I spent years watching a parade of ABA technicians step into our home and then disappear. At first I blamed our luck. Then I saw the pattern. The churn was baked into a system that sells hours because insurance pays for hours. We ended up there because our doctor recommended it fast and insurance approved it even faster. OT and Speech were treated like later or limited. That bias sent us down a road that never felt steady for our kids.
What did I learn from all those goodbyes? Turnover resets trust. Learning is relational. Your child needs time to feel safe with the person in the room. Every swap means you start over on sensory notes, communication tools, and comfort. The clinic can still bill. Your child pays with energy and stress.
In real life, it looked like this. If your child has trouble staying focused in therapy, a new person often pushes for longer sitting instead of setting up a movement corner. If your child uses an AAC device, a new tech may not know the layout. That silence is not lack of skill. It is a partner who does not yet know how to listen. If your child needs headphones or deep pressure, a rushed staff change can miss those signals. Meltdowns rise. Home gets harder.
“I do not want to teach another helper how to be with me.”
Here is the hard truth I wish I knew sooner. We were steered to ABA because it was simple to authorize in big blocks. That speed did not equal fit. OT and Speech were the better match for our kids, but our insurer made that route slow and limited. Coverage shaped the recommendation more than our children’s actual needs.
What finally helped us protect our kids and our sanity
- Ask for a staffing plan in writing. Names, roles, and how many people will see your child each week. Cap it at two.
- Require consent before any swap. New people must shadow several sessions first. You can say no.
- Insist on real caregiver coaching with a supervisor present. Not just a quick check-in.
- Run a short trial. Track sleep, appetite, willingness to go, and recovery after sessions. If those slide, pause.
- Request OT, Speech, and feeding evaluations in writing. Ask for goals tied to daily life at home.
- Push your insurer for concurrent authorizations and home coaching codes. Use functional goals in your appeal letter.
When we pivoted to licensed OT and ST, the faces stopped changing. An OT mapped sensory needs and adjusted routines. A speech therapist built functional communication and AAC in our kitchen. Fewer hours. More trust. Skills started to show up in real life, not just on a data sheet.
It can feel overwhelming to push back. You are not alone. If turnover keeps resetting your child, treat that as data. Choose providers who can stay, methods that honor regulation and communication, and goals your child values. Coverage is not care. Your gut matters here.
