Key Takeaways
- Learn Behavioral acquired Little Leaves on May 11, 2026. As Acuity reported, the deal moves Little Leaves’ 18 center-based ABA programs in Maryland, Virginia, and Florida under the Gryphon Investors-backed national network for the first time.
- Standardization is Chong’s precondition for everything else. Organizations cannot meaningfully automate clinical work or apply AI until they first standardize what they measure, how they measure it, and what outcomes they are targeting.
- Thriving providers in 2027 will report aggregate outcomes, not best-case anecdotes. Chong argues providers must benchmark their full caseload against industry standards such as the January 2026 Eldevik meta-analysis and be honest about which children are reaching meaningful progress and which are not.
- The apprentice program and the Marcus Crisis Prevention Program anchor Little Leaves’ workforce strategy. The April 2026 pilot gives near-BCBAs structured caseload practice that graduate school does not, while MCPP treats staff wellness as a first-tier safety priority alongside clients.
Halfway through 2026, the ABA industry is being asked to prove itself in ways it has not had to before. State Medicaid programs are auditing utilization, capping hours, and standardizing rates. The federal audit cascade has now flagged more than $123 million in improper or potentially improper payments across Indiana, Wisconsin, Maine, and Colorado, with Colorado alone accounting for $77.8 million. CareSource Georgia cut reimbursement to 80 percent of the state Medicaid fee schedule effective May 11, and North Carolina’s ABA Medicaid spending crossed $505 million in 2025, up from $1.9 million five years earlier. The pressure on providers is no longer about whether ABA works. It is about whether the field can demonstrate, in standardized terms, that it works consistently.
Few people have a clearer view of that question than Dr. Ivy Chong. The Chief Clinical Officer of Little Leaves Behavioral Services, treasurer of the Behavior Analyst Certification Board, and a licensed psychologist and BCBA-D with three decades in the field, Chong runs a center-based early-intervention model for children ages one to six across Maryland, Virginia, and Florida. On May 11, 2026, that work entered a new phase: Learn Behavioral, the Gryphon Investors-backed national autism services network, acquired Little Leaves from FullBloom.
In an interview with Acuity, Chong walked through what she sees as the defining challenge of 2026 and 2027 for ABA providers, the workforce question driving Little Leaves’ apprentice program, and why she believes standardization (not technology) is the precondition for everything else. Her thesis tracks what she told Acuity earlier this year for the publication’s Top 10 Clinical Leaders to Watch in 2026 feature, but with a sharper edge now that payer scrutiny has intensified.
ABA Data Standardization: Why Consistency Has to Come Before Automation
Asked about Little Leaves’ work to automate manual processes so clinical teams can focus on the children, Chong reframed the question. Automation is downstream of something more fundamental: agreement on what is being measured, how, and to what end.
“Automation for us in the first step is first you need to have the consistency of what you’re going to do, what you’re measuring, how you’re measuring it, what the outcome is intended to be, and then using those data to inform decisions along the way,” Chong said. Without that consistency, variability from human clinical judgment will continue to swamp any efficiency gains a platform might deliver. That logic mirrors what Acuity has heard from vendors trying to automate the most manual parts of ABA clinic operations: better interfaces are not the same as fewer manual steps, and AI only earns its keep when the inputs are consistent. In Chong’s view, AI is an enabler that becomes most valuable for establishing guardrails to reduce variability and standardize clinical processes, once an organization has defined what constitutes ‘success’.
The industry, Chong noted, has not reached that consensus. Generally accepted standards of care exist. For example, the Council of Autism Service Providers publishes ABA Practice Guidelines and a companion white paper on early intensive ABA treatment, which Chong recommends as foundational references. While trade organizations weigh in, provider-level agreement on the right metrics and platforms remains thin. “It’s difficult to make comparisons when you’re looking at apples to oranges versus apples to apples,” she said. That measurement gap is the same one Acuity covered out of the 2026 BHASe Summit in Miami, where executives acknowledged that behavioral health outcomes measurement is still improvised even at the most sophisticated operators, and payers are no longer willing to wait.
Where that work goes next at Little Leaves is now a question for its new parent. Learn Behavioral acquired Little Leaves from FullBloom on May 11, per Acuity’s prior reporting. Learn operates more than 100 learning centers across 17 states and is built around ABA, in contrast to FullBloom, which is primarily a private and special education organization.
The BCBA Workforce Pipeline: Apprentice Programs and the Invisible Burnout Problem
Little Leaves’ apprentice program, flagged as a 2026 priority when Chong was named to Acuity’s Top 10 list earlier this year, entered pilot in April. The first cohort is in Q1, and Chong said the early reads are positive: participants like the program and the time commitment is manageable.
The program is designed for students who have largely completed coursework and restricted experience hours and are approaching BCBA certification. It gives them structured support and applied caseload practice before they take on a full clinical role. Chong’s reasoning is that graduate school teaches the minimum requirements to become a behavior analyst, not necessarily the clinical application itself, and certainly not the assessment and case conceptualization decisions a new BCBA faces on day one.
She framed the workforce stakes bluntly. New BCBAs do not necessarily face a work overload in their first years, she said, but they face an invisible one as they simultaneously learn documentation, applied practice, their clients, and managing teams. “Truly the training in the field and the BACB exam to become a BCBA is the minimum requirement,” Chong said. Without additional structured support, turnover follows.
That workforce pressure is documented in Acuity’s own reporting. The ABA workforce shortage is, in practice, a retention problem rather than a recruitment problem, with median annual RBT turnover hovering around 65 percent and approaching or exceeding 100 percent at the largest organizations. First-time BCBA exam pass rates have fallen to 51 percent, the lowest the BACB has ever recorded. For a field where clinician supply is the binding constraint on most growth plans, programs like Little Leaves’ apprentice model are designed to address the structural training gap that no single graduate program can close on its own.
Chong also pointed to the Marcus Crisis Prevention Program, developed by Marcus Autism Center, as the clinical framework Little Leaves uses for safety and behaviors of concern. Unlike older crisis prevention programs, she said, MCPP foregrounds wellness and resilience for staff alongside clients and treats line clinicians as a first-tier safety priority, emphasizing that contextual and environmental variables (not just the child’s behavior) shape what good care looks like in a given moment.
ABA Aggregate Outcomes and the Eldevik 2026 Benchmark: What a Thriving Provider Needs by 2027
Pressed on what a well-run ABA provider needs to look like by the end of 2026 to thrive in 2027, Chong returned to the apples-to-apples thesis. The goal is not just measuring whether an individual child progresses but understanding aggregate outcomes across an organization’s full caseload, then benchmarking those results against the field.
She pointed to a January 2026 individual-participant-data meta-analysis published in Autism Research by Eldevik and colleagues, which examined data from 341 children who received early intensive behavioral intervention and 280 in comparison groups across 15 studies. The analysis reported effect sizes of 0.66 for adaptive behavior gains, 0.87 for intellectual functioning, and 1.36 for reductions in autism severity, with treatment intensity significantly associated with outcomes. For Chong, the proposed benchmarks are the kind of reference point providers should be measuring themselves against, not as a uniform expectation but as a way of asking what percentage of their caseload is making comparable gains.
The harder question, she said, is what are providers doing for the children who are not progressing? “There are some kids that learn very differently,” Chong said. “The procedures we are using, repetition, targets, and reinforcers are not working. There’s more going on that we’re not able to either adequately assess because of their age, interfering behaviors, or their communication level. And what do we do differently for those kids?” Treatment plan, intensity of hours, location, and caregiver training all become candidates for adjustment, she said, and the field has under-emphasized that work.
She is also skeptical of providers that put every child on a flat 30- or 40-hour schedule regardless of age or skill set. A two-year-old learning early language may need naps and unstructured time more than circle time or extended discrete-trial sessions. The argument that ABA must be delivered at a fixed ratio of clinic to home hours, common in payer policy debates, strikes her as a false choice. Her position aligns with the broader question Acuity has tracked: whether ABA treatment intensity should be a clinical judgment or a business decision. The question, in Chong’s framing, is where the child will learn the most quickly and how generalization is being planfully programmed.
Closing the interview, Chong summarized her two takeaways for the rest of 2026. Organizations need to minimize internal variability in utilization, supervision, and quality of supervision so the comparisons they and their payers make are meaningful. And they need to define what “good” looks like for their clients, with reference to industry standards, and be honest about which children are reaching it. “It’s what the needs are, how we define good, and how do we get there,” she said.
