I used to think we were unlucky. New ABA therapists cycled through our living room every few weeks. Then I realized the churn was not an accident. It was the business model. We landed there because our doctor recommended it fast and insurance approved it faster. OT and Speech were framed as later or limited. That bias steered us into a system built on billable hours, not steady relationships.
Why churn keeps happening
- Hours drive hiring. Clinics sell big schedules because insurers reimburse volume. Most of those hours are staffed by low paid, entry level workers who leave quickly.
- Authorization cycles create instability. When insurance cuts or shifts hours, rosters change. Families get reassigned. Staff chase full schedules elsewhere.
- Productivity over training. Tight margins mean short onboarding and thin supervision. Burnout rises. Turnover follows.
- Growth first. Many centers expand fast. They fill slots before building strong teams. Consistency takes a back seat.
“How many helpers is it this week?” my child asked one Tuesday. My heart sank.
How that hits your child
Learning is relational. Your child needs to feel safe with the person in the room. Every new face resets that safety. Sensory notes get missed. Communication tools get misused. Pressure rises.
If your child has trouble staying focused in therapy, a swap makes it harder. Instead of offering movement or a quieter space, the new person might push sitting time. If your child uses an AAC device or scripts, you end up re-teaching the partner skills again and again. If your child needs deep pressure or noise protection, a rushed tech may blow past those cues. The clinic still bills. Your child carries the cost at home.
What I learned to ask for
Protect consistency on purpose. Ask for names, roles, and how many people will work with your child each week. Cap it at two. Require your consent before any swap, with real shadowing first.
Get the staffing math in writing. Ask about average tenure, turnover last year, supervision frequency, and productivity targets. Vague answers are a red flag.
Start smaller. Run a short trial with one steady person. Watch your child’s energy, sleep, and willingness to go. If home gets harder, change course.
Request OT and Speech. Put evaluations in writing. Ask for goals tied to your daily life: regulation, communication, dressing, mealtimes. Consider feeding therapy if meals are tense. Push your insurer for concurrent authorizations and caregiver coaching, not just clinic hours.
Choose fit over speed. Licensed OT and ST gave us steadier faces and calmer days. Fewer hours, more trust, real carryover at home.
It can feel overwhelming to push back. You are not alone. Coverage is not care. If turnover keeps resetting your child, treat that as data. Pick providers who can stay, methods that honor regulation and communication, and goals your child values. Your gut matters here.
