Amber Nelms 0:00

Well, hello. Today's guest is Erin Stern, president of STEPS Behavioral Health, where she has spent nearly two decades building services and support systems for children and families navigating autism and developmental disabilities. With a background in special education and applied behavior analysis, Erin brings a unique perspective on leadership, family advocacy, workforce development, and creating organizations that grow alongside communities, they serve. Well, thanks for being on Accelerate with the Ember today. Thanks for having me. I appreciate it. Thanks for reaching out and I'm excited to be here. Fantastic. Well, let's get started on the first question because I think it's always lovely to hear how people get involved in the industry to start with. How'd you first decide? Like, I'm gonna get in here and help people.

Erin Stern 0:53

So I started, I always wanted to teach since I was little. Teaching was always something that I really wanted to do. And so I did that. And I started, I was a special educator. And prior to that, I had worked at a day camp for kids, and they had an amazing inclusion program. And I worked my way up to running and then starting a teen program for teens with disabilities. So I really got my hands very involved in building programs and designing programs and working with kids and teenagers with all sorts of disabilities, and I really loved it. It was really became a passion. So that kind of led me on the track of working with kids with more significant disabilities. I taught for several years, and while that was happening, I really a little bit boxed in while teaching in the school system. There was only so much I could do. Yeah.

Amber Nelms 1:50

Um that is always frustrating, isn't it?

Erin Stern 1:52

Yeah. There was only I could only work on academics where I saw families need had so many other needs, and that was frustrating. And so I slowly I actually one afternoon bumped into a a former parent that I had worked with, and I started working with them privately. And then, you know, I worked through my master's degree and my BCBA programming, and here we are. Yeah.

Amber Nelms 2:18

Well, we didn't actually put that in the intro that you're a board certified behavior analyst. How many years have you been certified? Since 2015, so quite a while. Amazing. Yeah. That's awesome. Well, talking about that, supporting families and not just serving them, how has your own experience as both a parent and a leader shaped the way you think about family-centered care?

Erin Stern 2:42

It's interesting. I always felt a strong connection to the families. I think working in services, I worked in a community center for a while, and I saw the families on the weekends where we provided respite services, and I saw the drain of these families, and I saw the needs of those families. And then I started working in the homes while I was teaching. And so I kind of saw both sides of the coin. I wasn't a parent though yet. And then becoming a parent, that perspective changes very quickly. You know, you're really living that life. I also, from a young age, really got to see my mom work through. My younger brother was diagnosed with ADHD around kindergarten, first grade. And I saw that challenge. And then I was also diagnosed with ADHD and learning disabilities around middle school. And then the 80s and 90s, that wasn't really happening. They started giving me like logic puzzles because they were like, well, she's fine. She's not a behavior problem. She's smart. She's doing all these things. My mom was like, No, I'm watching these test scores and they're dropping. Something's going on here. And she really had to go to bat to get me services. And so I saw that struggle and that challenge. And I felt it myself, but like at that age and at that time, it wasn't talked about at all. So I think paired with that and watching as I grew up and professionally was more involved, I just saw everything that goes into what a family deals with and sees. And I started when my son was born, it was fairly apparent pretty quickly that there were some things going on. And was able to kind of buckle down and start advocating and seeing what was needed. And it's hard. It's really hard. And that humanistic side and that emotional toll became very apparent that I wanted to be able to build something that not only supported the logistical side where families could access services and be connected with a variety of different, because I started very quickly connecting families with different people or different services in the community, but also being able to build a company that could support them emotionally. So we brought in social work to support that could help with the anxiety that the families are feeling, or if they couldn't access services, why aren't they accessing services? Oh, you're having housing issues? Well, let's help you connect with the right because you're not going to get the ABA isn't happening if you've got those other challenges. So we started working with a social worker that I had become colleague with through prior to steps really getting to where it is today. And she and I worked together to bill some of those services out so that we support families in all of those areas.

Amber Nelms 5:32

So is that you do not bill insurance for that? It's not like you got a credentialed for that.

Erin Stern 5:39

I personally don't. We do have a social worker who can bill. It is a small, I would say it's a small line item of the business that we do. So she can bill, but we've we've been able to support some teenagers and young adults who are trying to figure out different things where, like traditional ABA, it's not really what they need. They need more of that emotional support, dealing with anxiety, those kinds of services she'll work with, or she'll work with a family who is struggling with incredible anxiety or family, all related to their child's challenges. So we can support the families from both avenues.

Amber Nelms 6:17

I mean, I know this is not on the questions, but do you mind sharing anything about that? Because I don't know that I mean a lot of ABA companies don't have that. So that's a pretty yeah interesting thing. Was it hard to get that separate added-on CPT code? Was that difficult?

Erin Stern 6:32

It was just learning what those codes were. And I had, you know, like I said, it was talking to a variety of social workers and figuring it out. And then I I knew I had some friends that were social workers, and I was like, okay, what do I need to do? And they were like, yes, we'll do it. And we got them credentials. So it's been a process. I will tell you, it's been what's been challenging is finding the right social workers that want and understand the mission. So I haven't been able to build it out to the level that I would like to do it. However, I have one or two social workers that I can call when I need when I have specific family situations that I can bring in to support. And for right now, that's been very, very helpful. So you pay them hourly. We pay them, yep. And they they will bill.

Amber Nelms 7:25

That's nice. Yeah, that's fantastic. Thank you for being willing to share that. I think that's an important to think through as you're growing an organization. Like sometimes, you know, unfortunately, a lot of ABA companies are not necessarily run by somebody like me or you, right? And so I think that's a great example. And this is like a plug for both of our companies. Clinicians that own ABA companies, it's just a wonderful thing because we're really thinking, we have to think both sides. Like you did think about, you know what, I need to get reimbursed and I need to think about how to do this thing, but you were also thinking about what would help the families succeed. Some of it hasn't been reimbursed.

Erin Stern 8:00

So, like for instance, I have had staff that I have set up with my social worker, and I have paid for a couple of sessions with my staff who have been in, we all have had this situation, who have been in crisis situations that I have set up to work with her because that was more important to me to support my staff. And I looked at that as I'm supporting my team. So we've done it multiple times and it has been, it's always paid off.

Amber Nelms 8:37

Fantastic. I do find it very important to ask people that are scaling ABA companies because I think I'm very also interested in is the technology and where we're at today. And um yeah, I'm I that's one thing I think is very important that I met with a a founder that was just getting started out. And I met with a lady that was more similar to me that's been in business six years. And it's very interesting asking these questions to see how people are thinking through it. Because if you don't, you can really have problems in the future if you haven't thought through this. So, what are you thinking is under-leveraged right now? Where are we under-leveraged in the field? Where does there need to be more emphasis? Where's the stickiest point in the ABA industry in technology?

Erin Stern 9:25

It's interesting. I'll tell you, in the beginning, I was lucky. I got connected very early on with Rethink and Jamie Pagliero, who I had a connection with one of my university professors, and she highly recommended him. So we started talking, and I became one of Rethink's first like pilot testers. And we I was really small, and I shared with him like where we were and what we were doing. And so I started working with them. And I'll tell you, the industry has grown and steps has grown significantly. So I think back into those early days, and we were rough. There was a lot of spreadsheets, there was a lot of, you know.

Amber Nelms 10:06

Yeah, believe it.

Erin Stern 10:07

And now we're much more fluid. Trying to think how many years ago we brought on Monday.com that we've been utilizing as a workflow management, and we've built that out significantly. I would say that has been extremely beneficial with getting all of our processes, our workflow processes, our intake, our authorization, our staffing, our coordinating, all of that. We have worked with a couple years ago, we did a whole big project to kind of go through and see was Rethink continued, did Rethink continue to be the right resource? We were considering flipping to another platform. And after months of research and negotiation, we decided actually to stay with Rethink and utilize Theradriver and Brillium as well with them. And that has been it's been helpful and beneficial, but it's a work in progress. We put a lot of emphasis and money, so much money into it. And it's not perfect.

Amber Nelms 11:07

Yeah, I know. I've met with different people at different stages, and it's amazing. And that's why I think this question is relevant across whatever stage you're at.

Erin Stern 11:17

We're now on the customer. We were just asked to be on like the customer support team for Rethink. Rethink came to us and said, Will you be on some a board to help provide us feedback? So we've met with them significantly to give them feedback and help design and make Rethink better. And so we have done that. My COO is on that board to provide them some resources and support. And I'll tell you, thank goodness for her brain, because she has that brain. Where I'm very clinical, she definitely has the operations experience to understand those workflows and those connections. She's really thrives in that area. So that's very helpful because that is not my background. My background is absolutely clinical. I'm thinking about the kids, I'm thinking about that all day long. And to have that brain balance of somebody who can think that way is beneficial. You need that.

Amber Nelms 12:15

Yeah. Okay. Well, yeah, that is very interesting. Now, for me, I do have a COO too, which is wonderful, but I only recently just had that. So for I actually really enjoy that position, that was actually a hard thing for me to like go. I still kind of want to play around in that because I love that's probably why I'm very interested in the tech side of things. I love workflows. I like thinking about how it works. I like thinking about the systems, what's the best system, and how does it work best? And how do we keep progressing? Because when you're at one stage of the company that works, and then you can't be like that forever.

Erin Stern 12:46

No, we always say what got us here won't get us there. Like that's we're constantly adjusting that. And it's getting to the point where we're looking at now Monday.com has a CRM it didn't when we started. Oh, okay. So is that what you're using now? We're considering it. I actually just hired a business development person. Once she starts, we will look at either HubSpot or bringing on Monday.com CRM. So we that's I'm kind of waiting for her to determine, but we built up Monday.com enough that we can track our referrals, we can track our client leads, and it's working for now.

Amber Nelms 13:22

That's awesome.

Erin Stern 13:23

Yeah.

Amber Nelms 13:23

This is not on the questions, but I've been asking this from a decent amount of people recently. It's always interesting to hear what do you think the top three numbers every ABA organization should track every year? What are the most important numbers that you should be tracking?

Erin Stern 13:39

I'm always looking at how long it's taking to get people through the intake process.

Amber Nelms 13:47

Okay, so close rate. Close rate is very important. Yes. I would think a lot of people, a lot of ABA owners can't answer that question. That's a great one.

Erin Stern 13:54

Yeah, I want to get people in through the door and service them started. I don't want people sitting on wait lists. That is, that makes me crazy. So that's really important to me. I want to make sure that the funnel, so we're constantly looking at the intakes coming in and recruiting an attrition and watching those numbers to make sure that it's balancing out because if there's a blockage in one funnel, it's gonna hit another funnel. So we're constantly watching those numbers and seeing. I don't know if I could tell you three specifically, but I know that's a big one. We've just started monitoring how long a client stays in ABA therapy. I wouldn't necessarily look at that as a number that I care so much about because people leave for so many different reasons. We have kids that met their goals, but we have kids who leave because they're moving, it's just all sorts of reasons. But right now I've been tracking a lot. We've put a lot of money into our marketing and our digital marketing and how many leads are coming through on that. And are they qualified leads? That's been a big one that I've been watching.

Amber Nelms 14:58

Well, you're asking yourself the right questions. You'd be shocked how many people don't. And then you can't ask yourself how to open new locations if you don't know that kind of stuff. And you can't really also look at how much it's costing you to acquire a client in the first place and whether your marketing that you're spending money on right now, the ROI is there. If you cannot calculate that, you can't figure out the ROI. I think that is something that a baby business owner, those are the things. As I go forward, I know I'm gonna be creating more and more things to support clinicians that own company because these are the things that people don't know to ask themselves.

Erin Stern 15:36

Well, people don't know, and that's something I'll tell you. In the beginning, I didn't know either. And it's something that makes sense.

Amber Nelms 15:42

I didn't either, yeah.

Erin Stern 15:43

Right. You know, I was a special educator. I have a business partner, and that's he's extremely helpful for that piece. But I have learned, you know, I got a crash course in business learning this. What's your background?

Amber Nelms 15:53

Just I'm just interested in I don't have any background and I don't have any business partner. That's what I'm saying. It's taking me Yeah. I feel like I got my second master's in business. I just spent a lot of extra time and effort being a part of entrepreneur groups, being a part of different workshops, learning as much as I could, and I still do. And honestly, I've also spent a ton of time outside of the ABA industry.

Erin Stern 16:17

That's what I was gonna I was asking, like, what did you do prior to doing this?

Amber Nelms 16:21

Oh, I did nothing prior to.

Erin Stern 16:23

Good for you.

Amber Nelms 16:24

So yeah, no, I don't have any background in that at all. No, everything before owning an ABA company was still in the like, I did my bachelor's in family and child development, did my master's in applied behavior analysis. My only working career was in the helping and then owning a company. But once I owned a company, I just went like, whoa, I need to learn all this stuff. And like I said, one other thing that I recommend to a lot of people, and I haven't seen this all the time, like a lot of people stay in the circle of ABA and they just like, oh, well, I'm gonna learn. And the scary thing is sometimes this is what I think that's probably why I will be doing some more coaching within the field right now. There's not hardly any business coaching in the ABA world. Like, there's really not. They're not a really good, but for one, if you only experience business coaching in this ABA world, you can't even evaluate if these business coaching people really know what. Does that make sense? Like, I've spent a decent amount of time outside of the ABA world, just around other entrepreneurs or around other business coach type people that when you filter and they ask you questions just about business.

Erin Stern 17:36

Business is business. That's right. So I'm on a leadership board. It's called TAB. It's called the Alternative Board. And there, it's nationwide, but I'm in a the BWI group. And I have been able to be supported by other entrepreneurs who are leading businesses, and we talk about our business journey. And every month we meet and we talk about what are challenges, what are pain points. We're all having the same challenges, we're all having the same pain points. And we discuss it and we come up with solutions and strategies, and it's incredible because it's what allows me and them to learn and grow and build our business knowledge and background, where I have years and years of education and special ed and ABA background. That's great though. Makes you a great founder to have both. So that's been huge.

Amber Nelms 18:30

I agree. And so that isn't in the ABA world, right? And so that it pushes you to ask questions like you still have to ask, like what's your CAC? What's your all these different things, right? And that's a number you can ask yourself in any industry, right? And so sometimes when you stay in the ABA world, you get stuck with like the main same filtering, the same types of books, the same everything. And if you step out, you can hear things from a different angle and you can still come back and then apply it. But I do think that there is something highly powerful about using that approach and being willing to, because usually a lot of times it, or at least definitely in the past, it made me have to step back and be like, I don't know the answers. I better figure that out. You know, and because you can look, you can look really great on if you stay within your little world in your own little BCBA world, like I know this and I know that. And like, that's great, you know that you should know that. You did your masters in that. How about you put yourself in a thing where you don't know, and then you can find out the answer, and so then you can know both, because you should know both, because that is the most powerful to do.

Erin Stern 19:37

Also, you are leading an organization, so you better be able to actually lead the organization so that you're making smart business choices because I've seen, I think we probably all have seen organizations that are growing and then all of a sudden are like, oh, sorry, we're bankrupt. We are closing, and then it's the clients that are losing out, and they're the ones that are all of a sudden without services, and all of a sudden, and how I always worry about those clients, like what's happening to them.

Amber Nelms 20:04

Yeah, I know it's really sad. And honestly, and sometimes I also think about it is that I want clinicians to have a chance to work at a place run by a clinician, right? So it's twofold. You have those clients that don't get services and you don't get a place run by a clinician anymore because you weren't willing to learn both, and you have to be willing to learn both. I have people come to me all the time, like, oh, I want to open my own ABA company. What do you tell me? I'm like, okay, but do you want to be both? You have to decide. Don't tell me, oh, I want to do I've always wanted to run this type of program with my clients. I'm like, that's great, but you can't run that program and then not run a business. You have to do both, right?

Erin Stern 20:42

You have to look at the books and you have to understand the balance sheet and the PL and do the things.

Amber Nelms 20:49

Yeah, you have to have both identities. And I mean, that's just another area I'm really passionate about is that oftentimes people will say to me, I want to do this one thing, and how did you do this thing? And I said, Well, who do you see yourself as? Identity is everything because if you decide this is who I'm gonna be, you start doing the actions. So you have to decide that's who you are. That's right. And you have to walk that walk.

Erin Stern 21:13

Yeah, be that person. But I had to change, it's interesting because I remember having conversations with my partner, and he was like, You have to give up some of the control because I didn't want to for a while. I was so afraid to give up. I even remember like I wanted to stay and be, and my office was in the clinic for so long, and I loved it because I loved being able to see what was going on and making sure that things were. I also loved the kids like running into my office. The reality was we were getting too big and I was not able to focus and get things done. Also, I had like people coming in asking me where the markers were, and like I shouldn't have been dealing with that. So I now I we have an admin office that is not in the clinics. It's really close to the one of the clinics. We have three clinics currently, and it's great because I pop into the clinics all the time and I get to see them and I get to work with the kids when I want to, and I am always around staffing kids as needed, but I can think about the business and I can grow the business and grow the services and work on developing the services to the level of what I want it to be.

Amber Nelms 22:23

That's amazing. Well, I am very excited for you. Thank you so much, Erin, for being on the podcast.

Erin Stern 22:29

Absolutely.