What caught me off guard was the heartbreak. Not from meltdowns or tough days, but from the parade of new ABA therapists walking through our door. Each fresh face meant my kids had to rebuild trust from zero. I watched hope spike on Monday and sink by Friday.
“Is it a new helper again? I do not want to teach them me.”
That is the emotional cost of churn. Your child learns to mask with strangers, then unravels at home. You start bracing for the next goodbye. Progress notes might look tidy. Your living room tells a different story.
In our case, churn was not random. Doctors recommended ABA fast because insurance approved it fast. The system pays for hours, not stability. Clinics fill schedules with entry level staff and turnover follows. OT and speech were framed as limited or later, even though they fit our kids better.
Short fact: Many entry level ABA staff hold the RBT, which requires a brief 40 hour course plus a competency check before supervised practice (BACB).
How the switching hit our kids
If your child has trouble staying focused in therapy, a new person makes it harder. A stranger may push sitting longer instead of offering movement and a quieter space. If your child uses scripts or an AAC device, every swap means re-teaching how to listen and respond. If your child needs deep pressure or headphones, a rushed tech may miss those cues and push through. Your child carries that stress home.
What finally helped us
- Protect consistency. Ask for a staffing plan in writing. Limit your team to one or two steady people. Require notice and your consent for any swap.
- Start small. Begin with short sessions and track sleep, appetite, recovery time, and willingness to go. If those slide, change course.
- Observe. Watch how distress is handled. Comfort should not be withheld. Breaks should be real. Your child’s no should count.
- Request targeted evaluations. Ask for Occupational Therapy for sensory regulation and daily living. Ask Speech Therapy for functional communication and AAC in real spaces. Add feeding therapy if meals are tense.
- Ask for caregiver coaching. Tools that work in your kitchen beat perfect charts in a clinic.
- Work the insurance angle. Request concurrent authorizations for OT, ST, and feeding. Appeal caps using functional goals tied to safety, school access, and daily routines.
It can feel overwhelming to push back. You are not alone. We learned the hard way that easy-to-approve did not mean right for our kids. When we moved to steady, licensed OT and ST with clear home goals, the emotional whiplash eased. Fewer strangers. Fewer tears. More real communication and calmer days.
Your instincts count. If constant staff changes leave your child guarded or drained, pause. Choose supports that protect trust, honor communication, and keep the same caring faces in the room. Your child deserves that steadiness.
