This one’s for my fellow behavior analysts working in the insurance-funded autism services space (and for the rest of you who may be curious 👀). I can’t speak much to caseloads in school settings, but back when I worked as a behavior therapist in schools before becoming certified, I saw supervisors handling massive caseloads—sometimes 40 or 50+ students spread across multiple campuses in the district. I can’t say if that’s typical everywhere, but it’s what I witnessed firsthand.
In the insurance-funded world, my perspective comes from being a provider based in California. What’s often highlighted in online discussions is the 1:1 direct care model, which typically involves a clinical team consisting of at least one behavior technician (BT or RBT), sometimes a mid-tier supervisor (depending on the funder), and the BCBA as the primary supervisor.
The general consensus is that 20% of the recommended direct therapy hours should be dedicated to supervision. This ensures quality of care and supports the implementation by the BT or RBT. For example, if a client receives 10 hours of direct therapy weekly, the BCBA would supervise that case for 8 hours per month in a 4-week month or 10 hours per month in a 5-week month. Family guidance hours may also be included in that supervision time, if under the same billing code per the funder.
In a reel by Christina Torres, BCBA (@aba.madeez), she interviews the legendary Dr. Jon Bailey, a leader in ABA ethics, who suggests a manageable caseload is 8 clients or about 20 billable hours per week. The mention of 20 billable hours allows for flexibility, as each client’s treatment dosage should align with their unique needs. You can check out the full reel here.
In my experience, some companies push their supervisors to bill up to 30 or even 35 hours weekly with caseloads far exceeding 8 clients. Since the rise of investor-backed “big box ABA” companies, there’s been a trend of prioritizing billables over quality care. While some BCBAs find employers with reasonable caseload expectations, many others leave these settings to escape burnout by starting private practices, consulting, or applying ABA principles in fields beyond autism services, like health, fitness, or organizational behavior management.
Other Treatment Modalities
What’s often overlooked in discussions about caseloads are treatment modalities beyond direct therapy. For example:
• Parent-led models: Families may receive 2 hours of weekly treatment, or even 4 hours per month depending on the need, billed entirely by the BCBA or shared with a mid-tier supervisor.
• Social skills groups: Clients may attend 1–2-hour groups weekly, led by a facilitator. The supervision of these sessions may be billed entirely by the BCBA or shared with a mid-tier supervisor, depending on the company (each client in the group may belong to a different BCBA’s caseload). In some cases, I’ve heard of BCBAs running the groups themselves, which means they default to billing a group code instead of a supervision code.
Companies offering these models often boast “lower” billable expectations (e.g., 20 hours per week), but they still assign heavy caseloads, sometimes exceeding 45 clients. I’ve been in that position—working with 45+ clients, meeting a 25-hour minimum billable requirement. While 25 hours may sound manageable, juggling a high caseload meant constant prioritization, time management challenges, and ensuring every client received what they needed. Why would they do this? I believe it’s a way for companies to entice supervisors into employment while maximizing revenue. By focusing on lower-intensity treatment models like group services or parent-led approaches, they can take on more client intakes and bill for more assessments, rather than prioritizing higher-intensity 1:1 direct care cases that require more time and resources.
Tips for Advocacy
If you’re navigating the insurance-funded ABA world, here are some ways to advocate for yourself:
• Script for discussing caseload limits:
“I’d like to ensure I can provide high-quality supervision and care. Based on the recommended 20% supervision model and current best practices, I aim to maintain a caseload of no more than [X] clients to uphold these standards. Is there flexibility to adjust my caseload to meet this goal?”
• For billing expectations:
“I’ve noticed that the billable requirements and caseload don’t always align with the time needed for quality client care. Could we discuss restructuring hours or adjusting expectations to reflect this?”
Tips for Managing Caseloads
1. Delegate: If you have mid-tier supervisors, assign tasks like data collection reviews or initial behavior plan drafts to lighten your load.
2. Prioritize: Focus on clients with higher needs or cases requiring immediate attention.
3. Batch tasks: Group similar tasks (e.g., treatment plan updates) for efficiency.
4. Leverage telehealth: For family guidance or team meetings, telehealth can save time and reduce travel.
5. Set boundaries: Avoid overextending yourself. It’s okay to say no to additional tasks or cases if they compromise quality.
If you’re a BCBA in the insurance-funded space, take all this into account when evaluating opportunities. Don’t hesitate to advocate for yourself or seek another environment that aligns with your values.
This post was written at the request of a follower. Have a topic you’d like me to address? Let me know—I’m happy to help!
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