Since Little Leaves Behavioral Services was founded about five years ago, the center-based applied behavioral analysis (ABA) provider has grown by four times. That includes the addition of two new locations in the past few weeks, and its expansion from the Mid-Atlantic into Florida for the first time last year.
Now, the provider — which is a division of the special education and instructional intervention solutions company FullBloom — is eyeing opportunities in even more new states along the East Coast, according to Little Leaves President Marina Major.
Behavioral Health Business recently connected with Major to discuss the growth outlook and expansion strategy for Silver Spring, Maryland-based Little Leaves, which currently only has locations in Washington D.C., Virginia, Maryland and Florida.
She told BHB it all comes down to need, while also highlighting the importance of employee retention and development, which Little Leaves has honed over time with a specialty training program.
You can find BHB’s conversation with Major below, edited for length and clarity.
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BHB: First, can you tell me a little bit about Little Leave’s origin story and how it grew into the provider it is today?
Major: The idea for Little Leaves was born from what we were seeing at another program, the Auburn School, in the D.C. area.
The Auburn School has two locations that provide highly academic programs for students with social and communication challenges. What we were seeing during the admissions process about 10 years ago is that the youngest kids applying had skill deficits that we felt could have been helped by early intervention and changed the trajectory of their educations.
I was like, “I would love to start a program for preschool-aged children that would better prepare them for school.”
In doing the research, we found that families really struggle to access services in the early years, which is why they weren’t getting them. There were none available in their area, and if they did exist, they were spotty. Sometimes it was only a few hours of therapy or maybe it wasn’t high quality.
We set out to develop a program that would provide high-quality ABA therapy for families in their communities. We started, like a lot of people, as an in-home provider, but quickly realized that to be able to prepare kids for school, we needed to pivot to a center-based program for the youngest children. So in 2016-2017, we opened our first center, and that’s what we do today.
From your vantage point, what sets Little Leaves apart?
There’s a lot, to be honest, but I think what truly sets us apart is our clinical team.
From day one, we have focused on being high quality. It’s even one of our values. And like many service organizations, we recognize that we are only as good as our people, so the growth and professional development of our clinicians is key to ensuring the best outcomes of our clients.
I notice you’ve been really active on the growth front as of late. What’s driving all the new facility openings?
From day one, the vision has been to be in the communities where our families are, and the fact remains that there continues to be a deficit of options for families.
We have had families travel upwards to an hour to get to one of our centers, which is essentially two hours to and fro every day. And the truth is that’s unsustainable.
With opening a new center, for example, like the one we just opened in Ashburn, we are now in the communities where families live and work. We feel like that raises the quality of life for everyone, in particular for the child.
One reason it can be hard for families to find early intervention options is the nationwide shortage of ABA workers. How are you dealing with that at Little Leaves, especially as you expand?
It’s an issue throughout the industry, and we’re all trying to figure it out. At Little Leaves, we have not tried to focus on the shortage. We have instead looked internally at what we need to do to remain a great place to work.
People have choices about where they want to work, and we want to remain the employer of choice. So things like training and professional development opportunities are important. We also regularly review our pay and benefit policies, as well as the workplace environment, to see where we can improve. We also look at resources required so our teams in the centers have what they need to be the best they can be.
We want to be the employer of choice, which we are. We are seeing clinicians coming to us because they know we’re high quality.
Got it. It seems like your growth is need-based. But beyond that, do you have any set growth goals or targets for 2021 or beyond?
I can’t really get into the specifics, but a couple years ago, we had two centers, and now we have eight. We have always planned on growing.
The pandemic kind of put a halt on a lot of that. There were two centers that were planned for last year that just came out this year because we had to put everything on hold.
We’re just moving forward with our pace to open these centers. But our focus has been on developing centers following the model we’ve spent years in refining. It’s just something we want to be doing — to be in those communities.
Moving away from specifics, can you speak generally about what your growth strategy looks like? I’m interested in how you decide where to expand and what your expansion plan looks like. For example, you recently branched out from the Mid-Atlantic to open up your first location in Florida.
Our growth has been organic. We’ve been expanding to meet the need in our communities in Maryland and in Virginia — so that’s where you’ve seen most of our growth.
Opening the center in Florida was somewhat of a natural extension, as one of our best clinicians and earliest hires moved to Florida for personal reasons. It made sense for us because we knew families there needed quality ABA services, and we had a high-quality clinician.
The truth is, that expansion has made us think about other states on the east coast. The decision on exactly where we’ll go is based on a lot of factors, but the key is always the clinical team. The first thing we look at is: Do we have a clinical team member that will ensure the fidelity of the model? Once we know that, the rest is a lot easier to do.
In addition to new clinic openings, are acquisitions a growth pathway you’d consider?
Our focus has been on developing our own centers because we want to be focused on our model. We believe in being really good at what we do and not trying to chase other things.
But having said that, we’re always interested in acquiring like-minded organizations, we’d just want to make sure that they align with what we do.
Switching gears here a little bit: Working in the ABA field isn’t easy. Can you highlight some of the biggest challenges that you’re facing at Little Leaves, especially as you expand and look to cover more communities?
We face the same challenges as everyone. The biggest one we all face is finding well-trained clinical staff. They’re in high demand, and although every year more and more folks are becoming board certified behavior analysts (BCBAs), the truth is that is only the first step in their professional careers.
Trying to respond to that, we have spent years and years developing and refining our professional development program to ensure our BCBAs, as well as all of our team members, have the best training and supervision possible. That’s the only way we can grow and expand — because we want to do that without losing any of the quality we are known for.
What does that development program look like? For example, is it formal or informal?
It is a fully structured program. For example, if you are starting off as a behavior tech and moving through the program to become an registered behavior technician, we have a formal structure for how you work through the process. It’s all competency-based.
It is some classroom work, some online work and a lot of hands-on work.
Our team works through all these levels, developing their skill and their craft before we actually say, ‘Here’s a full caseload.’ And the whole time we are assessing and reviewing the progress and making sure that even our clinical team is meeting all the requirements they need to be the best they can be. It’s pretty intense, and it’s something that we have been building from day one.
And has that program helped with employee retention? We all know this field sees a lot of turnover.
Absolutely. I would say that probably the number one comment people say about our program is that the support, development and training is what drives them to remain with us.
Also, a lot of our staff started as behavior techs, so we believe in the grow-your-own model. You start with us, and we will provide you the support you need to become a better clinician.
Our pride is the fact that within our clinical team — our BCBAs — we have very little turnover, if any.
On the opposite side of the coin, what opportunities are you most excited about pursuing?
There still remains a severe lack of access to services in many communities, so we think there’s a lot of room for growth, especially for high quality services.
We want to close the gap and provide those high quality services in the areas where they’re most needed.
Little Leaves is owned by FullBloom, which was previously called Catapult Learning. What does that relationship look like?
We have been with them since November 2018, and we are their behavioral health division.
FullBloom, at the time called Catapult, saw this need to build out the continuum of care. It’s focused on underserved children in schools, so it’s intervention programs, as well as nonpublic schools or specialized schools. And they were seeing, just like we saw when we started, this need for a continuum of care.
How do you catch those kids really early and help change the trajectory of their lives? Although a lot of it was education, the belief is that at some point health care and education need to come together to benefit our children. That’s where Little Leaves came in.
And in return for filling that gap for them, I imagine Little Leaves now has some extra manpower and financial backing.
Absolutely. It’s resources that we didn’t have. But the biggest support is that we can focus on what we do really well, and there’s a lot I don’t have to worry about anymore. We can focus on the clinical quality of our product, while all the accounting can be taken by somebody else.
Finally, what can we expect to see from Little Leaves for the rest of 2021 and beyond?
I think what you’ll see is the continued development of centers closest to where families live and work within our current regions — and possibly in new states, yet to be determined.
Throughout the rest of the year and into the future, I hope you will see us remain focused on providing the high quality treatment with a laser focus on the training and professional development of our team.
I feel strongly, as a parent, that all children should be given the opportunity to thrive to the best of their ability. Families bring their children to us when they’re very, very young, and our mission is to provide the highest quality of services to prepare them.
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