Amber Nelms 0:00

Well, hello, Mandy. Welcome to Accelerate with Amber. I am so excited to have you on. I have been following you for years, been so impressed by all the things you have been building. And I'm like, are you fucking kidding me? I get to have you on the podcast. This is the best. So thanks so much for joining me. You are a serial founder, a neurodivergent advocate, and you're the CEO of Kids' Choice Therapy and Play Center. You have over 25 years of experience in the field helping hundreds of families. And you've also found it non-binary solutions. So pretty fantastic.

Amanda Ralston 0:44

Oh, thanks for having me. It's great to be here. And it's weird to hear that you've been following me for years. It's you and the CIA, I think, at this point.

Amber Nelms 0:51

So well, tell me the beginning. How'd you get started? How'd you become a BCBA?

Amanda Ralston 0:57

Yeah, so when I was in my last semester of college, undergrad at Center College in Danville, Kentucky, I had my abnormal quote unquote textbook tell me that there was a condition called autism, and it was diagnosed in about one in every 10,000 people. And the gold standard for treatment for autism, quote unquote, was something called applied behavior analysis. And so that was two paragraphs about autism. And I decided to do a research paper about it. So I met seven families in Lexington, Kentucky that were flying a consultant out from California once a quarter. And that consultant would come in and basically cobble together these ABA programs with families by using family friends or high school students, college students as independent contractors that were essentially technicians before the idea of a behavior technician was even a word at that point. And so after I wrote that paper, I ended up working with those seven families as a technician myself. So it was six boys and one girl, all levels of profundity. And I got to see firsthand what it was like to use this science to actually teach people to communicate and to become more independent and happier. And that's what got me hooked.

Amber Nelms 2:04

Awesome. So the work got you hooked, and you didn't even know. Absolutely. Yeah.

Amanda Ralston 2:09

Yeah, no, I'd always been good with kids, always liked kids being around them and hadn't really had that much interaction with individuals with disabilities. And just seeing the light bulb moments for them and their families to go off when they learn to use some kind of communication form was just life-changing for me.

Amber Nelms 2:24

Yeah, that's one of my favorite things about ABA. Watching people be able to go from barely getting their needs met to getting a ton of needs met. It's like, what? That's what we get to be a part of. It's so life-changing.

Amanda Ralston 2:37

It never gets old.

Amber Nelms 2:38

It does not ever get old. And you know, for me, it was watching my son go from not being able to play, like even his the things that he really he would destroy so many toys because he just didn't know how to play. And watching him be able to play and then all of a sudden be able to tell me what he wants to do and then have friends and all the things, I thought this is what I'm gonna give my life to, so other people can have it happen.

Amanda Ralston 3:01

It's fantastic.

Amber Nelms 3:02

You've built multiple organizations across clinical services and technology. What pattern or insight about scaling ADA organizations have you discovered that most founders miss early on?

Amanda Ralston 3:13

Yeah, well, I got a front road seat to this, I think, which was kind of a revelation for me. So my mentor was Dr. Vincent Carbown. Uh, got a little bit of a unicorn on the front end there. So he and I he had a boot camp situation in Jacksonsville, Florida in '99 that I went down to and basically had a 90-hour a week intensive course and then set forth to have my supervision with him for the next year to sit for my BC ABA. Okay. This is the BACB was started in 1998. And so in 1999, they started this program to bring people in that were already in the field to sort of jumpstart them into the certification process that didn't have master's degrees. That was me. And so Carbone and I literally sent VHS tapes back and forth in the mail to each other so that I could demonstrate my proficiencies to him. And then he would call me on a landline and give me feedback about the different techniques I was using, the teaching procedures and the interventions. And I literally sat for my exam with a number two pencil on a Scantron machine in 2001 in Nashville, Tennessee. So like dinosaur level, right?

Amber Nelms 4:13

You really are. That's so fantastic.

Amanda Ralston 4:15

So Carbone, as my mentor, was very intentional and very detailed about the type of supervision and the competencies and the knowledge, skills, and abilities that they expected me to demonstrate before he would sign off, quote unquote, with me sitting for an exam, and then continued that mentorship afterwards. So I had a very bespoke mentorship experience. So I started my clinic, one of my second clinics, and was very intentional about trying to put those same types of systems into place and growing my own interns and BCBAs internally. And they had a whole program that they went through and they had very specific mentorship and knowledge, skills, and abilities. And I stole as much as I could from the Carbone Clinic to replicate what they were doing there. So I had a good model. I knew what good look, right? Something to model myself after and the supervision after. Well, flash forward, I get to 2019 and I sell my clinic to a larger organization that is then a conglomerate of all these other organizations they've also acquired. And what I learned very quickly is that I can get a hundred of these different groups or a hundred different providers in a room together and put one person with autism in front of them and say, How are you going to approach support or treatment for this person? And they will all have completely different approaches.

Amber Nelms 5:27

Interesting.

Amanda Ralston 5:27

And most of the reason they do that is because that's how they've always done it. That's what they learned from their mentor, right? So operationally, these clinics scale pretty well for the most part, but clinically they don't scale well because nobody is doing the same thing the same way twice across organizations. And that's sort of where I had the idea to come up with Noetic and the clinical decision support software that I built as a digital bumper rail to get everybody to think about treatment planning and at least some kind of semblance of normalcy that you and I would reasonably arrive at the same conclusions about a person's treatment pathway as the next person, given the same amounts of information.

Amber Nelms 6:08

So exciting to think about that's very pinpointed information to really zero in on. And I it makes complete sense what you're saying. I it does. And it's one of the things it's missing. So I'm so glad you've been the answer to that. You know, some people bitch and say, Oh, no, you came up with an answer. Let's continue to build stuff that can I mean, not to complain about B C BAs, that is one thing that does drive me crazy. Is a lot of people, oh, this is so unethical. Like a lot of whining and no answers. Don't keep saying stuff and don't be the answer. Be the answer. Figure it out then. Because if you really care about that, then you should be a part of making that difference.

Amanda Ralston 6:48

Yeah, it's easy to criticize, right?

Amber Nelms 6:50

Yeah. It's another thing to be like, as you were building that, there was probably a million things that you could be like, well, what if I can't get it? Or what if I can't make this happen and I'm being willing to be a part of the answer? That's actually brave because then there's gonna be a lot of people criticizing who are you to do that, right?

Amanda Ralston 7:07

Oh, I'm fully aware of it. I mean, I had a little bit of imposter syndrome going into this and developing the software, but very quickly I got to a place of humility about it. I'm not gonna get it all right, right out of the gate. And so we have lots of feedback from our users and our customers about what we like, what we don't like, why do we like it, why do we not like it, so that we're constantly iterating that software or so that it actually makes sense. And that's that's a scientific process, right? Start out with a hypothesis, test it, take some data, and revise. That's what we're supposed to do as behavior analysts, and it's really no different when you create good software.

Amber Nelms 7:41

Absolutely. Well, I mean, I guess this question goes kind of into what you're saying. Where do you think the AVA industry is under-leveraging technology, particularly for referral management, insurance workflows, data visibility? Where do you think that is being underutilized?

Amanda Ralston 7:58

Yeah, again, this is part of what I was hoping to solve for or trying to solve for with Noetic. So the first software module within the software is called care navigation. And it is a very robust intake interview, clinical interview that really helps you understand who are these individual patients coming into your care. Part of what we're interested in finding out, built building a data set of patients in a structured way that we can then use supervised machine learning, aka human-in-the-loop machine learning, to understand who are these very different individuals with quote unquote autism coming into your care. Because as we all know, that's a very heterogeneous group of people. And so using data and technology to understand which types of individuals with quote unquote autism need what types of supports and what types of environments at what intensity or dosage for how long, right? So that we can actually get down to who does need 30, 35 hours a week of intensive services and who might only need 15 or 10 or 20 hours a week in a different type of setting, or who could benefit from only telehealth, or who needs to benefit from more parent training. That's the leverage of technology and clinical data that we actually really need to be employing at this point.

Amber Nelms 9:13

That makes sense. What have you learned from going from being a CEO that runs an ABA clinic to being a CEO that runs a SaaS company? What are the different skill sets that you have needed to up level to be able to run a diff a totally different beast?

Amanda Ralston 9:34

I got asked this question in a different way on a different podcast at one point. A couple of uh my colleagues from Kentucky that are in the startup ecosystem said if you had to give any advice to a young entrepreneur coming up in the startup world, what would you tell them they needed to do? And I said, be white and male.

Amber Nelms 9:51

That would help who will run a SaaS company. That is true. There's actually not a lot of females running SaaS companies. They aren't running gay companies either, though.

Amanda Ralston 10:01

Yeah, it's fair, right? So fun fact only 3% of all venture capital have gone to female founders in the startup world in the last three years, and that's an improvement. And that's if you're white.

Amber Nelms 10:11

Yeah. Yeah, that sounds right. That sounds absolutely right.

Amanda Ralston 10:15

Yes.

Amber Nelms 10:16

So did you have to gain venture capital to get your SaaS company off the ground?

Amanda Ralston 10:22

Absolutely. It's a very different process than running a or building a clinic. With the clinics, I was able to organically grow using the profits to grow the businesses over time. With a tech startup, you have to start by going out and raising capital in order to start building the product. So when you're first pitching, you're pitching on pre-seed or just idea only, which is a pretty hard sell. But you know, what those angel investors are doing is really saying, all right, I'm going to give some of my capital to somebody that has an idea as a long shot bet, hoping that they actually pay off. And maybe one in ten of those bets actually does pay at some point. But yeah, we raised $800,000 in the process of development. We're still raising to continue development. It's kind of an ongoing process. It's never really finished. We would technically still be in somewhere between a pre-seed and a seed round. A lot of the other software companies that you see out there are well into their series C, series D rounds of venture capital raise. I think Rethink being an example, I think just closed another round of possibly series C funding raising. So it never really stops until you get to either serious profitability or an acquisition of some sort.

Amber Nelms 11:29

Yeah, that makes sense. How many software developers did you have to start with to make it happen?

Amanda Ralston 11:35

So we had a dedicated team of say eight to ten individuals that were in the Ukraine. That's our software development team. So it was an independent group that we partnered with. So really my internal team at Noetic and Non-Binary Solutions is just me and my gaggle of white guys, which is my CTO, my CFO, and a co-CEO that's we brought in to help manage things with the fundraising, and also because I've taken this role as a CEO with Kids Choice.

Amber Nelms 12:03

Got it. Awesome. Well, it is so fun talking to you about this. I am really enjoying. I mean, that is a my I mean, I don't know if I should be sharing that on the podcast, but that's my next venture. So I'm super just interested in it personally as I'm moving forward. It's nice to already be able to talk to somebody that's done it before. Thank you for trial blazing. Seriously. Yeah. Exciting.

Amanda Ralston 12:27

Yeah, thank you.