Perch Behavioral Health opened in the Spring of 2016 with a business model that defied nearly all expectations for modern healthcare organizations. William Waldo (Billy, to us), with a background in business operations, wanted to create an ABA agency that focused on training, mentorship, and clinician wellness. This business guy with no clear personal interest in ABA and no clinical background, wanted to create a healthcare company that would invest in its people before all else. He did so knowing that investing in your people means high costs upfront for trainings, salaries, and benefits. But he still went even further and set the company standard for low caseloads for BCBAs. Lower caseloads of course meant lower profit (or, as he correctly anticipated, none at all for a while) but it also meant BCBAs that could invest meaningful time into the families they served, the BTs they supported, and their own mental health.
Had I any business sense about me back when I met Billy in 2016, I would have thought there was no way this operation would survive the next couple years let alone be thriving a full decade later with all of those same values perfectly intact. But here we are, so let me take a minute here to try to describe to you how against-the-odds beautiful this truly is.
In a field rife with high turnover, quick burnout, and low job satisfaction Perch has managed to hold on to our clinical staff. Our Camp Perch Director and BCBA Christina Boykin was Perch’s first hire as a BT. All of our case-supervising BCBAs: Alex Moody (joined in 2017), Sheena Meng (2017), Gabrielle Gersten (2018), Ilinca Ionescu (2019), and Saij O’Neil (2020) - were BTs for Perch first and have spent their entire professional careers together.
Our BT Ambassador, Michael Park, is in his 5th year with Perch, LABA Garrett Loders in his 5th, and RBT Tommy Heideger hits 5 years in March. Nearly every BT that has started at Perch has spent at least 2 years with us.
The BACB states that direct support staff in ABA have an annual turnover of 65% with a median tenure of just one year.
Now, sure, we have lost BTs and even BCBAs over the years but without a doubt it is almost always due to them moving away or moving along their career path. I have written countless letters of recommendation for BTs applying to their Master’s and PhD programs that will carry their BT experience with them into adjacent fields. We still keep in touch with our sorely missed BCBAs that have moved away or gone on to leadership positions at other agencies.
But okay, so why am I spending so much time in this milestone anniversary post to talk about staff retention? Because it is consistently the number one challenge cited by ABA agencies as a barrier to providing high quality, consistent services. I could do a mic drop right here but I’m not known for my brevity.
Happy, satisfied, clinicians show up to work. BCBAs showing up means better supported cases and better trained BTs, BTs showing up to work means consistency for clients and long-term sustainable skill growth without having to restart each time a BT must be replaced. A leadership team that has been working together for nearly a decade means higher levels of trust, constant collaboration, and assurance that every single client gets the use of 7 BCBA brains instead of just 1.
I’m so glad that I didn’t have the sense to do a doubletake when I was presented with Perch’s objectives back in 2016. I consider myself beyond fortunate to work alongside people that I genuinely look forward to seeing every week. I’m constantly humbled knowing how easily I could have ended up elsewhere, working 15+ cases, being forced to do telehealth supervision, and onboarding yet another undertrained BT every few months.
In a world where the dollar is king and sustainability an afterthought - where fast-fashion mindsets are seeping into the high-stakes fields of healthcare and education, Perch holds strong in resistance.
The only explanation I have for how we got here today is that Billy was absolutely uncompromising with his mission from the start. We have all now taken those values on as our own and we’ll continue to be the proof that investing in your people is good business. (I do also have a sneaking suspicion that Mrs. Waldo very likely had a lot more to do with our ability to keep this all afloat than any of us know but we’ll let her enjoy her anonymity…)
Here’s to another 10!
By: Loretta Hall
