Sep 1 / Gina Barboni, MA, BCBA & Jamie Turner, MBA, PMP, BCBA

Company Culture Turnaround OBM Case Study

We’re going to tell you a story about the roller coaster company culture of an Applied Behavior Analysis (ABA) clinic. What started as an amazing work environment with exceptionally high clinical quality and staff satisfaction quickly saw a rapid decline in morale. Acclaim Autism used Organizational Behavior Management (OBM) to turn the culture around into somewhere people want to work again, while maintaining high clinical quality throughout. We'll look at what they did, how they did it, and the valuable lessons that should be learned.

The Journey

The clinic was opened with a small but experienced team of dedicated staff. BCBA®s, and aspiring RBT®s who quickly became RBT® certified. Everyone shared the mission to provide high-quality individualized ABA in an area where it was hard to find, while becoming the best ABA service provider in the area.

With a high percentage of clients presenting with Medicaid insurance, funding was limited but workable. Caseloads were kept to a maximum in line with BACB standards, usually much less due to high hours cases. The team enjoyed learning from every client, regardless of complexity. Everyone got along well and was supportive of each other’s strengths and weaknesses. The clinic quickly grew, and the culture stayed positive.

One year in, everything was great. Staff turnover was 28.9%, which is low in the ABA field. People were happy.

Two years in, the team was feeling less supported due to the growth of the company and clinic. There were a lot of newer BCBAs that understandably needed more support. Staff turnover had increased to 67.1%.

An additional Director was hired. Staff felt supported again, and clinical quality improved even more. Families were incredibly engaged and grateful for such a dedicated, committed and talented team. Things started looking up again.
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“When a flower doesn't bloom, you fix the environment in which it grows, not the flower.”
(Alexander Den Heijer)

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Then, things got a little weird. BCBAs started reporting problems with the company. The good news was they were speaking up rather than staying quiet. The bad news was the complaints were numerous, and not easily ‘fixable’: 
  • Caseloads are too high, and unethical.

  • Providing services after 4pm in a Center is unethical.

  • The company is required to provide a second RBT non-billable for kids with aggressive behavior, or the company is unethical.
The list went on, and the word “Ethics” was weaponized against the company in almost every complaint. Then problems started compounding. One staff member would tell another about an ethical concern, the gossip mill would start, and the negativity compounded. Staff went from feeling positive about the company to overwhelmingly negative attitudes. In parallel with the cultural decline, the financial health of the clinic declined too.

Caseloads and major policies hadn’t changed, but the environment did.

Under the new Director, staff turnover declined but was still high:
  • Third year turnover: 50.8%

  • Fourth year turnover: 53.5%

The complaints were getting more and more numerous, and people were miserable. Human Resources (HR) and Leadership were receiving complaints about things from this clinic that didn’t seem to be an issue in other service areas.

OBM Assessment

Company leadership decided to do an OBM assessment. They started by:
  • Reviewing data (indirect assessment): Caseloads, cancellation rates, employee feedback from satisfaction surveys, turnover.

  • Visiting the clinic more regularly (direct observation): See what was happening, and try to discern why.

  • Interview staff: Hear directly from colleagues what they like about the clinic and organization, and what they don’t like.

The assessment revealed a lot:
  • The data review showed caseloads were about half what they were in other service areas; the clinic wasn’t following the company policy. Cancellations were high, and there was little enforcement of company policies.

  • Staff that were present at the clinic would either smile or frown when a member of the leadership team walked in. After a few visits it became clear that when certain staff members were present, everyone else would frown at the sight of leadership. When certain staff members weren’t present, everyone else would smile.

  • When a newer BCBA wasn’t sure what to do, they would assign blame to the company and use ethics as the reason.

  • Staff were pleasantly surprised at being interviewed and being asked what they think. Most of their complaints were due to misinformation about company policies.

  • People felt like they were isolated from the rest of the organization.

The confusing misinformation being circulated was resulting in extreme dissatisfaction among staff when actual company policies were enforced by the organization. The actual policies were fair, transparent, and incredibly employee-friendly, but not communicated consistently to staff at this location. Inconsistent enforcement was also an issue. 

Measurable Goals

The leadership team defined goals to help turn things around. The goals were essentially happier staff as measured by turnover, and consistent application of company policies. A goal was to decrease attrition to less than 50%, then less than 40%, and then 30% while monitoring caseloads and staff complaints. Another goal was to decrease cancellations from about 25% to 12%, and then further decrease from there. These are all quantifiable things that can be measured, that should be expected to move data towards a goal.

OBM Interventions & Data

The OBM interventions included:
  • A minimum of one company employee, not from this clinic, should visit at least once per week to help the team feel included, with in-person positive reinforcement for behavior that was observed.

  • Bring in a new Director to stay aligned with policies, host quarterly teambuilding events, and enable fun activities in the clinic.

  • A company leader would reset expectations with any clinician communicating wrong information about company policies, and positively reinforce correct policy application.

  • Staff would receive clear and consistent expectations from Operations & Human Resources with clinicians present, and held accountable if needed.

  • Implement better communication between leaders and staff:

  • Regular in-person meetings with Human Resources and Operations leadership at the clinic, with clinicians present, to align on policies and rationale.

  • Active listening from leaders helped staff feel heard. This also enabled leadership to give support that staff really valued, including positive reinforcement.

  • Providing staff with company information, explaining why the company can or can’t do certain things due to funding constraints.

  • Leading with empathy, validating this is a hard field and support is crucial.

  • Senior leaders hearing & talking through staff feedback.


As all these OBM interventions were implemented, the data were striking. Staff attrition and cancelled sessions are graphed below:
With the yellow line representing attrition, we were looking for the flat portions of the cumulative record to get longer and longer as these OBM interventions were implemented. The red line is the cancellation rate, with the percentage on the Y-axis, with the rate expected to go down. The first phase change was a resetting of expectations meeting with a BCBA. The second phase change was the resignation of someone who communicated a lot of incorrect policy data, as well as increased visits from company leadership. All other interventions were applied relatively consistently throughout, which essentially changed the environment in which people worked.

The data following these interventions includes:
  • Decreased turnover to 38.4%.

    • A noticeable decrease when annualized with seasonality factored in.

  • Cancellation level decreased when compared with similar in-school seasons.

  • Significantly fewer HR complaints, and unfounded accusations of unethical behavior decreased.

  • Although hard to quantify, there are lots of smiling faces in the clinic at each visit.

Lessons Learned

The cultural turnaround has been quite remarkable. Gina Barboni is the Director who oversaw this turnaround. The lessons learned are simple:
  • Clear and consistent expectations give people clarity about what’s expected of them.

  • Positive reinforcement is so important for staff, not just clients.

  • Staff engagement is so important; visit each clinic regularly and talk with people. It’s easy to talk to just a few familiar faces, but talking to each person reveals a lot.

  • Be open, transparent and consistent with communication, policy enforcement and rationale. 

  • Graph & monitor key data regularly, including data representing the work environment, and work on OBM interventions when needed.
Simple practices using the science we love can help any ABA organization succeed and keep staff engaged and happy. That application ultimately results in lower turnover and better services for clients, which is why we all got into this field to start with.

ABA practice owners can reach out for support any time. We don’t do paid consulting, and are simply happy to have conversations with like-minded BCBAs trying to improve the field. 

Gina Barboni

MA, BCBA

Jamie Turner

MBA, PMP, BCBA