Amber Nelms 0:00

Well, hello. Today's guest is Amber Furby, the board certified behavior analyst and founder and CEO of Aurora Behavior Services. Someone, I'm so excited to have you on with Accelerate with Amber today's podcast. Two Ambers together. We should be quite dangerous. I love it. Should be a good one. Well, you have brought a unique perspective on clinical leadership and ethical practice and an evolving landscape of autism services. Can you tell me how you got started in the industry, Amber?

Amber Furby 0:34

Yes. I've been working with individuals with developmental delays since I was a child myself. I grew up with a sibling with autism, and that was in the 90s, where no one really knew what it was. And so I would accompany him to his activities, things like that. He had limited vocal skills. And so I would kind of go to be my parents' eyes and ears. And so then I realized I wanted to maybe go into special education. I really enjoyed that type of work. And maybe around my junior year of my undergrad program, I was like, I just don't know if teaching for the rest of my life is really for me, at least in a traditional classroom. So I was telling a friend of mine, I was thinking about moving to a different program or something. And he said, and I told him that I was really interested in the behavior aspect of things. And he had told me that he had just started working as a tech. There was no RBT certification at the time. And he said, I really think you'd like it. And so I went and applied, and I was like, oh, I love this. Oh, that's amazing. Yeah. Yeah. That's how I discovered kind of fell into the field. Oh, wow.

Amber Nelms 1:46

That is a great why for why you got into the field. That makes me happy that you're running an ABA organization. That's one of my larger 10-year goals. As I grow Triangle ABA, I really want to build a system process and all the things to help clinicians own their own ABA company. I do not think there's enough clinicians at the top of ABA organizations. They're not the founders, they're not the 100% the owners. And that's my larger dream. Well, it sounds like you kind of similar. You've been very vocal about moving beyond over clinical protocol-driven approaches. What experiences led you to rethink what meaningful support for families should actually look like?

Amber Furby 2:29

Yes. So I want to be careful with that question because everything we do is rooted in evidence-based practices and what the literature tells us is best practices. However, it doesn't always translate in-home. I provided in-home services for many years, and I find that helping to bridge that gap for families is critical to make sure that the program, the protocol, whatever it implemented in-home consistently and there's some maintenance in place. So I think finding what's valuable to the family is the first step. Of course, we can change behavior. That's what we've all been trained to do. Sometimes the question should be: should we? Is this really socially valid? Is this socially significant to the family and the whole family ecosystem? So one of the things that we is part of our intake is I've trained all my supervisees to do this. I have done this for years. I always ask, if I could snap my fingers and fix three things for you tomorrow morning when you wake up, what would they be? And it always paints such a clear picture for what the family is really dealing with in that moment. And then also kind of tells you their values. As clinicians, we know when we go in, there's certain things that we see, we're observing, that we may want to prioritize. But then when you hear that feedback from the family, it's like, okay, well, maybe we need to compromise a little bit on our top priorities to make sure we're meeting your needs and bringing value to your life.

Amber Nelms 4:11

I love that. That's a great process and system in to ask that question. That's what I'm hoping this continually this podcast will do is bring out people thinking through hearing from other people that what they're doing and then ask themselves different questions and different systems that they can start applying in their own practices. As a provider and policy leader, you have a unique view of the field. What do you think is the biggest challenge facing ABA organizations today that clinicians may have not seen from the front lines?

Amber Furby 4:43

Amber, that's a tough one. That's okay. It's like asking, what's your favorite movie or what's your favorite album? It's like, yeah, there's no it's hard to answer.

Amber Nelms 4:56

That's fine. Give me five. We want to bring value to people. So I'm excited.

Amber Furby 5:00

So, in some ways, I think fitting clinical behavior analysis into a medical model is sometimes like forcing a square peg into a round hole. That's not how the field was birthed and the research was birthed. And so I think sometimes trying to fit it into this outpatient medical model presents its own challenges. Speaking to what you said earlier about we need more BCBAs in ownership and higher leadership positions, I 100% agree. On the other hand, none of us went to school for business and that's not our trainings. So I think that presents its own challenges. Is sometimes young clinicians are forced into roles that they may not have the life experience to help support them in those early days and years of that type of job. So let me go back a little bit because I'm kind of scattered. I think one is operational, and that's such a broad term. I think that is a real crux for our field right now. I think that is what drives families away. That's what drives early clinicians away. When there's poor scheduling systems, when intake or onboarding for clients and staff aren't as smooth as maybe in other fields. Our clinicians are so bogged down by the paperwork and the bureaucracy of dealing with insurance companies and dealing with these payers, and that is a changing landscape. Those are probably the two biggest ones. And then the other I would say is we're kind of lopsided right now with just seniority and age in our field. There are more of us who've been certified for less than five years that are on the other side. So I think we've got a lot of things kind of putting stress on the system right now. Speaking to the operational side, I led a panel earlier this year at a behavioral health conference, and we talked about systems, AI, RCMs, CRMs, all of that. And one key takeaway we had was that a new product is not going to solve operational issues. A new problem is not going to solve the way your team works together. And so identifying those gaps first in your systems before you introduce a new product. Also, the training piece that takes time and there's friction when you introduce anything new. So operationally, we need some help. We need some work.

Amber Nelms 7:46

What comes in my mind is very interesting. And obviously, I'm doing several of these podcasts. I just did a podcast before coming on here with you. And it is so intriguing thinking through what you just pointed out. And one thing I have learned after six years being in business, that I think I'm almost trying to help different founders figure out when they're evaluating the different tech stack that they need to add into their ABA company, what would help them make a better decision and how would they move forward with that? And one thing that you were talking about that brought out, and I know this from my own experience, is that if you don't know the numbers that you really want to know, like your close rate and your CAC and your LTV, and if you're not asking yourself all of those questions to start with, you can't evaluate anything in the right way. Honestly, I do think, and I think you were pointing out that if people were spending the time and the knowledge and growing that base when they go to evaluate something, that would really, instead of just throwing another thing and I'm like, oh, this will solve all the problems. Do you know what numbers you need to even track to start with? Do you even have that knowledge base? Because if somebody shows you something fancy that looks like really good, but then you can't really evaluate it from like, will it pull this report that I need? Will it do that? Because and it will give me that number fast and easy and be able to I know in the next year what numbers I really want. I don't think anybody really teaches that well in the ABA world. There is no consensus. And I mean, like I told you, that's what I want to be known for is helping build out the infrastructure that helps clinicians get that base so that they are set up to not get bought out, to be at the very top of running a good ABA organization that as a board certified behavior analyst, I can look at any of my BCBA's programs and know whether they're doing a good job or not, which I love. But I can also evaluate whether my company as a whole is heading in the right direction. So both of my teams can trust me, right? My clinical teams and then my admin team, because I'm also asking the right questions of every I can ask the right questions of my intake coordinator. And then I can say, hey, I think it should be able to do this. Our CRM should be able to do this. Why is it not set up to do that?

Amber Furby 10:08

This is what we need. Well, it's not just the clinician-owned agencies either. You know, I've spoken to some of these larger private equity-backed companies, and a lot of them are just as messy and unorganized as the small operations. I believe it.

Amber Nelms 10:25

It does not surprise me. Well, it's because you also get people that think owning a medical practice is gonna be simplistic, right? Or like they just look broadly at it and like the numbers, like, oh, well, I can do that. And like, well, do you understand how it truly works and what you should be measuring to start with? Because if not, you're gonna have a big problem. Yeah. Long term. So well, talking about that, do you want to talk about any of the different tech stacks that you've been evaluating as you scale your practice that you've found really helpful that you've zeroed in on?

Amber Furby 10:55

So I get asked this question a lot, and my answer may surprise you, maybe not. I am very particular. I don't like to spend my money unnecessarily. And I've made mistakes. I, like you, have been self-employed for about six, seven years now, and I've learned the hard way. And whenever I do make a mistake, I always say to myself, okay, that's my business school tuition. I didn't go to I don't have an MBC, that's my business school tuition. Won't make that mistake again. And one of the other things is we are very lean operationally. Our admin team is very lean and I like to keep it that way. And it only works because we have some strong systems in place. So I'm a bootstrap founder. Okay, so I had my savings, and that was about it. Started by doing all the direct therapy myself until I had enough to hire someone else and continue, and here we are. It's fabulous, and we have three locations, and it's so wonderful. So early on, I was limited by what I could afford, right? And so I had a system that did billing and scheduling. I had a system that was clinical, I had some things backed up on Microsoft SharePoint. We were using Google Forms for some things, and it worked okay in our first year when I was doing 80% of the clinical work and the admin work. And I quickly found as I brought on my BCBA, my first BCBA, and as I brought on my first full-time admin person that this was not going to be sustainable. It was so jointed, things weren't getting done, things weren't getting uploaded, saved. And I thought we are exposing ourselves. If we're in an audit, we're gonna have to go into five different systems to pull up these things.

Amber Nelms 12:46

People don't really think about how much that happens very fast. Before you even know it, you have like 50 systems. You're like, oh my God, what happened?

Amber Furby 12:53

Yes. And it was my thinking of, okay, let me save money. And so in systems, it's kind of a la carte. But then it's like, okay, well, if I just went with a more expensive system that's more comprehensive, that would fix a lot of these problems. It would fix the frustration, it would fix having to have 10 different tabs open to complete one tab. So currently we use Central Reach Enterprise. And I know people have feelings about Central Reach in the field. I like it. It works for us. Everything's in there. We've got C O G it is, it is. Well, really, Catalyst is, but Catalyst didn't do what they should have done back in about 2017. And so they got lapped by Central Reach. Because they didn't add an RCM product into this. Yeah. Yeah. Yeah. And I think the way that the learning trees, talking about the clinical component, the way the learning trees are built out in Central Reach versus how the programming is built out in Catalyst. I don't know. The interface, I guess maybe that's a preference, but the way the learning trees are built out in Central Reach is how I conceptualize. So I liked that. So we use Central Reach Enterprise. Everything that is in there is also backed up on SharePoint. And then we use Asana. If you're familiar with the project management software, Asana is incredible. We've got a project for everything we do from authorizations to our quarterly client family events that we host, a task in there for sending thank you notes to people for attending, reminder email, all that. I love Asana. And then it's so nice too because if someone does move into a new role or leaves, we just plug in whoever's going to take on that project or those tasks, just pop their name in, and it's really nice for a growing organization. So we've got Asana, SharePoint, Central Reach.

Amber Nelms 14:50

Do you do have a separate scheduling software, or you just do everything in like spreadsheets and use central reach?

Amber Furby 14:56

No, so I have this amazing Excel document that we've got a lot of functions built out in it. So build a schedule out in there, then we upload it to Central Reach. I've looked at different scheduling softwares. The way we'd schedule, there's some nuance to it that I haven't found the system that can quite capture that. Isn't that amazing how that's the case? Yeah. Yeah. And so, I mean, if we schedule differently, I think we probably could switch to ABA engine or one of these other softwares. So we don't cancel clients when staff call out and we do our best to not cancel our RBTs if we have a lot of client cancellations. And then there's certain people who can and can't work with certain clients, all of that. So we're antiquated in our scheduling, but our Excel is incredible. It'll kind of auto-populate who's available, who we know can work with clients, and then it gives us a little bit of flexibility to individualize. So it's nice.

Amber Nelms 16:01

That's awesome. Yeah. Wow, you are so cool. I just feel so thankful that you are willing to come on the podcast. And that's why I love doing this podcast because I am a forever learner. I love the opportunity to spend time with other entrepreneurs and learn how they're thinking through things and also just share some stuff I'm thinking through. It's such a privilege. And I was just saying to the last lady that was on the podcast, I was like, that is one of the things that maybe not everyone says, but I think is one of the huge benefits is that you get to be paid to learn as an entrepreneur. The most successful entrepreneurs are investing in development, right? That you are willing to develop constantly. And you have to if you're going to grow your company. That has to be your emphasis. If you do not, the company can only grow to the level to which you're willing to grow, which is a heavy weight, but it's also super exciting. Who else gets to get paid to do that? So you get to constantly push yourself to be the next level person that you want to be and spend your time working on those things and then encouraging other people that want or a couple steps behind you to continue to grow. And like it's a forever cycle. It's a lot of fun. Yeah. It is a lot of fun. Is there anything else you wanted to share in today's podcast to help any of our listeners? Just any words of wisdom or any lessons you've learned over the last couple of years that you would want to let everyone know you should think through this as you're running an ABA company.

Amber Furby 17:33

Yeah. So one thing I want to go back to when we were talking about the areas that are most challenging for our field right now, and we kind of skipped over it, the current ratio of senior clinicians to junior clinicians. And for a lot of these young folks who've maybe let's say they got into the field, let's just say after 2019, because I think that was a clear marker line in the sand. They came in as private equity is taking over the field. They came in maybe just before or as we were dealing with COVID. And so they came into a field that is offering very aggressive starting rates. Then you put on top of it COVID and the need to continue to provide services when everything is shut down. And so there were a lot of changes to policies and expectations because really it was let's just make sure that all these folks are getting the services that they need while the world is shut down. And so they came in during a very different landscape than probably what you and I did if you came into the field in the 2010s or 2000s, 90s earlier. And I think a lot of them come in with maybe misguided expectations of what the field is. I love this field. I love going to CASP and APBA and the big national conventions where we all get together and get to nerd out together. And I love that we're able to serve so many families. What seems to be kind of the motivation shift in young clinicians, where they're expecting the salaries of that of a BCBA that's been practicing for five plus years. They're expecting accommodations and privileges of that of a more senior BCBA. And then unfortunately, many of them didn't get sufficient training. A lot of them didn't get the same quality training that a lot of older clinicians did. And that has been frustrating.

Amber Nelms 19:54

I love that you're being honest about that. Thank you so much for bringing that up. We should talk about that more because no one hardly wants to bring that up, but it's a big issue.

Amber Furby 20:04

It's a huge one. And I'm sorry, if you were certified in the last 18 months, I'm not giving you $100,000 a year. You're not able to work from home three days out of the week. You're not getting 20 days of PTO. You haven't paid your dues to the company or to this field. Good for you. Yes. That's true. And yeah, it's frustrating. And I think a lot of I put it on us, whoever is supervising these folks, to ask these young clinicians, is this really what you want? Is this really the field that you want to be in? Because you laying out what you want in this offer letter doesn't really match what the field can maybe able to give you.

Amber Nelms 20:45

And maybe you are getting offers from other places, but how are they giving you the salaries and what kind of practices are in place? Like they're screwing over their RBTs to do that. The system, the processes for the clients, how they're doing things. Like if you want to be aligned with that type of company and you want to live a life like that, go ahead. But I mean, those salaries come with a hidden thing that you may not really want to align with, and you're not asking yourself that question. It's not apples to apples. It's not, yeah. I know exactly what you're talking about. It's very infuriating. But it's people who aren't just necessarily, and maybe me and you can talk about it more. Like, how do we help people ask those questions so they can be more informed when they're coming into it? I'm like, I know you got an offer like that, but how did that offer come to be? Have you asked yourself that question?

Amber Furby 21:38

Right. And I mean, we all want to live comfortably and be compensated for the work. That's not my message. Yeah, no. Where else is there value? And money might get you there, but it's not going to keep you there. And I've said this to some young clinicians who've left. You need to ask yourself that. What do you want for yourself in three to five years? Because this flashy salary, it may not serve you in the long run. I think it's on us to ask them those questions and prepare them. I tell my girls all the time, I want you to go experience other places. Go learn, come back if you still love us, but go experience other places. And I will equip them with, hey, you should be asking these questions when you're going in for interviews. I think it is our responsibility to help steward the younger clinicians and shape some thinking and correct some of what happened as a result of COVID and private equity infiltrating the field. Yeah.

Amber Nelms 22:36

Well, I do not disagree with you. Well, it has been a pleasure to have you on here today. Thank you so much. And if you can stay on when we end today, that'll help us with uploading. And yes, stay in contact, Amber.

Amber Furby 22:50

Yes, thank you.