clinical supervisor

behavior technician

paraprofessional

autism support professional

entry level behavior technician

Center For Autism and Related Disorders

I will start by disclosing that I was recently terminated while on medical leave for cancer testing. The company states they accepted my resignation even though I didn't resign.

I started working for CARD in Oregon about 11 months ago. I was really excited for the opportunity. As a mom with an autistic child I thought I would be making a difference...this was not the case. 

My first week was supposed to be training with the operations manager trainer. The person assigned to me was quitting and spent the majority of the week doing interviews and other things. I was given manuals to read but really had no training whatsoever. The person assigned to give me ongoing support never reached out or responded to requests for help so I had to wing it for several months.

I did a good enough job because I took our clinic from the bottom of the region to the top. This however wasn't good enough. My staff was super hostile to having an outside manager come in and did everything to make me miserable. My assistant and another therapist tagged teamed on doing everything to sabotage the good that was happening. 

Some of the specific problems that Oregon faces are:

1. Too much growth. The corporate office can't support the clinics that are already in place but they are hyperfocused on opening more. They won't listen to the employees who beg them to slow down and support what already exists.

2. Operations and admin are treated poorly. The focus is only on the clinical staff. Although we are managers by name, we are not managers by function. We are more like puppets for our regional manager to add hours. The only thing they care about is billable hours. The staff are supposed to have holidays off but we are pushed to stay open so they can bill at a premium rate. They get mad if the therapists actually want their holidays off. You get between ten and fifteen emails per day asking how many hours have been added. It's draining. Clinical supervisors, who are technically below managers, make $20,000 more per year. They get incentives such as PlayStations and big screen TVs, regional getaways and apple watches while admin gets a fruit basket and a $50 gift card. There is such a huge gap between the way clinical and admin are looked at by the corporate office.  The only reason that they call us operations managers is so they can claim exempt status and pay us a salary without overtime as we put in 60-70 hours/week. But...if you miss a day they will dock the pay.

3. Shortage of BCBAs. They will literally higher anyone. I was actually told that as long as the BCBA wasn't that bad then we really wanted to keep them happy. Let me remind you that they are creating programming for autistic kids.

4. Poor regional and corporate managers. Aside from one person, there is no support in Oregon. You will be ignored. You will not be helped. Of course, if you make a mistake then you will hear from them very quickly. But when you ask for help you get empty promises.

5. Structural damage to buildings and an unsafe work environment. Our clinic had metal grates falling from the ceiling. Our fire system was disabled the entire time I was there even though I tried to get it fixed. 

CARD says they have a discretionary bonus structure. When I was hired, this was not disclosed correctly. I was told that quarterly bonuses were part of my salary. They don't mention that the requirements to meet bonuses are only met by a handful of clinics and it's three quarters later that you would actually see the bonus if you are lucky enough to get one. They do this because the turnover is so high and if you are no longer working there then they don't have to pay you.

My turning point came in November. We were notified with very little notice that they were taking away Kaiser Permanente for insurance and only offering United healthcare. Prior to 2018 there were options at least. I was paying about. $600/month for premiums and as of 2019 that would jump to almost 40%of each paycheck. I have lupus and need continuity of care and was starting to have some other symptoms.

Our region was restructured as well and we had a horrible new manager come in who made things so much worse. I sent a detailed letter to the director of operations regarding the stress and decline of Oregon clinics. She didn't acknowledge or respond to it which wasn't entirely unexpected. They simply don't care. I went out on medical leave for only three weeks and was terminated while away. I had to have testing for breast cancer and blood cancer so it wasn't like I just had a cold. 

Bottom line...stay away. Even if you think it will be different for you, it won't be. I'd rather flip burgers or drive Uber than go through the stress and toxicity that this company creates. It's simply not worth it. You aren't helping autistic kiddos...you are helping the CEO and the executive team line their pocketbooks with money by adding hours. Take what I say with a grain of salt but so your research. I was one of the top performers in the region so I can only imagine what it is like for those who aren't.

Stay away from CARD as if your physical and mental health depend on it.... because it does.

If you're new to the industry and don't mind doing grunt work to gain valuable experience, this is a great place to work. If you want to have a career and find advancement within the organization, you might as well commit career suicide.

CARD will provide you with opportunities for free graduate degrees, and certifications. If you do not want to participate in these programs, you have no advancement alternatives. There are positions to advance to without these degrees and certifications, but good luck getting them and they are going to stop training people for them. 

At CARD, I encountered problems with every aspect of dealing with management and administration. 
If you want benefits, you have to follow difficult to achieve requirements in order to obtain them. Even if you have met the requirements and should be offered the benefits, they will wait until you hound them about it, because they don't really want to give you anything. They will also screw up your hours so you won't make the requirements without spending and exorbitant amount of time(think months and years, not hours) working for the company before they give in and give them to you. The average time it takes to obtain health benefits is about one year of service if you open all of your availability and work every opportunity you get. They say you can acquire these benefits by achieving 30 hours per week for three months straight. You do the math. 
You will not get leave benefits unless you are promoted to a senior therapist position or higher, which they have recently stopped training people for. 
If you want to be able to pay your bills, you have to open all of your availability in order to get sessions schedule, and you are expected to be on call at all times you are considered available even if you don't normally have a session. You will NOT be able to take a second job, it just isn't possible with the amount of time they ask of you to work for CARD. Additionally, you will likely end up working close to double the amount of hours you will actually be compensated for. 
You will have to work directly with a scheduler for everything, especially since your schedule is electronic and is frequently incorrect or missing key information required to attend sessions and receive correct compensation. Some of these schedulers will treat you like the dirt beneath their feet. Personally, I have had to even fight to take time off for being seriously ill. If your scheduler has had a bad day, good luck, you may find yourself dealing with a very nasty individual who appears to care very little about your well-being or even bothering to be polite.

There are a few quality things at CARD. Your coworkers are awesome! Everyone below management understands really well that you need to support each other. The time you spend with your team mates is key to your success. The children you will support are 100% worth your time and effort. These families work hard to stay on the same goal that you are, which is support their child in need. Again, you can receive benefits, there are ways to make up for lost time so you can try to meet your hourly goals and qualify for benefits.  This location in particular is run by a Clinical Director that really does care about the children as much as the dollar signs they represent. 

Overall, if you're young and fresh and looking for a good place to start, this place really is a great place to earn experience and learn about the industry first hand. If you are experienced and not looking to become a BCBA, don't even bother, you will be earning entry level compensation and you will not find any real opportunity to advance.

Positions and Growth
I started at CARD as an intern and held several roles during my 5 years there. I was the Corporate Admin Technician (position removed during COVID), Senior Behavior Technician (Trainer), Assaultive Behavior Manager Trainer, and Lead Behavior Technician for my office. I enjoyed each position and found several opportunities for growth while working there. I really enjoyed training new hires and providing overlaps to the BTs to help them feel supported. This also allowed me to work with more clients and build rapport. This is a challenging job and requires someone who cares and will put in the work. It is so rewarding but can be overwhelming.

Initial Training
When I started working at CARD, my initial training was longer and meetings/support were more readily available. Over time, however, training new hires became more concise but felt rushed. Training schedules were often changed without notifying the  trainers, making them feel unprepared and overwhelmed. For several months, trainer meetings were not available, leading to confusion among trainers. Luckily, trainer meetings eventually returned.

Supervision and Support
A few years into my time at CARD, we stopped having monthly team meetings for clients; these beneficial meetings allowed team members to discuss programming with supervisors and client families. Lack of these meetings contributed to misinformation and confusion. Supervisors were often available via iMessage on our iPads; however, some wouldn’t reply, despite reminders.  When I started at CARD, monthly mentor meetings were scheduled; however, these were removed after some time, making it more difficult to access support. Supervisors changed often, leading to sudden and frequent changes in programs and behavior plans. 

Scheduling 
BTs were often scheduled to work several shifts per day (as expected), some with their first starting at 8am and their last ending at 7pm with short breaks in between and schedules/sessions are different most days. It can be difficult to maintain this schedule. Most hours available in the afternoon. Scheduling was one of the biggest issues that I observed while working at CARD. Sometimes we were not notified of scheduling changes. We had a “Permanent Schedule” and our iPad app. We would be told to follow the permanent one day and the iPad another day. If the schedules varied, parents and BTs often became confused. 

Clients
During the first few years of my employment, teams members remained mostly the same for consistency purposes; however, later on, team members moved around a few times per year. While I understand the importance of generalization, it takes time to build rapport and sometimes things would switch when you finally established rapport which led to frustration for the clients and BTs. Sometimes we would have to stay on a case despite voicing that we didn’t feel confident or comfortable staying on a case. However, I genuinely loved working with each kiddo and seeing their progress each day.

Culture
CARD is a diverse workplace. My office had holiday parties and staff meetings involving training and staff building exercises. Most BTs were approachable and available to help. 

Management
My office had 5 different managers during my 5 years there. Each change led to confusion and changes. My last 3 managers in particular were supportive and approachable and cared about my career growth. 

Hours and pay:
Sessions are spread out, so an 8-hour paid day might mean an 8-1 client, a 2-4 client, then a 5-6. You're not guaranteed those hours if your client calls off, but reroutes are possible, but still not your guaranteed hours. Your pay is low and is not based on client difficulty; so you can still get paid the base pay of minimum wage if working with a highly aggressive client who will rip your clothes, smear feces on the wall, and bite you. Raises are given during your annual evaluation, when getting your RBT or BCAT, attaining a certain position, but these things don't even amount to the difficulty of this job. You get paid for drive time, but not always when you don't have a session afterwards; meaning you could drive 30+ minutes to a house and not get paid for that drive time if there's no session before or after. You get injured at work? Cool, you're taken care of. Injured outside of work? That sucks, you don't get medical insurance, dental care, or anything unless you have a full time position. Also, you only get a few days off in a year unless you're higher in the tier. 

Support, positions and promotions:
There is a lack of support from Operations Managers when there's nothing to do about the problem at hand. A lot of your good doings will be ignored and not praised if you're not the most outstanding individual in the office (heads up for favoritism: its not about skill or what you have, it's about if you're liked by management). Mostly, an email is sent out and a mentor meeting is set up, but the problem isn't solved. Promotions aren't guaranteed and moving up gets difficult unless you relocate to a different office from a different city that has available positions opening up. You're basically stuck where you're at even if you have your RBT or BCAT or other credentials. More critiques are given than praise, so it's constantly a put down for trying to do your best. Your problems have a hierarchy, so if it can't get solved at the bottom immediate tier, it doesn't even get sent up higher, and if it does, nothing gets done about it. If you eventually become a trainer, you still don't get the benefits you need of medical assistance unless you get hurt at work. You get barely an additional amount of vacation days, and a tiny bit of a raise. 

Co-workers:
This is what makes it or breaks it. For my office personally, gossip was flying everywhere, insults, drama, pettiness, and cliques. Social outings are done, but it doesn't help the office drama go away. No one listens to the "don't talk about things outside of work" policy, so gossip flies around like no one's business. Policy also states to not tell people what to do (if you're not a supervisor or assistant sup.) but that happens anyway, and if you don't listen to what they want you to do (their way), you get bad mouthed. 

Clinic work environment (surroundings):
Always messy, no one listens to the "clean up after your session" and "include it as a lesson" so a few of the same people get stuck cleaning the office over and over all the time. Everything breaks (toys, stimuli, etc.) and when things do, you either get it back again or dont at all. Super stressful to look at if this is what you're walking into every day, unless its a home session. 

Overall, I've worked here for 3 years now and the company has taken a huge turn within the last year. I've gotten my share of raises, but its not worth what you go through emotionally every day from your coworkers, management, and efforts.

I attempted for 7 years to work for CARD, applying at every opportunity but due to zoning requirements I was never hired. 
Then the magic happened, my first office was amazing and I have nothing negative to say. But upon transitioning to my second office I was met with a hostile "clique" like culture that took nearly 6 months to penetrate. 
Forward to my most recent office. The Startups portion of this company is aptly nick-named the "Wild West" as pretty much anything goes. The experience you gain from this portion of the company is unmatched by far, but it was still stressful not understanding the full capacity of my position and unclear expectations. 
The day came where my office transitioned to operations and everything changed. I had worked in an Ops office before and knew the standards, however the Regional and Corporate management team were horrendous. I was placed in dangerous offices, one which resulted in frequent calls to local police over transients following me, sleeping in hallways, stepping on needles etc. The next we faced a gas leak, no access to internet or phones for months which resulted in me using personal equipment that I was never reimbursed for but instead reprimanded for doing so. After a conservation with management regarding the legally required licensing I was placed in an inappropriate ethical compromise that I reported to HR. Immediately following this report to HR, alongside my requests for additional support to catch up from the 2 month lack of systems, and a team that was incorrectly trained, incorrect pay adjustments that I did not approve, and a medical leave for a life threatening condition that was physician verified, management began their retaliation. I was forced to resign after being told "If they don't ask, I won't tell," that I did not need the support I was requesting, being reprimanded for staff resigning due to hours I could not schedule because I was not permitted to make alternative arrangements for training despite the options available, and being inappropriately suspend for 1 week with NO communications from HR during that week for updates on the "pending investigation" (for refusing to provide management access to my personal cell phone/cell phone password to "prove" I did not record a meeting; which I did not do what I was accused of). The values of this company have changed dramatically over the past year. During my first year I planned to remain with CARD through my PhD, but I could not continue to work for a company thay encouraged the bullying of clients to fulfill our contracts (which on occasion are inappropriately requested), that reprimand sick employees, would force employees to engage in costly activities such as retreats and center events when the money was better served directly addressing client needs, and would retaliate against those who made HR reports. 

Be wary before beginning a career here. There are some offices that are wonderful and successful with an excellent management team and supports in place. My entire region did not have those; and I personally opened 3 offices in my region.

As a standard of practice, CARD really does do their best to benefit kids with autism and I saw some amazing growth in the kids, and their families while I was there. My initial training as a BT consisted of a trainer that had a hard time communicating and actually connecting with us, and my training ended by being extremely intimated by the other team members of the office. Each individual kid is given a “team” of therapist/technicians to work with them, and when you’re “brand new” you’re looked at like an enemy and like you don’t belong. 

Along with this, when I was hired I was told I’d have 30 hours a week, and was actually given 12-14 due to licenses that was never divulged to me. I was then scheduled entirely without my permission for sessions with kids I’d never worked with, or at times I had scheduled myself for other things because I was not previously given a work schedule. When this type of stuff is brought up, management just seemed to get irrited and would treat you like you’re hurting the kid by not being there. (Mind you, management gets bonuses if ALL their houses are scheduled appropriately, even if they should schedule you without your permission - I later found out this was against policy but was happening all over my region)

Fast forward to a few months later, I joined the administrative side of things. My trainer was rude, and spent about 30% of my training actually training me and spent the rest complaining about her life, or talking poorly about the technicians I had just worked with. Fast forward to my first dat as an administrative employee, at a new office, my supervisor had only been a manager for a couple months, had no idea how to train or support me and instead of discussing this with me, she discussed it with the office trainer within ear shot of me. She would just expect me to know things, and when I would ask a question or ask for support she would take the task or project away from me and do it herself. 

When I brought this up to the supervisor for the area, that same awful trainer (who only spent about 30% of her time with me), was sent to “support us” and concluded with telling me that I make myself seem important and I was not worth as much as I thought. She then gave me “busy work” in the form of a schedule and told me that I should be “happy now.”

CARD tries to make themselves seem like a supportive company, but behind the scenes employees aren’t treated well, managers are thrown in without really knowing what they’re doing or having support and each office is so different (not always for the better). 

My final leg with CARD brought me a different area of the company (not a specific office - so “higher up”) where I was guilt tripped into staying far longer than I should have and I barley made enough money to pay for gas, and food, none the less bills and life. 

If you do not need to financially support yourself off of a job (like you’re in school), CARD may be worth your time. But trying to balance my life, actually surviving and working did not go over well with this company.

This company at onset looks tobhave a lot of companies and policies that lack in the abs field. But as you progress past your first month you WILL have conflicting informations as there are CONSTANT protocol changes. You will have you therapis liaisons, supervisor assistants. Bcaba, BBC's, clinical lead manager, regional manager (for your region) all telling you different things and conflicting informations. Not only this but the therapist liaisons. Supervisor assistants, and bcabas and BBC's each have their own before mentioned mentors (calms and rlms). Yes to many people telling you what needs to be done who aren't on the ground. Will stress ethical but when you try to questions and defend your license they will try to rationalize unethical behavior. Their money and name on most autism and abs therapy related walks and conference will have you fooled. If you have heard this is a bottom of the barrel position please believe it. I heard the same thing and steered clear but gave it a try. Worst decision. Case in point as a clinical supervisor designee, the clinic was bear and had been run by an assistant case manager by herself and a new office manager by themselves. No resources were given and the clinic started off bear. You will in heritage cases not only cases (normal) but cases of kids who have has 3 or 7 diff supervisors in the past 1-2 years. Card is able to get this done by having bcbas from other states zoom in on iPad to supervise a kid in a clinis they have never been, never seen, and haven't or minimally have met the kid or read the plan. You have training but the honest truth is they train you for CARD and CARD only curriculum. I was not impressed over this highly talked about and talked up curriculum not because it's content but because all it the criteria you had to meet as a supervisor. Let's not talk about the zoom calls at least 3 -5bhours for the first 6 months of just training while being expected to be graded on how you turn around programs that were previously touched by 6 to 7 other people. They will sit on you parent meetings, staff meetings, clinics, etc just to provide feedback to meet their goals. Training of staff and hiring? Smh. I came in to some questions ok nanle hire that with further investigation most were hired via GROUP one time interviews. Most didn't know they had or knew what a RLT (LOUISIANA state license was) or were aware they had a code of ethis as a RBT/BCAT. Of course, not their fault so as to take time and truly teach and work on these core principles you have no time and will be asked to prioritize more clients but slowly trained staff, horrible scheduling, zoom calls from several other supervisors to your cases due to waiting on credentialing department(who may or may not change your client programming or give conflicting statements to you clinic staff), micromanagement, OVERtraining, slow credentialing department, horrible billing department that cause charge to families(and you as a supervisor have to relay this bad news about a family owong money), zoom calls all day,etc............just please stay away. Going from 100 or more clinics to 300 and more clinics in one year definitely shows CARDs money hungry and unethical ways.

I have been at CARD as a BCBA for 1 year and though there are things I appreciate such as all that I've learned clinically and professionally as well as my wonderful and helpful co-workers, I must say every day there is something that indicates this company is not a good fit for me. First let me start by stating that I wanted to work in a specific location, got sent to a different location and now I see the location that I wanted to work at a year ago is currently posted on this site, so there's that. 

Other issues I have had over the past year include but are not limited to: 

Scheduling doesn't take into consideration the needs of the client nor do they listen and respect clinical feedback provided by the actual clinicians. The center is messy and disorganized because the office manager isn't going to take on that responsibility nor does that task get assigned, so we just live in a disorganized mess. I'm assuming it's because everyone is over-worked but still, it makes it difficult for our therapists to run a session when they can't find stimuli. That's another thing... you would think CARD would have all the best stimuli for the patients - THEY DO NOT! They have even suggested that parents buy/make their own stimuli. 

Work Culture: Many who work here are well-meaning people who want to help those with special needs. But often times it feels like the therapists and parents can get away with dubious behavior that goes unchecked, policies are not enforced and this leads to confusion and overall low morale. In addition, it seems that job expectations are not clearly specified and so people often times don't even know what they are responsible for. Or sometimes it doesn't even make sense to have a particular responsibility.

Management: One manager says something completely different than another manager. They literally change a policy (no lie, every week there is a change) and then your local manger has no idea what the change was. This leads to more confusion.

CARD's "advantages" that were in place when I started such as having monthly clinics, an assessment tech and someone who organizes the center's stimuli - these positions have all been dissolved because they are non-billable. Many positions have been "rearranged" or tasks reassigned because the company is trying to maximize billable - which means overworking salaried staff and using our assistant supervisors and therapist trainer to do direct therapy instead of supervising and training.

Little Flexibility for BCBAs: BCBAs have to be at the center from 9-5, even though BCBA's have to sometimes stay later because our clients are there late. You would think that we could come in late but oooh no. And we could easily work form home some days but again - nope. We have about 10 people we report to and the BCBA training often times feels pointless and time consuming. Billable is 120/ month but with everything else it becomes overwhelming and stressful. Ultimately no-one cares and you end up having to work at home at night and on weekends to get your billable.

I don't want to leave but I don't think I can stay. This company is fever pitch busy and stressful.

Years ago, I would have said this place was a good choice. However, under the most current management, I cannot recommend that people seek out employment opportunities here. The company has undergone several management shifts in recent years and the current CEO hardly makes her presence known, except for the standard holiday emails. Positions that existed a year ago were quietly discontinued and the people in those positions were let go very suddenly. 
There is much less security here than there used to be and a number of people who were here for multiple decades suddenly left the company over the last year or two- this includes people in high level positions, with a history of dedication or who were significant decision makers. They began sending sketchy “today is my last day” emails that tell you it wasn’t their choice to leave a job they’ve worked at their entire life.
There’s a great chance you won’t be making what you should for your work- they much prefer to bring in new people and pay them more, so you can expect someone that just started to be making more for the same job than someone who’s been working at the company for awhile. If you’re lucky enough to get a raise in a given year (never a guarantee), it will be very low and there’s no real room for discussion or negotiation on it. 
Upper management lately doesn’t want to hear your ideas, they want to hear how much you agree with them. If you don’t…they’re only too happy to show you the door. If they DO ask about something they’re considering, they very rarely implement any feedback they receive (the only time I was asked for my input, it was ignored, but the person who did that was one of the many long time staff that left effective immediately when the new management took over). 
If you’re in a salaried position, the time off is pretty lacking (especially after they stopped letting you carry over PTO in most states) - of course, California and one other state still allow it, due to labor laws. That being said, if you work in any other state, just know that California gets a lot of preferential treatment and most of the attention from upper management. 
If you work an hourly position, your benefits can be taken at any moment, if your hours drop- even if it’s outside your control. People who have a history of loyalty and showing up lose their benefits because of clients restricting their hours and that’s not a great position to be in. If you do decide to go for extra credentialing, there’s no guarantee your pay will increase either, especially if they decide you don’t need that credential. 
All in all, if you don’t live in California, avoid this place, especially for now. The current administration does not know this field and is not focused on the company’s original mission statement. If you’re an established BCBA there are much better opportunities, with more freedom. If you’re looking for a more entry level position, the pay here is much less than you’ll get elsewhere and you will probably have better benefits and overall respect. Maybe this place will turn around one day and go back to what made it an industry leader, but not with the way it’s currently operated, for sure. 

I worked at CARD for several years. I moved along their career development pathway while I was there and learned quite a bit. As I moved into higher positions, the quality of clinical training and support stayed consistent. This is a great company for anyone who is a brand new BCBA. But I would encourage most to look at other options after 1-2 years of being a supervisor here. You will learn quite a lot here. 

But to my surprise, much of what I learned had to do with the way the ABA industry works. I actually learned quite a bit about mergers, acquisitions, private equity, and the current state of the field of ABA. I learned about insurance contracts and the ethics involved with billing practices.This knowledge has proven to be very valuable. And it also just might prompt you to look for employment elsewhere. 

The field of ABA, as a whole, has been experiencing massive growth over the last 5-10 years. In this economy, it's sink or swim, so most companies are adjusting their business practices so that they can take advantage of the increasing demands for ABA services. This is just a matter of being practical. However, there are many avenues that a company can take while moving in the direction of growth. 

CARD's growth is partly accomplished through expansions. They expand their company by opening new offices. This is partially due to their effort to provide ABA services to as many geographic locations as possible. For obvious reasons, proximity to an ABA clinic is positively correlated with favorable treatment outcomes. However, many of these expansion sites are not very sustainable. They aren't experiencing growth at the local level. And the offices that bring in tons of revenue are essentially the ones to fund these clinics. These offices bringing in a great deal of money are usually filled with overworked and underpaid staff.

Another way the company expands is less about increasing geographical presence and more about growth and profitability. They will identify offices that are at max capacity (there is not enough space/time in the day to fulfill the contracted hours of their patients). So they split these offices. Some offices have been split more than once. When the new office opens, there are no staff. So essentially, the staff from the original office is now split between two workplaces. Their demands are sharply increased. The only incentive is that they are eligible to participate in a multiple bonus pools. In other words, if you have 3 jobs, they will let you have the opportunity to earn 3 bonuses. However, no one can enjoy a bonus if they are working 16-18 hours per day.

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