This cluster shows why the people who help clients every day are leaving their jobs. It talks about low pay, long hours, and how COVID-19 made things harder. When these helpers quit, clients lose good care and BCBAs lose team members. Reading this helps BCBAs learn how to keep staff happy so clients can keep learning.
Common questions from BCBAs and RBTs
Low wages, limited benefits, inadequate supervision, and poor working conditions are the primary drivers. This is a systemic problem created by decades of Medicaid reimbursement rates set near minimum wage. Research shows gift cards and appreciation events do not fix it. Wage increases do.
Be an accessible, supportive supervisor. Make your feedback specific and frequent. Advocate with administrators for better compensation and working conditions. Document the connection between turnover and client outcomes to build the case for investment in staff.
Clients lose consistent relationships, behavioral progress erodes when new staff implement plans incorrectly, and the behavioral analyst spends more time retraining than advancing treatment. Stable staffing is a treatment quality issue, not just a human resources one.
Short, modular, context-specific training delivered close to the work environment. Staff with unpredictable scheduling cannot reliably attend long training blocks. Video-based training, brief on-the-job coaching, and regular feedback check-ins are more sustainable than periodic all-day workshops.
Most direct support professionals are paid with Medicaid waiver dollars, and the hourly rate agencies can afford to pay is directly constrained by what Medicaid reimburses. Without higher reimbursement rates from state Medicaid programs, agencies cannot raise wages even when they want to.