ABA C.A.R.E.S. Founder Holli Beth Clauser tells Acuity how RBT turnover, an empty HR seat, and her own autism built the Boston summit.
In 2016, every new hire at an ABA company passed through Holli Beth Clauser’s training room. Too many of them, she was beginning to think, should never have gotten that far.
She had come up through direct care and moved into training, which meant the entire hiring pipeline emptied out in front of her. The people arriving in it, she found, had almost no idea what they had signed up for. “They’d be shocked when we told them the kinds of behaviors we actually manage,” she told Acuity Media Network. “They couldn’t even picture what a session looked like.”
Some were worse than unprepared. One trainee, Clauser said, openly mocked autistic people in the room. “That’s not something you coach out of a person on day one. That’s a values problem, and it’s exactly the kind of thing the interviewer should have caught and didn’t.”
She started offboarding people before they ever began, the only trainer in the building doing it, and every one of those conversations pointed somewhere upstream of her, to a hiring process that had waved through candidates it should have stopped. “So I thought, maybe I belong in recruitment.”
A decade later, the detour has produced a four-day conference. The ABA C.A.R.E.S. Summit convenes August 4 through 7 at the Boston Marriott Long Wharf, with a livestream option for those who cannot travel, an odd creature on a behavioral health conference calendar whose marquee events tend to organize themselves around clinical science or dealmaking. Clauser, the Founder of ABA C.A.R.E.S. Staffing LLC, built hers around staffing instead. Responding to questions from Acuity ahead of the summit, she traced the entire thing back to that training room.
The condition she is describing is well documented. Median annual turnover among registered behavior technicians runs near 65 percent, and at the largest providers it approaches or passes 100 percent, which means some organizations cycle through their whole technician workforce inside a year. Acuity has reported that the shortage is better understood as a retention problem than a recruitment problem. Clauser arrived at that conclusion the long way, from inside the machinery.
From Behavior Technician to Recruiter: Where the ABA Workforce Problem Became Visible
Recruitment proved stranger than she expected. Here was a field that had staked its professional identity on measurement, on data, on the patient tracking of behavior, and it was tracking nothing whatsoever about its own hiring. “Nobody was using the science in that space,” she said. “People tracked time to fill and how many bodies they hired. Nobody tracked whether those people stayed, how long, or why it didn’t work out.” Nothing traveled back to the recruiters who had made the calls.
She tried the visible fix first. Working with the marketing team, she helped produce a day in the life of an RBT video, one of the first of its kind she is aware of in the field, so candidates could see the job before applying to it. That changed who walked through the door. The interventions that actually held people, though, were slower and less photogenic: better interview questions, then the harder discipline of learning to analyze the answers rather than merely collect them; training for the recruiters themselves; a working line of communication between departments that had never had one.
She has sat across from more than 10,000 RBTs and upward of a thousand BCBAs over the course of her career, by her own count, and even in those early years her numbers on hiring and retention were strong enough that she went looking for the reason why. What she found was less a series of mistakes than an architecture. “What I realized was that these were systems problems,” she said. “Nobody was being set up for success. It was a waterfall.” A break at the top ran downhill and landed in two places at once, on the health of the workforce and on the quality of the care that workforce could deliver. The industry keeps rediscovering the point from other angles. When one company scraped thousands of technician reviews to find out what RBTs were actually angry about, scheduling came first. Pay came third.
What C.A.R.E.S. Stands For: Care as a System, Not Just a Service
The name arrived by elimination. The working title had been the Autism Staffing Summit. “I said that acronym out loud once and realized it was never going to fly,” Clauser said.
C.A.R.E.S. is where she landed: Culture, Advocacy, Retention, Employee Relations, Systems. The five words map the territory, but the acronym is also making an argument. ABA is a discipline built end to end on the delivery of care, and it pours itself into the quality of the care it delivers to clients. “What we forget is that you can’t care for clients well if you’re not caring for the workforce delivering it,” she said. “We’re really good at care as a service. This is about care as a system, all the way back to the people doing the work.” The proposition is finding company. Practitioners told Acuity this spring that staff quality of life belongs in the outcomes conversation alongside the client’s, less a perk than a precondition.
Clauser is autistic, and she places that at the center of the origin story rather than at its margin. “Being neurodivergent is what led me here,” she said. “I don’t think I’d have seen any of this the way I do without it.”
She begins, unexpectedly, with attachment. Transitions are hard for her. People who move in and out of her life without resolution stay with her longer than she would like. And the thought that followed her out of that observation was about someone else entirely, the child who is never sat down and told why the person they trusted every day simply stopped coming. “In our field, that child is the client,” she said. “And the turnover we treat as a staffing metric is a person vanishing from their life with no explanation.”
The summit’s three pillars follow from that: care for the people receiving services, care for the people delivering it, and care for the employers, on the argument that bad hiring consumes money and resources at a scale most owners never bother to total. It is also why a failed hire still lands on her personally. She has watched people who wanted the work get dropped into it unprepared and walk away convinced they had failed at it. Usually, by her account, they had not been a bad fit for the field. They had been a bad fit for one company, and it was preventable.
The Missing HR Seat and the Case for Cross-Role Alignment in ABA
Suggest to Clauser that her summit treats turnover as a clinical and ethical matter rather than an HR one, and she declines the compliment. “I’ve never said turnover isn’t an HR problem,” she said. “It’s not solely an HR problem. The whole employee life cycle owns retention.” Her real complaint is structural, and blunter than the framing she was handed: HR, as a function, barely exists in ABA.
She explains it with a football team. An organization can field a strong quarterbacks coach, a capable offensive coordinator and a good special teams staff, and still come apart without a head coach holding the whole view and making sure everyone is running in one direction. In a company, that head coach is the HR function, and in ABA, she says, the seat sits empty. What she tends to find instead is one person administering benefits, another handling onboarding, and nobody thinking about the workforce strategically. When an organization does fill the chair, it often hires out of a hospital or another industry, someone who understands HR and does not understand ABA: the clinical realities, the billing, the shape of an RBT’s week.
“You need someone who understands HR and understands ABA, in the same person,” she said. Failing that, bring in a consultant, or train someone into it, because the cost of the empty chair, in money, in people and in the quality of care delivered, is by her reckoning enormous. Operators are hearing versions of the same argument from considerably less sentimental directions. Buyers now examine retention closely enough that lifting average RBT tenure from six months to eight registers as a material improvement in diligence, and at least one behavioral health operator has gone four years without touching agency staffing by building its pipeline from the inside. Clauser keeps circling a single word. “Preventable. None of this is bad luck. It’s a missing seat, and a missing seat can be filled.”
This year’s theme is alignment, and the four tracks (Executive, People Operations, Career Counseling and Clinical Leadership) are arranged to produce it. Repair one department in isolation, she says, and you tend to solve a single problem while setting off five others. Her preferred image for the alternative is the Mayo Clinic. A case complicated enough to defeat any one specialist does not get parceled out to five doctors in five rooms who never speak to each other. “You put the whole team around one table and solve it together,” she said. “It’s not going to be solved by owners in one room and RBTs in another.” Each track runs deep into its own reality. The design is that all of them sit in the same building, hearing the same conversation, and can speak to each other when they leave it.
The first edition, at Lake Nona in 2023, drew 118 people onsite and 90 more online, and Clauser spent the run-up in the condition familiar to anyone who has booked a ballroom on faith. What came back afterward was not praise for the programming. “It was ‘this felt different,’” she said. Everything was accessible. Nobody was separated out. Speakers stayed in the room for one another’s talks, which she notes is not how these things usually go. Attendees kept describing it as an industry offsite rather than a conference, and the phrase stuck. Asked when she knew the field needed such a thing, she rejects the premise of the question. It always felt that way, she says. The first room only confirmed she was not alone in it.
What she wants people carrying out of Boston is a line she attributes to Audrey Hepburn: to plant a garden is to believe in tomorrow. Her reading of the field is that much of it has quietly stopped planting, having filed turnover under weather and the RBT job under transient. “I don’t believe that for a second,” she said. “But when you accept it, you stop planting. You stop trying.” She wants attendees leaving with tools, and with people to call when a tool does not fit their organization on the first attempt. That is roughly the shape of what she is building next: smaller workshops hosted through a Skool community, and a training program for recruiters in the field that she plans to develop with collaborators. The summit stays. The intention is to carry it through the year, so the support does not evaporate when everyone flies home.
Disclosure: Acuity Media Network will cover the ABA C.A.R.E.S. Summit on a complimentary press pass provided by the organizers, who requested a profile of the event’s origins. Acuity retained full editorial control over this article, including its framing and conclusions.
