan, youmentioned FIT over here.
And with my aviation therapycompany years ago, we set up the
first hybrid program with FIT.
And what that meant was we got afantastic FIT professor to work

(40:38):
on our campus at our clinic.
we set up the fit mastersprogram there so our rbts at the
time they were behaviortechnicians actually did their
master's degree at our clinicwith the professor there so the
reason i'm bringing this up isbecause the way that we worked

(40:59):
around this was i had two feedersystems i taught at fiu i
recruited students there andthen once they were in doing
that kind of rbt back then roleThen we convinced them to do the
FIT program to get theirmaster's degree.
And the idea was, I live myprofessional life with a simple

(41:20):
credo, keep moving forward, keepmoving forward.
And I would stress that to mystaff all the time.
And if they were moving forwardwith their career, then we found
that there was a lot lessburnout.
There was a lot less turnover ifthey were focused on that.
And those two setups with thosetwo universities made such a

(41:42):
difference.
And I remember with the firstcohort of the master's program
through FIT, I covered the costof it for them.
just to get people excited aboutit because I knew that it would
work well.
And so many of the people thatgraduated through especially
those first cohorts arefantastic behavior analysts now

(42:05):
and run their own companies.
So I really look back on that assomething that I feel positive
that I contributed to the fieldis encouraging people to get
excited about our field not justworking with kids but also about
the science and fit does such agreat job of sticking to the
science not kind of venturingoff and they along with our work

(42:31):
experience i think we created alot of great behavior analysts
and that would be my advice tofolks out there you can do
Everybody tries to get clever.
Oh, let's do performancescorecards.
Let's pay them more money.
Let's give them more time off.
The way that I like solving thatturnover problem is give them

(42:51):
purpose.
Give them direction.
Say, you know what?
Here is this goal.
It's out in the distance.
It's three years out, but youcan become a BCBA one day.
You can do this.
You can do that.
And then here's a whole bunch ofshort-term objectives along the
way.
Let's hit one at a time.

(43:13):
You know, and something I usedto always say to my staff is,
I'm not sure, do you guys knowhow to eat an elephant?

SPEAKER_00 (43:20):
One bite at a time.
There you go.
One bite at

SPEAKER_01 (43:24):
a time.
I find that eating an elephantis one bite at a time.
And I said, the elephant isgetting your BCBA and being a
supervisor.
Because back then, everybodywanted to move.
You get worn out from doingdirect one-to-one care because
you can only get spit on andkicked and punched and scratched
and the rest of that so manytimes.

(43:45):
So I would give them this goaland say, listen, get through
three months and then six monthsand then a year.
And you just keep stackingaccomplishments, one on top of
the other.
And then you hit supervision.
And what I tried to do at myorganization was create keep
creating those benchmarks soeven if they hit became dcbas
something that we set up backthen that didn't always work out

(44:06):
well but we set up specialprojects and say hey what are
you interested in in behavioranalysis um besides therapy and
some people would be interestedin technology or research or
something like that so we triedto create avenues for people so
that they can keep movingforward and if they're moving
forward if you're busy you'renot thinking about some of the

(44:31):
hardships in your life becauseyou're busy i remember that was
something that i learned from mygrandmother when i was a kid um
you know that people i think aremost content with their life
when they're purposeful whenthey're working towards
something so i tried to takethat credo and pass it on to the

(44:53):
people that I worked with.
Not sure if that makes sense.

SPEAKER_00 (44:55):
No, it absolutely does.
And that's amazing.
I've been a trainer at myvarious companies for probably
the last 15 years.
And I've put, I don't know howmany people through the ASU
program for ABA.
And I've definitely noticed thatthe turnover rate is much less
for people that are movingforward in their career.
So kind of to what you're sayingthen and to what Mike said

(45:16):
earlier, if you are trying toset your staff goals as you
bring on more staff, then you'rebecoming kind of more of a staff
manager than the direct client.
Working with direct clients, isthat kind of what it became?
You were using your ABA more foryour staff than the clients and
then outsourcing the client workdirectly to the staff that you
were training?

SPEAKER_01 (45:36):
Yeah, you nailed it, absolutely.
So when you start a business, Imean, you guys know you're going
through it now, but when youstart a business, especially if
you do it by yourself, That was,by the way, one of the mistakes
that I made in the beginning wasI started by myself.
But when you start by yourself,you wear all the hats.
And then as you hire people, theidea is you take hats off and
you give the hats to somebodyelse.

(45:58):
And as the company grew, I woreless and less hats.
And then you start wearingdifferent hats and you start
having to learn how to, I got soused to in the beginning,
leading and motivating peopledirectly.
Like I told you when I had tohave that tough conversation
with my staff in the verybeginning, hey, you're not going

(46:19):
to get paid for 45 days.
I had it directly.
And even after the meeting, Italked to key people in that
group individually.
And I talked to them about theimportance of what we're trying
to do.
And I had a direct impact.
But as your company grows andyou get people underneath you,

(46:42):
There's a great book, if youguys are ever interested.
It's called The LeadershipPipeline, one of the most
fantastic books I've ever readabout leadership.
And as you grow as aprofessional and as you climb,
let's say, the corporate ladder,you have to pick up new skill
sets.
Because if you keep doing theother skill set, you what they

(47:04):
call in the book you clog up theleadership pipeline you have to
teach other people how to dowhat you were doing and then
back off and lead them and asyour organization grows you lead
fewer and fewer people but theleadership you engage in has
bigger and bigger impact and ittook me nobody really ever

(47:28):
masters that i mean the GreatestCEOs in the world are still
learning every day how to dothat better.
But that was one of the big ahamoments that I had is as that
pyramid, let's say, grows andyou take off hats, the things
that you do every day, theinteractions that you have with

(47:51):
your direct reports, who for mein the end were clinical
directors, executive teammembers, those sorts of people,
every word that you say mattersbecause it gets amplified
throughout the course of thecompany.
And that, that was something Ithink all CEOs struggle with.
And I certainly did.

SPEAKER_00 (48:12):
That's so hard to like, even just with like admin,
you know, a lot of times peoplejust don't do it the way you
want it to be done.
And, you know, that getsmagnified as you get higher and
higher.
And when you're talking about acompany vision, like to make
sure that your vision is stillmanifested as you're adding
layers to that direct lineemployee.
And the vision is something youspend years and years and we

(48:34):
spent countless hours creatingwith the company and you did as
well.
Um, that's a lot of faith and alot of trust.
And I'm sure that's, I mean,that's even challenging now just
in one layer.
Sometimes it's like, you know,I'll do the Excel spreadsheet
because I just, I don't, I,it'll be quicker and it'll get
done the way you, I want it tobe done.

SPEAKER_03 (48:52):
And learning to allow that too.
For my end, for example, youtake on that and I don't care
what it looks like as long as itmakes sense and it gives us the
information we need.
I really appreciate you talked,you've used this phrasing about
sort of preserving the science.
I don't know if that's the exactverb you used, but the
partnership that you had set upwith academia to then be able to

(49:12):
train your staff or to do thingsconcurrently, that's ideal.
I know that's something thatwe're looking for.
One thing I like to say is youcan provide training say to a
prospect of rbt to pass that rbtcompetency exam and by passing
that exam you can then throwthem into a session and and you

(49:33):
may not have taught them how todo that in other words they
don't know how to apply thosethings that allowed them to pass
that exam

SPEAKER_00 (49:38):
they know the differential reinforcement
definition but not what it lookslike

SPEAKER_03 (49:42):
right or what are the the different things that
can be done and i know that youknow long uh long storied career
that i've had in this seen a lotof changes remember creating
treatment plans and programbooks that looked like
unabridged dictionaries back inthe day when we were using
paper.
And we somehow had this visionthat you were going to plan out

(50:03):
the entire session frombeginning to end, and this is
the way it was going to look.
And then you would get youngerprofessionals out there, and the
first five minutes, that planwould go out the window.
And now they had their RBTcompetency, but they don't know
what to do next.
What's been your experiencein...
kind of reconciling those twosides of putting out a super
well-trained professional.

(50:25):
And again, starting with theidea that you want to preserve
the science, you want them toknow what these terms mean on
paper from an academicperspective.
You want them to be able totranslate those into action that
now looks good in somebody'sliving room with their
four-year-old who's been havinga tantrum for the past 45
minutes.
That's a big translation.

(50:46):
What's been your...
know your go-to what's been yoursuccess uh in that realm and
making that translation foryounger pros

SPEAKER_01 (50:55):
yeah that's that's always a big challenge um you
know it's interesting you talkedabout um creating a behavior
plan and i'll use a couple ofold sayings here um so i'll use
two um because i think they'reboth relevant so i don't think a
uh business plan or behaviorplan survive first contact with

(51:16):
a consumer

SPEAKER_03 (51:17):
nice

SPEAKER_01 (51:18):
so and the other saying that i'll say here i'll
quote mike tyson because i thinkmike once once said that
everybody's got a plan untilthey get punched in the face
there you go i'm sure you heardit oh i love it love it And I
think both of them apply here,because literally sometimes you
will get punched in the face.
And it's certainly a challenge,I think, I mean, there's so many

(51:44):
specific things you can do.
I think shadowing is absolutelymandatory.
And every ABA therapy companyfaces the same challenge.
You know, it's getting people into do this work.
And a lot of people cut corners.
And I'm going to be honest withyou guys.
There were some times when I hadmy ABA therapy company before
that I cut corners.

(52:04):
And then I paid for it later.
And one of the lessons that Ilearned is you never ever get
away with anything, ever.
And people may think you do ifyou're running a company or just
in life in general, no one evergets away with anything.
Because if you do something thatyou're not supposed to, even if

(52:26):
you don't get caught in thatmoment, you're still impacting
your own behavioral repertoireand you think you can do that
again, you do it again and thensomething really bad happens.
Unfortunately, the contingenciesare not ideal in our industry
right now, and they haven't beenfor a long time.
And if you don't have propertraining, and we can have a

(52:50):
whole discussion about whatproper training means.
Are you using behavior analysisto teach behavior analysis?
Are you using PSI?
Are you using precisioninstruction?
Are you training to fluency?
Are you even training tocompetency?
Forget fluency.
Are you even training tocompetency, or are you just
training to the exam?
And not everyone is doing that.

(53:11):
And we're all vulnerable, Iwould say, to some of the
contingencies that are outthere, some of the financial
contingencies, some of thestatus contingencies.
We don't talk about statusenough.
And that, you know, a behavioralperspective money is a

(53:31):
generalized condition reinforcerbut status and social praise
falls under that generalizedsocial reinforcer um category as
well and you know i think that'ssomething that we don't talk
about enough as well and i thinkwe're all vulnerable to those
different contingencies and endup doing things that we

(53:51):
shouldn't and i think it's a Ithink it's a day-to-day grind.
I think we have to do a good jobto make sure that we...
And we were talking about theripple effect earlier of the CEO
throughout the company.
As a CEO, I think probably themost important skillset,

(54:14):
probably in life as well, butfor a CEO is self-control,
self-discipline.
If you make impulsive choices asa CEO, and I've made so many of
them myself, that has a rippleeffect in your company.
And if you choose in thatmoment, you know what?
Somebody comes to you and says,well, this new RBT hasn't had a

(54:36):
proper training or hasn't hadenough time to shadow.
And then you make that onedecision in that one moment and
say, it'll be okay.
I've met with them.
I've seen them.
They'll be fine.
I don't know, I didn't do a lot,but those times when I made
those really bad decisions, italways ended in problems.

(55:00):
And so I would say, do your bestto have a good training program
that's built on a foundation ofbehavior analysis.
Train at the very least tocompetency, at least.
And if you have the opportunity,train to fluency and then use
behavioral skills training forthe love of God.
Make sure that people aregetting regular feedback and

(55:25):
make sure that your company isset up so that you set up a
culture of feedback.
So many people...
Talk about, oh, well, I had ameeting, and I gave them
feedback.
No.
Create a culture of feedbackwhere people are regularly
giving people feedback in themoment or right after

(55:46):
performance occurs, those sortsof things.
So I would say, from a CEOperspective, make those
self-control, self-disciplinedecisions as many of the moments
of your workday as you can.
And you'll see that over time itbuilds.

(56:08):
You know who does a great jobdescribing this is James Clear
and his book, Atomic Habits.
And he talks about everyself-control decision you make
is an investment in yourindividual future.
And I think that that happens atyour organization as well.
If you decide to live aprofessionally self-disciplined

(56:28):
life, After six months, ninemonths, 12 months, you're going
to see that ripple across yourbusiness and you'll provide
better care for the clients thatyou're with.
You're going to raise betterbehavior analysts and make no
mistake, if you're a CEO, youare raising professionals.
They're listening and they'rewatching every single thing that

(56:50):
you do and I think As CEOs, youneed to realize that and make
decisions accordingly.

SPEAKER_03 (56:57):
I love what you just explained there.
In the short term, people mighttake it as a loss to invest that
extra time to cultivating thatyounger professional.
They see it as a monetary loss.
You're saying, no, that's yourinvestment.
That's going to pay off.
And in fact, if you don't do it,you might end up with a real
loss.

SPEAKER_00 (57:17):
Yes.

(57:41):
And I talked to the highermanagement and like, look, we're
having turnover, like probably50% of the staff is leaving
within six months.
This has got to be costing you aton of money because you're
investing time.
And they're like, yeah, the RBTis just a revolving door.
Like it's not a long termposition anyway.
And I was like, is this reallywhat?
And this is kind of what we'retalking about with saving the
RBT.
Is this?

(58:02):
Is this really how we're goingto look at it?
Because at the end of the day,yeah, the RBT suffers, but the
client suffers as well becausethey're not getting competent,
consistent care.
So then we left.
But I think that, again, reallytalks to what you're talking
about, about having competentstaff that is hopefully fluent,
but at least competent.
And I feel like a lot of timesbecause of maybe the level of
whether it's reimbursement orcredentials that a lot of

(58:24):
companies now are not looking atthe RBT as needing that level of
competency.
It's just like get them in andget them out and start billing
and then we'll higher and justcreate this cycle, which seems
defeating in the long run.

SPEAKER_03 (58:38):
Oh, and Dan leaves us with a couple of good
questions there for Adam, soyou'll have to make sure and
tune in for part two of ourinterview with Adam Ventura.
In the meantime,

SPEAKER_02 (58:48):
always analyze responsibly.

SPEAKER_03 (58:52):
ABA on Tap is recorded live and unfiltered.
We're done for today.
You don't have to go home, butyou can't stay here.
See you next time.

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