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Attending to the lived experiences of behavior technicians to discover the keys to retention: an exploratory study

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Attending to the lived experiences of behavior technicians to discover the keys to retention: an exploratory study

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Content Attending to the Lived Experiences of the Behavior Technicians to Discover the Keys to
Retention: An Exploratory Study
Mayu Fujiwara Tsuchikawa
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
May 2024

© Copyright by Mayu Fujiwara Tsuchikawa 2024
All Rights Reserved

The Committee for Mayu Fujiwara Tsuchikawa certifies the approval of this Dissertation
Eric Canny
Patricia Elaine Tobey
Theresa Haskins
Alison Keller Muraszewski, Committee Chair
Rossier School of Education
University of Southern California
2024

iv
Abstract
This study utilized the social cognitive theory (SCT) as a lens to examine the various influences
driving behavior technician (BT) retention. BTs play an essential role supporting the
enhancement of self-advocacy skills for autistic individuals. The high turnover of BTs negatively
impacts the opportunity for autistic individuals to strengthen their self-advocacy skills. The
purpose of this study was to explore and evaluate the behavioral, environmental, and personal
factors contributing to BTs’ decision to remain as an employee at the agency providing
behavioral services using qualitative methods research approach. The data gathered through a
semi-structured interview aimed to explore the reasons for the current retention status and how to
either maintain or improve upon the status. The findings from this study showed the triadic
reciprocal relationship between the personal, behavioral, and environmental domains. The
contributing factors to the retention of BTs in the personal domain were motivation, prior
knowledge, and purpose. In the behavior domain, person-centered approach, communication,
and coping skills were contributing factors to BT retention. In the environmental domain,
supervisor support, support system, and support from the organization were factors affecting BT
retention. This study enhanced the voice of BTs in identifying provisions to increase BT
retention. Recommendations to improve BT retention were outlined for the organizational
leaders seeking to maintain and expand the talent capital at an organization providing Applied
Behavior Analysis support to autistic individuals.

v
Dedication
To my boys, you will always be my “why.” Don’t be afraid of failure. You have the
strength and the tools to get up and try again. If I can do it, you can do it.

vi
Acknowledgements
Completion of this dissertation required much encouragement, guidance, and support. I
would like to first thank my chair, Dr. Alison Muraszewski for your encouragement, guidance,
and pushing me through this process. I would also like to thank my committee members. Dr. Eric
Canny for guiding me to engage in deep thinking. Dr. Patricia Tobey for her feedback, guidance,
and words of encouragement. Dr. Theresa Haskins for meeting with me even before start of the
dissertation process to offer her expertise, guidance, and words of encouragement. I owe a special
thank you to Dr. Douglas Lynch for introducing me to Dr. Haskins. I have learned a great deal
through each of the courses I have taken throughout the OCL program. Thank you to each and
every one of the leaders who taught me.
I could not have completed the dissertation support without the support of my family. First
to my husband for never questioning my decision to start this process. I will do my best to start
helping out with chores and you can now go to bed with lights turned off. I also want to thank my
boys for their patience through this process. I hope that I can be of inspiration to you to continue
lifelong journey of learning. My mother for unwavering support and home cooked meals of course.
My father for supporting achieving higher education. My sister for understanding and always being
available whenever needed. My brother for being present for the boys when I could not be.
Thank you to the organization that allowed me to conduct this study and to all the
participants who took time to participate in my study. Thank you for sharing your thoughts and
experiences with me.
Finally, my reading group friends who have been through this process with me. I will
forever cherish our friendship. You know when this dissertation is being submitted!

vii
Table of Contents
Abstract.......................................................................................................................................... iv
Dedication....................................................................................................................................... v
Acknowledgements........................................................................................................................ vi
Table of Contents.......................................................................................................................... vii
List of Tables ................................................................................................................................. ix
List of Figures................................................................................................................................. x
List of Abbreviations ..................................................................................................................... xi
Chapter One: Introduction to the Study.......................................................................................... 1
Context and Background of the Problem............................................................................ 1
Purpose of the Project and Research Questions.................................................................. 2
Importance of the Study...................................................................................................... 3
Overview of Theoretical Framework and Methodology .................................................... 4
Definitions of Terms........................................................................................................... 7
Organization of the Dissertation ......................................................................................... 8
Chapter Two: Literature Review .................................................................................................... 9
Historical Marginalization and Role of Applied Behavior Analysis.................................. 9
Behavior Technicians............................................................................................ 12
Turnover of Behavior Technicians ....................................................................... 13
Effect of Burnout on Behavior Technician Turnover........................................... 14
Effects of Behavior Technician Turnover on Autistic Individuals and Their
Families................................................................................................................. 15
Effects of Behavior Technician Turnover on the ABC Company........................ 17
Effects of Behavior Technician Turnover on the Community.............................. 18
Application of Social Cognitive Theory on Behavior Technician Turnover.................... 19
Personal Domain Related to Behavior Technician Turnover ........................................... 19
Effects of Self-Efficacy on Behavior Technician Turnover ................................. 20
Behavioral Domain Related to Behavior Technician Turnover ....................................... 21
Effects of the Use of Coping Skills on Behavior Technician Turnover ............... 21
Environmental Domain Related to Behavior Technician Turnover ................................. 22
Effects of Supervisory Support on Behavior Technician Turnover...................... 23
Conceptual Framework..................................................................................................... 24
Conclusion ........................................................................................................................ 26
Chapter Three: Methodology........................................................................................................ 28
Research Questions........................................................................................................... 28
Overview of Design .......................................................................................................... 29
Research Setting................................................................................................................ 29
The Researcher.................................................................................................................. 30
Data Sources ..................................................................................................................... 31
Credibility and Trustworthiness........................................................................................ 34
Ethics................................................................................................................................. 35
Chapter Four: Findings................................................................................................................. 37
Description of the Participants.......................................................................................... 37
Findings Research Question One...................................................................................... 40

viii
Discussion: Research Question One ................................................................................. 48
Findings Research Question Two ..................................................................................... 48
Discussion Research Question Two.................................................................................. 52
Findings Research Question Three ................................................................................... 53
Discussion Research Question Three................................................................................ 62
Summary of Findings........................................................................................................ 63
Chapter Five: Recommendations.................................................................................................. 66
Findings............................................................................................................................. 66
Recommendations for Practice ......................................................................................... 73
Recommendation 1: Affect Retention through Supervision Support ............................... 73
Recommendation 2: Affect Retention through Staff Recognition.................................... 75
Recommendation 3: Affect Retention through Motivation and Value ............................. 77
Integrated Implementation and Evaluation Plan............................................................... 79
Limitations and Delimitations........................................................................................... 92
Recommendations for Future Research ............................................................................ 93
Conclusion ........................................................................................................................ 94
References..................................................................................................................................... 96
Appendix A: Survey Protocol..................................................................................................... 125
Appendix B: Interview Protocol ................................................................................................. 127
Appendix C: Information Sheet for Research Participants......................................................... 131
Appendix D: Immediate Evaluation Instrument – Sample Program Evaluation........................ 133
Appendix E: Immediate Evaluation Instrument – Sample Observer Checklist.......................... 134
Appendix F: Delayed Evaluation Instrument – Sample Program Evaluation ............................ 135

ix
List of Tables
Table 1 Data Sources.................................................................................................................... 29
Table 2 Participant Overview ....................................................................................................... 38
Table 3 Findings: Self-Efficacy .................................................................................................... 42
Table 4 Findings: Intrinsic Motivation Subtheme ........................................................................ 43
Table 5 Findings: Extrinsic Motivation ........................................................................................ 44
Table 6 Findings: Coping.............................................................................................................. 51
Table 7 Outcomes, Metrics, and Methods for External and Internal Outcomes........................... 81
Table 8 Critical Behaviors, Metrics, Methods, and Timing for Behavior Technicians................ 82
Table 9 Required Drivers to Support Behavior Technician Critical Behaviors ........................... 84
Table 10 Evaluation of the Components of Learning for the Program......................................... 88
Table 11 Components to Measure Reactions to the Program....................................................... 89

x
List of Figures
Figure 1: Conceptual Framework for the Study of Behavior Technician Retention Rate at ABC
Agency .......................................................................................................................................... 24
Figure 2: Factors Contributing to Behavior Technician Retention Rate at ABC Agency............ 63

xi
List of Abbreviations
ABA Applied behavior analysis
ASAN Autism Self Advocacy Network
ASD Autism spectrum disorder
BACB Behavior Analysis Certification Board
BCBA Board Certified Behavior Analyst
BT Behavior technician
CDC Center for Disease Control
DD Developmental disability
DDS Department of Developmental Services
DSM-5 Diagnostic and Statistical Manual of Mental Disorders-5
DSP Direct support professional
NASDDDS National Association of State Directors of Developmental Disabilities
RBT® Registered behavior technician
SCT Social cognitive theory

1
Chapter One: Introduction to the Study
The high attrition rate of behavior technicians (BTs) negatively affects the self-advocacy
skills of autistic individuals. More specifically, job dissatisfaction expressed by BTs at a private
organization providing Applied Behavior Analysis (ABA) services lead to a high turnover rate.
The primary expectation of BTs is to demonstrate technical skills to implement a behavior
management program. However, in the recent years, there has been more attention placed on the
Registered Behavior Technicians™(RBTs®) Ethics Code (2.0) (Behavior Analyst Certification
Board, 2022) to emphasize the effects of BTs interface with autistic individuals. The high
turnover rate of BTs due to job dissatisfaction (Giangreco et al., 2001; Langeliers, 2013)
exacerbates the inability to apply knowledge they may have acquired to support autistic
individuals. Compared to an average of 19% turnover rate for the healthcare industries
(O’Donnell, 2019), the turnover rate of BTs is at a higher average of 35% to 77% (Molko, 2018;
Novak & Dixon, 2019). Failure to address the turnover rate of BTs will deplete the talent capital
for the organization’s survival (Costanza et al., 2015) in the behavior services market. Moreover,
the negative ramifications of BT turnover on the self-advocacy skills of autistic individuals will
result in further marginalization, hinder diversification of the workforce, and escalate reliance on
government subsidies to support the livelihood of autistic individuals.
Context and Background of the Problem
Various research has identified factors associated with BT turnover. These causes of BT
turnover include lack of acknowledgment of contribution towards progress of autistic individual,
compensation not meeting expectations, lack of training, lack of supervisory support, lack of
representation of BT voices, and daily stress of the job (Ghere & York-Barr, 2007; Giangreco et
al., 2001; Langeliers, 2013; Novak & Dixon, 2019). Research has shown the turnover of BTs

2
causing disruption in the continuity of services and the adverse effect on the quality of services
(Friedman, 2021a; Hurt et al., 2013). In addition, BT turnover affects the morale and
productivity of the remaining employees at the organization, stakeholder satisfaction, and cost to
the organization to train new BTs and maintain other aspects of operations at the organization
(Ghere & York-Barr, 2007). Current literature investigating BT turnover recommends strategies
to increase retention based on causes of turnover (Ghere & York-Barr, 2007; Giangreco et al.,
2001; Langeliers, 2013; Novak & Dixon, 2019) However, further investigation of the lived
experiences of BTs is necessary to highlight the voices of BTs in the retention endeavor. The
effect of staff retention on the self-advocacy skills of autistic individuals is vital in addressing the
equity of the marginalized autism population.
Purpose of the Project and Research Questions
The purpose of this study is to explore and evaluate the behavioral, environmental, and
personal factors contributing to BT’s decision to remain as an employee at “ABC” agency using
qualitative methods design. The qualitative data collected through the interview process will
investigate the lived experiences of BTs to explore how to increase BT retention. Specifically,
elements influencing employees’ decision to maintain employment at ABC agency for 12
months or more will be explored and evaluated.
The study utilizes Bandura’s (1986) social cognitive theory to examine the various
influences driving BT retention. As such, the following questions guide the study:
1. What are the personal factors influencing a BT’s decision to remain in the profession at
the ABC organization?

3
2. What behaviors influence a BT’s decision to remain in the profession at the ABC
organization?
3. What environmental elements influence BT’s decision to remain in the profession at the
ABC organization?
Importance of the Study
In 2017 U.S. Department of Health and Human Services reported approximately 1.4
million individuals with DD, including autism, received support from direct support
professionals (DSPs). Direct support professionals play an integral part in inclusion of
individuals with disability in the society (Friedman, 2021a; Friedman, 2021b; Novak & Dixon,
2019). At ABC agency, the employees receive additional training specifically in ABA
methodologies, qualifying them to be a BT rather than a DSP. The training equips BTs to support
the learning of autistic individuals utilizing behavior modification strategies. BTs play an
essential role in supporting and elevating the lives of autistic individuals.
Despite studies pointing to vital role of BTs to assist autistic individuals, job
dissatisfaction (Giangreco et al., 2001; Langeliers, 2013) lead to high turnover, ranging from 35-
77% (Molko, 2018; Novak & Dixon, 2019) compared to 19% for other healthcare industries
(O’Donnell, 2019). Studies have shown that high staff turnover adversely affects continuity of
support for autistic individuals and impedes community access and inclusion (Friedman, 2021a;
Novak & Dixon, 2019). Research studies suggest exclusion, segregation, and social isolation of
autism population across settings (Conrad, 2020; Gur & Bina, 2022; Hall, 2010; McConkey et
al., 2019). Ableism, which posits that opinions of non-disabled are superior and that individuals
with Developmental Disability (DD) lack the ability to provide meaningful input, diminishes

4
voices (Stafford, 2017) and values of individuals with Dis/Ability (Lalvani & Bacon, 2019).
Ableism is a bias observed across environments, including school (Lalvani & Bacon, 2019) and
the workplace (Barnes & Mercer, 2005). According to the data released by the U.S. Bureau of
Labor Statistics in 2021, 17.9% of individuals with Dis/Ability were employed compared to
61.8% of individuals without disability in 2020. Furthermore, data indicates employment rate of
autistic individuals are lower than those with other forms of DD and Dis/Ability (Ates, 2022; Ohl
et al., 2017).
Without BTs, ABC agency is not able to accomplish the mission to transform the lives of
autistic individuals. More importantly, the role of BTs is critical in pursuing justice and equitydriven inclusion process (Dudley-Marling & Burns, 2014; Love & Beneke, 2021) for individuals
with DD, specifically, autistic individuals.
Overview of Theoretical Framework and Methodology
The study utilizes social cognitive theory (Bandura, 1986) as a lens through which to
view the problem of practice. Triadic reciprocity is a key principle of the social cognitive theory
(SCT) which exemplifies reciprocal interaction between the person, the behavior, and the
environment (Bandura, 1986). Adding the person as a factor in triadic reciprocity and the idea of
observational learning differentiates the SCT from behaviorism (Skinner, 1965). Schunk and
Usher (2019) also posit the important effect of self-efficacy and self-regulation on learning and
motivation.
Bandura’s (1986) social cognitive theory (SCT) provides a tool for assessing behavioral,
personal, and environmental relations and aligns with an investigation of retention rate of BTs.
Especially important is the application of the framework in assessing the effect of the
environment on BT and manifestation on motivation (Schunk & Usher, 2019). Ozyilmaz et al.

5
(2018) identified the effects of self-efficacy and environment on turnover and employee
satisfaction. In another study, Ford et al. (2020) applied the social cognitive framework to
examine the motivational and self-efficacy effect on goal outcomes. Similarly, self-efficacy,
environmental influence, and motivational influence on the retention of BTs at the organization
will be the foundation for the problem of practice.
Studies including BTs voices focusing on retention are not as common as those focusing
on BTs turnover rate at ABA agencies. The current study will employ a qualitative research
approach, which incorporates data for in-depth analysis of the questions posed incorporating BT
voices and increasing the trustworthiness of the research (Creswell & Creswell, 2018; Merriam
& Tisdell, 2016). The qualitative data will explain the reason for the current retention status of
BTs and how to either maintain or improve upon the status (Merriam & Tisdell, 2016). The study
site will be “ABC” agency where the researcher is currently employed. The site enables access to
over 1000 current BTs from different regions of the country representing various demographics.
Initial access to a substantial number of BTs will allow for more comprehensive representation
of BTs voices while increasing the pool of BTs that meet the criteria for the study. The
researcher will interview BTs not overseen by the researcher, decreasing the likelihood of
reactivity during the interview process while increasing the chances of obtaining genuine
feedback.
Key Stakeholder Group: Behavior Technicians
The key stakeholder group at the epicenter of power to achieve change is BTs, who are
the decision makers maintaining or terminating employment with ABC agency. Currently 40-
77% of BTs per training session per region terminate employment with the ABC agency within
the first 3 months of employment. This aligns with the high attrition rate of BTs in the ABA

6
field. Without BTs in the field, ABC agency cannot accomplish the mission to transform the
lives of autistic individuals.
BTs are at the center of every accountability relationship, whether with the agency or
autistic individuals. Taking internal and external sources of control into consideration, although
BTs are at the bottom of the agency hierarchy, they are the ones with the most face time with the
funding sources for the agency. The funding sources could potentially decide to end or expand
the contract with the agency depending on the performance of BTs and the outcomes observed in
autistic individuals. BTs become the epicenter of internal power for the agency as the external
sources of control hold the agency accountable for producing outcomes. In addition, when there
is a shortage of BTs at the agency, the agency is less likely to terminate employment with BTs.
Ontologically, BTs hold a specific ethicality and relationality relationship (Dubnick, n.d.) with
both the agency and autistic individuals. Ethically, BTs may seek a career in the field of ABA
because they value inclusion for autistic individuals or the cultural norm for BTs is to help those
in need. The new hire BTs are bound by a contractual relationship when they sign the offer letter.
In contrast, the relationship with autistic individuals is more informal and may become aversive
or gratifying depending on the situation.
The difficulty may be BTs could effortlessly break the ontological and epistemological
accountability relationship with the agency without much of a consequence to BTs individually.
The new hire BTs can establish ethical and relational accountability relationships with autistic
individuals based on values and morals while working at another agency. It does not have to be
at ABC agency. As such, BTs are at the epicenter of power to decide employment status with the
agency no matter what training, information, or support the agency provides. The organizational
outcome is impinging on BTs employment decision with the agency.

7
Definitions of Terms
• Ableism is discrimination and prejudice of individuals with differing abilities diminishes
voices (Stafford, 2017) and values of individuals with Dis/Ability (Lalvani & Bacon,
2019)
• Applied Behavior Analysis (ABA) is systematic modification of socially significant
behavior based on respondent and operant conditioning learning theory, frequently used
to support autistic individuals (Cooper et al., 2007; Sulzer-Azaroff & Mayor, 1991).
• Autism or autism spectrum disorder (ASD) is neurodevelopmental condition, present
from early childhood, characterized by difficulty in communication and social domains,
and self-regulation (Autism Society, 2023). Autism is experienced differently by each
individual (Autism Society, 2023; Autistic Self Advocacy Network, 2023).
• Behavior Technician (BT) is paraprofessional who implements ABA based support in
various settings (e.g., home, center, school, community), working directly with autistic
individuals (Dauster, 2017; Kazemi et al., 2015).
• Client is autistic individuals whom BT is entrusted to support.
• Direct Support Professional (DSP) is a person who directly supports individuals with
differing abilities with daily living tasks, including support in the community (Friedman,
2018).
• Self-advocacy is the process of verbally or non-verbally communicating one’s wants and
needs effectively (Autistic Self Advocacy Network, 2023).
• Supervisor is person whose responsibility includes support for BTs to implement the
ABA program across various settings, ABA programming and assessment for autistic

8
individual, and communication with team members supporting autistic individuals
(Dauster, 2017; Kazemi et al., 2015).
• Turnover rate is the ratio of the number of workers that had to be replaced in a given time
period to the number of workers remaining at the organization (Dauster, 2017).
Organization of the Dissertation
The dissertation follows a traditional five-chapter model. Chapter One provides an
overview of the study. Chapter Two highlights the relevant literature and the conceptual
framework for the study. Chapter Three details the research methodology. Chapter Four provides
the findings (qualitative). Finally, Chapter Five details the proposed recommendations.

9
Chapter Two: Literature Review
The purpose of the literature review in this chapter was to examine the causes of BT
turnover in the field of Applied Behavior Analysis (ABA) and the impact of BT turnover on
autistic individuals. The chapter begins with a brief review of the prevalence of autism. Next, a
literature review on the historical exclusion and marginalization of autistic individuals and the
importance of self-advocacy in relation to the number of BTs in the field of ABA is presented.
Then, the role of BT in relation to the self-advocacy skills of autistic individuals is explored
concerning effect on employment. Next, the causes of BT turnover are reviewed, followed by the
impact of the turnover on autistic individuals, families, and the ABC organization. The factors
that influence employee turnover were considered through the social cognitive theory lens. Due
to the scarcity of research exploring BT retention from the social cognitive theory and positive
practice perspective, a review of the literature was conducted on the effects of self-efficacy,
coping skills, and supervision as related to BT turnover.
Historical Marginalization and Role of Applied Behavior Analysis
In 2023, the Center for Disease Control and Prevention (CDC) reported one in 36
children identified as being on the autism spectrum. The estimated numbers have steadily
increased from one in 150 in 2000 to one in 68 by 2010 to one in 36 by 2020, as reported by the
Autism and Developmental Disabilities Monitoring (ADDM) network within the CDC.
According to findings by Maenner et al. (2020), prevalence in California was higher at one in 22
among eight-year-old children. Individuals with Dis/Ability continue to be oppressed under the
notion of privileging able-bodied voices (Nario-Redmond, 2019) and have been since the 13th
century continuing into the present (Conrad, 2020). Generalized perception of individuals with
Dis/Ability as incapable (Abbott & McConkey, 2006; Stafford, 2017) and ableism ideology

10
(Nario-Redmond, 2019) has led to dismissal of individual voices. Although the promotion of
self-determination (Department of Developmental Services, 2022) has increased the presence of
Dis/Ability voices, individuals with Dis/Ability continue to be excluded across environments
(Barnes & Mercer, 2005; Lalvani & Bacon, 2019; Raji & Hollins, 2001; Robinson et al., 2020).
Lack of voice profoundly affects the exclusion of individuals with Dis/Ability, not only at an
early age, but also into adulthood when individuals are ready to join the workforce (Barnes &
Mercer, 2005).
Exclusion and othering of individuals with Dis/Ability has been noted across time,
environments, situations, and people. Social exclusion and stigma are still observed and felt by
individuals with DD (Gur & Bina, 2022; Hall, 2010; McConkey et al., 2019) despite the progress
made with the inclusion of individuals with DD across settings (Conrad, 2020). In behavioral
terms, this can be categorized as a generalized behavior that occurs intrinsically without practice
(ABA Connect, 2018). Ableism diminishes voices (Stafford, 2017) and values of individuals
with Dis/Ability (Lalvani & Bacon, 2019) and is observed in many environments, including
school (Lalvani & Bacon, 2019) and the workplace (Barnes & Mercer, 2005). Ableism is
comparable to color blindness in that the existence of differences is not acknowledged. Ableism
is also referred to as disability oppression as perspectives of non-disabled individuals are
privileged (Nario-Redmond, 2019). In the school environment, ableism is often expressed as “we
are all special”, which continues to reproduce the otherness of individuals with Dis/Abilities
(Lalvani & Bacon, 2019). Even when the students with Dis/Ability are placed in the general
education classroom, they are often seated on the outskirts of the class, in front closest to the
teacher, or away from the reach of other students leading to exclusion within the classroom
(Gabel et al., 2013).

11
Ableism also masks the voices of individuals with Dis/Ability. Due to the perception that
individuals with Dis/Ability cannot contribute meaningfully to their thoughts and opinions
(Stafford, 2017), many are not asked for input. For example, in a study by Abbott and McConkey
(2006), individuals with DD indicated having support from specialists contributed to exclusion
as the voices of specialists trumped the voices of the individuals with DD. With increased
awareness and promotion of self-determination (Maenner et al., 2020; Ne’eman & Bascom,
2020; Waltz et al., 2015; Zuber & Webber, 2019), and self-advocacy, (Autistic Self Advocacy
Network, 2023; Ne’eman & Bascom, 2020; Waltz et al., 2015; Zuber & Webber, 2019)
individuals with DD are allowed to voice their own opinions (Gibson, 2006).
The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) by the American
Psychiatric Association (2013) lists social communication as one of the criteria areas to
determine autism spectrum diagnosis. Social communication, as indicated by the Autistic Self
Advocacy Network (ASAN), is an essential skill for autistic individuals to self-advocate.
However, autism is a spectrum disorder, meaning individuals possess varying abilities. As such,
some autistic individuals need support to communicate (ASAN, 2023). ABA is an evidencebased approach to systematically modify socially significant behaviors based on respondent and
operant conditioning learning theory, frequently used to support autistic individuals (Cooper et
al., 2007; Sulzer-Azaroff & Mayor, 1991). In recent years, there has been increased discussion
amongst the autism community regarding negative (Anderson, 2023; Bottema-Beutel &
Crowley, 2021; Cernius, 2022; Human, 2016; Sandoval-Norton et al., 2019; Scott, 2022; Smith,
2021) and positive impact (Gitimoghaddam et al., 2022; Gorycki et al., 2020; McCabe et al.,
2023) of ABA on the lives of autistic individuals. Nevertheless, ABA is still considered an
effective evidence-based approach to support autistic individuals across the spectrum

12
(Gitimoghaddam et al., 2022; Hume et al., 2021; Hyman, et al., 2020; Irwin & Axe, 2019; Jensen
& Sinclair, 2002; Kazemi et al., 2015; Rogers & Vismara, 2008) acquire and develop social
communication skills.
With the prevalence of autistic individuals and ABA being an evidence-based method to
support autistic individuals (Hume et al., 2021; Rogers & Vismara, 2008), the need for BTs to
implement the ABA program has been increasing. According to the Behavior Analyst
Certification Board (BACB), the number of Registered Behavior Technicians™(RBTs®) has
increased from 324 in 2014 to 130, 273 in 2022. The U.S. Department of Health and Human
Services in 2017 reported approximately 1.4 million individuals with Developmental Disability
(DD), including autism, received support from direct support professionals (DSPs). Direct
support professionals play an integral part in the inclusion of individuals with disability in
society (Friedman, 2018; Friedman, 2021a; Novak & Dixon, 2019). BTs, like the DSPs, play an
essential role in supporting and enhancing the lives of autistic individuals (Gitimoghaddam et al.,
2022; Hume et al., 2021; Irwin & Axe, 2019; Kazemi et al., 2015; Rogers & Vismara, 2008).
ABA-based programs advancing the self-advocacy skills of autistic individuals cannot be
implemented without BTs.
Behavior Technicians
BTs are paraprofessionals who provide direct support to autistic individuals under
supervision guidance. BTs are responsible for implementing ABA programs designed by the
supervisors to support the development of communication, social, and independent living skills
goals. BTs are also tasked to manage maladaptive behaviors (i.e., behaviors that impede
functional participation in the community), such as physical aggression, elopement from the
area, and high-pitched screaming. The ABA supports are provided across environments,

13
including the community, home, and school. Although not a requirement, those BTs certified by
the Behavior Analysis Certification Board (BACB) are identified as registered behavior
technicians (RBT®). According to BACB (2024), RBTs increased from 328 in 2014 to 160,041
in 2023. 84.85% of the RBTs primary area of professional emphasis is autism spectrum disorder
(ASD). The data presented by BACB and the exponential growth of the number of RBTs point to
the growing need for BTs to support autistic individuals.
Turnover of Behavior Technicians
A high attrition rate of BTs continues to be a problem despite the increased need for BTs.
American Network or Community Options and Resources (ANCOR) labeled the lack of DSPs to
support DD individuals as a crisis. The turnover of BTs in the field of ABA is high compared to
other related healthcare professions. Compared to an average of 19% turnover rate for the
healthcare industries (O’Donnell, 2019), the turnover rate of BTs is at a higher average of 35% to
77% (Molko, 2018; Novak & Dixon, 2019; Samadi et al., 2023). Moreover, a report by the
National Association of State Directors of Developmental Disabilities (NASDDDS) and Human
Services Research Institute (HSRI) through the National Core Indicators® (NCI) report indicated
that 47.7% of DSPs terminate their employment within the first year of employment. Just 16.2%
of DSPs have maintained employment for three years or more (NASDDDS, 2020). Zippia
(2023), a job search engine, indicates the highest turnover of BTs before the second anniversary.
Numerous studies have pointed to reasons such as lack of recognition, lack of proper
compensation, and lack of supervisory support as reasons for the high turnover (Giangreco et al.,
2001; Harvey, 2023; Kazemi et al., 2015; Langeliers, 2013; Mor Barak et al., 2001; Novak &
Dixon, 2019). Many of the research studies focus on reasons and sources of the turnover
(Giangreco et al., 2001; Harvey, 2023; Kazemi et al., 2015; Langeliers, 2013; Mor Barak et al.,

14
2001; Novak & Dixon, 2019) or study retention quantitatively through a survey (Dauster, 2017;
Gibson et al., 2009; Thornton, 2018). However, there is a dearth of study examining the lived
experiences of BTs exploring why BTs chose to remain in the profession. The study by
Hirakawa et al. (2019) reflected the voices of home-visit care workers through an interview
process, but incorporating BT voices in studying the retention of BTs at an ABA organization is
scarce.
Effect of Burnout on Behavior Technician Turnover
One of the primary causes of BT turnover is burnout. Burnout is when physical and
emotional stress leads to a feeling of reduced accomplishment (Aarons & Sawitzky, 2006;
Dauster, 2017; Hastings et al., 2004; Paris & Hoge, 2010; Thornton, 2018). Studies have
associated work stress, work overload, and conflict at work with burnout (Ghere & York-Barr,
2007; Gray-Stanley & Muramatsu, 2011; Langeliers, 2013; Mutkins et al., 2011; Paris & Hoge,
2010). BTs make various decisions while working with autistic individuals. The decisions vary
from implementing specific strategies, to assessing the situation and environment, to conducting
reinforcer assessment, and deciphering what autistic individual is communicating (Melton et al.,
2023). In addition, BTs manage challenging behaviors that the individuals may engage in, and
the various personalities of the adults interacting with autistic individuals (Devereux et al., 2009;
Kazemi et al., 2015; Mutkins et al., 2011; Novak & Dixon, 2019). BTs need to ensure progress
of autistic individuals across skill areas (Melton et al., 2023), especially with the ability to selfadvocate. To determine progress over time, BACB outlines data collection as a requirement in
the RBT task list. Job effectiveness also involves BTs ability to understand and implement ABA
programs daily (Melton et al., 2023). All these factors can result in work-related stress (Boujut et
al., 2017; Devereux et al., 2009; Mutkins et al., 2011).

15
Paris and Hoge (2010) compiled several studies that indicated higher proportions of
burnout among mental health professionals. However, self-efficacy and supervisor support act as
mitigating factors to reduce burnout and, in turn, effect the rate of turnover (Gray-Stanley &
Muramatsu, 2011; James, 2020; Kazemi et al., 2015; Langeliers, 2013; Mutkins et al., 2011). In
addition, studies have shown that BTs demonstrating effective coping skills were less likely to be
part of the turnover statistic (Mutkins, et al., 2011; Novak & Dixon, 2019). Specifically, coping
skills that are problem-focused (Nevill & Havercamp, 2019), task-oriented (Zijlmans et al.,
2015), and involve mindful response reduce burnout (Nevill & Havercamp, 2019). Problemfocused coping strategies, such as active coping and positive reframing, increased perception of
personal success (Nevill & Havercamp, 2019), leading to self-efficacy.
Effects of Behavior Technician Turnover on Autistic Individuals and Their Families
The turnover of BTs negatively impacts autistic individuals. Consistency is vital in
supporting autistic individuals (Friedman, 2021a; Friedman, 2022a; Hewitt et al., 2004; Sulek et
al., 2017). Unfortunately, the turnover of BT disrupts consistency and stability and creates undue
stress for autistic individuals and their families (Hurt et al., 2013). The effects are apparent in the
slowing down or lack of progress (Hurt et al., 2013; Kazemi et al., 2015; Novak & Dixon, 2019),
increase in challenging behaviors (Hastings & Remington, 1994), decreased opportunities for
autistic individuals to access the community (Abbott & McConkey, 2006; Friedman, 2021b;
Friedman, 2022b), and lack of responsiveness from autistic individuals (Kazemi et al., 2015;
Sulek et al., 2017). Every time a new BT is introduced, there is a need for rapport building, for
the BT to learn the protocols of the program, and for autistic individual to generalize the skills
they have previously acquired (Hurt et al., 2013; Kazemi et al., 2015; Novak & Dixon, 2019;
Sulek et al., 2017).

16
In addition, families often feel the stress of having someone new in the home and
explaining the history of support their children have received in the past (Grindle et al., 2009;
Harvey, 2023; Larson et al., 2004). There is also no guarantee that a new BT would be found
immediately, leading to possible pause in service or programs not implemented to fidelity
(Friedman, 2022b; Sulek et al., 2017). If a new BT is not found, the autistic individual will be on
the waitlist, which means they will be without the support needed until a new BT is identified,
the autistic individual may be on the waitlist for weeks or months (Charlton, 2023).
The disruption in services and lower quality of care can have long-lasting effects.
According to the data released by the U.S. Bureau of Labor Statistics in 2021, 17.9% of
individuals with Dis/Ability were employed compared to 61.8% of individuals without disability
in 2020. Pre-COVID-19 pandemic in 2019, 19.3% of individuals with Dis/Ability were
employed compared to 66.3% of individuals without disabilities (U.S. Bureau of Labor Statistics,
2021). Furthermore, data indicates that the employment rate of autistic individuals is lower than
those with other forms of DD and Dis/Ability, ranging between 4.8% to 11.8% (Ates, 2022; Ohl
et al., 2017; Taylor & Seltzer, 2011). Several studies have shown the difficulty autistic
individuals face acquiring a competitive job (Butterworth et al., 2015; Chen et al., 2015; Scott et
al., 2019; Taylor & Seltzer, 2011). Taylor et al. (2015) showed autistic individuals had difficulty
maintaining a job once a job is secured. Chen et al. (2015) specified the presence of challenging
behaviors (e.g., aggression, ritualistic behavior), lack of appropriate communication skills, and
lack of social skills (e.g., interrupting conversation, inability to adjust to routine changes) often
lead to termination of employment or decrease the chances of employment. With individualized
support, however, autistic individuals could maintain a job and work towards reducing necessary
support (Brooke et al., 2018; Johnson et al., 2020).

17
Effects of Behavior Technician Turnover on the ABC Company
The turnover of BTs negatively impacts the ABC organization as well. With an estimated
turnover rate between 50% to 59% (Behavioral Health Center of Excellence, 2021), an average
cost per hire of DSP at $2413, and an estimated 625,000 DSP, the average cost per termination
of DSP could be as high as $784 million (Hewitt & Larson, 2004). Furthermore, the organization
inherits the cost of staff development for inexperienced staff, recruiting, hiring, additional
administrative support, paying out on accrued time, and the cost of marketing (James, 2020;
Wine et al., 2020). The expense of recruiting and training new staff ranges from 90% to 200% of
the terminated employee (Li et al., 2016). The organization must also consider the indirect cost
of BT turnover, such as a decrease in productivity, decrease in morale of staff left at the
organization, reduced service quality, decrease in consumer satisfaction, and a decrease in
supervisor support to staff left as the new hire requires more attention (Ghere & York-Barr,
2007; James, 2020) There is also loss of revenue for cancelled sessions if a new BT is not
identified immediately (Dauster, 2017; Wine et al., 2020). Any investment made by the
organization towards professional development of the BT (e.g., certification, advancement within
the organization, knowledge of company protocol) is also lost. In addition, high turnover rates at
an organization can negatively affect the reputation of the company amongst the community
members and funding sources (Ghere & York-Barr, 2007). Most of all, the organization loses
human capital essential to survival in the competitive ABA field (James, 2020).
On the other hand, retention increases productivity, and organizational functioning,
maximizes human intellectual capital (Dauster, 2017). Wheelan (2019) characterized human
capital as skills that an individual possesses due to education, experience, personal character, and
intelligence. Gary Becker (1999, as cited in Wheelan, 2019) deemed human capital to be the

18
most important, comprising 75% of the wealth of the modern economy. The importance of
human capital to the agency is the productivity and the skill each person contributes to the
organization, but the organization first needs to invest in a solution (Wheelan, 2019).
Epistemological Accountability Binary Between the Behavior Technician and ABC Company
BTs are at the epicenter of challenges within the epistemological accountability binary.
The adverse selection (Hentschke & Wohlstetter, 2004) occurs when the hiring managers at the
agency do not have the appropriate information regarding the potential candidates. Work
assignment is based on agency need (i.e., autistic individuals on the waitlist to receive services),
giving BTs limited decision rights (Hentschke & Wohlstetter, 2004). Regarding divergent
objectives, BTs may be interested only in financial compensation and not care about the
wellbeing of autistic individuals. Information asymmetry is at play as BTs have the most up todate information as the frontline workers in the field. Weak incentives across the board lead to a
lack of performance by BTs (e.g., lack of acknowledgement, lack of pay) (Hentschke &
Wohlstetter, 2004). Issue with decentralized authority comes into play when the agency clinical
manager miscalculates the skillset of BTs. Lastly, but maybe most importantly, the agency’s
legitimacy is a direct result of the support BTs offer in the field to autistic individuals. The
challenges within the epistemological accountability binary may lead to resignation
consideration for BTs.
Effects of Behavior Technician Turnover on the Community
When autistic individuals are unemployed, the government provides financial support to
unemployed autistic individuals. Autistic individuals receive $831 monthly through
supplemental security income (SSI). The autism collaboration, accountability, research,
education, and support (CARES) Act of 2019 authorized $369.7 million in spending through

19
2024 to support autistic individuals, including research and services such as ABA services. In
addition, the CDC reports that national healthcare disability-associated expenditures total $868
billion. California expenditure totaled $102.8 billion in 2021, 38% of the state’s healthcare
spending. This is equivalent to about $19, 949 per person with disability. However, when autistic
individuals are working, the government benefits in the form of taxes, which could be up to
$50,000 per person per year (Austin & Pisano, 2017). In addition, Bozek (n.d.) cited a report by
Accenture (2018) which showed companies that employed individuals with disabilities achieved
28% higher revenue and 30% higher economic profit margin compared to companies in the same
field (Palumbo, 2021). At the state level in California, the signing of Senate Bill 639 (SB 639,
2021) by Governor Newsom in September 2021 supports the integration of individuals with
Dis/Ability in the labor force. However, the bill does not address the systemic issue of the
nation’s unemployed Dis/Ability population.
Application of Social Cognitive Theory on Behavior Technician Turnover
The social cognitive theory will be utilized to examine the effects of high BT turnover on
the self-advocacy skills of autistic individuals. Triadic reciprocity is a key principle of SCT,
which exemplifies reciprocal interaction between the person, the behavior, and the environment
(Bandura, 1986). Adding the person as a factor in the triadic reciprocity and observational
learning highlighted by Bandura differentiates SCT from behavioral theories presented by B.F.
Skinner that learning occurs through the effect of the environment on individual action (Skinner,
1965).
Personal Domain Related to Behavior Technician Turnover
The first domain of SCT to consider is the person. The personal domain includes the
acquisition of knowledge, beliefs, attitudes, skills, and strategies through interaction with others

20
(Schunk & Usher, 2019). Individuals exercise control over actions, feelings, and thoughts. The
construct considered in this domain is self-efficacy. The BT’s command of the knowledge
necessary to function in their role as the BT to perform daily duties in their role play a vital role
in self-efficacy. BTs’ belief in their ability to execute a task in pursuit of a goal leads to selfefficacy (Bandura, 1978).
Effects of Self-Efficacy on Behavior Technician Turnover
Self-efficacy is an individual’s belief that they have control over their behavior and the
environment (Bandura, 1978). Studies have shown a correlation between self-efficacy and the
turnover or intention of turnover in BTs. Namely, increased self-efficacy was associated with
decreased turnover (Fida et al., 2018; Gibson et al., 2009; Novak & Dixon, 2019; Robertson &
Sadri, 1993; Stajkovic & Luthans, 1998). Significant for BTs is the self-efficacy affects
cognition, coping ability, motivation (Fida et al., 2018; Schunk & Usher, 2019) and the
implementation of teaching programs for autistic individuals (Corona et al., 2017).
Cognition involves not only learning, but also problem-solving. Four sources support an
individual’s acquisition of self-efficacy: performance experience, modeled experience, social
persuasion, and physiological index (Bandura, 1977; Chami-Malaeb, 2022). BTs learn through
modeling of others (Schunk & Usher, 2019), either the colleagues who are working in the same
environment, participating in the same training, or the supervisors supporting in the field. BTs
also acquire knowledge through performing the task (Schunk & Usher, 2019). To increase selfefficacy, BTs first need to have a clear understanding of the protocols and strategies to function
in their role as the BT, required administrative tasks, ABA methodologies, and support plans to
implement with autistic individuals (Dauster, 2017). A study by Corona et al. (2017) found that
prior training on autism and positive behavior strategies (PBS) promoted cognition and self-

21
efficacy. Environmental support, in the form of onboarding training (Corona et al., 2017; Kazemi
et al., 2015), and supervisor support in the field support the BT’s cognition (Kazemi et al., 2015;
Rosales et al., 2023).
Research by Gibson et al. (2009) described longer tenure working with autistic
individuals associated with increased self-efficacy. Increased self-efficacy led to feelings of
increased job effectiveness and value (Gibson et al., 2009). Likewise, individuals with higher
self-efficacy strived to work harder and achieved better results (Chami-Malaeb, 2022; Schunk &
Usher, 2019). In addition, increased self-efficacy positively impacted BTs ability to cope with
stressful situations associated with the job (Chami-Malaeb, 2022). Higher levels of self-efficacy
enabled engagement in independent problem solving when faced with unexpected situations
(Bandura, 1977; Schunk & Usher, 2019). Similarly, self-efficacy increases motivation of BTs to
support autistic individuals as they are more confident in their ability.
Behavioral Domain Related to Behavior Technician Turnover
The behavior domain considers the expertise and skill the BT demonstrates. The behavior
construct examined was coping skills. The use of coping skills allows BTs to not only cope with
situations they encounter at the job, but also to identify effective means of managing their own
mental and physical needs to effectively support with the development of self-advocacy skills for
autistic individuals.
Effects of the Use of Coping Skills on Behavior Technician Turnover
BTs make various decisions while working with autistic individuals. The decisions vary
from implementing specific strategies to assessing the situation and environment, conducting
reinforcer assessment, and deciphering what autistic individual is communicating (Melton et al.,
2023). In addition, BTs manage challenging behaviors that autistic individuals may engage in,

22
manage relationship with family members of autistic individuals, and the various personalities of
the adults interacting with autistic individuals (Devereux et al., 2009; Elfert & Mirenda, 2006;
Kazemi et al., 2015; Mutkins et al., 2011; Novak & Dixon, 2019). BTs need to ensure the
progress of autistic individuals across skill areas (Melton et al., 2023), especially with the ability
to self-advocate. To determine progress over time, BACB outlines data collection as a
requirement in the RBT task list. Job effectiveness also involves BTs ability to understand and
implement ABA programs daily (Melton et al., 2023). These factors can result in work-related
stress (Boujut et al., 2017; Devereux et al., 2009; Mutkins et al., 2011).
BTs need productive coping skills to increase their effectiveness with autistic individuals.
Coping is when an individual responds psychologically or behaviorally to stressful situations
(Nevill & Havercamp, 2019). Studies have shown that BTs demonstrating effective coping skills
were less likely to be part of the turnover statistic (Mutkins, et al., 2011; Novak & Dixon, 2019).
The same effects regarding effective use of coping strategies supporting retention are
demonstrated in special education teachers (Cancio et al., 2018). Specifically, coping skills that
are problem-focused (Nevill & Havercamp, 2019), task-oriented (Zijlmans et al., 2015), and
involve mindful response reduce burnout (Nevill & Havercamp, 2019). Problem-focused coping
strategies, such as active coping and positive reframing, increased perception of personal success
(Nevill & Havercamp, 2019), leading to self-efficacy.
Environmental Domain Related to Behavior Technician Turnover
The environment is another factor affecting the turnover of BTs. The environment
includes not only the physical environment, but also who or what is in the environment. The
construct explored in this section is supervisory support as related to BT turnover. Supervisory

23
support explores the literature associated with the level and type of support affecting BTs
dedication to supporting autistic individuals.
Effects of Supervisory Support on Behavior Technician Turnover
There are numerous studies indicating the impact of supervisor support on the turnover
rate of BTs (Alvero et al., 2001; Casey & McWilliam, 2011; Chami-Malaeb, 2022; Daniels,
2022; Eisenberger et al., 2002; Gibson et al., 2009; Levin & Decker, 2008). Studies have shown
that lack of supervisor support lead to higher rates of turnover of BTs, while the opposite can be
said of appropriate levels of supervisor support (Afzal et al., 2019; Chami-Malaeb, 2022;
Dounavi et al., 2019; Eisenberger et al., 2002; Gibson et al., 2009; Kazemi et al., 2015;
Thornton, 2018). Novak and Dixon (2019) and others have indicated quality and quantity of
supervision affect BT turnover (Afzal et al., 2019; Dounavi et al., 2019; McNeese-Smith, 1996).
BTs not only seek administrative and clinical supervision, but also compassionate care (Austin,
2022) and emotional support (Chami-Malaeb, 2022; Devereux et al., 2009). Compassionate care
involves asking the BT about non-work-related issues, checking in on how the BT feels, and
showing genuine care (Austin, 2022; LeBlanc et al., 2020; Taylor et al., 2019). A review of the
literature by Devereux et al. (2009) found lower levels of burnout when staff felt comfortable
talking to the supervisor about work and non-work-related problems.
In addition, environmental factors vary depending on where BTs support autistic
individuals. The BT may work in the clinic, community, home, or school setting. Based on the
environment, BTs interact with different people, different work settings, and diverse cultures.
The factors external to the direct interaction with autistic individual affect BTs job effectiveness,
need for supervisor support, and self-efficacy, which in turn affect the turnover rate of BTs
(Valenti et al., 2013; Villanueva Jasa, 2021; Zheng & Liu, 2017). The supervisor’s support

24
increased self-efficacy and motivation (Afzal et al., 2019; Chami-Malaeb, 2022; Daniels, 2022)
establishing reciprocity between the environmental and personal factors.
Conceptual Framework
According to Maxwell (2013), a conceptual framework is established based on empirical
data, literature, and personal experiences. The conceptual framework directs the search for
related literature and study methodology (Maxwell, 2013). As such, the conceptual framework
represents the researcher’s perspective on the research problem supported by evidence from
previous research to explain the relationship between the research elements (Grant & Osanloo,
2014; Miles et al., 2020).
Bandura’s (1986) social cognitive theory (SCT) provides a tool for assessing behavioral,
personal, and environmental relations and aligns with an investigation of the retention rate of
BTs. Essential is the application of the framework in assessing the effect of the environment on
the BT and manifestation of motivation (Schunk & Usher, 2019). Ozyilmaz et al. (2018) posited
the effects of self-efficacy and environment on turnover and employee satisfaction. Ford et al.
(2020) applied the social cognitive framework to examine the motivational and self-efficacy
effect on goal outcome in another study. Similarly, the self-efficacy, supervision support, and
coping skills impact on the retention of BTs at the organization will be the foundation for the
problem of practice.
In alignment with social cognitive theory, the conceptual framework for this study
examines the triadic relationship between self-efficacy, coping skills, and supervisor support.
Figure 1 illustrates how each of the domains influences one another to affect BTs intention to
maintain employment at the organization.
Figure 1

25
Conceptual Framework for the Study of Behavior Technician Retention Rate at ABC Agency
The BT’s personal influence includes self-efficacy. Self-efficacy, represented by the
yellow circle, affects BTs’ intrinsic motivation, ability to manage unexpected situations, and
problem-solving skills (Bandura, 1977; Schunk & Usher, 2019). Self-efficacy also empowers
BTs to work harder toward results leading to better work outcomes (Chami-Malaeb, 2022;
Schunk & Usher, 2019). Personal factors influence BT’s decision to maintain employment at the
organization.
The behavior influence includes coping skills, represented by the blue circle. BTs
displaying effective coping skills are less likely to leave the job (Mutkins, et al., 2011; Novak &
Dixon, 2019). Additionally, the coping strategy may be a skill the BT has acquired through
supervisor support (Schunk & Usher, 2019). The coping strategy demonstrated by the BT may be

26
an individual safeguard for BTs to maintain employment. The behavior factor is influenced by
both personal and environmental factors.
The environmental factor includes supervisor support. Supervisor support is critical in
BTs’ decision-making process to maintain employment at the organization (Afzal et al., 2019;
Dounavi et al., 2019; McNeese-Smith, 1996; Novak & Dixon, 2019). The clinical guidance and
compassionate interaction from the supervisors create a safe space for BTs to perform, ask
questions, and seek support as necessary (Austin, 2022; LeBlanc et al., 2020; Taylor et al.,
2019). The environmental factor, like the personal and behavioral factors, appears to influence
BTs decision to maintain employment at the organization.
All the constructs in each theoretical domain interact reciprocally to influence the BT’s
decision making. Therefore, these variables should be explored further to analyze the effect on
BT’s decision to maintain employment at the organization and remain in the profession.
Conclusion
The high turnover of BTs in the field of ABA negatively impacts the self-advocacy skills
of autistic individuals. The literature review established the sources for BT turnover and
recommendations to curb the turnover. Despite the suggestions by experts in the field and
research studies to affect change, the problem of BT turnover continues to exist. BTs are
essential in preparing autistic individuals with the tools necessary to self-advocate. With BT
turnover, autistic individuals miss the opportunity to build their self-advocacy skills, which
contribute to marginalization, exclusion, and loss of their voice. Therefore, focusing on BT
retention is crucial. While the literature review presented with a myriad of studies that focused
on BTs’ perception of intent to leave the organization, there is a lack of literature focusing on
lived experiences of BTs and the reasons for maintaining employment through the social

27
cognitive lens. Therefore, Chapter Three will outline the methodology used to investigate the
personal, behavioral, and environmental factors contributing to the retention of BTs.

28
Chapter Three: Methodology
Chapter Three describes the research design, data collection methods, and data analysis
procedures. This study aimed to understand the lived experiences of BTs in the field of applied
behavior analysis. The study explored the behavioral, environmental, and personal factors
contributing to the BT’s decision to remain as an employee at the ABC organization. The study
participants and the selection method are described. The theoretical and conceptual frameworks
are delineated to illustrate the origin of the research questions. The chapter presents ethical
considerations for the preservation of participant confidentiality as well as the credibility and
trustworthiness of the research. The chapter closes with exploration of limitations and
delimitations of the study.
Research Questions
The study utilized Bandura’s (1986) social cognitive theory to examine the various
influences driving BT retention. As such, the following questions guide the study:
1. What personal factors influence BT’s decision to remain in the profession at the ABC
organization?
2. What behavioral factors influence BT’s decision to remain in the profession at the ABC
organization?
3. What environmental elements influence BT’s decision to remain in the profession at the
ABC organization?

29
Overview of Design
Studies including BTs’ voices focusing on retention are not as common compared to
studies focusing on BTs turnover rate at ABA agencies. The current study employed a qualitative
phenomenological research approach, which incorporated in-depth analysis of the questions
posed incorporating BT voices and increasing trustworthiness of the research (Creswell &
Creswell, 2018; Merriam & Tisdell, 2016). The qualitative data aimed to obtain findings to
explain the current retention status and how to maintain or improve upon the status (Merriam &
Tisdell, 2016).
Table 1
Data Sources
Research questions Semi-structured
interviews
RQ1: What personal factors influence BT’s decision to remain at the ABC
organization?
X
RQ2: What behavioral factors influence BT’s decision to remain at the
ABC organization?
X
RQ3: What environmental elements influence BT’s decision to remain at
the ABC organization?
X
Research Setting
The study site was “ABC” agency where I am currently employed. The site enabled
access to over 1000 current BTs from different regions of the country representing various
demographics (e.g., ethnicity, gender identity, age, education). Initial access to a substantial
number of BTs allowed for more comprehensive representation of BTs voices, while increasing
access to potential participants in the study. I interviewed BTs not overseen by myself for at least

30
nine months before the start of this study, decreasing the likelihood of reactivity during the
interview process and chances of obtaining genuine feedback. Excluding BTs I directly oversee
only reduced the potential sample size by 10 BTs.
The key stakeholder group at the epicenter of power to achieve change were BTs as the
decision maker to maintain or terminate employment with ABC agency. Without BTs in the
field, ABC agency cannot accomplish its mission to transform the lives of autistic individuals.
The Researcher
The knowledge and experience gained as a clinical manager shed light on the importance
of BTs in supporting autistic individuals. The experiential knowledge (Maxwell, 2013) gained
across settings, organizations, and interactions with BTs and autistic individuals have contributed
towards understanding of the depth of the problem surrounding BT turnover and the negative
effect on self-advocacy skills leading to lack of employment opportunities for autistic
individuals. My underlying assumption was that autistic individuals have differing abilities, and
the role of the BT is to build skills to reinforce the existing abilities. My positionality as the
clinical manager also created bias towards expectations for BT’s interaction with autistic
individuals, professionalism, and a person’s suitability for the BT position. Considering the
insider and outsider status introduced by Merriam and Tisdell (2016), my former experience as
the BT gave me an insider status with BTs, while my current position as the clinical manager
made me an outsider status with BTs. However, as Maxwell (2013) noted, bias does not reduce
validity if the researcher conducts the study with integrity. Attention to reflexivity throughout the
study allowed for critical research and alleviated potential bias (Merriam & Tisdell, 2016).

31
Data Sources
The purpose of the survey was to establish participant inclusion criteria to purposefully
select and determine eligibility of interview participants (Creswell & Creswell, 2018; Robinson
& Leonard, 2019). I sent out a survey to all staff at the organization using the organization’s
mass email system to show the legitimacy of the survey and increase the likelihood of employee
responses (Robinson & Leonard, 2019). The online survey administration through Qualtrics
allowed distribution to a larger sample size supporting recruiting efforts. Responses through
Qualtrics also allowed anonymity for the participants, increasing the likelihood of participation
(Robinson & Leonard, 2019). The survey was emailed out after IRB approval in mid-August and
was open for three days.
Once the participants were determined, interviews were conducted. The basic qualitative
research was to find how people make sense of their lived experiences (Merriam & Tisdell,
2016). Semi-structured interviews captured the participants’ lived experiences. Interview
questions were presented in an open-ended and non-leading manner to elicit authentic responses
from BTs. The consent was obtained in late August from the participants before the interviews
began and the interviews concluded by the end of August.
Method
The method has three parts: survey, data review, and interview. The survey was
distributed via the online Qualtrics platform to establish participant inclusion criteria as part of
the recruiting process. The data review authenticated the length of employment, position of the
participant at the organization, RBT status, and eligibility of the employee for the study. Finally,
the interview examined the lived experiences of BTs.

32
Participants
The key stakeholder group at the epicenter of power to achieve change were BTs as the
decision makers to maintain or terminate employment. Analysis of yearly data through the
organization’s data analysis platform depicts 82% of the total BT termination occurring before or
within days of the first anniversary with ABC agency. The percentage is even higher than the
report by the National Association of State Directors of Developmental Disabilities (NASDDDS)
and Human Services Research Institute (HSRI) indicating 47.7% of DSPs terminate their
employment within the first year of employment, although consistent with data indicating BT
turnover being the highest within the first two years of employment (Zippia, 2023).
The sampling of the interviews was purposeful (Creswell & Creswell, 2018; Merriam &
Tisdell, 2016). The purposeful recruiting was to gain deeper insight into the lived experiences of
BTs who have maintained employment for a minimum of 12 months and were still in the BT
role. I triangulated the information gained from the ABC organization data analytic platform and
the survey results to identify potential participants for the interview. The first 10 to 12 BTs to
respond to the Qualtrics survey who meet the inclusion criteria were chosen to participate in the
study. The sampling method allowed for purposeful, but random representation of BTs across the
organization (Creswell & Creswell, 2018). The target sample size was also achievable, given the
limited research resources.
Instrumentation
A survey was distributed through an online Qualtrics platform to establish participant
inclusion criteria and identify potential research participants. The survey specifically inquired
about the tenure of BTs in the field of ABA, tenure of BTs at the organization, the role of the
respondents at the organization, and willingness to participate in an interview process. The

33
survey protocol is included in Appendix A. The semi-structured interview approach allowed
participants to express their lived experiences in unrestricted form while allowing me to have a
list of questions aligned with research questions (Merriam & Tisdell, 2016). The list of questions
was asked of all participants, although the order of the questions was not predetermined, and the
wording of the questions may have changed. The interview consisted of three to four questions
per conceptual framework key concepts plus an opening and closing question, totalling14
questions. In addition, the research questions and key concepts were explored through probe
questions (Creswell & Creswell, 2018) to respond to interviewee answers flexibly (Merriam &
Tisdell, 2016). The interview protocol is included in Appendix B.
Data Collection Procedures
The survey was emailed during the summer and was open for three days considering the
workflow of the BT’s (Robinson & Leonard, 2019; Salkind & Frey, 2019). BTs have a lighter
caseload during the summer months with decreased daily administrative duties. Initial inquiries
were emailed during the second or third week of August. Reminder emails were not sent due to
the number of responses gained from the initial participation inquiry. The survey should have
taken no more than five minutes to complete.
Prior to face-to-face interviews, informed consent was obtained from the participants.
The interviews were conducted via synchronous Zoom online teleconference platform. Each
interview was approximately 30-45 minutes and conducted over a two-week period. The
interviews were recorded and transcribed on an online platform, Otter.ai. A voice recorder was
available as a backup system in case of recording failure. The voice recorder was not used.

34
Data Analysis
Data analysis is essential for the research study to understand and interpret the data
collected (Merriam & Tisdell, 2016). The data was analyzed simultaneously with the data
collection and writing of the findings according to the steps outlined by Creswell and Creswell
(2018). The first step was transcribing the interview using an online transcription platform for
data analysis. Otter.ai was used for this research. The second step was to review the
transcription, note impressions from the interview, and engage in the self-reflection process. The
third step was to apply the inductive code based on the conceptual framework using the online
coding platform. ATLAS.ti 23 was used for this research. The fourth step was to identify themes
and apply axial coding. Finally, the themes were interpreted in relation to the study’s research
questions and conceptual framework.
Credibility and Trustworthiness
Inclusion of BTs across demographics, including years of experience, would increase the
applicability, validity, and reliability of the study (Merriam & Tisdell, 2016). Interview questions
were open-ended and non-leading to elicit authentic responses. Furthermore, random sampling of
participants through an organization analytic platform and conducting interviews with non-direct
BTs mitigated assumptions and bias towards responses provided by BTs. The transcription and
recording ensured the reliability of the data collected (Creswell & Creswell, 2018), while the
triangulation of survey responses with ABC organization analytic data platform results ensured
the trustworthiness of study participants (Creswell & Creswell, 2018; Merriam & Tisdell, 2016).
Consistent reflection on personal bias and values and consideration for reflexivity increased
credibility and trustworthiness (Creswell & Creswell, 2018). Furthermore, conducting the survey
to filter participants for the study anonymously and conducting interviews with non-direct BTs

35
mitigated assumptions and bias towards responses provided by BTs. Lastly, transparency of the
information about myself and the study’s intention to the participants increased trustworthiness
(Merriam & Tisdell, 2016).
Ethics
Ethics affects the trustworthiness of research. As such, ethics should be part of the
research planning process (Glesne, 2011). Included in ethical considerations were confidentiality
of the participant and the data, informed consent, storage of collected data, consideration of
power dynamics, and reciprocity (Glesne, 2011; Merriam & Tisdell, 2016). Approval by the
institutional review board (IRB) was necessary before conducting the study (Creswell &
Creswell, 2018; Merriam & Tisdell, 2016). In addition, I obtained consent from the organization
to allow BTs to participate in the study. At the start of the study, I disclosed the purpose of the
study and obtained informed consent. The information sheet conveyed voluntary participation in
the study, the confidentiality of information obtained, and the right to withdraw without any
repercussions (Creswell & Creswell, 2018; Merriam & Tisdell, 2016) to BTs. I communicated to
the participants that there is no association between the study and the organization as the study is
part of a dissertation. BTs had the choice to respond or not to the online survey sent via email
ensuring voluntary participation. The use of pseudonyms in transcriptions and documents and
anonymous responses to the survey ensured confidentiality. An AI platform, Otter.ai, transcribed
the recordings. I can share the data obtained with the organization and BTs during clinical round
meetings after completion as appropriate. If conducted critically, the research should serve the
interest of multiple groups including the organization, BTs, and ultimately autistic individuals.
The organization would see return on expectation (ROE) benefits (Kirkpatrick & Kirkpatrick,

36
2016). BTs would benefit from increased morale, while autistic individuals would access
increased autonomy with community and workforce participation.
On the other hand, the study may have harmed the organization if the survey provoked
BTs to advocate for increased contribution by the organization. The study may also have harmed
BTs if the interview triggered an emotional response for BTs. The analysis reflected my
perspective even though BTs were responding to the survey and the interview questions. My
perspective as a researcher was at the center of the design, the framing, and the analysis of the
results. Therefore, reflexivity and awareness of one’s bias were essential in conducting critical
research.

37
Chapter Four: Findings
The purpose of this qualitative study is to explore the lived experiences of BTs to
enhance understanding of factors contributing to their retention. Chapter Four uncovers the data
aligned with the study’s research questions, shaped by the lens of the social cognitive theory
framework (Bandura, 1986). This chapter aims to examine elements associated with the retention
of BTs at ABC agency.
The following questions guided the data collection to determine the personal, behavioral,
and environmental influences affecting BTs’ decision to maintain employment with the ABC
organization:
1. What personal factors influence BT’s decision to remain in the profession at ABC
agency?
2. What behavioral factors influence BT’s decision to remain in the profession at ABC
agency?
3. What environmental elements influence BT’s decision to remain in the profession at
ABC agency?
Interview questions aligned with the key SCT theory key principle revealed key themes
related to the retention of BTs at ABC agency.
Description of the Participants
The participating stakeholders of this study were BTs at ABC agency. An email was sent
to all clinical staff at ABC agency with a survey attached to establish participant inclusion
criteria to select and determine the eligibility of interview participants purposefully. There were
222 respondents within the first three days of the survey dissemination. Of the 222 respondents,
55 (25%) met the criteria for the interview process. The survey closed after three days due to the

38
abundance of responses and interest in participation in the study. The 55 respondents were then
purposefully grouped into five categories based on tenure at the agency. The first three
respondents from each category were contacted to schedule interviews. The fourth respondent
was contacted if no response was received within two days of the email being sent. The process
was repeated until three participants from each category were confirmed for the interview. The
only exception was in the 37–48-month category where only two BTs had responded to the
interview inquiry. Due to the time constraints of the research, another participant was selected
from the 25–36-month category. A total of 15 participants were selected and interviewed for the
study. The only demographic information relevant to the study was their tenure as a BT at ABC
agency, which was validated through ABC agency’s data analytic platform. In addition, RBT
status of the participant probed for any correlation between retention and the RBT status using
the same agency analytic platform. Table 2 reflects an overview of the participant information.
Table 2
Participant Overview
Participant* Number of months as BT RBT held –
Yes/No
Number of
supervisors
Work
environment
1. Diana 19-24 months Yes 2 Home, Community
2. Adam 19-24 months No 3 Home, Community
3. Allison 25-36 months Yes 2 Home
4. Bridget 37-48 months No 1 School
5. Cheryl 25-36 months Yes 2 School, Home,
Community
6. Claire 25-36 months Yes 2 School, Home

39
7. Chloe More than 49 months Yes 2 School, Home
8. Cindy 37-48 months No 1 School
9. Erica More than 49 months No 1 Home, Community
10. Jackie 19-24 months Yes 2 School, Home
11. John 12-18 months Yes 2 School, Home
12. Kylie More than 49 months Yes 1 School, Home,
Community
13. Sarah 12-18 months Yes 1 School
14. Stella 12-18 months Yes 2 Home, Center
15. Theresa 25-36 months No 1 School
* Pseudonyms replaced actual names
Based on the general hiring criteria for the BT position, all participants had some level of
experience working with children of various ages and had a high school diploma or higher degree.
The interview process discovered that seven of the 15 (47%) participants had prior experience
working as a BT at another agency. Of the 15 participants, three disclosed having disabled family
members and two specifically having autistic siblings. All participants indicated that they support
two or more autistic individuals throughout the week. The number of supervisors the participants
interacted with across the week varied from one to four. BTs’ work environments varied between
schools, homes, and community-based programs. The participants’ experience also varied
regarding the diagnostic levels of autistic individuals they supported. No significant patterns in the
theme were noted based on the participant tenure at ABC agency or RBT status.
Findings

40
The following section considers the themes and findings from the interviews held with
BTs regarding their lived experience at ABC agency. The collection of data offers interpretation
of the factors contributing to BT’s decision to maintain employment at ABC agency. The section
is structured to explore ascertain alignment between data gathered and the factors identified as
essential to BT retention. The findings are grouped by themes associated with each research
question that emerged through the interviews, followed by subthemes that surfaced to influence
each present theme.
Findings Research Question One
The individual’s knowledge, beliefs, attitude, skills, and strategies are elements of the
personal domain defined by the SCT framework. Motivation, prior knowledge, and purpose were
the themes that appeared as factors within the personal domain contributing to the retention of
BTs. Within the motivation theme, self-efficacy, intrinsic and extrinsic motivation appeared as
subthemes. Within the prior knowledge theme, experience emerged as the subtheme. This
section will first discuss the themes, followed by the subthemes under each theme discovered in
the personal domain.
Motivation Supports BT’s Decision to Remain in Their Position
Motivation contributed to BT retention. All the participants interviewed for this study
expressed motivation as a key factor in BT retention. The participants in various forms expressed
self-efficacy, intrinsic motivation, and extrinsic motivation contributing to their decision to
remain in their position as the BT. The participants conveyed motivation as a mitigating factor to
burnout. Jackie expressed, “I just see it as like, like every job kind of, you know, you'll get burnt
out … I want to do a job that I actually enjoy working at so I just see it as if it outweighs it or
not.” Eighty percent of BTs interviewed communicated motivation contributing to seeing the

41
daily work as more than a job. Kylie’s response summed the sentiment of the BTs when she said,
“For some people, it’s more than just a job. And I like that, like we come in we actually have
fun.” BTs remained with ABC agency when they thrived on motivation.
Self-Efficacy
BTs expressed belief in self-efficacy contributing to retention at ABC agency. Fourteen
of the 15 BTs believed that they have the skills necessary and would be successful in supporting
autistic individuals. As Theresa expressed:
It's kind of like they gave me the recipe, and I made my own little cake out of it. Like
they gave me the ingredients. But I tweaked it. And I made it to where it's going to fit to
the, to the client. And it's just so cool.
Theresa’s comment reflects sentiments of thirteen other BTs who responded mastery experience
as a source of influence for development of self-efficacy. Experience influenced the confidence
BTs felt to support autistic individuals. Sarah concisely reflected, “Practice really will make you
like more confident.” The same sentiment was shared by John, who said, “As I’m learning more,
as I kind of get more experience, and kind of piece together the narrative in my own head.”
Experience allowed BTs to remain calm in stressful situations, empowering them to problem
solve through the challenge. The more experience the BTs had, the more confident they were to
support autistic individuals across various settings and functioning level of the individuals.
Cheryl explained, “It doesn't matter what environment you're in, you're going to be able to
implement those strategies and I feel highly confident in myself about that.” BTs expressed the
ability to rely on intuition because they believe they can manage the situation at hand. Table 3
presents sentiments expressed by BTs regarding their experience contributing to their
confidence.

42
Table 3
Findings: Self-Efficacy
Participant
pseudonym
Example quote
1. Erica “If we know what needs to be done, or we know how this needs to be
redirected … And things like that have given me the emotional
capacity to shut my own emotions down and make me confident that.
Yes, I know this.”
2. Cheryl “I’ve been well versed in a lot of different ages and a lot of different
challenges not only with autism … so I feel like I really have a wide
range that I feel like I can be thrown on any case.”
3. Stella “It's just like being able to go with the flow of the situation rather than
having a preset idea of what needs to happen.”
The cycle of encountering stressful situations, independent problem solving, and successfully
overcoming challenges enhanced self-efficacy for BTs. Two BTs specifically alluded to the
vicarious experience while working in the field contributing to their sense of self-efficacy, while
10 BTs referred to social persuasion affecting self-efficacy. Theresa shared:
I’m having teachers with special ed program reach out to me and asked me if I want to
work for them there, like in their classroom and do this and do that…It makes my heart
really really happy.
The belief BTs developed of their ability to be successful in supporting autistic individuals selfadvocate contributed to the decision to remain in their position as the BT at ABC agency.
Intrinsic Motivation
Intrinsic motivation promoted BTs ability to support autistic individuals. Allison’s
response reflected the sentiment of 12 of her colleagues when she shared, “It’s really the clients
and the families and just loving what I do.” BTs also expressed that the work itself is fulfilling

43
and rewarding. BTs shared the sense of wanting to help others and wanting to influence BT
retention. Seven BTs suggested not starting in the field of ABA to begin with if the person is
lacking intrinsic motivation. Responses from nine participants showed curiosity and challenge
associated with daily functioning of a BT effecting intrinsic motivation. Chloe expressed:
All the things that you couldn’t do before I came to you and now that you doing that
makes me proud. So, I wonder what else can she do? Like I got her to do this. Let me see.
How can I make her life better.
Table 4 below reflects similar sentiments voiced by BTs on how motivation contributed to
maintaining employment as BT.
Table 4
Findings: Intrinsic Motivation Subtheme
Participant
pseudonym
Example quote
1. Cindy “I really enjoy it. I really love it…when I got hired, I was like I’m
gonna be working with kids, but I never really pictured, you know
what I’m doing. But I honestly fell in love with it. So it’s something
that I’m very very passionate about.”
2. Erica “This has been a part of who I am as a person. This is all I’ve ever
known is knowing or having somebody close to me that I love very
much that has intellectual disabilities and being subject to others in
varying capacities. My whole life and it’s been a passion. I’m good at
it. I like it”
Passion was a key word portraying the intrinsic motivation for 12 BTs. Simply put, it is what
they love to do. Intrinsic motivation in the form of passion expressed by the BTs is an influential
factor in BT retention.
Extrinsic Motivation

44
BTs expressed the importance of extrinsic motivation in BT retention. Ten BTs voiced
recognition as a contributing factor to retention. Recognition may be in the form of progress of
autistic individuals and social reinforcement from the supervisors, parents, and school staff. BTs
equated progress of autistic individuals to recognition by others of the positive impact BTs have
on autistic individuals. When reflecting on what has kept her motivated, Cindy, Kylie and John
expressed progress demonstrated by the autistic individuals across various skill areas
contributing to their motivation. John voiced, “I think the one thing that just kept me going was
seeing the progress or seeing you know, maybe the occasional like oh man like this kiddo did
this thing.” Autistic individuals’ progress meant BTs were implementing the ABA program
effectively, contributing to the mastery experience and recognition from others. Table 5 shows
the comments from BTs highlighting the importance of recognition in their decision-making
process.
Table 5
Findings: Extrinsic Motivation
Participant pseudonym Example quote
1. Allison “My client’s mom would be like ‘Oh my gosh, look at his
speech. How far he’s come and this has improved our lives in
so many different ways”
2. Bridget “Because it just shows that they’re able to be independent. And
like, that’s what we’re working for, you know … Yeah, like
just him being independent. Like that’s rewarding.”
3. Jackie “I feel like it’s very rewarding to see them grow … I really
enjoy like the day to day.”

45
4. John “Kiddo that I’ve been working with, like does something brand
new and like amazing. And I’m like, what, that’s wild, you
know? So things like that. I guess. Kind of keep me going.”
5. Cheryl “What I love about being a behavior technician, really, it’s
getting to see that moment when you’ve been working towards
something with your client and that first time that they get it …
I feel like that makes me really, really happy.”
6. Cindy “Just knowing that you’re appreciated. You know, it helps to
feel your family appreciate it. Like you know my work isn’t
unnoticed like it’s noticed every day … little things like that,
for me, mean a lot.”
7. John “Every now and then like just like someone will like ‘hey,
thanks for everything you do, I know it’s pretty difficult.’ …
Because at least for me, like I sometimes I just need anything
that I can take.”
Autistic individuals’ progress led to social reinforcement from supervisors, parents, and school
staff. Ten of the 15 BTs said they looked forward to and thrived on the positive feedback directly
from the families. Another 10 BTs indicated feeling recognized when supervisors would ask for
their input for programming. Chloe recalled an instance she encountered when going to one of
autistic individual’s homes:
Just like somebody just say when you walk up to the gate and go up to their home and
they say ‘whoa Chloe. Thank gosh you’re here.’ That right there is everything. I feel like
I’m making a difference here. They need me. That matters.
Sarah and three other BTs expressed a similar reaction when recalling parents providing positive
feedback about ABA support. Social reinforcement validated and endorsed their professional
ability as a BT contributing to their decision to remain in their role as a BT.
Prior Knowledge

46
The participants voiced the importance prior knowledge plays in their role as a BT.
Thirteen participants acknowledged prior knowledge contributing to BT retention. Eight of the
13 BTs expressed they lacked prior knowledge and therefore realized the importance after
starting their position, while five of the 13 expressed having prior knowledge and its contribution
to maintaining their role as BT. John conveyed:
When I started, I realized like, wow, you actually have to juggle a whole bunch of things
at one time. Yeah, I think that that's probably like the difference between what I
originally expected and what it was.
While John expressed his desire for knowledge prior to starting the BT position, Stella expressed
how prior knowledge helped her maintain her position as the BT:
I have a sister with special needs so I’ve grown up knowing how that looks. So for me,
I’m not being so anxious or nervous about what my client might do. Or say or what the
parents might think because I’ve seen it from that angle too.
Prior knowledge not only about BT’s role but also what to expect from autistic individuals was a
key factor. The knowledge allowed BTs to manage and overcome challenging situations, such as
being yelled at by a teacher, being the target of physical aggression, or being called derogatory
names. In addition, prior knowledge allowed BTs to interact with autistic individuals,
emphasizing rapport building to get to know the individuals first, not as someone BTs are
helping. The BTs who successfully built relationships with autistic individuals were the same
BTs who indicated receiving social reinforcement. Therefore, inference can be made that prior
knowledge contributes to BTs’ professional ability and contribute to motivation.
Sense of Purpose

47
Sense of purpose was another influence in the personal domain that supported BT
retention. Twelve of the 15 BTs voiced the importance of sense of purpose to BT retention. The
alignment between values and actions of BTs, driven by their motivation, creates a sense of
purpose. The compassion BTs had either for the dis/Ability population or for autistic individuals
led to the motivation to serve autistic individuals. Cindy’s response epitomized the view of her
colleagues by saying, “I feel like I’ve really found like what I was meant to do.” Like motivation,
80% of the BTs interviewed voiced sense of purpose being a reason they get out of bed in the
morning to go to work. Chloe commented:
I’ve been through a lot and I’ve had a lot of people in my family that were like my mom,
blind and mentally disabled and were taken advantage of a certain way. And so I always
have a soft spot for anyone that’s in my path that have a disability.
Ten BTs believed that those without sense of purpose were more likely to be burned out and
leave the profession. Chloe summed the sentiments of nine other BTs in her statement:
I would say if your heart is not in in it, then you should slowly back yourself on out of it.
Because this field every, not every day, but most days it will test you it will test you and
it will test you
The statement reflects the opinion of the BTs on the importance a sense of purpose has on the
retention of BTs. BTs expressed that while some of their colleagues have left their position as
BT, they have remained in their position as they believed their purpose was to help the autistic
individuals. In one statement Allison shared, “At the most basic level is just wanting to help
people improve their lives.” Alignment between BTs’ sense of purpose and agency mission to
transform lives contribute to the retention of BTs.

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Discussion: Research Question One
Discussion took place surrounding the themes related to personal domain in the retention
of BTs according to the participants’ views. Analysis of the responses to the first research
question aligned with the literature pointing to the importance of self-efficacy in BT retention.
The findings revealed self-efficacy was not the sole element affecting BT retention, however.
Motivation, prior knowledge, and sense of purpose emerged as crucial factors contributing to BT
retention. Motivating operations is an ABA concept that reflects how behavior may be
influenced by someone’s internal process or desire (Cooper et al., 2007; Sulzer-Azaroff &
Mayor, 1991). The concept touches more on motivation as related to external reinforcers instead
of intrinsic motivation. Responses from BTs delineated the significance of non-observable
factors contributing to BT retention. The findings from the interviews revealed the importance of
intrinsic motivation and sense of purpose, which may not be easily observed nor measured. BTs
used passion to describe their intrinsic motivation during the interview process. A sense of
purpose emerged as a catalyst for BTs to get out of bed every day. The findings also implicated
prior knowledge contributing to BT access to extrinsic motivation and professionalism. All the
elements suggested by the BTs are valuable fluences to consider to positively affect BT
retention.
Findings Research Question Two
The individual’s ability to perform a behavior based on knowledge, and skills are
elements of the behavior domain defined by the SCT framework. The BT must know what to do
and how to do it. The person-centered approach and coping skills appeared as factors within the
behavioral domain contributing to the retention of BTs. BTs not taking things personally and

49
patience emerged as subthemes under person-centered approach. This section will first discuss
the themes, followed by the subthemes discovered under each theme in the behavioral domain.
Person-Centered Approach
The person-centered approach means considering the human rights of autistic individuals
in the decision-making process (Breaux & Smith, 2023). The person-centered approach was a
theme that emerged as an influence affecting BT retention. BTs who stay in their role as the BT
exhibit an understanding of this concept by demonstrating patience and not taking things
personally. Kylie commented, “Don't take it personal because at the end of the day for even for
life, it's more about them than it is about you.” When a BT recognizes their contribution is to
support human rights, such as autonomy, making choices, and inclusion in their environment
(Breaux & Smith, 2023) of autistic individuals, the focus is on autistic individuals, not on BTs
themselves.
Not Take Things Personally
Cindy and eight other BTs expressed the importance of not taking things personally. In a
relaxed manner Cindy commented, “I think just not taking it serious,” while Adam shared a
similar sentiment expressing:
I'm fairly lucky in the sense that I don't really care as much. Like it doesn’t bother me.
Like I don't remember and kind of go next.
BTs alluded to the ease of focusing on what the autistic individuals are trying to communicate
when they do not take things personally. Cindy said, “You know, these kids. Like, they don't
mean it. So I think just kind of, I think the important thing is just not taking this serious.” BTs
who understood that physical or verbal aggression demonstrated by the autistic individuals are a
form of self-advocacy due to delay in effective communication expressed less instance of burn

50
out. In addition, BTs shared negative comments from school staff and community members
negatively affected their emotions. However, focusing the attention back to the autistic
individuals needs allowed BTs to reduce their negative emotions. Four of the BTs expressed not
taking things personally is challenging at times and requires time to develop the skill. However,
once acquired, the skill is effective in supporting a person-centered approach.
Patience
When the focus is off themselves, BTs can demonstrate increased patience as they
interact with autistic individuals. Eight BTs interviewed commented on the importance of being
and having patience Theresa expressed, “I learned like this job isn't for someone who doesn't,
who is impatient. Because it takes a lot of patience.” Patience is required to observe and decipher
what autistic individual is trying to communicate by behaving in a particular way. Sara observed,
“I've noticed that working like, like in a company that deals with like, autistic autism like
everybody, my coworkers case managers, everybody likes supervisors, they're all really patient.”
In addition, five BTs commented on how patience has allowed them to remain calm in triggering
situations. Jackie noted how patience has helped her at work by remarking, “Having a lot of
patience. And understanding is like the best way to stay calm during work.” In addition, six BTs
noted patience being a key factor in retention as observable progress for autistic individuals may
take a long time. Cindy voiced:
I definitely would say Have patience. You know, because, like I said, things don't happen
overnight. And especially in this job in this field, you know, it takes time you know, it
takes time to see progression you know.

51
The BTs expressed the longer it takes for the autistic individual to demonstrate progress, the
more rewarding it is to see the outcome. Instead of getting discouraged at the lack of progress,
BTs demonstrating patience remained dedicated to their clients.
Coping Skills
The application of a person-centered approach necessitated BTs to be mentally and
physically available for autistic individuals. All the BTs interviewed voiced the importance of
having an effective coping strategy contributing to BT retention. BTs shared various coping
skills that allowed them to be present in the moment. Being present meant not only being at work
physically, but also mentally available to focus on supporting autistic individuals. Cindy shared,
“I feel like you can't pour from an empty cup.” Some of BTs developed coping skills on their
own, such as listening to music, exercising, and journaling, while other BTs chose to seek out
therapy to find out the best ways to understand themselves and their needs. Stella conveyed:
I just knew from a young age, like I wanted to figure out the best ways I needed to set up
my life so that I could, you know, maintain kind of a control over any mental illnesses or
struggles that I had. Because I personally struggle with like anxiety and ADHD and I was
like, I don't want that to affect my work life.
Table 6 reflects various coping skills shared by the BTs.
Table 6
Findings: Coping
Participant pseudonym Example quote
1. Diana “I listened to music. I always have my water with me. Like to stay
hydrated. … I feel like the music kind of like, settles me down a
little bit … You know, just focus like I can focus on the music.”

52
2. Allison “I tried to keep a pretty good exercise regime, not not super
intense, but I like to go biking on the weekends. We do kind of
longer distances”
3. Bridget “So my self-care lately is like, I would watch Netflix … and then I
go on to cooking. That's also kind of like a self-care to me, just
because like, I'm in my own little bubble.”
4. Claire “I work out like I always have like a me time, you know, on the
weekends. I like to go out and like watch movies, how to
decompress things like that.”
5. Chloe “My coping strategy is me. I am the coping strategy. I am the like,
I stay grateful. I don't know if this is even a coping strategy. I don't
think that's a coping strategy. But I always stay grateful for my
situation”
6. Stella “Journaling or eating a nice dinner or whatever it has to be. and I
think BTs have to do that and know that they are their own support
system too sometimes”
7. Erica “I've done a lot of personal therapy myself … Yes, you're a
therapist for other people, but you also are this is helping you as
well.”
8. Adam “I'm pretty big on self-care and work life balance … Like if, if I'm
off the trip, I'm off the clock. I no longer exist. I am gone.”
The various coping strategies allowed BTs to focus on autistic individuals by reacting to the
situation based on the supports necessary for autistic individuals instead of reacting based on
their own emotional needs. In addition, coping skills, such as journaling and exercising outdoors
allowed BTs time to detach from work and self-reflect to ready themselves back to work. Proper
coping skills are essential to the wellbeing and retention of BTs.
Discussion Research Question Two
The two themes uncovered in the behavioral domain were the importance of
demonstrating a person-centered perspective and the use of coping skills. Centering autistic
individuals and their desires necessitated effective use of coping skills as a means of maintaining
focus on autistic individuals. BTs shared various coping strategies they utilize to maintain a

53
positive outlook while supporting the autistic individuals as well as while working with the
school staff and the families. Whether BTs developed coping strategies on their own or with the
help of a professional, coping strategies supported the BTs decision to maintain employment at
ABC agency. To center the needs of the autistic individuals, BTs specified the need to
demonstrate patience and not take things personally. The autistic individuals may engage in
challenging behaviors as a form of self-advocacy. BTs were able to demonstrate an effective
person-centered approach when they understood that the acting out behavior is due to
underdevelopment of effective communication skill, not due to mal intent. Effective coping skills
and person-centered approach were key behavioral factors contributing to BT retention.
Findings Research Question Three
The SCT framework posits that individuals learn through observation and modeling
occurring within the environment and are affected by who or what existents in the environment.
The environmental factors influencing the BT retention are supervision support, the presence of
support system, and organizational support. Modeling and feedback were subthemes under
supervision support. The presence of support system included within-organization support,
outside of organization support, and work environment. Lastly, compensation and training
appeared as subthemes under organizational support. This section will first discuss the themes,
followed by the subthemes under each theme discovered in the environmental domain.
Positive Relationship with the Supervisor
The positive relationship with the supervisor was a recurring theme across BTs
throughout the interview. All BTs interviewed voiced supervision support significantly
influencing BT retention. Stella’s comment, “I think a supervisor can really make or break your
experience for sure” and Claire’s comment, “The reason why I'm at this company is specifically

54
because of the supervision actually, because I left my last company for not having the
supervision” epitomized the significance of the supervisor on the BT retention. The
characteristics of the supervisors contributing to the positive relationship included
responsiveness, experience, knowledge, and ability to collaborate. Seven BTs commented on the
importance of responsiveness of the supervisors and the direct relationship to effective
communication. Adam exclaimed, “She's really communicative when you ask it and she's also
quite fast respond.” Chloe also commented, “First off, first off is response time. Emails or text
messages. Number one, that's number one.” The supervisors’ responsiveness led to BT’s
perception that they were heard. Eight BTs interviewed expressed experience and knowledge of
the supervisors contributing to building a trusting relationship. BTs demonstrated appreciation to
the supervisors having effective responses to their questions. Cindy communicated, “I've always
had really nice, very knowledgeable supervisors.” In addition to clinical skills and
responsiveness, three BTs specifically commented on compassion demonstrated by the
supervisors supporting their trusting relationship. Bridget voiced:
I feel like she's very understanding and very, like, she cares. I feel like she does care.
Like she will listen. Like she understands like, the emotional part that comes with the job.
And I think that's a big thing for me.
Five BTs expressed the trusting relationship with the supervisor affected their interaction not
only with the autistic individuals, but also the families and the school staff. BTs felt confident
that supervisors “would have their back” as Stella expressed in times of need. BT Positive
relationship with the supervisor is vital to BT retention.
Modeling by the Supervisors

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BTs also valued modeling by the supervisors. Six BTs reflected on the positive effect of
modeling by the supervisors on BT retention. Modeling allowed BTs to learn from observation.
Claire said:
I think modeling for me is the biggest one. Like, every time supervisors have asked me to
implement something I always ask them, like, can you model it for me first, because I
want to make sure I'm doing the right thing.
In addition, supervisors modeling implementation of the program indicated the competency of
the supervisors to BTs, which improved their confidence in following the supervisor’s lead. The
confidence in the supervisors gave rise to a sense of support BTs needed for retention. As Sarah
remarked, “For me, like, seeing my supervisor, I was really impressed my supervisor, being able
to like, completely, like change the child's behavior, like redirect him and use all these like
strategies.” The supervisor became a support person for BTs, who not only supported in
challenging times, but also produced a feeling of “if she/he/they can do it, so can I” mindset
conveyed by 12 BTs, contributing to retention of BTs at ABC agency.
Feedback from Supervisors
The feedback from the supervisors contributed to BTs’ better implementation of the
program protocol. Nine BTs highlighted the importance of feedback as part of supervision
support. Effective communication when providing feedback was a crucial component of BT
retention. Jackie summed the sentiments shared by five other BTs advocating, “Just good
communication. I care mostly mainly about that with the company than the job itself.” Stella
recalled, “The supervisor will give like, here's what you can do better or even if the technician
doesn't even notice that they're doing something incorrectly.” Cheryl shared how feedback
contributed to her confidence as a BT:

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I feel like when specific points of my intervention are brought to my attention and why
they liked what they saw, or or even go as far to say is like, I didn't think of something
like that. And I like the way that you define and I like to see how the client reacted to
that. I feel like that always kind of adds to being able to say like, yeah, I can do this.
Of the 15 participants, 11noted supervision feedback allowing them to grow in their role as BT.
Feedback from the supervisor offered BTs opportunities for professional growth. Five of the BTs
interviewed indicated they would suggest to newer BTs to seek feedback from supervisors as
often as possible. Kylie remarked, “I would say always ask for feedback and comments. Always
listen to it. And if you don't get it to ask for like, oh, can you show me.” Feedback from the
supervisors contributed to building a positive relationship with the supervisors and contributed to
BT retention.
Support System
The presence of an effective support system emerged as a key element in staff retention.
Twelve of the 15 BTs voiced significance of support system on BT retention. As Chloe
expressed, “I feel supported like that support. I keep coming back to that. When you feel
supported. And you feel supported by your team. That that gives you a different kind of
confidence too.” The support system existed both within the organization as well as outside of
the organization to support BTs. Additionally, the support system in the work setting itself
contributed to BT retention. The specifics of these subthemes are described below.
Support System Within Organization
All BTs interviewed emphasized the importance of supervision support within the
organization. The supervisors established themselves as mentors to BTs in challenging times.
John voiced:

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It always felt like, like a mentor in a way if that makes any sense. Having a mentor and
being able to be like, hey, like, I can go to you for like, not just like, questions about work
or like questions about like, am I am I slowly losing it … That sense of like, Hey, you can
go to people which was really nice.
In addition, for many BTs, having a peer within the field of ABA also proved to be a valuable
element in the retention effort. Kylie communicated, “Just having friends that are in the field was
so helpful for me, because it's like, oh, we both understand each other.” She went on to say, “I
noticed I've gone to them first before I go to my childhood friends now or like my family.
Because it's like, you know what I'm going through.” Theresa divulged a similar sentiment, “I
think everybody needs that type of support, you know. Having someone that's on your side and
let you rant and let you get things out.” The bond formed between BTs who shared similar
experiences was a coping strategy for some BTs to overcome a challenge faced in the field. Also,
talking to other BTs about their experience made three BTs feel better about their situation
relative to experiences shared by colleagues. Support system within the organization contributed
to BT retention.
Support Outside of the Organization
For some other BTs, support outside of the organization was more important. Eleven of
the BTs interviewed the importance of support outside of the organization. Seven specifically
leaned on their friends, significant others, or their family members for encouragement. Stella
leaned on her significant other stating, “My boyfriend who I talked to you about things if I have
a hard day.” Theresa shared a similar sentiment:
I have a partner and they're very supportive and everything so they are able to help me on
a bad day when I'm tired and they are able to pick up slack.

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John reflected on the need for support within and outside of the organization saying, “If I haven't
talked to a friend a while. I'm like, Hey, like I had a pretty tough day at work. It's family, friends,
and work coworkers.” BTs were able to endure tough days at work and continue to serve autistic
individuals as long as there was someone to listen to them. BTs shared that support system did
not need to be within an organization as emphasis was on availability of the support in times of
need.
Support in the Work Setting
The effects of support in the work setting cannot go unmentioned. Of the 15 interviewees,
seven referred to the importance of having support within the work environment. The work
setting may differ for BTs depending on which individuals they support. Although the managers
at ABC agency assign the autistic individuals to BTs, the agency does not regulate what occurs
in the environment. BTs have a positive mental attitude when the work setting is desirable.
Cheryl shared:
I feel like you know, we get to social network during those moments. And I feel like that
makes me happy too … you know, but in this field, you're constantly meeting new people
and you never know who you're gonna meet.
Sarah shared how much the work setting contributes to her positive mood:
I just like love being in this high school setting. Like, all of like the kids joke around with
me. I don't feel like I'm like even at work. Like I don't ever, you know. It's fun.
Support systems that contribute to the BT retention involve support within and out of the
organization and the work setting. The interviews also revealed a support system as the coping
mechanism for BTs. Within the work environment, there may be other BTs from ABC agency
supporting other students in class. Two BTs especially indicated the importance of having a

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sense of community if multiple BTs are in the same setting. Stella shared, “There's other
therapists there. So it was like there was more of that social aspect of being able to talk to your
coworkers or whatever, or something.” BTs reported checking in with each other if problems
arise and supporting each other in times of need. Other support in the work environment included
the administrative team on campus, campus maintenance person, other service providers (e.g.,
occupational therapist, speech pathologist, physical therapist), and teachers. One BT also shared
the negative impact of work setting. Cheryl shared:
“People I was working with at the middle school, we were like, a community we're like,
there was unity. Everyone was like family there, you know, and then you know, that's not
going to be at every place. And that's exactly what happened when we went to another
school. It's not that at all. So it's a big like, culture shock first, you know, it's like, almost
like, oh, going to a new office, like what are the what are the office vibes at this place?”
Sentiments shared by the BTs revealed the impact work environment has on BT retention.
Organizational Support
Despite the best intentions of BT, available support systems, and the support from the
supervisors, there are factors the organization needs to address to support the retention efforts of
BTs. Eleven of 15 BTs interviewed commented on the role of the organization as a contributing
factor to BT retention. Three subthemes appeared: compensation, training, and continual learning
opportunities.
Compensation
Compensation is crucial in providing a sense of stability and comfort for BTs. As
Maslow (1943) illustrated through the hierarchy of needs, basic physiological (food, shelter) and
safety and security (employment, health) are at the base of human needs. Claire declared,

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“Always driven by the fact that I have to make money to support myself”, while Cheryl
expressed the financial need by stating the financial difficulty faced during the breaks from
school, “You know, just not getting paid summers and winters and spring breaks and all that like
it's really hard.” Specifically for BTs who have had school case assignments, lack of
compensation when the students are absent from school sometimes caused financial hardship.
Furthermore, for some BTs the pay reflected their worth to the agency. In other words, financial
compensation may be a recognition that BTs receive from the agency. To this point, Cheryl
responded:
I feel like I just know my worth as a technician where I feel like whether it was an easy
case or hard case, like I know what I bring to the table and how much I deserve to make,
you know, for those hours that I'm going to be there.
The alignment between BTs belief of their worth and needs being met, and actual agency
compensation is another key factor contributing to BT retention at ABC agency. Table 11
summarizes similar sentiments shared by other BTs.
Effects of Training
Training provided by ABC agency is another contributing factor to BT retention. Seven
of 15 participants voiced effects of training on BT retention. Included in the training component
is not only the facilitation of knowledge acquisition, but also transparency with what may be
encountered in the role as a BT. John shared:
I think maybe a little more transparency … I think in being more transparent, you know,
sure people are gonna be like, maybe not, but I think the people who will stick it out are
going to be like, “Okay, now I know what I'm going to expect.”

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BT responses varied with regards to form of training. Some appreciated the structured classroom
style teaching, while others expressed being overwhelmed with the amount of information
reviewed. Seven BTs specifically requested an increase in and consistent need for shadowing
opportunity before starting their own cases. Regarding knowledge acquisition, remarks from BTs
revealed a connection back to the behavior domain and learning through observation and
modeling. Stella reflected, “I think prolonging the process of overlapping with the client is one
thing that would need to be done.” The observation of other BTs, in addition to transparency of
information shared during training allows BTs an opportunity prior to starting their position as
BTs to determine whether this is the role that they want to pursue. The training opportunity, in
turn, increases the likelihood of retention as BTs enter the field of ABA with an understanding of
and agreement with the expectations. Table 11 illustrates BTs thoughts on the effects of training
on retention.
Continual Learning Opportunities
BTs expressed the availability of continual learning opportunities as motivation to remain
at ABC agency. Sixty percent of the BTs conveyed availability of learning opportunities
contributing to BT retention. Regardless of the tenure with ABC agency, finding learning
opportunities in the daily functioning, where new experience was encountered on a routine basis,
distinguished the BT role from other routine based jobs. Diana said, “It’s never the same so it’s
kind of fun.” In another statement Bridget asserted, “I think that learning aspect of working with
the actual school now is what kind of motivates me to go to work.” Cheryle expressed:
First thing that always been like that constant learning, like always like that, like I felt
like a snowball just like getting bigger and bigger and bigger, right? Like everything that
I was like doing was learning.

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Learning led to a sense of accomplishment, which in turn motivated BTs to continue in
their endeavor to facilitate the learning of autistic individuals. Kylie summed the idea of learning
as a motivating factor by concluding, “I feel like it's me as a human. Like I like to keep growing.
I want to learn more. Grow in a company to be able to see that clearly and see like the path has
given me it's making me want to stay.” As said in the supervision section, supervision created
opportunities for learning for BTs. Additionally, three BTs communicated interest in taking on
additional roles within the agency. Taking on more roles will naturally create opportunities for
learning.
Discussion Research Question Three
The three themes uncovered in the environmental domain were the importance of
supervision support, having an established support system, and organizational support.
Supervision support especially was essential in BT retention efforts as the supervisors were the
receivers of BT voices, the support system within the agency, and a contributor to BT’s continual
learning. All BTs interviewed touched on supervision support being a key factor their success as
a BT. The support system of BTs created an outlet for BTs to express themselves further and to
cope with stressful situations. The work setting culture also contributed to BTs comfort in going
to work daily. The supervisors were often part of BTs support system. Additionally,
organizational support addressed factors that support systems could not address to facilitate
retention, such as compensation, training, and continual learning opportunities. Compensation
should be specifically highlighted for BTs as a reflection of their abilities and worth at the
agency. The themes revealed in the environmental domain aided BT retention.

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Summary of Findings
This study endeavored to uncover the contributing factors to BT retention by centering on
the lived experiences of BTs themselves. The SCT framework served as a lens to reveal the
personal, behavioral, and environmental factors contributing to the BT retention. The study
confirmed the triadic reciprocal relationship between the three domain areas. The interviews not
only showed the significance of self-efficacy, coping skills, and supervisor support, but also
revealed more themes not identified through literature review. Figure 2 below depicts the
findings from the current study.
Figure 2
Factors Contributing to Behavior Technician Retention Rate at ABC Agency

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The personal factors necessary to positively influence BT retention were motivation,
prior knowledge, and purpose. Self-efficacy, intrinsic motivation, and extrinsic motivation
affected motivation while prior knowledge was affected by experience. The effects of selfefficacy on BT retention aligned with the literature review. Motivation, prior knowledge, and
purpose emerged as additional key components in the personal domain to positively affect BT
retention.
Secondly, the behavioral factors necessary to influence BT retention were personcentered thinking and coping skills. Demonstration of patience and not taking things personally
enabled BTs to achieve person-centered thinking. The demonstration of appropriate coping skills
allowed BTs to be mentally and physically present with autistic individuals. Effective coping
skills support the literature review, while person-centered thinking surfaced as additional
elements to affect BT retention.
Lastly, the environmental factors necessary to positively influence retention were
supervision support, presence of an effective support system, and organizational support.
Supervision support aligned with literature review as a crucial part of BT retention. Modeling
and providing feedback affected supervision support. The support system necessary in BT
retention included within organization support, outside of organization support, and work setting
support. Organizational support through compensation, training and continual learning
opportunities augmented BT retention efforts.
The data collected in this exploratory study revealed the lived experiences of BTs
aligning with the personal, behavioral, and environmental factors identified through literature
review. In addition, the research revealed additional key factors contributing to BT retention

65
under each domain. The study confirmed the conceptual framework notion of triadic reciprocal
relationship by showing the influences each of the three domains have on one another.

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Chapter Five: Recommendations
The closing chapter contains the recommendations based on the findings from the
research analysis. The chapter begins with a brief review of the study purpose and research
questions, followed by a summary of findings from chapter four. Then recommendations for
practice are outlined based on the findings centering the voices of BTs interviewed for this study.
Next, the goals and evaluation plans to monitor the implementation of the recommendations are
discussed. Finally, the chapter concludes with limitations and delimitations of the research and
recommendations for future research.
Findings
The retention of BTs depends on a triadic relationship between personal, behavioral, and
environmental factors that affect their beliefs and decision-making. The findings of this study
revealed the key concepts in each of the domain areas contributing to BT retention. This section
describes key findings from each of the domain areas.
Research Question One: Personal Factors Contributing to Retention
The key concepts expressed by BTs in the personal domain contributing to the retention
were motivation, prior knowledge, and purpose. Three subthemes supported the idea of
motivation and one subtheme supported prior knowledge. This segment depicts the findings to
the first research question.
Motivation
All the research participants emphasized the importance of motivation to BT retention.
Specifically, extrinsic motivation, intrinsic motivation, and self-efficacy sustained motivation.
BTs attributed motivation to counter the effects of burnout, which endorsed research by Kazemi

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et al. (2015) and others (Gray-Stanley & Muramatsu, 2011; James, 2020; Langeliers, 2013;
Mutkins et al., 2011).
All the participants interviewed conveyed recognition as a key element in their decision
to remain in their position as the BT. BTs expressed recognition was shown through social
praise, progress by autistic individuals, and positive collaboration with the supervisor. The social
praise and progress contributed to BTs values continuing in their role as BTs. As Bandura (1977)
proposed, verbal encouragement by others is one of the determining factors of self-efficacy,
which has been highlighted by several researchers as an essential factor in BT retention (Fida et
al., 2018; Gibson et al., 2009; Novak & Dixon, 2019; Robertson & Sadri, 1993; Stajkovic &
Luthans, 1998). As Giangreco et al. (2001) and Serna-Olander (2022) showed in their research,
appreciation and acknowledgement promotes retention of direct support professionals. Similarly,
recognition of BTs in the form of social praise, autistic individual’s progress, and collaboration
with the supervisor promotes retention of BTs.
The data revealed intrinsic motivation as a key element in BT retention. Twelve
participants remarked on intrinsic motivation’s role in their decision to remain in their position as
the BT. Intrinsic motivation is what drives BTs to engage in their job whether external
reinforcement is present or not (Ryan & Deci, 2000; Smith, 2005). BTs communicated they
wake up in the morning ready to work because they find the job rewarding and they love what
they do.
Belief in self-efficacy also supported BT retention at the agency. Especially important for
BTs is the effect self-efficacy has on cognition, coping ability, motivation (Fida et al., 2018;
Schunk & Usher, 2019) Gibson et al. (2009) described increased self-efficacy associated with
longer tenure working with autistic individuals. Higher levels of self-efficacy enabled

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engagement in independent problem-solving when faced with unexpected situations (Bandura,
1977; Schunk & Usher, 2019). Similarly, self-efficacy increases the motivation of BTs to support
autistic individuals as they are more confident in their abilities. Increased self-efficacy led to
feelings of increased job effectiveness and value (Gibson et al., 2009).
Prior Knowledge
Two lines of thought on prior knowledge emerged as principal factors supporting BT
retention. One was having or not having prior knowledge about what entails being a BT and the
other about the characteristics of autistic individuals. Importance of prior knowledge was
acknowledged by 13 of the 15 participants as a contributing factor to the retention of BTs. Some
of BTs had prior knowledge because of having a family member with a disability and having
seen ABA sessions conducted in the home. Forty-seven percent of the participants indicated
working at another ABA agency prior to the transition to ABC agency. Previous research shows
the experience as a mitigating factor to turnover (Billingsley & Bettini, 2019; Nagro & Monnin,
2022). Henry et al. (2011) outlined the increased effectiveness of teachers with an increase in
experience. Likewise, BTs in the study indicated their experience contributing to effectiveness as
a BT in supporting autistic individuals. In addition, the sentiment conveyed by BTs to show
experience contributes to retention, which supports Guarino et al. (2006) that higher attrition was
seen among less experienced teachers.
Sense of Purpose
Eighty percent of the research participants voiced the importance of having a sense of
purpose to BT retention. The responses from BTs are consistent with the previous research
which indicated importance of purpose (McGee & Johnson, 2015; Ryan & Deci, 2000; Rycraft,
1994) and sense of value (Sartore et al., 2023; Smith, 2005) in staff retention. BTs conveyed

69
happiness in finding a sense of purpose in their role as a BT. Some BTs discovered a sense of
purpose as they started as a BT. Still, some others, who had family members with disabilities,
indicated coming into the field with a sense of purpose. The sentiment of BTs is that a sense of
purpose is a key factor in BT retention.
Research Question Two: Behavioral Factors Contributing to Retention
The data analysis points to the importance of three key factors to BT retention in the
behavior domain. The key factors were engagement in person-centered approach and
establishment and use of effective coping skills. The findings in the behavior domain are
discussed in this section.
Person-Centered Approach
Breaux and Smith (2023) defined the person-centered approach as considering the human
rights of autistic individuals in the decision-making process. BTs described the significance of
patience and not taking things personally as components contributing to their ability to
implement a person-centered approach. BTs who voiced the importance of the person-centered
approach signified the ability to focus on the autonomy of autistic individuals, contributing to
their success as a BT. As such, the BT’s recognition of their positive impact supporting the
autonomy, choice-making, and inclusion of autistic individuals (Breaux & Smith, 2023)
influences BT retention.
Coping Skills
All BTs interviewed communicated the significance of effective coping skills in BT
retention. Coping skills, such as engagement in physical activity, listening to music, and
journaling improved work-related stress (Boujut et al., 2017; Devereux et al., 2009; Griffith, et
al., 2014; Mutkins et al., 2011) and allowed BTs to cope with stressful situations (Nevill &

70
Havercamp, 2019). Mutkins et al. (2011) and Novak and Dixon (2019) have previously
suggested coping skills for mitigating BT turnover. Similarly, the research participants noted
effective coping skills contributed to BT retention. BTs also expressed the ability to focus on
autistic individuals and their needs when they engaged in effective coping skills. Cancio et al.
(2018) suggested a similar idea in their study on the special education teacher’s commitment to
teaching. Overall, BTs voiced coping skills as an essential component of BT retention.
Research Question Three: Environmental Factors Contributing to Retention
Data analysis revealed the environmental factors influencing BT retention are supervision
support, the presence of a support system, and organizational support. Previous research aligned
with the current finding that supervision support was essential to BT retention. In addition, a
support system and organizational support appeared as key factors in BT retention. The findings
in the environment domain are discussed in this section.
Supervision Support
All of the participants expressed the influence of supervision support on their decision to
remain in their role as the BT. Studies have indicated the effect of supervision on BT turnover in
terms of quality and quantity (Afzal, et al., 2019; Dounavi, et al., 2019; McNeese-Smith, 1996;
Novak & Dixon, 2019; Smith, 2005). The characteristics of the supervisors highlighted as
positive by BTs included responsiveness, experience, knowledge, and ability to collaborate. In
contrast, negative characteristics included a lack of responsiveness, a lack of collaboration, and
pushing their own agenda. BTs learn through modeling by others (Schunk & Usher, 2019). The
participants communicated that the modeling of skills by the supervisors contributed to their
confidence in performing their jobs. Studies have shown an increase in BT’s cognition when
supervisors support in the field (Kazemi et al., 2015; Rosales et al., 2023). In addition, BTs

71
sought administrative and clinical supervision, and emotional support (Chami-Malaeb, 2022;
Devereux et al., 2009) was also crucial. Compassionate care involves asking the BT how they are
feeling, and showing genuine care (Austin, 2022; LeBlanc et al., 2020; Serna-Olander, 2022;
Taylor et al., 2019). When participants felt comfortable talking to the supervisors about nonwork-related problems and case-related problems (Devereux et al., 2009), lower levels of
burnout were observed. The positive collaboration with the supervisor showed BTs that the
supervisors heard their voice and valued their input in supporting the advancement of skills of
autistic individuals. The findings show positive support and the relationship with the supervisor
contributed to BT retention.
Effective Support System Increase Staff Retention
An effective support system within and outside of the organization surfaced as a key
element in staff retention. As Cancio et al. (2018) highlighted in their study, BTs indicated the
importance of support from colleagues as a within-organization support. Additionally, the
support system in the work setting itself contributed to BT retention. The specifics of these
subthemes are described below. The insight shared by BTs on the importance of supervision
support within the organization in the form of mentoring also aligns with previous research
(Cancio et al., 2018; Mrstik et al., 2019; Ortogero et al., 2022) to support retention efforts.
Furthermore, BTs pointed to the benefit of a support system outside of the organization, such as
family members, friends, and significant others contributing to retention, consistent with findings
by Cancio et al. (2018) and Nevill and Havercamp (2019).
Organizational Support
There were elements shared by BTs that affected retention requiring organizational
intervention. Eleven of the 15 respondents highlighted the importance of organizational support

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in BT retention efforts. The key points shared by BTs were compensation, training, and
availability of continual learning opportunities. The responses shared by BTs align with findings
from Li-Ping Tang et al. (2000), which alluded to the positive correlation between financial
stability and intrinsic job satisfaction and negative correlation between staff turnover. Similarly,
Kazemi et al. (2015) and Mitchell and Braddock (1994) named pay as one of the predictors of
BT turnover. Seven BTs specifically voiced the effect of monetary compensation in the decision
to remain as a BT at the agency. As Maslow (1943) illustrated through the hierarchy of needs,
basic physiological (food, shelter) and safety and security (employment, health) are at the base of
human needs, which highly corresponds with financial compensation.
In addition, BTs expressed the influence training has on BT retention. Research in human
resources has shown the effectiveness of training in staff retention (Arnold, 2005; Herman, 2005;
Hiltrop, 1999; Reed & Henley, 2015). Input from seven BTs reflected the importance of training
on BT retention not only about technical skills, but also expectations of the BT position. Kazemi
et al. (2015) found satisfaction with training was one of the predictors of BT retention.
Additionally, a study by Luiselli et al. (2017) found the importance of incorporating BT feedback
in development of individualized training for BTs.
Furthermore, 73% of BTs interviewed communicated the presence of continual learning
opportunities on BT retention, which aligns with earlier research supporting continual learning
opportunities on retention (Arnold, 2005; Herman, 2005; Hiltrop, 1999; Kyndt et al., 2009). Data
analysis suggests continual learning opportunities affect the motivation of BTs and, in turn,
support retention.
Implication of Findings

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Eighty percent or more of the participants shared three specific ideas as significant to BT
retention across each of the personal, behavioral, and environmental domains. These ideas were
supervision support, a sense of purpose, and motivation. Specifically, intrinsic motivation and
extrinsic motivation were recurring subthemes of motivation. As such, the next section will
consider these three key areas to make recommendations for practice.
Recommendations for Practice
The high turnover rate of BTs negatively affects the self-advocacy skills of autistic
individuals. Several reasons have been identified by previous studies on the turnover and burnout
of BTs (Ghere & York-Barr, 2007; Giangreco et al., 2001; Langeliers, 2013; Novak & Dixon,
2019). However, there is a dearth of research centering on the voices of BTs to find key factors
affecting retention. If unresolved, further marginalization and exclusion of the autistic population
from the neurodiverse society is inevitable. This study aimed to examine the factors within the
personal, behavioral, and environmental domains that influence BT retention at ABC agency
through interviews centering on the voices of BTs. Three recommendations are outlined below to
address key findings affecting the retention of BTs.
Recommendation 1: Affect Retention through Supervision Support
The study participants clearly expressed the positive impact supervision support plays in
BT retention. Novak and Dixon (2019) and others have shown quality and quantity of
supervision affect BT turnover (Afzal et al., 2019; Dounavi et al., 2019; McNeese-Smith, 1996).
As such, the recommendation is twofold: first is to increase the number of supervisors. The
second is to develop comprehensive supervisor training. The goal of the first recommendation is
to affect the personal and environmental domains of the SCT framework.
Increase the Number of Supervisors

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BTs expressed the importance of the responsiveness of the supervisors as a crucial factor
in feeling supported. BTs also expressed modeling of ABA strategies, behavior management
protocols, and program goal implementation in the field. Modeling of ABA skills has been found
to increase positive rapport between supervisor and BT (Hewitt et al., 2004). Because the ABA
services are often offered in the environment in which autistic individuals take part (e.g., school,
home, community), the supervisors are tasked to travel between locations to provide field-based
support. Despite the positive impact of supervisory support, the caseload of the supervisors often
does not allow for adequate support for each BT (Plantiveau et al., 2018). Increasing the number
of supervisors at ABC agency would allow a faster response rate from the supervisors and
increased supervision support to each of BTs on the supervisor caseload. A review of the
literature by Devereux et al. (2009) found lower levels of burnout when staff felt comfortable
talking to the supervisor about work and non-work-related problems. The supervisors could
increase field-based support for BTs and increase the frequency of check-ins with BTs. In
addition, modeling in the field by the supervisors would increase observational learning for BTs,
which positively affects the self-efficacy of BTs necessary to mitigate turnover.
Develop a Comprehensive Supervisor Training
Supervisors are often promoted based on their job performance as BTs. Essentially, the
supervisors know the technical aspects of ABA programming. However, supervisors need proper
training to assess BTs’ needs, address the mental and physical wellbeing of BTs, and support the
professional development of BTs (Blackman et al., 2023; Reed & Henley, 2015; Serna-Olander,
2022). Currently, the newly promoted supervisors are not provided formal training before
starting in their position as a supervisor. They model after what their supervisors had modeled
for them, which results in an inconsistent supervision support model for BTs. The new

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supervisors are often busy learning the position’s requirements instead of assessing and
supporting the needs of BTs. In addition, as stated by a few of the research participants, newly
promoted supervisors assert their authority by directing BTs instead of assessing BTs’ skills and
collaborating with them. As such, comprehensive supervisor training should focus not only on
administrative and technical aspects of supervision, but also on soft skills such as empathic
listening (Nemec et al., 2017), mental health support (Ellis et al., 2017), mentoring (Valentino,
2022), and self-reflection (Coleman, 2022; Serna-Olander, 2022). Quality of supervision, as
shared by BTs, included modeling of Applied Behavior Analysis (ABA) skills, collaborating on
the ABA program, and authenticity of the supervisor. The agency protocol should be for the
newly assigned supervisor to participate in formal supervisor training before starting their role in
supporting BTs. Recommendation is for ABC agency to increase training for the supervisors that
get promoted within the agency to provide effective support to BTs (Hewitt & Larson, 2004).
Recommendation 2: Affect Retention through Staff Recognition
The study participants expressed staff recognition as a contributing factor to BT
retention. Several researchers have called attention to self-efficacy as one of the responsible
factors for BT retention (Fida et al., 2018; Gibson et al., 2009; Novak & Dixon, 2019; Robertson
& Sadri, 1993; Stajkovic & Luthans, 1998). Bandura (1977) identified verbal encouragement by
others as one of the determining factors of self-efficacy. As Giangreco et al. (2001) established
in their research, appreciation and acknowledgment promotes the retention of direct support
professionals. The goal of the second recommendation is to affect the personal and
environmental domains of the SCT framework.
Enactment of Staff Recognition Program

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The recognition program would address the motivation aspect of BT retention.
Kirkpatrick and Kirkpatrick (2016) highlight the importance of required drivers to build critical
skills. One form of required drivers is a rewarding demonstration of critical behaviors. When
reinforcing BTs, it is important to recognize their specific performance (LaLiberte et al., 2005;
McGee & Johnson, 2015) to increase self-efficacy and tie back to the agency’s goal (Dykstra,
1999; LaLiberte et al., 2005). The program would allow the supervisor to reinforce the
knowledge and performance of BTs (Wiegand, & Geller, 2005) leading to consistency with
program implementation and ABA strategies, which affect the confidence to perform the task
and motivation (Schunk & Usher, 2019). Specific reinforcers for BTs should be assessed
individually (Henley, 2022; Wilder et al., 2006; Wine & Doan, 2022). Examples of performance
recognition are an upward trend in progress, positive feedback received from parent/school staff,
implementation of strategies to fidelity, and demonstration of professionalism when interacting
with teachers. The reinforcement received from the supervisors would support increased rapport
between the supervisor and BTs positively affecting BT retention.
Collaboration with the Supervisor
Supervisors asking for input on daily programming from BTs would provide recognition
(Giangreco et al., 2001; Langeliers, 2013). BTs would feel respected and acknowledged for the
daily support they provide to the autistic individuals (Giangreco et al., 2001). This in turn creates
mentoring opportunities within the agency and increases confidence for BTs to express
themselves comfortably. The research participants shared the presence of a mentor at the agency
as a motivating factor for maintaining their position as BT at ABC agency. Additionally,
increased confidence in ABA programming by the agency BTs is another benefit observed by the
outside stakeholders, leading to an increase in referrals and positive branding (Wheelan, 2019).

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Increased branding accounts for 20% of total revenue (Meir, 2022). Increased referrals would
create increased opportunities for BTs to take on new or additional roles within ABC agency
promoting continual learning opportunities for BTs (Biswas & Suar, 2016; Löhndorf, &
Diamantopoulos, 2014; Yadav et al., 2020), which research participants indicated as a critical
motivational factor in retention.
Recommendation 3: Affect Retention through Motivation and Value
Data shows BTs who have a sense of purpose beyond financial gains demonstrate
increased compassion and rapport with autistic individuals leading to person-centered care. BTs
who focus on their purpose and the autistic individual are more likely to remain in their position.
Pintrich (2003) suggests the importance of identifying what is motivating, how to access the
motivation, the effects of motivation on cognition, changes in motivation over time, and the role
of context and culture. The goal of the final recommendation is to affect the personal domain of
the SCT framework by attending to motivation and purpose.
Consideration of Ikigai as a Concept
Reflection on personal ikigai should be explored as part of the training for BTs. Ikigai is
a Japanese philosophical concept with four components: passion (what you love), mission (what
the world needs), vocation (what you are good at), and profession (what you can be paid for)
(Hikmawan et al., 2019; Kono & Walker, 2020; Kumano, 2018; Poindexter, 2023; Sartore et al.,
2023; Yamamoto-Mitani & Wallhagen, 2002). The concept sits at the intersection of motivation
and value. Identification of an ikigai is the identification of a purpose or intrinsic motivation
(Kumano, 2018; McGee & Johnson, 2015; Ryan & Deci, 2000; Rycraft, 1994) and sense of
value (Kumano, 2018; Sartore et al., 2023; Yamamoto-Mitani & Wallhagen, 2002) which
positively affects retention efforts. Furthermore, identification of ikigai has been associated with

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superior physical well-being (Sone et al., 2008; Tanno et al., 2009) and mental health (Gaines,
2020; Wilkes et al., 2023). As revealed in the findings through the interview process, BTs voiced
passion, profession, vocation, and mission as key concepts in BT retention. Passion was
expressed in the form of intrinsic motivation, profession in the form of experience and selfefficacy, vocation in the form of compensation and recognition, and mission in the form of sense
of purpose. Although ikigai is terminology unfamiliar to the field of ABA, the lived experiences
of BTs reflect essence of Ikigai. Based on the voices of BTs, Ikigai is a concept worth exploring
at ABC agency to affect the retention of BTs by aiding in identifying purpose without extrinsic
influences.
Relationship Building
ABC agency should include BT opportunities for interaction with autistic individuals
who are not clients of ABC agency as part of the training process. This could be in the form of
setting up volunteering opportunities, inviting an autistic individual for a question/answer
session, or taking part in community activities centering on autistic individuals. The research
participants called attention to the importance of intrinsic motivation and value on retention
efforts. However, as the participants expressed, many come into the field of ABA as a BT not
having any knowledge or previous interaction with autistic individuals. Various research has
found positive outcomes for neurotypical individuals after interacting with individuals with
disabilities (Helmstetter et al., 1994; Hughes et al., 2001; Peck et al., 1990; Perales, 2019;
Travers & Carter, 2022a; Travers & Carter, 2022b). Examples of positive outcomes included
development and maintenance of friendship (Helmstetter et al., 1994; Peck et al., 1990; Perales,
2019), development of value (Helmstetter et al., 1994; Peck et al., 1990), and personal growth
(Hughes et al., 2001; Perales, 2019; Travers & Carter, 2022b). Specifically, the interactions led

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to a view of individuals with disability as individuals, not as someone with a disability. The
opportunity to engage in non-work-related interaction with autistic individuals would enhance
BT retention by supporting the promotion of motivation and value.
Integrated Implementation and Evaluation Plan
The New World Kirkpatrick Model (NWKM) will be used to assess and support the
effectiveness and utility of the recommended intervention. The agency’s goal is to increase staff
retention (i.e., employees maintain employment with the agency for one year or more after
completion of new hire training) across every region to 100% of BTs across 12 out of 12 months.
Implementation and Evaluation Framework
The New World Kirkpatrick Model (NWKM) developed in 2010 by James and Wendy
Kirkpatrick, addresses the challenges faced by the modern fast-paced business standards, the
integration of computer technology, and an applicable evaluation framework across practices
(Kirkpatrick & Kirkpatrick, 2016). The four levels of the NWKM address reaction, learning,
behavior, and results. Applying the NWKM in reverse order, starting with level 4, emphasizes
the desired outcome, serving as the foundation for the training to avoid dysfunction within the
organization. In addition, by scaffolding the four levels in reverse order, the NWKM framework
ensures support and evaluation at multiple levels to strengthen the stakeholder learning and the
behavior change, as well as the implementation of a measurement system to assess the progress
towards the overarching organizational goal. Furthermore, proactive identification of the
organizational goal leads to return on expectations (ROE) for the organization to demonstrate not
only the training value, but the collaborative efforts of those involved to avoid silos within the
organization.

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Level 4 discerns the organizational goal or the desired outcome due to the
implementation of the training (Kirkpatrick & Kirkpatrick, 2016). These markers lead to Level 3,
which names critical behaviors necessary to achieve organizational goals. It is crucial at this
level to communicate individual responsibility towards the maintenance of the learned behavior
to the participants, as well as to determine the required drivers to reward, reinforce, monitor, and
encourage to maintain change. Level 2 assesses the knowledge, skill, attitude, confidence, and
commitment the participants learned from the training. Finally, Level 1 measures the extent to
which the participants found the training relevant, informative, and met satisfaction standards.
Organizational SMART Goal
ABC agency’s goal is to increase staff retention (i.e., employees maintain employment
with the agency for one year or more after completion of new hire training) across the California
region to 100% of BTs across 12 out of 12 months.
Stakeholder of Focus SMART Goal
As previously stated, BTs play an essential role in the mission and organizational goal of
ABC agency to transform the lives of autistic individuals. Therefore, the key stakeholder goal is:
After participation in new hire training and direct experience in the field, 100% of BTs in the
California region will choose to remain with ABC agency beyond the three-month probationary
period for 12 out of 12 months as measured by data collection.
Level 4: Results and Leading Indicators
To ensure ABC agency meets its staff retention goals to transform the lives of autistic
individuals, the agency needs metrics to measure progress towards the attainment of the goals.
These outcomes will substantiate both internal and external measurable outcomes. Table 7 shows
the proposed Level 4 external and internal outcomes, metrics, and methods that would indicate

81
the achievement of the goal. Meeting the internal outcomes should be consummate in achieving
the external outcomes.
Table 7
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metric(s) Data collection method(s)
External outcomes
1. Increased community
participation by autistic
individuals
1. The number of outings,
participation in community
activities autistic individuals are
willing/wanting to participate in.
1. Bi-monthly feedback from
parents/caretakers on the
frequency and ease of community
participation through a survey.
2. Increased demonstration
of self-advocacy skills by
autistic individuals.
2. The number of skills
demonstrated under “selfadvocacy” category in the home
and community.
2. Monthly anecdotal feedback
from parents/caretakers regarding
observation of the use of selfadvocacy skills outside of ABA
sessions.
3. Increased relationship
with the funding source.
3. Rating of satisfaction survey 3. Semi-annual analysis of results
from the Likert scale satisfaction
survey sent to funding sources;
Semi-annual collection and
analysis of anecdotal feedback
provided by funding sources.
Internal outcomes
4. Increased long-term staff
retention.
4a. The number of BTs
maintaining employment with the
agency past 3-month probationary
period
4a. Semi-annual data analysis of
the number of BTs who have
maintained employment with the
agency for 3 months or more.
4b. The number of BTs at the
agency.
4b. Compare the number of BTs
hired and BT resignation semiannually; Data analysis of the
number of BTs who have
maintained employment with the
agency for 6mo, 9mo, 1yr, 2yrs,
and on.
5. Increased number of
individuals receiving
services through the agency.
5. The number of clients at the
agency Year Over Year (YOY)
5. semi-annual review of the
number of clients serviced by the
agency.

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6. Increased staff morale,
motivation, and satisfaction.
6. Number of staff complaints and
employee satisfactions scores.
6. Annual review of BT
satisfaction survey, feedback from
BTs during their annual review,
analysis of collected staff
complaints bi-monthly.
7. Increased permanent BT
assignments for six months
or more for each individual.
7. The number of individuals on
the waitlist.
7. Weekly review of waitlist data
for number of individuals on the
waitlist, length of time any single
individual is on the waitlist due to
loss of BT
Level 3: Critical Behaviors
Critical Behaviors
BTs are the key stakeholders whose behaviors are critical to achieving the agency’s goal
to retain BTs at the agency beyond the three-month probationary period. Table 8 depicts critical
behaviors BTs must exhibit, metrics, data collection method, and review timing for successful
employment retention. The first critical behavior is for BTs to thoroughly understand the BT role
and its effects on autistic individuals. The second critical behavior is for BTs to develop a
positive relationship with the supervisor, specifically reaching out to the supervisors for support
with work and non-work-related issues. The ability of BTs to build a positive relationship with
the supervisor is critical in receiving supervision support and to make supervision support more
effective through identification of specific needs. The third critical behavior is for BTs to
demonstrate self-efficacy in the form of errorless implementation of ABA programs. The fourth
critical behavior is for BTs to effectively use coping strategies. Achievement, demonstration, and
maintenance of these critical behaviors will lead to Level 4 results.
Table 8
Critical Behaviors, Metrics, Methods, and Timing for Behavior Technicians
Critical behavior Metric(s) Data collection
method(s) Timing

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1. BTs verbalize and
demonstrate behavior
with supervisor and
trainer related to daily
job requirement and
their effects on autistic
individuals.
1a. The number of times
BTs verbalize and
demonstrate behavior
with supervisor and
trainer.
1a. Permanent product of
competency assessment
that agency has internally
for professionalism and
Registered Behavior
Technician™(RBT®)
assessment through the
Behavior Analyst
Certification Board
(BACB).
1a. Monitor weekly
for the first 30 days,
then bi-weekly for
another 30 days, then
random checks during
field visits thereafter.
1b. The frequency of
attendance at the NHT
1b. The permanent
product of sign-in/sign-out
sheet at the NHT indicates
name, date, and time.
1b. Monitor daily at
the start and end of
training sessions for
the duration of NHT.
2 BTs to develop a
positive working
relationship with the
supervisor, specifically
reaching out to the
supervisors for support.
2a. The frequency of the
BT contacting the
supervisor for support
and/or sharing personal
details.
2a. Permanent product of
text messages, phone
calls, and emails from BTs
to supervisors.
Partial interval or
momentary time sampling
of smiles towards the
supervisor during field
observation
2a. Monitor weekly
during the first 30
days - Emails/text
messages/phone calls;
monthly or as needed
thereafter.
Smiles = monitor
weekly for the first 30
days. As needed
thereafter
2b. The number of times
the BTs ask questions
during NHT.
2b. Rate the number of
times the BT raises hand
and or speaks up during
NHT.
2b. Monitor Daily for
the duration of the
NHT.
3. BTs demonstrate selfefficacy.
3a. The frequency of
BTs implementing ABA
programs to fidelity.
3a. Fidelity of
Implementation check.
3a. Monitor weekly
for the first 30 days,
then monthly during
field visits thereafter.
3b. The percentage of
opportunities the BT
can verbally explain
how to implement a
target goal program for
autistic individual.
3b. Opportunity-based
data collection during
field visits.
3b. Monitor weekly
for the first 30 days,
then random checks
during field visits
thereafter.
4. BTs demonstrate
effective use of coping
skills.
The frequency of the
BT using coping
strategy of choice when
presented with negative
Fidelity of implementation
data of use of coping
strategy and frequency
count of BTs ignoring
Monitor weekly for
the first 30 days, then
bi-weekly thereafter
for another 30 days,

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comments and/or
challenging behaviors.
negative comments during
observation.
then monthly
thereafter.
Required Drivers
The critical behaviors outlined cannot exist without the support from required drivers in
the form of reinforcement, encouragement, rewarding, and monitoring. Data collection
throughout level 3 allows for adjustments to required drivers as necessary during the behavior
change program. Table 9 highlights the drivers that are essential to direct the attainment of the
desired outcomes.
Table 9
Required Drivers to Support Behavior Technician Critical Behaviors
Method(s) Timing Critical behaviors supported
Reinforcing
Field visit by the supervisor at
each client assignment.
Weekly 1, 2, 3
Clear communication from
administration and trainers
regarding dates and times of
NHT.
One week prior to start of NHT 1
Provide list of resources for
volunteering opportunities
Ongoing 3
List of contact information and
delineation of who to contact
for what problem
Ongoing 2, 4
Encouraging
Modeling of skills and
techniques by supervisor and
trainer
Ongoing 2, 3
Immediate in vivo feedback by
supervisor and trainer
Ongoing 1, 2, 3, 4
Rewarding
Public acknowledgement/social
reinforcement in monthly
Monthly or as positive behavior
noticed, but at least quarterly
2, 3, 4

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newsletter, email shout out,
email to leadership team by
supervisor
Gift cards in lesser amounts
(e.g., $5 to Starbucks, $10 to
Amazon)
Entry in raffle each time
positive behavior noted
1, 2, 3, 4
Small goodies brought out
during field visits (e.g., cookies,
lunch, stickers, coffee)
Intermittently, but at least every
2-3 months.
1, 2, 3, 4
Monitoring
1:1 meeting with the supervisor
outside of session time
As needed, but at least every
couple of months.
2, 3
Observation in the field and
during NHT
Daily for NHT and weekly for
field supervision.
1, 2, 3
Professionalism competency
checklist
Monthly 1, 2, 3, 4
Fidelity of Implementation Monthly 2, 3, 4
Supports from Associated Critical Stakeholders Within the Organization
The leadership team needs to clearly communicate the mission and vision of the agency
and the importance of BTs in achieving the agency goal. The leadership team needs to be present
and participate in data collection of BT satisfaction survey to gain knowledge of needs in the
field. In addition, administrative team, including human resources department, scheduling
department, and IT department, play a critical role in reinforcing daily functioning of BTs. For
example, BTs are unable to convert their sessions and enter notes without a properly working
iPad issued by the IT department or BTs need the sessions entered by the scheduling department
so they can convert sessions on time to be paid. Leaders need to align resources to support
attainment of the goals as well as to model the behaviors they seek. The resources include proper

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staffing at each department, training, and review of compensation for BTs that match the field
standard.
Level 2: Learning
Learning Goals
Following the completion of the recommended solutions, BTs at ABC agency will be
able to:
1. List daily job responsibilities as a BT.
2. Reflect on use of behavior management strategies based on summary of progress.
3. Identify when to reach out to the supervisor to get support.
4. Identify how to reach out to the supervisor to get support.
5. Recognize actions, comments, and situations involving others that trigger a negative
emotional, mental, or physical response in oneself.
6. Utilize coping strategies to manage stress associated with triggering actions, comments,
and situations.
7. Indicate confidence in the ability to independently support autistic individuals in the
field.
Program
BTs will achieve the learning goals in the previous section through a series of
synchronous and asynchronous training to provide foundational knowledge of the role of BTs
supporting autistic individuals, expectations of conduct of BTs in the field, and resources
available to BTs. The total time for training will be 40 hours, with the synchronous portion of the
training being 30 hours and the asynchronous portion of the training being 10 hours. The trainers
will provide job aids (e.g., contact list of supervisors, IT, HR; procedural guidelines, decision-

87
making tree) and online learning modules as part of the training. In addition, a minimum of 3
hours of volunteer opportunities will be required at affiliate organizations. The list of affiliate
organizations with times of operation, contact information, and sign-in/sign-out sheet will be
provided during the synchronous training.
A series of five asynchronous online learning modules will provide BTs with an
overview of autism, client confidentiality, mandated reporting requirements, overview of
Applied Behavior Analysis methodologies to support autistic individuals, and self-care. Each
module will provide case examples/scenarios and pre and post knowledge check to ensure
understanding of the material. A training certificate showing completion of the module will be
emailed after successfully passing the post knowledge check. Once all the modules are complete,
BTs will receive an email confirmation from the training coordinators acknowledging and
attesting completion of the asynchronous portion of the training.
The synchronous training sessions over the course of five days will provide time for
demonstration of the methodologies by the trainers, role based experiential training, meeting
with the supervisors and managers, mentors sharing lived experiences, autistic individuals
sharing lived experiences, and guided walkthrough of communication system set up. As part of
the synchronous training will be the new BTs shadowing the seasoned BTs (i.e., BTs that have
been with the agency for two years or more demonstrating fidelity of implementation at 90% or
higher) in the field prior to case assignment. BTs will submit a completed form reflecting on the
observation and any questions that arise during the observation. Additionally, the training will
give an opportunity for BTs to reflect on why they chose to be a BT. Furthermore, BTs will
receive ongoing field support from the supervisor on a weekly basis and will be introduced to
staff in the mental health division of the agency.

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Evaluation of the Components of Learning
As Kirkpatrick and Kirkpatrick (2016) noted, evaluation of the learning is necessary to
confirm acquisition of the knowledge by BTs as declarative knowledge is necessary to solve
issues regarding self-efficacy and interactions and supports provided to autistic individuals.
Trainers must evaluate participants to ensure understanding of key concepts, strategies, and
application of the learning in the field. In addition, assessment of BTs confidence to apply the
learned skills in the field is a measure of commitment to utilize the skills in the field. Lastly,
evaluation of BTs perception of the value regarding the learning experience is necessary to
assess effectiveness of training. Table 10 lists the methods and/or activities and timing associated
with the elements of learning.
Table 10
Evaluation of the Components of Learning for the Program
Method(s) or activity(ies) Timing
Declarative knowledge “I know it.”
Knowledge checks using multiple choice. At the end of each module of the asynchronous
training.
Knowledge check through contrived scenariobased activities and discussions.
During synchronous training
Knowledge check through verbalization portion
of the competency assessment.
During supervision in the field.
Procedural skills “I can do it right now.”
Demonstration of the skills (e.g., use of ABA
methodologies, graphing, coping) during role
play activities.
During synchronous training.
Implementation of the skills (e.g., use of ABA
methodologies, graphing, coping) with autistic
individuals.
During shadowing sessions.
Retrospective learning evaluation. After day 1 and day 5 of synchronous training.
Attitude “I believe this is worthwhile.”
Retrospective learning evaluation. After day 1 and day 5 of synchronous training.

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Discussion of the ikigai and value in supporting
autistic individuals
During synchronous training and supervision in
the field.
Supervisor check ins. After 1 week of independent sessions in the field.
Confidence “I think I can do it on the job.”
Retrospective learning evaluation. After day 1 and day 5 of synchronous training.
Discussion following role play activities. During synchronous training.
Supervisor check ins. After 3 independent sessions in the field.
Commitment “I will do it on the job.”
Retrospective learning evaluation. After day 1 and day 5 of synchronous training.
Individual professional development plan During mentorship session and supervision in the
field.
Level 1: Reaction
Feedback from BTs on the training program reflects their satisfaction and perception of
relevance of the training to their role. Throughout the training, BTs have multiple opportunities
to provide feedback in the areas of engagement, relevance, and satisfaction (Kirkpatrick &
Kirkpatrick, 2016). Table 11 outlines the measures used to assess BTs reaction to the training.
Table 11
Components to Measure Reactions to the Program
Method(s) or tool(s) Timing
Engagement
Attendance at synchronous training sessions. At each day of synchronous training sessions.
Timely completion of asynchronous online
modules.
At each day of synchronous training sessions.
Observation and feedback from trainers Ongoing and at the conclusion of synchronous
training sessions.
Program evaluation After day 3 and day 5 of synchronous training
sessions, at the end of each asynchronous online
module, and 2 weeks after completion of
training.
Relevance
Asynchronous training evaluation. At the end of each asynchronous online module.
Program evaluation 2 weeks after completion of training.
Customer satisfaction

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Asynchronous training evaluation. At the end of each asynchronous online module.
Trainer evaluation At the end of each synchronous training session.
Program Evaluation At the end of synchronous training and after each
asynchronous training module, and 2 weeks after
completion of training.
Evaluation Tools
Immediately following the Program Implementation
The learning management system (LMS) will assess BT’s completion of the
asynchronous modules and administer pre and post knowledge check. The LMS data in
conjunction with the program evaluation survey (see Appendix D) will validate BT engagement
with the training provided by ABC agency. The observer checklist (see Appendix E) completed
by the trainers will provide further evaluation of the Level 1 and Level 2 measurements on
reaction and learning outcomes immediately after the training. The combination of evaluation
completed by BTs and the checklist completed by the trainers will represent effectiveness of the
training in meeting Level 2 goals. In addition, the combination of measurements will gauge
interplay of BT engagement, satisfaction with the training, and perceived relevance of the
training topics to their role as BT in meeting Level 2 goals.
Delayed for a Period after the Program Implementation
At four and eight weeks after the completion of the synchronous sessions and the
asynchronous modules, BTs will receive a separate program evaluation (see Appendix F) via
email to reflect on the experience and effectiveness of the training program. The evaluation will
measure post learning reaction (Level 1), knowledge maintenance and application (Level 2),
acquisition of the critical behaviors necessary for BT retention (Level 3), and extent to which the
training align in meeting stakeholder and organizational goals (Level 4). The delayed evaluation

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will also give an opportunity for any other feedback BTs may want to provide based on their
lived experience in the field supporting autistic individuals.
Data Analysis and Reporting
Retention of BTs at ABC agency is vital in supporting autistic individuals in the
community. To determine the level of progress, the organization should engage in quarterly
analysis of the key metrics of the internal and external organizational outcomes. Review of data
with the leadership, clinical, administrative, IT, and HR teams should increase collaboration
among the departments to support BT retention efforts. Conducting the evaluation on-going will
ensure maintenance and generalization across the California region of ABC agency. Annual
analysis and evaluation could be conducted once organizational and stakeholder SMART are met
at 100% for three consecutive years. The leadership team at ABC agency should share data
collected to all levels of employees at the agency to increase motivation, learning culture, and
transparency. Furthermore, the data will hold ABC agency accountable for their commitment to
transforming the lives of autistic individuals.
Summary
The New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2016) provides a
framework to develop a measurable strategic program to aid ABC agency reach organizational
goals. The evaluations implemented at every level of the New World Kirkpatrick Model
(NWKM) ensure alignment between each segment of the critical areas towards attainment of
stakeholder goal. Attainment of the stakeholder goal leads to achievement of the organizational
goal by ensuring acquisition of critical behaviors by BTs to maintain employment with the
agency. Continuous evaluation allows for assessment of progress and develop strategies to align
behaviors to strategic goals (Kirkpatrick & Kirkpatrick, 2016). The alignment between the

92
organizational goal and the training goals at each level will provide evidence of the value of the
training as a return on expectation (ROE) (Kirkpatrick & Kirkpatrick, 2016. Lastly, the
framework ensures programming efforts towards systemic culture and behavioral change in the
organization (Kirkpatrick & Kirkpatrick, 2016) aligned to the mission of transforming the lives
of autistic individuals.
Limitations and Delimitations
Limitations are potential areas of weakness that I do not have control over. For this study,
I do not have control over the truthfulness of the respondents. Reflexibility of the participants is
a limitation of qualitative research (Merriam & Tisdell, 2016). For recommended programs, I do
not have control over how BTs would receive the program as I do not have control over effects
of culture on BT lived experiences and decision making nor the biological neurological learning
capabilities of BTs. It is also a challenge to forecast the status of ABA services. Specifically,
responsible parties for future ABA funding for autistic individuals and reimbursement rates
associated (i.e., insurance vs. regional center vs. school district), viability of ABA services for
autistic individuals, and trajectory of ABA as a field in supporting autistic individuals.
Delimitations are the boundaries and scope of the study. Delimitations to the study
associated with the selection of the participants for the research and the questions specifically
aligned with exploratory research. The decision regarding the selection of participants were
made due to access to participants, limited resources, and time. I recognize the lack of
generalization of study findings across agencies and the field of ABA. In addition, because the
intention of the research is an exploratory study, the wording of the questions was intended to
elicit positive responses, which may have excluded critical comments (i.e., what is not working
or can be improved) from the participants. However, I recognize that the critical comments are

93
part of the lived experiences of BTs. Format of the questions to potentially exclude part of the
lived experiences of BTs may deplete opportunities to gain insight into potential future
recommendations in the BT retention process. The study may limit BTs’ voices to make a
positive impact on the lives of autistic individuals.
The effects on autistic individuals, families and the communities are not considered by
choosing to center BTs as the stakeholder. Therefore, the voices of those affected by the BT
turnover are excluded from this study. However, there may be underestimation of the benefits of
addressing the BT turnover issue as the problem has substantial economic impact in other areas,
such as government subsidies. In addition, pay rate, which is one of the factors leading to BT
turnover, is not addressed. BTs whose main motivation is financial gain may still choose to
terminate their employment with the agency. Future consideration may be to analyze the BenefitCost of addressing pay rate for BTs. It should also be noted that only one form of economic
evaluation was considered in this paper. Although the evaluation plan utilizing the NWKM
framework was utilized to assess the effectiveness and utility of the interventions, the evaluation
plan is not tied to economic evaluation. Future consideration may be to analyze economic value
associated with achievement of organizational and stakeholder SMART goals.
Recommendations for Future Research
The current study centered on the voice of BTs at a single ABA agency, which limits
generalizability of the findings and excludes the voices of countless BTs in the field of ABA. It
is recommended that future research include participants from multiple agencies nationwide to
further analyze factors contributing to BT retention. In such cases, mixed methods research may
be more appropriate to find the trend through quantitative measures, while finding the reasons
through qualitative measures.

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Although literature review points to the effect of BT turnover on autistic individuals and
their families, the current research did not include their experience. Understanding the
perspectives and lived experiences of autistic individuals and their families would further the
knowledge of the impact of BT retention on the growth of autistic individuals and their families
as a positive practice study. One challenge to consider in conducting such research may be that
autism is a spectrum disorder. The voices of those on the spectrum that are not able to express
themselves may continue to be excluded until future research begins to focus on representing the
voices of autistic individuals who express themselves in non-traditional ways.
Furthermore, it is important to recognize the burnout and turnover factors that affect the
supervisors in the field of ABA. BT retention cannot be resolved without addressing burnout and
turnover of supervisors. As found in the current study, consistent supervisor support was a
crucial factor in BT retention. As such, it is recommended that future research center on the
voices of supervisors at ABA organizations to analyze factors contributing to the retention of
supervisors. Understanding both the BT and supervisor perspectives would result in a more
inclusive understanding of investing in human capital vital to the ABA organizations and
resulting effect on autistic individuals.
Conclusion
The high attrition rate of BTs negatively affects inclusion autistic individuals in the
community. The turnover of BTs results in lack of consistency and negatively affects progress
towards development of self-advocacy skills for autistic individuals. Although numerous
research suggests the need to rectify the turnover of BTs in the field of ABA, high attrition rate
of BTs continue to plague many agencies providing ABA services. As reported by ADDM, the
number of individuals diagnosed with autism has increased significantly in the last 20 years. The

95
need for BTs to provide ABA support to autistic individuals is going to continue with the same
trajectory as the diagnosis of autism. ABA agencies must find a solution towards retention of
BTs to maintain consistency of ABA support to effectively aide in the enhancement of skills and
extend the abilities of the autistic individuals.
BTs are not only essential in providing support to autistic individuals, but they also
support agency branding by representing the ABA agency in the field where families, teachers,
and funding sources observe and assess the effectiveness of the ABA agency. Despite the
importance of the role of BTs for the ABA agency, the voices of BTs have been disregarded for
far too long. Therefore, investigation of the lived experiences of BTs was necessary to center the
voices of BTs to mitigate turnover and positively impact retention efforts. Attending to the lived
experiences of the BTs is crucial in development of effective systems to facilitate and nurture
retention efforts. The effect of BT retention is crucial in addressing the equity and inclusion of
the marginalized autism population. Without BTs, organizations providing ABA support are not
able to enhance the lives of autistic individuals. Together we can.

96
References
Aarons, G. A., & Sawitzky, A. C. (2006). Organizational climate partially mediates the effect of
culture on work attitudes and staff turnover in mental health services. Administration and
Policy in Mental Health and Mental Health Services Research, 33(3), 289–301.
https://doi.org/10.1007/s10488-006-0039-1
ABA Connect (2018, January 27). ABA terms: generalization. https://www.abaconnect.com/abaterms/gneralization
Abbott, S., & McConkey, R. (2006). The barriers to social inclusion as perceived by people with
intellectual disabilities. Journal of Intellectual Disabilities, 10(3), 275–287.
https://doi.org/10.1177/1744629506067618
Accenture. (2018). Getting to equal: The disability inclusion advantage. Accenture.
https://www.accenture.com/content/dam/accenture/final/a-com-migration/pdf/pdf89/accenture-disability-inclusion-research-report.pdf
Afzal, S., Arshad, M., Saleem, S., & Farooq, O. (2019). The impact of perceived supervisor
support on employees’ turnover intention and task performance: Mediation of selfefficacy. The Journal of Management Development, 38(5), 369–382.
https://doi.org/10.1108/JMD-03-2019-0076
Alvero, A. M., Bucklin, B. R., & Austin, J. (2001). An Objective Review of the Effectiveness
and Essential Characteristics of Performance Feedback in Organizational Settings (1985-
1998). Journal of Organizational Behavior Management, 21(1), 3–29.
https://doi.org/10.1300/J075v21n01_02

97
American Psychiatric Association. (2013). Autism spectrum disorder. In Diagnostic and
statistical manual of mental disorders (5th ed.).
https://doi.org/10.1176/appi.books.9780890425596.dsm05
Anderson, L.K. (2023). Autistic experiences of applied behavior analysis. Autism : the
International Journal of Research and Practice, 27(3), 737–750.
https://doi.org/10.1177/13623613221118216
Arnold, E. (2005). Managing human resources to improve employee retention. The Health Care
Manager, 24(2), 132–140. https://doi.org/10.1097/00126450-200504000-00006
Ates, B. (2022). Autism unemployment rates. Good Autism School. Autism Unemployment
Rates | Autism Expert Advices (goodautismschool.com)
Austin, A. (2022). Evaluating Compassionate Supervisory Practices and Burnout among ABA
Staff (Order No. 29167959). Available from ProQuest Dissertations & Theses Global;
ProQuest One Academic. (2746055645).
http://libproxy.usc.edu/login?url=https://www.proquest.com/dissertationstheses/evaluating-compassionate-supervisory-practices/docview/2746055645/se-2
Austin, R. D., & Pisano, G. P. (2017). Neurodiversity as a competitive advantage. Harvard
Business Review, 95(3), 96-103.
Autism Society. (2023). The autism experience: understanding autism.
https://autismsociety.org/the-autism-experience/
Autistic Self Advocacy Network. (2023). About autism. https://autisticadvocay.org/aboutasan/about-autism/
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change.
Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

98
Bandura. (1978). Reflections on self-efficacy. Advances in Behaviour Research and Therapy,
1(4), 237–269. https://doi.org/10.1016/0146-6402(78)90012-7
Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory.
Prentice-Hall.
Barnes, C. & Mercer, G. (2005). Disability, work, and welfare: Challenging the social exclusion
of disabled people. Work, Employment and Society, 19(3), 527–545.
https://doi.org/10.1177/0950017005055669
Behavior Analyst Certification Board (2018). RBT task list (2nd ed.). Littleton, CO: Author.
https://www.bacb.com/wp-content/uploads/2020/05/RBT-2nd-edition-task-list-230130-
a.pdf
Behavior Analyst Certification Board (2024). BACB Certification Data. Littleton, CO: Author.
https://www.bacb.com/bacb-certicant-data/
Behavioral Health Center of Excellence (2021). 2021 ABA compensation & turnover report.
BHCOE. https://www.bhcoe.org/project/2021-aba-compensation-and-turnover-report/
Billingsley, B., & Bettini, E. (2019). Special Education Teacher Attrition and Retention: A
Review of the Literature. Review of Educational Research, 89(5), 697–744.
https://doi.org/10.3102/0034654319862495
Biswas, M. K., & Suar, D. (2016). Antecedents and Consequences of Employer Branding.
Journal of Business Ethics, 136(1), 57–72. https://doi.org/10.1007/s10551-014-2502-3
Blackman, A. L., DiGennaro Reed, F. D., Erath, T. G., & Henley, A. J. (2023). A Survey of Staff
Training and Performance Management Practices: An Update. Behavior Analysis in
Practice, 16(3), 731–744. https://doi.org/10.1007/s40617-022-00762-0

99
Bottema-Beutel, K.& Crowley, S. (2021). Pervasive undisclosed conflicts of interest in applied
behavior analysis autism literature. Frontiers in Psychology, 12, 676303–676303.
https://doi.org/10.3389/fpsyg.2021.676303
Boujut, E., Popa-Roch, M., Palomares, E.-A., Dean, A., & Cappe, E. (2017). Self-efficacy and
burnout in teachers of students with autism spectrum disorder. Research in Autism
Spectrum Disorders, 36, 8–20. https://doi.org/10.1016/j.rasd.2017.01.002
Bozek, R. (n.d.). The hidden value of disability inclusion: 5 benefits that can help your company.
https://www.understood.org/en/articles/hidden-value-of-disability-inclusion-5-benefitsthat-can-help-company
Breaux, C. A., & Smith, K. (2023). Assent in applied behaviour analysis and positive behaviour
support: ethical considerations and practical recommendations. International Journal of
Developmental Disabilities, 69(1), 111–121.
https://doi.org/10.1080/20473869.2022.2144969
Brooke, V., Brooke, A. M., Schall, C., Wehman, P., McDonough, J., Thompson, K., & Smith, J.
(2018). Employees with Autism Spectrum Disorder Achieving Long-Term Employment
Success: A Retrospective Review of Employment Retention and Intervention. Research
and Practice for Persons with Severe Disabilities, 43(3), 181–193.
https://doi.org/10.1177/1540796918783202
Butterworth, J., Hiersteiner, D., Engler, J., Bershadsky, J., & Bradley, V. (2015). National Core
Indicators: Data on the current state of employment of adults with IDD and suggestions
for policy development. Journal of Vocational Rehabilitation, 42(3), 209–220.
https://doi.org/10.3233/JVR-150741

100
California Legislative Information. (2021). Minimum wages: persons with disabilities, California
Senate Bill 639, chaptered by Secretary of State. 2021-2022 regular session, chapter 339
(Cal.Stat.2021).
https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB639
Cancio, E. J., Larsen, R., Mathur, S. R., Estes, M. B., Johns, B., & Chang, M. (2018). Special
Education Teacher Stress: Coping Strategies. Education & Treatment of Children, 41(4),
457–482. https://doi.org/10.1353/etc.2018.0025
Casey, A. M., & McWilliam, R. A. (2011). The Characteristics and Effectiveness of Feedback
Interventions Applied in Early Childhood Settings. Topics in Early Childhood Special
Education, 31(2), 68–77. https://doi.org/10.1177/0271121410368141
Cernius, A. (2022, May 13). The autistic community is having a reckoning with ABA therapy.
We should listen. Fortune. https://fortune.com/2022/05/13/autistic-communityreckoning-aba-therapy-rights-autism-inusrance-private-equity-ariana-cernius/
Chami-Malaeb, R. (2022). Relationship of perceived supervisor support, self-efficacy and
turnover intention, the mediating role of burnout. Personnel Review, 51(3), 1003–1019.
https://doi.org/10.1108/PR-11-2019-0642
Charlton, C. (2023, May 9). On a waitlist for ABA therapy? What you can do right now. Metro
Parent. https://www.metroparent.com/sponsored-content/on-a-waitlist-for-aba-therapy
Chen, J.L., Leader, G., Sung, C., & Leahy, M. (2015). Trends in Employment for individuals
with autism spectrum disorder: A review of the research literature. Review Journal of
Autism and Developmental Disorders, 2(2), 115–127. https://doi.org/10.1007/s40489-
014-0041-6

101
Coleman, M. L. (2022). The Use of Counseling Skills Within Evaluative Contexts. Counseling
Outcome Research and Evaluation, 13(1), 22–29.
https://doi.org/10.1080/21501378.2022.2025771
Conrad, J. (2020). On intellectual and developmental disabilities in the United States: A
historical perspective. Journal of Intellectual Disabilities, 24(1), 85-101.
https://doi.org/10.1177/1744629518767001
Cooper, J.D., Heron, T.E., & Heward, W.L. (2007). Applied Behavior Analysis (2nd ed.).
Pearson Education.
Corona, L.L., Christodulu, K. V., & Rinaldi, M. L. (2017). Investigation of School Professionals’
Self-Efficacy for Working With Students With ASD: Impact of Prior Experience,
Knowledge, and Training. Journal of Positive Behavior Methods, 19(2), 90–101.
https://doi.org/10.1177/1098300716667604
Costanza, D.P., Blacksmith, N., Coats, M. R., Severt, J. B., & DeCostanza, A. H. (2015). The
effect of adaptive organizational culture on long-term survival. Journal of Business and
Psychology, 31(3), 361–381. https://doi.org/10.1007/s10869-015-9420-y
Creswell, J. W. & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed
methods approaches. SAGE Publications.
Daniels, E. (2022). School Counseling Site Supervision: A Grounded Theory Inquiry (Order No.
30241223). [Doctoral dissertation, Brandman University]. ProQuest Dissertations
Publishing.
Dauster, M. M. (2017). Job Retention and Job Satisfaction at the Behavior Therapist Level
Working in ABA Companies in the Home Setting. (Publication No. 10268313) [Doctoral
dissertation, Brandman University]. ProQuest Dissertations Publishing.

102
Department of Developmental Services. (2022). Self-Determination Program (SDP).
https://www.dds.ca.gov/initiatives/sdp/
Devereux, J., Hastings, R., & Noone, S. (2009). Staff Stress and Burnout in Intellectual
Disability Services: Work Stress Theory and its Application. Journal of Applied Research
in Intellectual Disabilities, 22(6), 561–573. https://doi.org/10.1111/j.1468-
3148.2009.00509.x
Dounavi, K., Fennell, B., & Early, E. (2019). Supervision for certification in the field of applied
behaviour analysis: Characteristics and relationship with job satisfaction, burnout, work
demands, and support. International Journal of Environmental Research and Public
Health, 16(12), 2098–. https://doi.org/10.3390/ijerph16122098
Dubnick, M.J. (n.d.). Guest Lecturer: Dr. Melvin Dubnick, Part 2 [Recorded lecture]. Digital
Campus. Lecturer: Dr. Melvin Dubnick, Part 2 (instructure.com)
Dudley-Marling, C., & Burns, M.B. (2014). Two perspectives on inclusion in the United States.
Global Education Review, 1(1), 14-31.
Dykstra, A. Jr., (1999). Quality performance and human resources. In J.F. Gardner & S. Nudler
(Eds.), Quality performance in human services: Leadership, values, and vision (pp.123-
140). Paul H. Brookes Publishing Co.
Eisenberger, R., Stinglhamber, F., Vandenberghe, C., Sucharski, I. L., & Rhoades, L. (2002).
Perceived Supervisor Support: Contributions to Perceived Organizational Support and
Employee Retention. Journal of Applied Psychology, 87(3), 565–573.
https://doi.org/10.1037/0021-9010.87.3.565

103
Elfert, M., & Mirenda, P. (2006). The experiences of behavior interventionists who work with
children with autism in families’ homes. Autism : the International Journal of Research
and Practice, 10(6), 577–591. https://doi.org/10.1177/136236130606850
Ellis, A. M., Casey, T. W., & Krauss, A. D. (2017). Setting the Foundation for Well-Being:
Evaluation of a Supervisor-Focused Mental Health Training. Occupational Health
Science, 1(1–2), 67–88. https://doi.org/10.1007/s41542-017-0005-1
Fida, R., Laschinger, H. K. S., & Leiter, M. P. (2018). The protective role of self-efficacy against
workplace incivility and burnout in nursing: A time-lagged study. Health Care
Management Review, 43(1), 21–29. https://doi.org/10.1097/HMR.0000000000000126
Ford, T.G., Lavigne, A. L., Fiegener, A. M., & Si, S. (2020). Understanding district support for
leader development and success in the accountability era: A review of the literature using
social-cognitive theories of motivation. Review of Educational Research, 90(2), 264–307.
https://doi.org/10.3102/0034654319899723
Friedman, C. (2018). Direct Support Professionals and quality of life of people with intellectual
and developmental disabilities. Intellectual and Developmental Disabilities, 56(4), 234–
250. https://doi.org/10.1352/1934-9556-56.5.234
Friedman, C. (2021a). The impact of ongoing staff development on the health and safety of
people with intellectual and developmental disabilities. Journal of Developmental and
Physical Disabilities, 33(2), 181–196. https://doi.org/10.1007/s10882-020-09743-z
Friedman, C. (2021b). Reducing “Challenging” Behavior by Training Support Staff to Promote
Dignity and Respect. Journal of Developmental and Physical Disabilities, 33(3), 449–
458. https://doi.org/10.1007/s10882-020-09757-7

104
Friedman, C. (2022a). The impact of human service provider quality on the personal outcomes of
people with intellectual and developmental disabilities. Frontiers in Rehabilitation
Sciences, 2. https://doi.org/10.3389/fresc.2021.780168
Friedman, C. (2022b). The Impact of Continuity and Security on Quality of Life. Intellectual and
Developmental Disabilities, 60(2), 101–112. https://doi.org/10.1352/1934-9556-60.2.101
Gabel, S.L., Cohen, C. J., Kotel, K., & Pearson, H. (2013). Intellectual disability and space:
Critical narratives of exclusion. Intellectual and Developmental Disabilities, 51(1), 74–80.
https://doi.org/10.1352/1934-9556-51.01.074
Gaines, J. (2020, November 17). The philosophy of ikigai: 3 examples about finding purpose.
Positive Psychology.
https://positivepsychology.com/ikigai/#The%20Ikigai%20Diagram:%20A%20Philosophi
cal%20Perspective
Ghere, G. & York-Barr, J. (2007). Paraprofessional turnover and retention in inclusive programs:
Hidden costs and promising practices. Remedial and Special Education, 28(1), 21–32.
https://doi.org/10.1177/07419325070280010301
Giangreco, M.F., Edelman, S.W., Broer, S.M. (2001). Respect, appreciation, and
acknowledgment of paraprofessionals who support students with disabilities. The council
for Exceptional Children, 67(4), 485-498. https://doi.org/10.1177/001440290106700404
Gibson, S. (2006). Beyond a “culture of silence”: inclusive education and the liberation of
“voice.” Disability & Society, 21(4), 315–329. https://doi.org/10.1080/09687590600679956
Gibson, J.A., Grey, I. M., & Hastings, R. P. (2009). Supervisor Support as a Predictor of Burnout
and Therapeutic Self-Efficacy in Therapists Working in ABA Schools. Journal of Autism

105
and Developmental Disorders, 39(7), 1024–1030. https://doi.org/10.1007/s10803-009-
0709-4
Gitimoghaddam,M., Chichkine, N., McArthur, L., Sangha, S. S., & Symington, V. (2022).
Applied Behavior Analysis in Children and Youth with Autism Spectrum Disorders: A
Scoping Review. Perspectives on Behavior Science, 45(3), 521–557.
https://doi.org/10.1007/s40614-022-00338-x
Glesne, C. (2011). Becoming qualitative researchers: An introduction. (4th ed.). Pearson.
Gorycki, K.A., Ruppel, P. R., & Zane, T. (2020). Is long-term ABA therapy abusive: A response
to Sandoval-Norton and Shkedy. Cogent Psychology, 7(1).
https://doi.org/10.1080/23311908.2020.1823615
Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical
framework in dissertation research: Creating the blueprint for your “house.” Administrative
Issues Journal Education Practice and Research, 4(2). https://doi.org/10.5929/2014.4.2.9
Gray-Stanley, J.A., & Muramatsu, N. (2011). Work stress, burnout, and social and personal
resources among direct care workers. Research in Developmental Disabilities, 32(3),
1065–1074. https://doi.org/10.1016/j.ridd.2011.01.025
Griffith, G. M., Barbakou, A., & Hastings, R. P. (2014). Coping as a predictor of burnout and
general health in therapists working in ABA schools. European Journal of Special Needs
Education, 29(4), 548–558. https://doi.org/10.1080/08856257.2014.952915
Grindle, C.F., Kovshoff, H., Hastings, R. P., & Remington, B. (2009). Parents’ Experiences of
Home-Based Applied Behavior Analysis Programs for Young Children with Autism.
Journal of Autism and Developmental Disorders, 39(1), 42–56.
https://doi.org/10.1007/s10803-008-0597-z

106
Guarino, C. M., Santibañez, L., & Daley, G. A. (2006). Teacher Recruitment and Retention: A
Review of the Recent Empirical Literature. Review of Educational Research, 76(2), 173–
208. https://doi.org/10.3102/00346543076002173
Gur, A. & Bina, R. (2022). Facilitators of sense of belonging among people with intellectual and
developmental disabilities: A systematic review. Journal of Intellectual Disabilities.
Advance online publication. https://doiorg.libproxy2.usc.edu/10.1177/17446295211068424
Hall, E. (2010). Spaces of social inclusion and belonging for people with intellectual disabilities.
Journal of Intellectual Disability Research, 54(s1), 48–57. https://doi.org/10.1111/j.1365-
2788.2009.01237.x
Harvey, J. (2023). A Survey of Factors Contributing to RBT Burnout in ABA Clinics.
(Publication No. 30540965) [Master’s thesis, Youngstown State University] ProQuest
Dissertations Publishing.
Hastings, R. P., & Remington, B. (1994). Staff behaviour and its implications for people with
learning disabilities and challenging behaviours. British Journal of Clinical Psychology,
33(4), 423–438. https://doi.org/10.1111/j.2044-8260.1994.tb01140.x
Hastings, R.P., Horne, S., & Mitchell, G. (2004). Burnout in direct care staff in intellectual
disability services: a factor analytic study of the Maslach Burnout Inventory. Journal of
Intellectual Disability Research, 48(3), 268–273. https://doi.org/10.1111/j.1365-
2788.2003.00523.x
Helmstetter, E., Peck, C. A., & Giangreco, M. F. (1994). Outcomes of Interactions with Peers
with Moderate or Severe Disabilities: A Statewide Survey of High School Students.

107
Journal of the Association for Persons with Severe Handicaps, 19(4), 263–276.
https://doi.org/10.1177/154079699401900403
Henley, A.J. (2022). Supervision and mentoring. In Luiselli, J. K., Gardner, R. M., Bird, F. L., &
Maguire, H. (Eds.). Organizational behavior management approaches for intellectual
and developmental disabilities. (2nd Edition; pp.141-164). Routledge.
https://doi.org/10.4324/9780429324840
Henry, G. T., Bastian, K. C., & Fortner, C. K. (2011). Stayers and Leavers: Early-Career Teacher
Effectiveness and Attrition. Educational Researcher, 40(6), 271–280.
https://doi.org/10.3102/0013189X11419042
Hentschke, G.C., & Wohlstetter, P. (2004). Cracking the code of accountability. University of
Southern California Urban Education, Spring/Summer, 17-19
Herman, R. E. (2005). HR managers as employee-retention specialists. Employment Relations
Today, 32(2), 1–7. https://doi.org/10.1002/ert.20058
Hewitt, A. S., Larson, S. A. (2004). Supporting and training supervisors. In S.A. Larson & A.S.
Hewitt (Eds.), Staff recruitment, retention, & training strategies for community human
services organizations (pp.197-214). Paul H. Brookes Publishing Co.
Hewitt, A. S., Larson, S. A., Lakin, K. C., Sauer, J., O’Nell, S., & Sedlezky, L. (2004). Role and
Essential Competencies of the Frontline Supervisors of Direct Support Professionals in
Community Services. Mental Retardation (Washington), 42(2), 122–135.
https://doi.org/10.1352/0047-6765(2004)42<122:RAECOT>2.0.CO;2
Hikmawan, R., Sari, D. P., Majid, N. A., Ridwan, T., Nuriyah, W., Aprilia, L., & Diani, D.
(2019). Development of Ikigai instructional method to cultivate computational thinking of

108
millennial generations. Journal of Physics. Conference Series, 1318(1), 12007-.
https://doi.org/10.1088/1742-6596/1318/1/012007
Hiltrop, J.-M. (1999). The quest for the best: human resource practices to attract and retain talent.
European Management Journal, 17(4), 422–430. https://doi.org/10.1016/S0263-
2373(99)00022-5
Hirakawa, Y., Chiang, C., Uemura, M. Y., & Aoyama, A. (2019). Job Satisfaction Among
Japanese Home-Visit Care Workers. Home Health Care Management & Practice, 31(1),
3–8. https://doi.org/10.1177/1084822318803861
Hughes, C., Copeland, S. R., Guth, C., Rung, L. L., Hwang, B., Kleeb, G., & Strong, M. (2001).
General Education Students’ Perspectives on Their Involvement in a High School Peer
Buddy Program. Education and Training in Mental Retardation and Developmental
Disabilities, 36(4), 343–356.
Human, E. (2016, March 10). Cognitive dissonance in a different key. NeuroQueer.
Neuroqueer.blogspot.com/2016/03/cognitive-dissonance-in-different-key.html
Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B.,
Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2021). EvidenceBased Practices for Children, Youth, and Young Adults with Autism: Third Generation
Review. Journal of Autism and Developmental Disorders,51(11), 4013–4032.
https://doi.org/10.1007/s10803-020-04844-2
Hurt, A.A., Grist, C. L., Malesky Jr, L. A., & McCord, D. M. (2013). Personality traits
associated with occupational “burnout” in ABA therapists. Journal of Applied Research in
Intellectual Disabilities, 26(4), 299–308. https://doi.org/10.1111/jar.12043

109
Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, C. S., Davidson, L. F., Ellerbeck,
K. A., Foster, J. E. A., Noritz, G. H., O’Connor Leppert, M., Saunders, B. S., Stille, C.,
Yin, L., Brei, T., Davis, B. E., Lipkin, P. H., Norwood, K., Coleman, C., Mann, M., …
Paul, L. (2020). Identification, evaluation, and management of children with autism
spectrum disorder. Pediatrics (Evanston), 145(1), 1-. https://doi.org/10.1542/PEDS.2019-
3447
Irwin, C. & Axe, J. B. (2019). Overview of applied behavior analysis and early method for
autism spectrum disorder. In Behavioral methods in schools: Evidence-based positive
strategies (2nd ed., pp. 205–226). American Psychological Association.
https://doi.org/10.1037/0000126-012
James, K.L. (2020). Strategies to Mitigate Employee Turnover in the Human Services Special
Needs Industry. (Publication No. 28261211) [Doctoral dissertation] ProQuest
Dissertations Publishing.
Jensen, V.K., & Sinclair, L. V. (2002). Treatment of autism in young children: Behavioral
method and applied behavior analysis. Infants and Young Children, 14(4), 42–52.
https://doi.org/10.1097/00001163-200204000-00006
Johnson, K.R., Ennis-Cole, D., & Bonhamgregory, M. (2020). Workplace Success Strategies for
Employees With Autism Spectrum Disorder: A New Frontier for Human Resource
Development. Human Resource Development Review, 19(2), 122–151.
https://doi.org/10.1177/1534484320905910
Kazemi, E., Shapiro, M., & Kavner, A. (2015). Predictors of intention to turnover in behavior
technicians working with autistic individual spectrum disorder. Research in Autism
Spectrum Disorders, 17, 106–115. https://doi.org/10.1016/j.rasd.2015.06.012

110
Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick's four levels of training evaluation.
Association for Talent Development Press.
Kono, S., & Walker, G. J. (2020). Theorizing Ikigai or Life Worth Living Among Japanese
University Students: A Mixed-Methods Approach. Journal of Happiness Studies, 21(1),
327–355. https://doi.org/10.1007/s10902-019-00086-x
Kumano, M. (2018). On the Concept of Well-Being in Japan: Feeling Shiawase as Hedonic
Well-Being and Feeling Ikigai as Eudaimonic Well-Being. Applied Research in Quality
of Life, 13(2), 419–433. https://doi.org/10.1007/s11482-017-9532-9
Kyndt, E., Dochy, F., Michielsen, M., & Moeyaert, B. (2009). Employee Retention:
Organisational and Personal Perspectives. Vocations and Learning, 2(3), 195–215.
https://doi.org/10.1007/s12186-009-9024-7
LaLiberte, T.L., Hewitt, A.S., & Larson, S.A. (2005). Staff motivation and recognition. In S.A.
Larson & A.S. Hewitt (Eds.), Staff recruitment, retention, & training strategies for
community human services organizations (pp.197-214). Paul H. Brookes Publishing Co.
Lalvani, P., & Bacon, J. K. (2019). Rethinking “We Are All Special”: Anti-Ableism Curricula in
Early Childhood Classrooms. Young Exceptional Children, 22(2), 87–100.
https://doi.org/10.1177/1096250618810706
Langeliers, A.L. (2013). Perceived supervisor support, job satisfaction, and burnout among
ABA therapists for children with autism. (Publication No. 3593586) [Doctoral
dissertation, California School of Professional Psychology, Fresno campus]. ProQuest
LLC.
Larson, S.A., Hewitt A.S., & Lakin, C.K. (2004). Multiperspective analysis of workforce
challenges and their effects on consumer and family quality of life. American Journal on

111
Intellectual and Developmental Disabilities, 109(6), 481-500.
https://doi.org/10.1352/0895-8017(2004)109<481:MAOWCA>2.0.CO;2
LeBlanc, L.A., Taylor, B. A., & Marchese, N. V. (2020). The Training Experiences of Behavior
Analysts: Compassionate Care and Therapeutic Relationships with Caregivers. Behavior
Analysis in Practice,13(2), 387–393. https://doi.org/10.1007/s40617-019-00368-z
Levin, A., & Decker, J. T. (2008). The assessment of staff satisfaction as compared to client
satisfaction in two department of social service residential treatment facilities. Residential
Treatment for Children & Youth, 23(3-4), 61–82.
https://doi.org/10.1080/08865710609512717
Li, J., Lee, T. W., Mitchell, T. R., Hom, P. W., & Griffeth, R. W. (2016). The Effects of
Proximal Withdrawal States on Job Attitudes, Job Searching, Intent to Leave, and
Employee Turnover. Journal of Applied Psychology, 101(10), 1436–1456.
https://doi.org/10.1037/apl0000147
Li-Ping Tang, T., Kim, J. K., & Shin-Hsiung Tang, D. (2000). Does attitude toward money
moderate the relationship between intrinsic job satisfaction and voluntary turnover?
Human Relations (New York), 53(2), 213–245. https://doi.org/10.1177/a010560
Löhndorf, B., & Diamantopoulos, A. (2014). Internal Branding: Social Identity and Social
Exchange Perspectives on Turning Employees into Brand Champions. Journal of Service
Research : JSR, 17(3), 310–325. https://doi.org/10.1177/1094670514522098
Love, H.R. & Beneke, M.R. (2021). Pursuing justice-driven inclusive education research:
Disability critical race theory (DisCrit) in early childhood. Topics in Early Childhood
Special Education, 41(1), 31-44.

112
Luiselli, J.K., Draper, C., & Sperry, J. M. (2017). Brief Report: Assessment of Training and
Supervision Needs Among Registered Behavior Technicians. Child & Family Behavior
Therapy, 39(4), 304–310. https://doi.org/10.1080/07317107.2017.1375710
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.
https://doi.org/10.1037/h0054346
Maxwell, J. A. (2013). Qualitative research design: An interactive approach. (3rd ed.). SAGE
publications.
McConkey, R., Peng, C., Merritt, M., & Shellard, A. (2019). The meaning of social inclusion to
players with and without intellectual disability in unified sports teams. Inclusion, 7(4),
234–243. https://doi.org/10.1352/2326-6988-7.4.234
McCabe, H., Barnes, R. E., & Jiang, T. (2023). Ethical Issues in ABA-based Service Provision
for Autism in Limited-Resource Contexts: A Case Example of the People’s Republic of
China. Behavior Analysis in Practice, 16(1), 40–50. https://doi.org/10.1007/s40617-022-
00692-x
McGee, H. M., & Johnson, D. A. (2015). Performance Motivation as the Behaviorist Views It.
Performance Improvement (International Society for Performance Improvement), 54(4),
15–21. https://doi.org/10.1002/pfi.21472
McNeese-Smith, D. (1996). Increasing employee productivity, job satisfaction, and
organizational commitment. Journal of Healthcare Management, 41(2), 160-.
Maenner, M.J., Warren, Z., Robinson Williams, A., Amoakohene, E., Bakian, A.V., Bilder,
D.A., Durkin, M.S., Fitzgerald, R.T., Furnier, S.M., Hughes, M.M., Ladd-Acosta, C.M.,
McArthur, D., Pas, E.T., Salinas, A., Vehorn, A., Williams, S., Esler, A., Grzybowski, A.,
Hall-Lande, J., … Shaw, K.A. Prevalence and Characteristics of Autism Spectrum Disorder

113
Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring
Network, 11 Sites, United States, (2020). MMWR Surveillance Summaries 2023;72(No. SS2):1–14. http://dx.doi.org/10.15585/mmwr.ss7202a1.
Meir, J. (2022, November 03). Impact of financial value of brands verified. Marketing
Accountability Standards Board. https://themasb.org/impact-of-financial-value-of-brandsverified/
Melton, B., Marchese, N., & Weiss, M. J. (2023). Leading with Compassion: A Discussion and
Steps Forward for Behavior Analysts. International Electronic Journal of Elementary
Education, 15(3), 225–232. https://doi.org/10.26822/iejee.2023.295
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: A guide to design and
implementation. (4th ed.). Jossey-Bass.
Miles, M.B., Huberman, A. M., & Saldaña, J. (2020). Qualitative data analysis : a methods
sourcebook (Fourth edition.). SAGE.
Mitchell, D., & Braddock, D. (1994). Compensation and turnover of direct-care staff in
developmental disabilities residential facilities in the United States. II: Turnover. Mental
Retardation (Washington), 32(1), 34–42.
Molko, R. (2018, November 7). Improving Retention in ABA Services. Forbes.
https://www.forbes.com/sites/forbesbooksauthors/2018/11/07/improving-retention-inaba-services/?sh=57c0d62c73b8
Mor Barak, M.E., Nissly, J. A., & Levin, A. (2001). Antecedents to retention and turnover
among children welfare, social work, and other human service employees: what can we
learn from past research? A review and metanalysis. The Social Service Review
(Chicago),75(4), 625–661. https://doi.org/10.1086/323166

114
Mrstik, S., Pearl, C., Hopkins, R., Vasquez, E., & Marino, M. T. (2019). Combating Special
Educator Attrition: Mentor Teachers’ Perceptions of Job Satisfaction, Resiliency, and
Retention. Australasian Journal of Special and Inclusive Education, 43(1), 27–40.
https://doi.org/10.1017/jsi.2018.20
Mutkins,E., Brown, R. F., & Thorsteinsson, E. B. (2011). Stress, depression, workplace and
social supports and burnout in intellectual disability support staff. Journal of Intellectual
Disability Research, 55(5), 500–510. https://doi.org/10.1111/j.1365-2788.2011.01406.x
Nagro, S. A., & Monnin, K. (2022). Using Simulated Video Analysis to Promote Special
Education Teacher Candidates’ Professional Knowledge and Reflective Ability. Teacher
Education and Special Education, 45(4), 269–285.
https://doi.org/10.1177/08884064211059854
Nario-Redmond, M.R. (2019). Ableism. In Disability in American Life: An Encyclopedia of
Concepts, Policies, and Controversies: Volume 1: A–L (pp. 1–5).
National Association of State Directors of Developmental Disability Services. (2020). 2020
National Core Indicators® – Intellectual and Developmental Disabilities Staff Stability
Survey Report. https://legacy.nationalcoreindicators.org/upload/core-indicators/2020-
21_NCI-IDD_National_At-A-Glance_Report.pdf
Ne’eman, A., & Bascom, J. (2020). Autistic Self Advocacy in the Developmental Disability
Movement. American Journal of Bioethics, 20(4), 25–27.
https://doi.org/10.1080/15265161.2020.1730507
Nemec, P. B., Spagnolo, A. C., & Soydan, A. S. (2017). Can You Hear Me Now? Teaching
Listening Skills. Psychiatric Rehabilitation Journal, 40(4), 415–417.
https://doi.org/10.1037/prj0000287

115
Nevill, R.E., & Havercamp, S. M. (2019). Effects of mindfulness, coping styles and resilience on
job retention and burnout in caregivers supporting aggressive adults with developmental
disabilities. Journal of Intellectual Disability Research, 63(5), 441–453.
https://doi.org/10.1111/jir.12594
Novak, M.N., & Dixon, D.R. (2019). Predictors of burnout, job satisfaction, and turnover in
behavior technicians working with autism spectrum disorder. Journal of Autism and
Developmental Disorders, 6(4), 413–42. https://doi.org/10.1007/s40489-019-00171-0
O'Donnell, R. (2019, June 27). Hospital turnover in 2018: the trend continues. Hospital
Recruiting. https://www.hospitalrecruiting.com/blog/5729/hospital-turnover-in-2018-thetrend-continues/
Ohl, A., Sheff, M. G., Little, S., Nguyen, J., Paskor, K., & Zanjirian, A. (2017). Predictors of
employment status among adults with autism spectrum disorder. Work (Reading, Mass.),
56(2), 345–355. https://doi.org/10.3233/WOR-172492
Ortogero, S. P., Barcarse, T. O., & Ray, A. B. (2022). Developing the Knowledge and Mentoring
Skills of Future Special Education Leaders. Rural Special Education Quarterly, 41(4),
211–226. https://doi.org/10.1177/87568705221092765
Ozyilmaz, A, Erdogan, B., & Karaeminogullari, A. (2018). Trust in organization as a moderator
of the relationship between self‐efficacy and workplace outcomes: A social cognitive
theory‐based examination. Journal of Occupational and Organizational Psychology,
91(1), 181–204. https://doi.org/10.1111/joop.12189
Palumbo, J. (2021, April 27). Why autism speaks is encouraging companies to hire those on the
autistic spectrum. Forbes.

116
https://www.forbes.com/sites/jenniferpalumbo/2021/04/27/why-autism-speaks-isencouraging-companies-to-hire-those-on-the-autistic-spectrum/?sh=1f3034f552a2
Paris, M., & Hoge, M. A. (2010). Burnout in the Mental Health Workforce: A Review. The
Journal of Behavioral Health Services & Research, 37(4), 519–528.
https://doi.org/10.1007/s11414-009-9202-2
Peck, C. A., Donaldson, J., & Pezzoli, M. (1990). Some Benefits Nonhandicapped Adolescents
Perceive for Themselves from Their Social Relationships with Peers who Have Severe
Handicaps. Journal of the Association for Persons with Severe Handicaps, 15(4), 241–
249. https://doi.org/10.1177/154079699001500403
Perales, J. L. (2019). Peer Supported Arrangements: How Does Participation as a Peer Support
Effect Non-Disabled Peers? In ProQuest LLC. ProQuest LLC.
Pintrich, P. R. (2003). A Motivational Science Perspective on the Role of Student Motivation in
Learning and Teaching Contexts. Journal of Educational Psychology, 95(4), 667–686.
https://doi.org/10.1037/0022-0663.95.4.667
Plantiveau, C., Dounavi, K., & Virués-Ortega, J. (2018). High levels of burnout among earlycareer board-certified behavior analysts with low collegial support in the work
environment. European Journal of Behavior Analysis, 19(2), 195–207.
https://doi.org/10.1080/15021149.2018.1438339
Poindexter, K. (2023). Seeking Ikigai: Purpose, Power, and Passion as a Guide to Address
Nursing Workforce Challenges. Nursing Education Perspectives, 44(4), 201–202.
https://doi.org/10.1097/01.NEP.0000000000001166

117
President's Committee for People with Intellectual Disabilities: U.S. Department of Health and
Human Services. (2017). America’s direct support workforce crisis: effects on people
with intellectual disabilities, families, communities and the U.S. economy [Report].
Raji, O. & Hollins, S. (2001). Exclusion from funerary rituals and mourning: implications for
social and individual identity. In J. Hubert (Ed.), Madness, Disability and Social
Exclusion (1st E., pp. 208-216). Routledge. https://doiorg.libproxy2.usc.edu/10.4324/9781315812151
Reed, F. D. D., & Henley, A. J. (2015). A Survey of Staff Training and Performance
Management Practices: the Good, the Bad, and the Ugly. Behavior Analysis in Practice,
8(1), 16–26. https://doi.org/10.1007/s40617-015-0044-5
Resnick, A. (2022, July 21). What is Neurodivergence and What Does it Mean to be
Neurodivergent?. verywellmind. https://www.verywellmind.com/what-isneurodivergence-and-what-does-it-mean-to-be-neurodivergent-5196627
Robertson, I. T., & Sadri, G. (1993). Managerial Self-efficacy and Managerial Performance.
British Journal of Management, 4(1), 37–45. https://doi.org/10.1111/j.1467-
8551.1993.tb00160.x
Robinson, S., Hill, M., Fisher, K. R., & Graham, A. (2020). Belonging and exclusion in the lives
of young people with intellectual disability in small town communities. Journal of
Intellectual Disabilities, 24(1), 50–68. https://doi.org/10.1177/1744629518765830
Robinson, S. B., & Leonard, K. F. (2019). Designing quality survey questions. SAGE
Publications, Inc.

118
Rogers, S.J. & Vismara, L. A. (2008). Evidence-Based Comprehensive Treatments for Early
Autism. Journal of Clinical Child and Adolescent Psychology, 37(1), 8–38.
https://doi.org/10.1080/15374410701817808
Rosales, R., León, I. A., & León-Fuentes, A. L. (2023). Recommendations for Recruitment and
Retention of a Diverse Workforce: A Report from the Field. Behavior Analysis in Practice,
16(1), 346–361. https://doi.org/10.1007/s40617-022-00747-z
Ryan, R. M., & Deci, E. L. (2000). Intrinsic and Extrinsic Motivations: Classic Definitions and
New Directions. Contemporary Educational Psychology, 25(1), 54–67.
https://doi.org/10.1006/ceps.1999.1020
Rycraft, J. R. (1994). The Party Isn’t Over: The Agency Role in the Retention of Public Child
Welfare Caseworkers. Social Work (New York), 39(1), 75–80.
https://doi.org/10.1093/sw/39.1.75
Salkind, N.J., & Frey, B.B. (2019). Statistics for people who (think they) hate statistics (7th ed.).
SAGE Publications, Inc.
Samadi, S. A., Biçak, C. A., Osman, N., & Abdalla, B. (2023). Organizational Challenges in
Healthcare Services Providers for Individuals with Autism Spectrum Disorder (ASD)
Considering Personnel Turnover Rate. Brain Sciences, 13(4), 544–.
https://doi.org/10.3390/brainsci13040544
Sandoval-Norton, A.H., Shkedy, G., & Shkedy, D. (2019). How much compliance is too much
compliance: Is long-term ABA therapy abuse? Cogent Psychology, 6(1).
https://doi.org/10.1080/23311908.2019.1641258

119
Sartore, M., Buisine, S., Ocnarescu, I., & Joly, L. R. (2023). An Integrated CognitiveMotivational Model of Ikigai (Purpose in Life) in the Workplace. Europe’s Journal of
Psychology, 19(4), 387–400. https://doi.org/10.5964/ejop.9943
SB 639. (2021). Maria Elena Durazo Senate. Retrieved from
https://sd24.senate.ca.gov/news/2021-09-27-governor-newsom-signs-senator-durazos-billsb-639-prohibit-paying-workers
Schunk D.H., & Usher, E.L. (2019). Social cognitive theory and motivation. In Ryan, R.M.
(Eds.), The oxford handbook of human motivation (2nd Edition; pp.123-140). Oxford
University Press. https://doi.org/10.1093/oxfordhb/9780190666453.013.2
Scott, M. (Host). (2022, October 7). The battel over autism therapy ABA[Audio podcast
episode]. The Pulse. WHYY. https://whyy.org/episodes/the-batthle-over-autism-therapyaba/
Scott, M., Milbourn, B., Falkmer, M., Black, M., Bӧlte, S., Halladay, A., Lerner, M., Taylor, J.
L., & Girdler, S. (2019). Factors impacting employment for people with autism spectrum
disorder: A scoping review. Autism: the International Journal of Research and Practice,
23(4), 869–901. https://doi.org/10.1177/1362361318787789
Serna-Olander, N. (2022). Reducing Turnover and Improving Retention of Direct Support
Professionals in Intellectual and Developmental Disabilities: A Qualitative Study.
(Publication No. 2022. 29319220) [Doctoral dissertation, Colorado Technical University]
ProQuest Dissertations Publishing.
Simonian, M. J., Brand, D., Mason, M. A., Heinicke, M. R., & Luoma, S. M. (2020). A
Systematic Review of Research Evaluating the Use of Preference Assessment

120
Methodology in the Workplace. Journal of Organizational Behavior Management, 40(3–
4), 284–302. https://doi.org/10.1080/01608061.2020.1819933
Skinner, B.F. (1965). Science and human behavior. Macmillan.
Smith, B. D. (2005). Job retention in child welfare: Effects of perceived organizational support,
supervisor support, and intrinsic job value. Children and Youth Services Review, 27(2),
153–169. https://doi.org/10.1016/j.childyouth.2004.08.013
Smith, K.E. I. (2021). Understanding and Promoting the Human Rights of Autistic People.
Societies Without Borders, 15(1), 1–.
Sone, O., Nakaya, N., Ohmori, K., Shimazu, T., Higashiguchi, M., Kakizaki, M., Kikuchi, N.,
Kuriyama, S., & Tsuji, I. (2008). Sense of life worth living (Ikigai) and mortality in Japan:
Ohsaki study. Psychosomatic Medicine, 70(6), 709–715.
https://doi.org/10.1097/PSY.0b013e31817e7e64
Stafford, L. (2017). “What about my voice”: Emancipating the voices of children with
disabilities through participant-centered methods. Children’s Geographies, 15(5), 600–613.
https://doi.org/10.1080/14733285.2017.1295134
Stajkovic, A. D., & Luthans, F. (1998). Self-Efficacy and Work-Related Performance: A MetaAnalysis. Psychological Bulletin, 124(2), 240–261. https://doi.org/10.1037/0033-
2909.124.2.240
Sulek,R., Trembath, D., Paynter, J., Keen, D., & Simpson, K. (2017). Inconsistent staffing and
its impact on service delivery in ASD early-intervention. Research in Developmental
Disabilities, 63, 18–27. https://doi.org/10.1016/j.ridd.2017.02.007
Sulzer-Azaroff, B., & Mayer, G. R. (1991). Behavior analysis for lasting change. Holt, Rinehart,
and Winston.

121
Tanno, K., Sakata, K., Ohsawa, M., Onoda, T., Itai, K., Yaegashi, Y., & Tamakoshi, A. (2009).
Associations of ikigai as a positive psychological factor with all-cause mortality and causespecific mortality among middle-aged and elderly Japanese people: Findings from the Japan
Collaborative Cohort Study. Journal of Psychosomatic Research, 67(1), 67–75.
https://doi.org/10.1016/j.jpsychores.2008.10.018
Taylor, J. L., Henninger, N. A., & Mailick, M. R. (2015). Longitudinal patterns of employment
and postsecondary education for adults with autism and average-range IQ. Autism : the
International Journal of Research and Practice, 19(7), 785–793.
https://doi.org/10.1177/1362361315585643
Taylor, B.A., LeBlanc, L. A., & Nosik, M. R. (2019). Compassionate Care in Behavior Analytic
Treatment: Can Outcomes be Enhanced by Attending to Relationships with Caregivers?
Behavior Analysis in Practice,12(3), 654–666. https://doi.org/10.1007/s40617-018-00289-3
Taylor, J.L., & Seltzer, M. M. (2011). Employment and Post-Secondary Educational Activities
for Young Adults with Autism Spectrum Disorders During the Transition to Adulthood.
Journal of Autism and Developmental Disorders, 41(5), 566–574.
https://doi.org/10.1007/s10803-010-1070-3
Thornton, C.R.. (2018). Direct Support Staff Retention and Turnover in the Field of Applied
Behavior Analysis: A National Survey. (Publication No. 13419944) [Master’s Thesis]
ProQuest Dissertations Publishing.
Travers, H. E., & Carter, E. W. (2022a). A Systematic Review of How Peer-Mediated
Interventions Impact Students Without Disabilities. Remedial and Special Education, 43(1),
40-57. https://doi-org.libproxy2.usc.edu/10.1177/0741932521989414

122
Travers, H. E., & Carter, E. W. (2022b). How Do Peers Benefit From Peer-Mediated
Interventions? Examining Impact Within Secondary and Postsecondary Programs. Research
and Practice for Persons with Severe Disabilities, 47(2), 72–89.
https://doi.org/10.1177/15407969221093380
U.S. Bureau of Labor Statistics. (2021). Persons with a disability: Labor force characteristics
summary. https://www.bls.gov/news.release/disabl.nr0.htm
Valenti, M., Malfa, G.L., Tomassini, A.R., Masedu, F., Tiberti, S., & Germana Sorge. (2013).
Burnout among therapists working with persons with autism after the 2009 earthquake in
L’Aquila, Italy: a longitudinal comparative study: Burnout in autism therapists after an
earthquake. Journal of Psychiatric and Mental Health Nursing, 21, 234–240.
https://doi.org/10.1111/jpm.12054
Valentino, A.L., (2022). Supervision and mentoring. In Luiselli, J. K., Gardner, R. M., Bird, F.
L., & Maguire, H. (Eds.). Organizational behavior management approaches for
intellectual and developmental disabilities. (2nd Edition; pp.141-164). Routledge.
https://doi.org/10.4324/9780429324840
Villanueva Jasa, S.J. (2021). Factors Affecting Registered Behavior Technicians’ (RBTs’) Intent
to Stay or Leave: A Delphi Study. (Publication No. 2021.28716629) [Doctoral dissertation,
University of Nevada, Las Vegas] ProQuest Dissertations Publishing.
Waltz, van den Bosch, K., Ebben, H., van Hal, L., & Schippers, A. (2015). Autism self-advocacy
in the Netherlands: past, present and future. Disability & Society, 30(8), 1174–1191.
https://doi.org/10.1080/09687599.2015.1090954
Wheelan, C. (2019). Naked economics: Undressing the dismal science; 3rd Edition. New York,
NY: W.W. Norton & Company.

123
Wiegand, D. M., & Geller, E. S. (2005). Connecting Positive Psychology and Organizational
Behavior Management: Achievement Motivation and the Power of Positive
Reinforcement. Journal of Organizational Behavior Management, 24(1–2), 3–25.
https://doi.org/10.1300/J075v24n01_02
Wilder, D. A., Therrien, K., & Wine, B. (2006). A comparison between survey and verbal choice
methods of identifying potential reinforcers among employees. Journal of Organizational
Behavior Management, 25(4), 1–13. https://doi:10.1300/J075v25n04_01
Wilkes, J., Garip, G., Kotera, Y., & Fido, D. (2023). Can Ikigai Predict Anxiety, Depression, and
Well-being? International Journal of Mental Health and Addiction, 21(5), 2941–2953.
https://doi.org/10.1007/s11469-022-00764-7
Wine, B. & Doan, T. (2022). Supervision and mentoring. In Luiselli, J. K., Gardner, R. M., Bird,
F. L., & Maguire, H. (Eds.). Organizational behavior management approaches for
intellectual and developmental disabilities. (2nd Edition; pp.141-164). Routledge.
https://doi.org/10.4324/9780429324840
Wine, B., Osborne, M. R., & Newcomb, E. T. (2020). On Turnover in Human Services.
Behavior Analysis in Practice, 13(2), 492–501. https://doi.org/10.1007/s40617-019-
00399-6
Yadav, L. K., Kumar, A., & Mishra, S. (2020). Can Organizations Leverage Employer Branding
to Gain Employee Engagement and Reduce Turnover Intention? An Empirical Study
with Organizational Trust as a Mediator. Vision (New Delhi, India), 24(4), 496–505.
https://doi.org/10.1177/0972262920943774

124
Yamamoto-Mitani, N., & Wallhagen, M. I. (2002). Pursuit of psychological well-being (ikigai)
and the evolution of self-understanding in the context of caregiving in Japan. Culture,
Medicine and Psychiatry, 26(4), 399–417. https://doi.org/10.1023/A:1021747419204
Zheng, X., & Liu, X. (2017). The buffering effect of mindfulness on abusive supervision and
creative performance: A social cognitive framework. Frontiers in Psychology, 8, 1588–
1588. https://doi.org/10.3389/fpsyg.2017.01588
Zijlmans, L. J. M., Embregts, P. J. C. M., Gerits, L., Bosman, A. M. T., & Derksen, J. J. L.
(2015). The effectiveness of staff training focused on increasing emotional intelligence
and improving interaction between support staff and clients. Journal of Intellectual
Disability Research, 59(7), 599–612. https://doi.org/10.1111/jir.12164
Zippia. (2023). Behavioral Technician demographics and statistics in the US.
Zippia.https://www.zippia.com/behavioral-technician-jobs/demographics/
Zuber, W. J., & Webber, C. (2019). Self-advocacy and self-determination of autistic students: a
review of the literature. Advances in Autism, 5(2), 107–116. https://doi.org/10.1108/AIA-02-
2018-0005

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Appendix A: Survey Protocol
Introduction to the survey:
Email Qualtrics survey link to all ABA organization employees with the following message:
Hello everyone,
My name is Mayu Fujiwara Tsuchikawa and I am a doctoral candidate at the University
of Southern California. I am also a regional clinical manager for the WLA center at STAR of
CA/The Stepping Stones Group.
I am asking for your participation in my research study exploring keys to behavior
technician retention. Please complete the 5-minute survey through the link below by
DATE/TIME. Thank you in advance for your participation!
ADD LINK TO SURVEY
The Survey will have the following questions:
Question Response options Decision logic
1. Are you in a behavior
technician role at the agency?
Yes
No
If yes: move on to question 2.
If no: Thank you for participating in this
survey. You do not qualify for this
research study.
2.Do you have more than 12
months of experience as a
behavior technician.
Yes
No
If yes: move on to question 3.
If no: Thank you for participating in this
survey. You do not qualify for this
research study.
3. How many years have you
been a behavior technician at the
organization?
a-1-2 years
b-3-4 years
c-4-5 years
d-6 years or more
Move on to question 4
4. Are you willing to participate
in a 30–45-minute interview to
share your experience?
Yes
Maybe
No
If yes or maybe: move on to question 5.
If no: Thank you for participating in this
survey.

126
**Attach information sheet (see
Appendix C)
5.Please provide me with the best
email address to contact you.
Fill in option Thank you for participating in this
survey. I will be in contact with you
within 48hrs.

127
Appendix B: Interview Protocol
Introduction to the Interview:
Thank you for taking the time today to meet with me for this interview. As I indicated in
the email, the interview should take no more than 30-45 minutes of your time, but I want to make
sure that we have enough time for you to share all that you want to share. This still works for
you?
Today I come to you, not in my usual role as a behaviorist, but as a graduate student at USC
conducting a research study on BT retention. Specifically, I want to know more about the effects
of BT retention on advocacy skills for autistic individuals. I am interviewing BTs, like yourself,
that have been in the field for more than a year to seek insight on this topic.
Please know that the purpose of the interview is solely to seek input based on your lived
experience in your role as BT, not evaluative in any way and there are no right or wrong
answers. The information shared with me during the interview will be confidential and will not
be shared with any other person. All the documents will be stored on a password-protected
computer that no one else has access to. I would be happy to share my findings with you after
finalizing my studies if you are interested. If at any point you want to end the interview, please
let me know and we will end the interview process immediately. Ending the interview will not
reflect negatively of you in any way. My goal is to have an open dialogue through a series of
questions that I will ask.
With that said, I would like to get your permission to record the interview today to ensure
I am hearing all of what you will be sharing with me accurately. This is the only part I will be a
behavior analyst and say that memory is not as good as immediate data. May I have your
permission to record our conversation?

128
Do you have any questions about anything before we get started?
Interview Questions
Interview questions Potential probes RQ
addressed
Key concept
addressed
1.What was your previous
work experience prior to
ABC organization?
1. What was that experience
like for you?
2. What made you come to
ABC organization instead?
N/A Ice Breaker
2. Can you describe what
your typical day at work
looks like?
1. How might the day look
different depending on the
environment you are
working in?
2. How do you feel about
your day-to-day duties?
3. How does it compare to
what you thought your job
as a BT was going to be
like?
RQ 1, 2 Personal – selfefficacy
Behavior –
coping skills
3.How confident do you feel
about supporting clients in
the (school, home,
community) setting?
1. What factors influence
how you feel?
2. What are some skills you
feel are important in
supporting your clients?
3. What are your areas of
strength as a BT?
RQ 1, 2 Personal – selfefficacy
Behavior –
coping skills
4. How might supervisor
support play a role in how
confident you feel?
1. Can you give me some
examples of the support the
supervisor provided you?
2. If you did not feel
supported, what would have
helped you?
RQ 3 Environment –
supervisor
support
5. What does your support
systems look like at the
organization?
1. Is there a particular
person you would reach out
to at work?
2. How did you establish the
support system?
3. If you do not have a
support system at the
organization, what supports
would have helped you as
you started at the
organization?
RQ 1, 2, 3 Personal – selfefficacy
Behavior –
coping skills
Environment –
supervisor
support

129
6. What coping strategies, if
any, do you use to manage
challenging or unexpected
situations at work?
1. What coping strategies do
you use to manage stress?
RQ 2 Behavior –
coping skills
7. How, if at all, do you
reach out to your supervisor
for support?
1. What are some reasons
you may reach out to your
supervisor?
RQ 3 Environment –
supervisor
support
8. How would you describe
your relationship with your
supervisor?
1. What support does your
supervisor provide you?
2. How do you feel about the
supervisor’s support?
RQ 3 Environment –
supervisor
support
9.What is some advice
related to stress management,
if any, you would give to a
new BT just going through
new hire training?
1. What part of the BT job
do you enjoy?
RQ 2 Behavior –
coping
10.What gets you out of bed
in the morning to go to work
every day?
1. How do you get over the
rough days?
2. What is the most
rewarding part of work?
RQ 1, 2 Personal – self -
efficacy
Behavior –
coping skills
11. How confident are you
with your knowledge about
self-advocacy for autistic
individuals?
1. What does self-advocacy
mean to you?
2. How confident are you in
your client’s ability to selfadvocate?
2.What role do you play in
your client’s ability to selfadvocate?
RQ 1 Personal – selfefficacy
12.How confident are you in
your client’s ability to
communicate?
1. What role do you play in
your client’s ability to
communicate?
2. What role does the
supervisor play in the
client’s ability to
communicate?
RQ 1 Personal – selfefficacy
13. Can you provide
examples of what may help
the new BTs stay in the field
as long as you have?
1. How did you acquire
_____ (base on example
provided)?
RQ 1, 3 Personal – selfefficacy
Environment –
supervisor
support
14. How did this interview
experience feel for you?
N/A Closing question

130
Conclusion to the Interview:
Thank you again for taking the time to share your lived experience with me today. Your
willingness to engage in this open dialogue has helped so much towards my research study. I
appreciate and value your input. Would it be okay if I contact you via email if I have follow up
questions I think of at a later time? It will be within a month or so from today if I need to contact
you at all. As a token of appreciation, I am going to send you an e-gift card for Amazon. Please
give me the email address you want the gift card sent to. Thank you. I appreciate you!

131
Appendix C: Information Sheet for Research Participants
University of Southern California Research Information Sheet
My name is Mayu Fujiwara Tsuchikawa, and I am a doctoral candidate at the University of
Southern California. I also hold the role of the Regional Clinical Manager of the WLA Center at
STAR of CA/Stepping Stones Group. I am seeking your participation in this study. Please read
through this form and ask any questions you might have before deciding whether you want to
participate. Your participation is completely voluntary, and I will address your questions or
concerns at any point before or during the study.
PURPOSE OF THE STUDY
This research study intends to explore lived experiences of the behavior technicians to find keys
to retention. The name of this research study is “Attending to the Lived Experiences of the
Behavior Technicians to Discover the Keys to Retention: An Exploratory Study.”
PARTICIPANT INVOLVEMENT
You may be eligible to participate in this study if you meet the following criteria:
1. You have been with the organization for 12 months or more.
2. Your current role at the organization is behavior technician.
If you decide to participate in this study, you will be asked to do the following activities:
1. Participate in a 1:1 online interview via Zoom or in person at the WLA Center or office
for 30-45 minutes. You do not have to answer any questions you do not want to.
2. Be available for follow up questions via email as necessary.
Within an hour after you complete the interview, you will receive a $40 electronic gift card for
Amazon via email provided to the researcher.
CONFIDENTIALITY
I will publish the results in my doctoral dissertation. Any identifiable information obtained in
connection with this study will remain confidential. Participants may be identified by their
pseudonym in the results. I will take reasonable measures to protect the security of all your
personal information. Direct identifiers will be destroyed after data collection, and all data will
be de-identified prior to any publication or presentations. I may share your data, de-identified
with other researchers in the future.
INVESTIGATOR CONTACT INFORMATION
If you have any questions or concerns about the research, please feel free to contact Mayu
Fujiwara Tsuchikawa at mayufuji@usc.edu or 818-577-0245.
IRB CONTACT INFORMATION
If you have any questions about your rights as a research participant, please contact the
University of Southern California Institutional Review Board at (323) 442-0114 or email
irb@usc.edu.

132

133
Appendix D: Immediate Evaluation Instrument – Sample Program Evaluation
The course held my attention and aided me in learning the topics. (Engagement)
1 2 3 4
The trainer held my attention during training. (Engagement)
1 2 3 4
The course enhanced my knowledge of autism, ABA methodologies. (Declarative knowledge)
1 2 3 4
The knowledge gained from the course enhanced my ability to apply the skills in the field.
(Procedural)
1 2 3 4
What I learned will help me support individuals with autism better.
(Relevance)
1 2 3 4
I recommend this training to my colleagues entering the field as a BT. (Customer Satisfaction)
1 2 3 4
4-point Likert scale rating
1= Strongly Disagree
2= Disagree
3= Agree
4= Strongly Agree

134
Appendix E: Immediate Evaluation Instrument – Sample Observer Checklist
Participant name:
Training Date/topic:
Rating Comments
Overall level of engagement
(Engagement)
Level of participation during role play
(Engagement, Procedural, Relevance)
Comprehension of topic (Declarative
Knowledge)
Openness to feedback (Attitude)
On topic question asking
(Engagement, Procedural)
4-point Likert scale rating
1= Strongly Disagree
2= Disagree
3= Agree
4= Strongly Agree

135
Appendix F: Delayed Evaluation Instrument – Sample Program Evaluation
I am confident in my ability to support autistic individuals. (Confidence)
1 2 3 4
I am confident in my ability to seek help when needed from my supervisor.
(Confidence)
1 2 3 4
I understand what is expected of me as a Behavior Technician. (Declarative Knowledge)
1 2 3 4
I plan to apply what I have learned when I support individuals with autism in the field.
(Commitment)
1 2 3 4
I believe my support as a Behavior Technician is valuable in supporting autistic individuals.
(Attitude)
1 2 3 4
Knowledge I gained during training has helped me perform my job as a BT.
(Procedural)
1 2 3 4
I can effectively utilize coping skills to manage stress associated with my job. (Confidence)
1 2 3 4
4-point Likert scale rating
1= Strongly Disagree
2= Disagree
3= Agree
4= Strongly Agree

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Asset Metadata

Creator Fujiwara Tsuchikawa, Mayu (author)

Core Title Attending to the lived experiences of behavior technicians to discover the keys to retention: an exploratory study

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2024-05

Publication Date 04/30/2024

Defense Date 04/03/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag autistic individuals,behavior technicians,motivation,OAI-PMH Harvest,qualitative study,retention,social cognitive theory,turnover

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Muraszewski, Alison (committee chair), Canny, Eric (committee member), Haskins, Theresa (committee member), Tobey, Patricia (committee member)

Creator Email mayufuji@usc.edu,mft0720@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113911907

Unique identifier UC113911907

Identifier etd-FujiwaraTs-12872.pdf (filename)

Legacy Identifier etd-FujiwaraTs-12872

Document Type Dissertation

Format theses (aat)

Rights Fujiwara Tsuchikawa, Mayu

Internet Media Type application/pdf

Type texts

Source 20240503-usctheses-batch-1146 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu