At our ABA clinic, the person working with my son changed roughly every week. There was nobody available to talk to about it. The clinical director was never there.
For a long time I thought we had simply picked a bad clinic. Then I read the actual credentialing requirements, and I stopped thinking it was bad luck.
What the credential actually requires
The people delivering most direct ABA hours are Registered Behavior Technicians. The requirements are published by the certifying body itself, in the RBT Handbook. To be certified you must:
- Be at least 18 years old at the time you apply.
- Have “at least a high school-level education or the equivalent.”
- Complete a 40 hour training.
- Pass a competency assessment overseen by a qualified BACB certificant.
- Pass a background check and the certification exam.
Forty hours is one working week. That is the training standard for the person who will spend more time alone with your child than almost any other adult outside your family.
I want to be fair about this. An RBT is not supposed to be designing your child’s programme. That is the supervising analyst’s job, and the model assumes the technician is delivering a plan someone more qualified wrote. The question is how much of that supervision actually happens.
The five percent number
The same handbook answers it. A certified RBT must receive ongoing supervision for “a minimum of 5% of the hours you spend providing behavior-analytic services each calendar month,” including at least two face to face contacts per month.
Do the arithmetic for a child at 20 hours a week. The supervision floor is one hour. At 40 hours a week it is two. For the remaining 95% of the time, the person in the room is the person in the room.
Five percent is a floor and not a description of the whole field. Good providers exceed it, sometimes by a lot. But a floor tells you what a clinic can do while remaining fully compliant, and “the clinical director was never there” turns out to describe a service operating within its standard rather than one breaking the rules.
Why the faces keep changing
Weekly turnover was the thing my son felt most directly, and it is worth saying plainly what it costs a child.
Every new person means starting again. Not the programme, which carries over on paper, but the actual relationship: whether this adult can be trusted, what they do when you are overwhelmed, whether they will notice. For a child who finds new people effortful, a rotating cast means paying that cost repeatedly, forever, while the data sheet records continuity.
None of this is the technicians’ fault. Several of ours were kind, and most were barely out of school and holding a caseload that would test someone with a decade of experience. A job with entry-level pay, a 40 hour training, and emotionally demanding work produces turnover. That is a predictable feature of how the work is structured, not a character flaw in the people doing it.
The contrast that told me what I had been missing
When we started with an occupational therapist, two things happened in the first week that had never happened in years of ABA.
The OT and the clinical director both sat down and explained everything to me. And rather than starting with a target list, they let my son play with different toys and games and watched what he actually gravitated toward.
My son wanted to come back the next day. He did not want to wait a week. This is a child who had been refusing to get in the car and inventing reasons to go to the park instead.
I am not putting that forward as evidence. It is one child, and the difference I saw was real but modest: within about four weeks I noticed more confidence, better impulse control, and one afternoon he invited another child to play with him. Not a transformation. Just more than I had seen across many hours of the other thing.
What I take from it is not that one profession is better than another. It is that supervision being present, sessions being built around the child rather than around compliance, and someone treating the whole family as part of the picture are things you can actually ask about in advance.
Questions to ask any provider before you start
These work regardless of discipline, and the answers are more revealing than any brochure.
- Who will actually be in the room with my child each week, and what are their qualifications?
- How much supervision do those hours receive, and by whom? Ask for a number, not a reassurance.
- What is your staff turnover, and how long has my child’s assigned person been with you?
- How is the plan built? Ask specifically whether it starts from an assessment of what my child is drawn to, or from a standard target list.
- What are the exit criteria, and what would make you recommend less rather than more?
- If my child is distressed, what changes? If the only lever is more hours, that tells you what the model can do.
- Can I observe a session?
- What would you recommend if coverage were not a factor?
Question two is the one I would not skip now. And question six is the one that would have saved us the most time, because when I eventually did raise my son’s distress, the answer I got was a request that I ask insurance for more hours.
A fair caveat
There are skilled, well supervised ABA providers, and there are poorly run clinics in every discipline including the ones I moved my son to. Credentials are a floor, not a guarantee, and a warm well supervised technician may serve your child better than a distracted specialist with more letters after their name.
The point of knowing what the standard requires is not to disqualify anyone. It is so that when you walk in and ask who will be with your child and how closely they are supervised, you know what the answer means.
