Rad N Bad Podcast

Somewhere along the way, applied behavior analysis took an intensely personal clinical question—what does this unique child and family actually need right now?—and turned it into an algebra problem. Higher support needs? Add hours. More assessment goals? Add hours. Comprehensive treatment? Hand over 30 to 40 hours of your week.We spend our entire careers training parents, schools, and technicians not to explain behavior with circular labels. We tell them to find the environmental variables, analyze motivating operations, and identify reinforcement contingencies. Yet, when someone asks why an autistic child needs 30 hours of ABA, our answer basically amounts to: "Because they're in the 30-hour tier."That isn’t a functional analysis. That’s circular reasoning with a CPT billing code slapped onto it.On this episode of Rad N Bad, Sean Yocum and Mike Carrero stop ducking the hardest, most guarded debate in the behavioral health industry. We trace the history of high-dosage ABA from Lovaas in 1987 to the landmark 2024 JAMA Pediatrics meta-analysis, run a ruthless systems-level contingency analysis on fee-for-service reimbursement, and challenge every clinician in the field to take The Zero-Dollar Test.In this episode, Sean and Mike break down:Where Did 40 Hours Actually Come From? Deconstructing the 1987 UCLA Young Autism Project, replication attempts by Smith and Eikeseth, the 2001 National Research Council report, and why our field mistook a broad treatment package for a single active ingredient.The 2024 Sandbank Meta-Analysis: What 144 studies and over 9,000 children published in JAMA Pediatrics actually tell us about the lack of a universal linear dose-response curve.Volume vs. Intensity (The Baseball Practice Metaphor): Why hours only measure elapsed time on a clock—and why 15 hours of dense, high-integrity, parent-embedded teaching can be far more behaviorally "intensive" than 35 hours of passive technician time.Follow the Money (Contingency Analysis): How traditional fee-for-service reimbursement actively punishes clinical titration, rewards dependence, and turns a BCBA who successfully makes therapy unnecessary into an operational nightmare.The Caregiver Gap: Why 30 hours of therapy only touches 18% of a child’s week, and why under-reimbursing parent coaching keeps families trapped in professional dependency.The Zero-Dollar Test: If your organization’s revenue was completely disconnected from the volume of direct billable hours delivered, would your treatment recommendations look the same tomorrow morning?

There is a brutal reality nobody warns you about when you sit for your BCBA exam: within 18 months of launching an independent practice, you aren't analyzing behavior graphs. You're staring at generic QuickBooks spreadsheets at midnight, explaining CPT codes to an accountant who doesn't know ABA, and watching payroll approach while commercial payers sit on your claims for 90 days.The dirty secret of our industry right now isn't that clinical models are failing—it's that independent, clinician-owned operators are getting choked out by cash flow.On this episode of Rad N Bad, Sean Yocum and Mike Carrero sit down with Ethan Schwarzbach, co-founder of Flychain, to cut directly into the financial engine of ABA. We pull back the curtain on how predatory private equity actually took over the space (hint: it wasn't superior clinical care) and how independent clinics can build modern financial infrastructure to stay open, stay ethical, and compete.In this episode, we break down:The Fixed-Payroll vs. Variable-Reimbursement Trap: Why paying staff on a strict bi-weekly schedule while waiting on unpredictable 60-to-90-day payer cycles creates an operational crisis.The Myth of Private Equity Clinical Superiority: Why corporate roll-ups dominate through capital reserves, data infrastructure, and secret contracted rate bargaining—not clinical outcomes.True Unit Economics: Calculating the fully burdened cost of an RBT hour (taxes, benefits, non-billable drive time, supervision allocation) vs. raw hourly pay.The Quota Trap: Why pushing clinicians to maximum billable capacity masks broken margins and accelerates burnout, turnover, and clinic failure.Leveling the Playing Field: How machine-readable payer rate transparency and CFO benchmark tooling give independent owners the leverage to negotiate higher reimbursement rates.Visit Flychain at https://www.flychain.us/

For decades, the applied behavior analysis sector in autism has treated the broader healthcare ecosystem like an aversive stimulus. We built a fortress out of rigid jargon, locked the gates, and convinced ourselves that clinical isolation equals purity.Here’s the unfiltered truth: our stubborn refusal to practice basic selective accommodation and collaborate across disciplines is putting our own field on a fast track to being faded out permanently.On this episode of Rad N Bad, Sean Yocum and Mike Carrero sit down with physician executive, health system leader, and author Dr. Steven Merahn, MD (Care Evolution) to hear what the rest of the medical world actually says about behavior analysis behind closed doors.In this episode, we unpack:Autism is Neurodevelopmental, Not Behavioral: Why treating autism strictly through a reductionist behavioral lens violates the medical principle of Rational Therapeutics.Hours Are Not Dosage: Why prescribing arbitrary 30-to-40-hour weekly clinic minimums fails pharmacokinetic principles and alienates pediatricians and health plans.Why Our Assessments Are Inherently Ableist: How comparing autistic children against normative peer curves or criterion sequences creates deficit-based traps rather than functional trajectories.The 5 Rules of Earning Professional Equity: Why behavior analysts must leave their echo chamber, attend adjacent medical conferences, read journals like JAMA Pediatrics, and stop denigrating allied disciplines.The "Default Mode Network" & Inner Life: Understanding the neuroscience of attention, why joint attention doesn't require forced eye contact, and why developmental relationship-based models (DRBI) must be respected.Professional Humility: Moving past professional supremacism to recognize that ABA is a powerful tool in the healthcare toolbox—not the entire toolbox.Find Dr Steve on Linkedin here: https://www.linkedin.com/in/stevenmerahn/

We love to say we value lived experience. We talk constantly about assent, compassionate care, social validity, and person-centered treatment. We’ve gotten really good at saying all the right words. But are we actually listening?When someone tells our field, "ABA helped me," we lean in. But when someone says, "ABA hurt me," or "ABA failed my family," we immediately jump into defense attorney mode: What kind of ABA was it? When did it happen? That’s not real ABA.On this inaugural episode of our new series, The Other Side of the Table, Sean Yocum and Mike Carrero stop explaining and start listening. We sit down with Kim Lambert, a single mother from North Carolina recently interviewed in the New York Times Article about ABA and whose son, spent years inside the ABA system.Kim pulls no punches as she shares the raw reality of navigating our field:The "Trust the Process" Trap: Why telling exhausted parents to "trust the process" often just means "hand over your judgment and stop asking questions."Graphs vs. Real Life: Why mastering "touch the blue square" at a clinic desk means nothing when a child still can't eat, sleep, use the bathroom, or leave the house without a 4-hour meltdown.The Fear of Telling the Truth: Why parents hide severe behaviors from BCBAs because they're terrified of being judged, blamed, or reported.From 30 Hours of "Babysitting" to True Independence: How moving away from cookie-cutter clinic quotas and into functional, parent-involved accountability completely transformed Rhett's future from institutional talk to sleepaway camp and public school.

Filing an ethics complaint against us would require actually citing the ethics code—and honestly, we’d appreciate the peer review.On this episode of Rad N Bad, Sean Yocum and Mike Carrero sit down with ethics heavy-hitters Dr. Jon Bailey (founder of the ABA Ethics Hotline) and Zachary Stevens (co-authors alongside Dr. Mary Burch of The Ethical Behavior Analyst) for an unfiltered examination of modern behavioral healthcare.We move past checklist compliance and memorize-the-code ethics to ask the hard questions: What happens when ethical practice collides with corporate private equity and billable hour quotas? Why are we teaching supervisees like they’re taking driver’s ed instead of preparing them for the clinical highway? And why is the true goal of ABA not great therapy, but making therapy completely unnecessary?Key Discussion Points:Driver’s Ed Ethics vs. Ethical Judgment: Why memorizing the BACB ethics code doesn’t prepare clinicians for real-world clinical pressure.The Conflict of Interest Trap: How tying compensation to billable quotas, 25-to-40-hour minimums, and "drive-by supervision" undermines client care.Outcome-Based vs. Dosage-Based Models: Why the field must shift from billing hours to measuring functional, real-world skill acquisition.The Supervision Reality: Moving beyond checking off 2,000 fieldwork hours to modeling how to handle denials, mistakes, and true client advocacy.The Mirror Moment: Why behavior analysts must embrace feedback, kick out private equity exploitation, and never lose sight of the human being across the table.You can pick up a copy of the Ethical Behavior Analyst right here! https://www.routledge.com/The-Ethical-Behavior-Analyst/Stevens-Bailey-Burch/p/book/9781032988849?gad_source=1&gad_campaignid=23976946742&gbraid=0AAAAACWuhHWAw1T6SJ5lQNVEYoky-9B4T&gclid=CjwKCAjwtKrUBhAhEiwAr77Zol_NkaYtUw4k7TMT4rxYZUP2YiRttF1P7SXqJ_LyNZ6yf2Y28qkO7BoCzsAQAvD_BwE