Amber Nelms 0:00

Well, hello, Chris. It is awesome to have you on Accelerate with Amber's podcast today. You are the founder and chief clinical officer of Virginia Therapeutic Network.

Christopher Allen 0:14

Yeah. I'm the co-founder. I had two other two other founders that are BCBAs with me.

Amber Nelms 0:18

Fantastic.

Christopher Allen 0:19

Yeah, I kind of started this clinician-owned company about three years ago.

Amber Nelms 0:23

Congratulations. Well, I don't know if you already know this about me or not, but I talk about clinician-owned companies a lot. I'm love to see BCBA starting companies and learning how to scale them and make them sustainable because unfortunately, you know, I don't know the stat on that. How many ABA companies are not fully owned by BCBAs? Because, you know, you'll see somebody that's like a founder, but they still have an investor, or they still have somebody else that's truly not a BCBA. It would be really cool data to know.

Christopher Allen 0:53

We are 100% clinician owned, which are the three of us. We own it 100% of it. And we have scaled it independently and we've done everything and that is a big hell yeah.

Amber Nelms 1:03

I love to hear it.

Christopher Allen 1:05

Yeah, it's not been easy.

Amber Nelms 1:07

Oh, I know. I bet it's been very hard. I know that's not on the questions. Do you want to talk about that a little bit? About what made you start the company? Because that's how'd you get started in the industry? That's our first question. Anyway, so yeah.

Christopher Allen 1:20

I can kind of start how I got started in the industry, and then I can bleed into how we started the company. My background was evolutionary biology, and I was an evolutionary anthropologist. And so I did a lot of studying of primate behavior, specifically in Africa, for a couple of years, and really foundationally really liked answering the question why? Why do we do what we do? And evolutionary, you know, you always look at alleles and allele representation and all these things. And so I did that for a little while, and I, you know, didn't want to pursue that as a grad program. So when I got back, I kind of started teaching and really working with more challenging kids and youth and things like that. And then I kind of found ABA where I was like, oh, it's teaching and science. And so that's kind of what led me into ABA, but I don't have a strong background in working with little kids because I was mostly a high school teacher. And I don't have a huge background of working with autism. Most of my background was working either in residential facilities after that and worked in really more complex kind of cases with challenging kids, specifically adult high school. And so then when I kind of found it took me a while to figure out exactly an ABA where I fit. And then down here in Virginia, they have a therapeutic consult which works with adults with intellectual disabilities or anyone, primarily adults.

Amber Nelms 2:29

Before you go into that more in depth, is that a separate, like a waiver or something type of program in Virginia specifically that's different than like the R, I don't know if you call it the same thing in Virginia, like the RHBTH type?

Christopher Allen 2:45

It'd probably be a similar program. Here in Virginia, we call it a therapeutic console and is a waiver-based service.

Amber Nelms 2:51

Okay, but different than billing 97153. Or do you use that CBT code? What do you what CPT code do you use? Or no? 97159.

Christopher Allen 3:00

Well, 979. There's two of them we use. One for dolls for the BCBAs, and then one for rec therapist. What's it? 97139, I think. It's kind of a generic code. It's a generic code where each state kind of uses it differently. If you look it up, it's just just says like support code. Virginia uses it as a therapeutic consult code. So our physical therapists, our occupational therapists, our speech, and our behavioral support who do consultation all use the same code.

Amber Nelms 3:26

No fucking way. Sorry, I'm swearing a lot. This podcast.

Christopher Allen 3:29

I don't know why you bring out a lot of curse words in me. I'm used to it.

Amber Nelms 3:34

I don't know why. Well, I'm just excited. I like this is why I enjoy this podcast so much too, as I love learning. I think that's a huge part of being an entrepreneur. That's what I was said on my last podcast. You know what? That is one of the amazing benefits. You get paid to learn as an entrepreneur.

Christopher Allen 3:48

Yeah. Right? Unfortunately, sometimes you don't want to learn and you have to.

Amber Nelms 3:53

Yeah. I enjoy learning. And then you also get the paid to be developing yourself personally. The most that you're able to develop is as far as your company will go. And that's so fun because you can't question whether that's a good investment. Growing yourself is never a bad idea. But anyway, that is very interesting that they can all build this same code. How did you figure out that program and all the stuff?

Christopher Allen 4:16

Yeah, it's a therapy that consultation code where anyone on a waiver is entitled to consultative services to come out and help train their care staff on whatever support principles that are, whether it's a behavioral support plan or an occupational therapy support plan or speech and language pathology support plan or a physical therapy support plan. It's all guided under the same principles where we come out, we build a plan, we train the caregivers on that support.

Amber Nelms 4:40

Is that your full model?

Christopher Allen 4:42

Right now, yeah. We have some other services we've just added. But for the last three years, our primary model has been interprofessional support. So we built a company not to use just behavioral support, but to have all the programs. So we have a we have physical therapist, occupational therapist, speech, recreation, and behavioral support. And we build interprofessional teams around that individual based on what that person needs.

Amber Nelms 5:06

How fun.

Christopher Allen 5:07

Yeah. And we all work together. And with because consultative services, you can concurrently bill with each other while you're collaborating.

Amber Nelms 5:13

I wonder if North Carolina has anything similar. Every state is a little bit different.

Christopher Allen 5:18

They have the one for behavior, but I don't know how it works if they can bill with the other services. I know behavior one is similar, but I don't know if they have the same service for speech and OT and the other services like they do behavior.

Amber Nelms 5:29

We have something called innovations waiver in North Carolina. And I don't know how similar this would correlate. We still bill the same RHBTH code, I think, when using it. So it's not that equivalent. The billing is not anything different. I definitely don't think you can do anyway. I'm gonna look into it. That's really cool. And that's awesome with Virginia. Sorry, I'm just wanting to ask more questions about your state because that's very interesting. I have heard overall the establishment, I mean, you already had a licensure in Virginia before we did. Is there any trends in Virginia that you see that you find like advantageous to you opening a company there or difficulties? I know you guys have been more established. Yeah.

Christopher Allen 6:09

The waiver service has been really beneficial. It's been around for a while, but they part of the Department of Justice lawsuit a couple of states were part of that years ago for how they support individuals with special needs that are high risk for hospitalization. The Department of Justice kind of sued a number of states for this, for how they were supporting that. And out of that lawsuit came this consultative service years ago. And then for the past number of years, they have pushed the rate higher to attract behavior analysts. And so now the rate is at a level where it can attract a lot of behavior analysts, providing a lot of support. And you're seeing a lot of companies, and mostly small clinician-owned companies, because it has because it's a new service in you know, private equity hasn't figured it out.

Amber Nelms 6:50

So we gotta be careful how this is getting out there. That's part of the problem. This podcast has been picking up some traction. We have to be careful what we're doing.

Christopher Allen 6:59

That's all right. They come for us. We're not selling it, and we have our markets pretty block blocked down. So I don't know what we can do.

Amber Nelms 7:06

Well, I am here to, you know, that's what I'm trying to continue. I know in the next 10 years, that's where I'm gonna be focused. I'm gonna be still growing triangle, but I want to grow, you know, like a system process and infrastructure that helps clinicians own companies and teaching them how to scale and do all the things. Because I think that's really a missing thing in the market. I think one of the biggest things a lot of people ha struggle with is they don't really know how important identity is. And they won't accept like you have to be willing to see yourself in and take on the identity of being an entrepreneur, and still the identity of being a BCBA and all of those things, and you have to fully assimilate them inside and be that for it to happen.

Christopher Allen 7:50

Yeah, and on that same trend, we don't have to look for BCBA jobs. Every BCBA is like BCBA jobs. There's no reason why BCBA couldn't open group homes and run them with really good practices on building skills through task analysis and independent living. All of those things can be done, but yet we don't do that because that that model hasn't been shown to BCBAs yet.

Amber Nelms 8:09

Are you interested in doing that in the future?

Christopher Allen 8:11

We just opened our community coaching program and we're looking at community engagement. So to take individuals with intellectual disabilities out in the community. Um we just licensed for our community coach, which is a one-to-one support for high-risk individuals that struggle. And then we'll be working on our licensure for community engagement, which is a one to three one to three ratio, and we're gonna build some community, some city exploration program because I'm here in Richmond, Virginia. We'll teach individuals how to navigate their city, the bus system, because here in Richmond, the bus system's free, at least for the moment. And so there's no barrier for cost for our individuals. So we can go teach them how to access the city for free. So we have some some services we're gonna push into into that more adult services that isn't behavior analytical, it's more just adult services. But there's no reason that DCBAs can't run those services.

Amber Nelms 8:58

And probably do a fantastic job. You know, I think it's also very exciting because you know, both a lot of PE companies they don't really want to take adults because it's not convenient and all the stuff, and it's not as profitable.

Christopher Allen 9:11

As an owner, there's not nearly as much money in it.

Amber Nelms 9:13

Yeah, that makes sense, but it's fantastic. I mean, that's one of the things we're super proud of at Triangle, is we still take adults and we take older kids, and I mean it's much harder, but we're growing a whole group of behavior analysts that don't even know what it's like to help somebody like that. And it's a disservice to our field. I get very frustrated when I meet a lot of newer BCBAs and their whole experience, they do not, and they're also just being like, Well, that's just the state of ABA. I'm like, are you looking at other options? Are you opening your mind to are you only choosing these out of box kind of cookie-cutter ABA companies? Because of course, and you're not gonna grow your skills, you're gonna stay stagnant. And I don't know what to tell you, but that's a sad thing.

Christopher Allen 9:58

You're gonna run a VB map, you're gonna pull 14 goals from that VB map, and you're gonna make sure your RBT is implementing them. And if that's what you want to do, great. But in my opinion, there's very little creativity in that model. And I really like creatively support planning, and that's why I really like adult services because there is nothing other than me coming in and analyzing what's important to this individual. How do I get them skills to help alleviate any symptoms that they're seeing from not having those skills?

Amber Nelms 10:24

Yeah, that's fantastic. Well, you know what I think is interesting between both me and you, Chris, is that it's clear to me your company attracts certain types of people. Isn't it great to build a company where your culture attracts the right people, right? You probably have clear core values and you know why you do what you do. And yeah, like not, I love that. When I interview people, I tell them, like, you we are not for everybody. And I don't want everybody. I want people that want to grow, that want to push themselves, that want to ask themselves the next questions that can be a leader in not just be a little because one of our core values is lions, not lambs. And I want people courageous with our life and not just falling around the same thing. We're not gonna be innovative, we're not gonna continue to push forward. And I don't want to attract people like that.

Christopher Allen 11:04

Yeah. Uh one of my first things I always ask when my screen people that apply with us is what are you passionate about? What's important to you? And before we get into any job, what we offer anything like that, I want to know what's important to you, and then I'll go over what our company does and we try to see if those line up because we've had a lot of individuals that have come. You know, we've hired some BCBAs in the past that have come and they want that more middle management role. They don't want to be out directly working with their clients, they want to make sure their RBT is doing it. And it doesn't translate that well into adult services because the group home staff, I don't employ them. And so they're not gonna just do what I say because I ask them to. I have to show benefit there. And so we've had a lot of BCBAs that have come from that more traditional middle management role in autism companies into adult services, and it didn't work out because they're used to just managing kind of people and not critically problem solving.

Amber Nelms 11:50

Yeah. Well, I'm very excited for you. Let's talk a little bit more. You've talked about burnout. What do you think the field needs to do differently to keep that from happening?

Christopher Allen 12:00

I think a number of things. One, I think BCBAs need to be responsible for their own revenue generation at a company. We can't have a pyramid model where you only have to supervise RBTs. Um, RBT supervision is the number one burnout when you're supervising schedules and people and all these things. And then you're also trying to bill. I think there's too much to manage. And I think finding ways to have multiple pathways, whether you want to be a BCBI direct work directly with clients, you don't have to then move to a supervisor. Right now, the way the model's set up is you pretty much exclusively have to be a supervisor. You have to supervise RBTs to make money, to make your position worth it. And not everyone wants to be a supervisor, not everyone has the skills to be a supervisor. My opinion, not everyone needs to be a supervisor. And so I think that's a the big burnout. If anyone's ever been in middle management anywhere, supervising people is the number one burnout thing for anyone. It's just tough. And we make every BCBA do that just about. So that's a huge component, I think, in burnout. And then just that paperwork component of I'm not working with my clients, I'm doing the back-end stuff of on, you know, calls with insurance companies, and I'm doing all that stuff, and they're getting farther away from what they got into is helping people. When now I'm back end, I'm calling insurance companies, I'm dealing with schedules and doing all this, and then I talk to my RBTs in some meetings, but I'm not actually working with my clients and the people that got me into the field anymore. And I think that has created a lot of burning.

Amber Nelms 13:22

That makes sense. That makes sense. I can understand that.

Christopher Allen 13:26

And so when people come to the adult services, you generate your own revenue. You're billable, so you don't have to supervise anyone, you make your own schedule. It's not like, oh, my RBT called out today. You make your own schedule, you go support the people that are caregivers for that individual. So you have to be helpful to them. If you're not helpful, they're not gonna want to work with you. And you have to go and do the things that that you're you're saying you're gonna do. You know, you can't just rely on the RBT or the behavioral tech to do the things. You have to go out and do those. And I think that instills a lot of pride in the BCBAs because now they build relationships. They built these strong relationships with the client, they built strong relationships with the parents, with the caregivers, with the whole team. And what I've seen more in that the autism model is that RBT gets that strong relationship. The BCBA doesn't always get to build those strong relationships anymore with the clients and the caregivers because they're supervising the RBT.

Amber Nelms 14:15

Well, I mean, that's one of the things I'm constantly trying to problem solve of not just following the 97153 code around and making that my primary thing. I literally have somebody just specializing in helping BCBAs get their calendar maximized and contacting the family for them so that they can get parent trainings in. Because I remember as, you know, taking on a caseload and being like, I have to fucking get a 97156 in. How am I gonna do this when I'm running around helping the RBTs? That has been the biggest unlock for my BCBAs is like, thank goodness, I don't have to keep doing this. And like, because they feel bad, right? They burn out because they don't feel like they can connect and they feel discouraged because they can't make a difference like they want to because they're not being able to meet with the family. It's not like they're trying to do not be able to do it. It's very hard to juggle all those things. So that has been the newest thing we've done in the last six months that I'm seeing. I'm seeing 97156 go up so much more. And I'm like, that's what I want. Because as a parent of a child on the spectrum myself, I know how important it is to help the parents understand what we're actually doing so that they can take it. I don't want kids to be with me forever. I want them to get the services and then the parents understand what they're doing. And so then they can say goodbye. But we do have to create six systems and structures that allow people to be able to do that. So that is great. Let's talk about tech because that's actually what this podcast is predominantly actually supposed to also bring out. Because I do think that's the other side passion that I have is I think that we are very underutilizing what is available. And we really just don't have what we need, in my opinion, for the industry still. So, where do you think that you see for scheduling practice management? Where do you think scaling an ABA organization, or I guess you don't have a typical organization? What kind of tech stack do you think is most important and what you have seen?

Christopher Allen 16:07

So it's for us, a lot of the ones we can't find one that fits what we need because that doesn't surprise me.

Amber Nelms 16:13

Nobody really can, actually, in my opinion.

Christopher Allen 16:15

Yeah. So the bigger thing for us is a lot of that that intake, getting, you know, release of information. Because I work with a client and then I gotta get a that client sometimes their own legal guardian. So I have to get a release of information for the group home, for their psychiatrist, for their parents, for so I have to get a lot of documentation sometimes. And so it's really hard to get that intake correct.

Amber Nelms 16:37

Do you have a good CRM? Sorry to cut you off because that is immediately where my brain went, you would need a very strong CRM.

Christopher Allen 16:43

We're in the process of retooling the one that we have.

Amber Nelms 16:46

What do you have right now?

Christopher Allen 16:47

We use Rethink right now through the Salesforce platform, and it didn't meet what our needs are. Yeah. And so there isn't so we've switched from more ABA software into looking at more, you know, case management software, more social services software. And so there's a handful we've looked at to figure out kind of what those needs are. But but the other side for that CRM is my client a lot of times is functioning at a four or five-year-old level and they're their own legal guardian. I can't send them digital paperwork because they don't know how to sign that. And so sometimes it is challenging to chase down all those and figure out with how the legal system works and everything, making sure everything is kind of in order. That's one of our bigger barriers.

Amber Nelms 17:32

Well, I understand that. I mean, if you ever, I will have to say that is something I'm constantly working on. I'm always here to talk through that kind of thing. That's one thing that's why this is on the podcast. I'm so passionate about the fact there's not really good CRM tools for a lot of ABA companies, in my opinion. No one builds them really understanding what is really needed. And I mean, I have to I don't know, I have never used Rethink, but I highly doubt it pools the reports you really need. You don't know your close rate probably from there. Does it pool that kind of data and report?

Christopher Allen 18:03

It has a pretty, pretty solid, re robust data systems that I can customize reports and things for. But the Dalt Services is very different, which is the harder part because I may get an authorization. I'm like, this person is like high support needs. So I'm thinking I'm gonna need a lot of hours, but it's really hard to schedule with that person. So maybe I'm only billing two to three hours a month on that individual, even though they probably need more. Uh why?

Amber Nelms 18:28

Why is it hard to schedule them? Because they can't make the group home, yeah.

Christopher Allen 18:32

Maybe the group homes are very, you know, not responding very well, or they're out on their community program during the day, and so they're out in the community, so it's hard to figure out times to meet with them in the community because then I have to meet within somewhere in the community if I want to meet with them during that time. And then like, oh, they don't get back to their group home till maybe six o'clock at night after transition. So now it's like, okay, now I have to meet at the group home in the evening. So maybe I do a telehealth session. So it poses problems in because we're just a consultant, I'm not necessarily a ton of direct.

Amber Nelms 19:00

Well, what do you do for scheduling then? I love thinking about technology and how to support things.

Christopher Allen 19:05

I mean, we just use Google, like you call a client, you just put it on your software. There's no, there's no way I could have a uh a group home click on a link to schedule with me. They wouldn't Man.

Amber Nelms 19:17

Yes. My brain is immediately thinking, like, what kind of tech would you need?

Christopher Allen 19:22

Most of them they don't even want to meet with me. They're like, oh, I've got my own thing going. And so maybe the legal guardian who someone else wants me to come in there and help support in the group home doesn't really want anyone in the home because they don't want support, it's just another thing they have to do. So the adult services is wildly different than a lot of other services.

Amber Nelms 19:41

You know what came in my mind when I'm listening to you talk, though?

Christopher Allen 19:44

Yeah.

Amber Nelms 19:45

And this is gonna sound a little bit distasteful, maybe using this term, but I think when I'm hearing you discuss, you you would need to almost train everybody to be pretty good at sales.

Christopher Allen 19:55

Yeah. I tell people you have to be balance being useful with being annoying or being helpful with being annoying. Because you have to be annoying enough to kind of perseverate and be like, hey, I'm I'm gonna reach back out again. Hey, do you have time to schedule next week? Oh, I called again. So you spend weeks calling, emailing, and they're not responding. And then what happens is they go to the state and the states, the state's like, Oh, did you meet with your behavioral specialists? Oh, they never reached out, and so I have to be like, Oh, no, no, no, no. Here's our call log, here's all the things we did.

Amber Nelms 20:22

Do you have a sales script? Have you ever thought about getting that nitty-gritty?

Christopher Allen 20:26

We have like our kind of pitch of what we do because some people are like, Oh, your director gonna come in here and help me. So I come in and they're like, Oh, your clients over there, and they leave. And I'm like, No, no, my job is to help you, so you need to be present. So we do have some some pitches on kind of what that consult model looks like versus that direct model, but we don't have necessarily that that a full like.

Amber Nelms 20:44

No, that makes sense. You know, I mean, I just feel like as a board certified behavior analyst, we were never taught any of these things. And that has been the fun journey for me of being like, wait a minute. I realized in my own company, it was like I naturally am decent at sales, right? But like that's not some I never went did formal, I never had a job in sales before. I think that is another whole area in pocket nobody really talks about in the ABA world. Nobody really thinks about. And I think clinician-owned companies being able to even get their mind around what that means and how that can look and not even feel icky about the word. It's like this is the word we use because of like industry standards and business. It's not to me like we're sell, but there are better ways to do things. That's how I look at it. It's like if you had this, this would help you do better. And here's almost like a process and system. As you can see, I'm a systems lady. I think I'm a systems.

Christopher Allen 21:39

Yeah, yeah, I was telling people you have to be liked, unfortunately, in this field, like an adult. You have to pitch yourself and you have to be liked. That's how they're gonna run your plan. So it could be a great plan, but if they don't like you, the group home manager who's overworked that doesn't have those eight million call outs that day is is gonna struggle to follow that plan unless they really like you have a strong connection with them.

Amber Nelms 21:59

Yeah. Well, I it has been a pleasure having you on. I'm very excited to meet you. You better stay in contact. And I'm excited that you exist in this world helping people. And I'm glad that you are staying strong and doing great work. And it's so nice to have you on.

Christopher Allen 22:16

Yeah, the goal is to build cool companies and have BCBA do cool things. So that's what we're doing.

Amber Nelms 22:21

Fantastic. Thank you so much.