The ABA Therapy Guide to Digital Marketing

Introduction

Welcome to “The ABA Therapy Guide to Digital Marketing,” a comprehensive resource designed to help ABA (Applied Behavior Analysis) therapy providers navigate the complexities of online marketing. This guide provides actionable strategies to enhance your online presence, attract more clients, and optimize your marketing efforts for maximum effectiveness.

My name is Reece Epstein, and I am the founder and CEO of Reputation Elevation. Reputation Elevation has helped ABA therapy practices across the US achieve their growth objectives using digital marketing services tailored to their unique needs.

ABA therapy practices face unique challenges that other B2C (business to consumer) businesses do not have to worry about due to the complexity involved in getting clients authorized for service. 

That’s because a child is typically only qualified for services if:

• He or she has an autism diagnosis.
• The family has insurance that you are in network with (unless you go for SCAs or private pay).
• He or she is in the age range you service.
• He or she is in the area that you service or can consistently commute to your center.

Thus, it is not enough for a parent to say “yes” to services. Many families who may in theory want your services will not be able to receive them.

My preferred approach to addressing these challenges is to focus on getting a large enough volume of parents interested in services to find the ones who will qualify to get the life-changing help that your organization provides.

Yet volume may not be enough. Digital marketing efforts – whether through search or social media – attract parents who only know about you in the context of whatever marketing materials they interacted with.

When a family finds you by way of referral from a pediatrician’s office, they already trust you to a degree because they trust the professional who is recommending you. That makes it relatively easy to convince a parent that you are the service for them (unless the referral source provided multiple competing referrals).

But when someone clicks on an ad or a search result, there is no third party validating the quality of your services. Thus, you will need to build trust as best you can through other means while making a compelling case for your services.

This guide is here to get you moving in the right direction towards doing just that.

As you explore this guide, you may want to reference Reputation Elevation’s ABA Therapy Marketing ROI Calculator, a Google Sheet we designed to help you plan your budget. 

You can make a copy of the calculator using this link. This instruction video will show you how to use the calculator.

Chapter 1: Understanding the Digital Marketing Numbers Game

Most practices get started with a marketing strategy that relies on referrals, brochures, local events, and basic properties such as a website and social media profiles.

For some ABA therapy practices, those efforts suffice to provide enough cases to sustain growth.

Referrals are quite cheap (free, in fact, other than your investment in time and basic marketing collateral).

Yet referrals are inconsistent. You cannot tell a pediatrician how many parents to refer to you next month. And you cannot guarantee that a referral source will stay loyal to you and not send families in the direction of other providers.

If you value scalability, (relative) predictability, and independence, then digital is the way to go.

Here are some terms you will need to know:

1. Impressions: how many times your ad/post/search listing is seen.
2. Clicks: how many times people clicked on what they saw.
3. Clickthrough rate: the percentage of people who saw your online property/post/ad and clicked on it.
4. Leads: people who contact you with interest in your services.
5. Conversion rate: the percentage of clicks that turn into leads.
6. Appointments: conversations with leads.
7. Appointment rate: percentage of leads who have conversations with you (some will disappear or be unreachable).
8. Qualified leads: leads who are a fit in terms of age, location, diagnosis, and insurance.
9. Close rate: percentage of leads who enroll in services.

Now that you have the vocabulary down, let’s review a couple of hypothetical scenarios…

Scenario 1

ABC ABA is a home-based practice with 50 cases. Referrals are inconsistent, and some cases will be graduating services as they age out or progress enough to no longer warrant a diagnosis. Management wants to replace a cohort of 8 cases whose services will be ending soon… on time to keep their therapists on payroll.

In addition, they want to grow at a manageable pace of 5 to 7 cases per month thereafter.

Since ABC ABA needs 8 new cases in the immediate future, we have to figure out how many leads they will need from their digital marketing efforts.

Management is aware that about 45% of referrals enroll in services… but is also aware that leads from digital marketing efforts will have a lower close rate than that. Eyeing a Google Ads campaign, they figure that 5% of leads will be unreachable, 50% of the remainder will be qualified, and of those about 30% to 40% will ultimately enroll in services. 

In other words, 14.25% to 19% of contacts from Google Ads will enroll in services. That means 42 to 56 leads from Google will be needed to enroll 8 cases. 

ABC ABA does some research and finds that clicks in their area are likely to cost $5 to $8 each. They assume that 5% to 10% of clicks will become leads (by phone, form, or chatbot). Therefore, the expected cost per lead is $50 to $160 each. 

To get 42 to 56 leads, they will need to invest $2,100 to $8,960 – a broader range than they perhaps expected when they first sat down with a pen and calculator (or Excel sheet). 

To put it another way, each new case is likely to cost $262.50 to $1,120 each.

Considering that they can expect to generate $50,000 to $90,000 in revenue per case, that seems like a reasonable investment. 

Even if each case costs $1,120 in advertising, getting 8 more cases means approximately $560,000 in new revenue for the year ahead.

But ABC ABA doesn’t want to throw money at the wind. They want to put in the time and effort to dial in their search strategy, track conversions effectively, and write effective ad content. There’s a lot of work to do.

Scenario 2

Happy Place Therapy is a center-based practice looking for a strategy to build up a waitlist so that there are always new cases available whenever old cases leave.

They aren’t in a hurry to grow, per se. They just want more parents to get in touch. And they notice that their website isn’t really coming up in Google search when they type in “ABA therapy.”

Their web developer said he had included “SEO” (whatever that means). But the website is just sitting there and not a lot of people are finding it.

Happy Place Therapy starts looking into Search Engine Optimization. What they discover is a lot of confusing and sometimes contradictory advice. But they come to understand that Google’s objective is to provide searchers with the most satisfying possible search results, and they will have to think through how to make their website appear more valuable and relevant to Google in order to rank high and get more organic search traffic.

Scenario 3

Behavior Buddies is a home-based practice looking to go big. Their objective is 10 to 20 cases per month. Behavior Buddies takes a wide range of payors and ages and services a wide geographical area.

They set their sights on social media as a way to generate a large volume of leads – knowing that the lead quality may not be so great, but that numbers will make up for the tire kickers and window shoppers (not to mention no-shows).

Behavior Buddies starts by posting to their Facebook and Instagram pages… but quickly finds that their posts get little reach or reaction.

Facebook suggests that they “boost” their posts. And so they do, for $5/day. But not much happens except that someone commented about how you can get a free cryptocurrency account if you click on a certain link.

Exasperated with all this boosting business, Behavior Buddies sets up a Facebook Ads Manager account and creates some ads to send traffic to their website. They figure out the conversion tracking setup (though it’s hard to tell for sure if that is working) and turn on their ads. 

After spending about $300, they get their first phone call. That’s satisfying, but they don’t want to pay $300 per lead on social media, especially given that the lead quality on social media is lower than on Google Ads.

Behavior Buddies does some more research and learns that their approach has been all wrong. Firstly, they need to expect that 50% to 60% of leads from Meta will never get on the phone at all. Maybe they were just curious. Maybe they just like clicking on things. Maybe they are bots. Behavior Buddies will never know.

Of those who do get on the phone, only around 10% to 20% will be qualified and want to proceed with services.

For every 100 leads, they can expect:

• 60 to be unreachable.
• 40 to get on the phone.
• 15 to 25 of those on the phone to lack a diagnosis, have the wrong insurance, or be in the wrong age range.
• 4 to 12 of the original 100 to proceed with services.

But… with the right strategy, Behavior Buddies can get leads for anywhere from $15 to $35 each. Even if the conversion rate is low (4% to 12%), the numbers still look good. The cost per case acquisition should range from $125 to $875 each.

If 100 leads cost $3,500 in advertising, and Behavior Buddies gets 4 to 12 cases enrolled, they can look forward to $280,000 to $840,000 in revenue for the coming year. Not bad, even if the intake coordinator doesn’t like the phone numbers that don’t work… or the phone numbers that get answered by people who have no idea who they are. It’s worth it to get to the leads who are well-qualified and interested in services.

Behavior Buddies starts to think about how they could keep their cost per lead down. After all, they did hear that some companies are paying a much higher cost per lead of $50 to $80 each. And they think that marketing automation could help reduce the amount of work their intake team has to do.

Chapter 2: Selecting a Strategy

I recommend the following platforms for client acquisition:

1. Google
2. Meta (Facebook/Instagram)

While this guide focuses more on the client side of things, it’s worthwhile to mention that the following platforms are most relevant for recruitment purposes:

1. Google
2. LinkedIn
3. Indeed 

There are no big surprises on these lists, but you may notice the omission of a few different websites:

• TikTok: this platform is riddled with serious ethical issues, such as being known to show suicidal content to suicidal people. We choose to stay away until the platform is reformed.
• Pinterest: the ads platform is best for e-commerce, not lead generation.
• X (Twitter): the ads platform is not so well-suited for therapy-related ads due to the limited available writing space and very broad targeting options.

Thankfully, Google and Meta provide plenty of opportunities to attract new cases.

In the hypothetical scenarios described above, ABC ABA, Happy Place Therapy, and Behavior Buddies each confronted different business challenges with a different choice of marketing strategy.

I consider the following factors before making a recommendation on marketing strategy:

1. Payor list: is it broad or narrow? Do you take Medicaid and the MCOs?
2. Age: what ages will you service? If you are only looking for ages 1 to 5, that matters a lot when selecting a marketing strategy.
3. Patience and commitment: if you rely on an intake coordinator who doesn’t want to put a lot of effort into follow-up, stay away from social media.
4. Time frame: how soon do you need cases?
5. Objective: how many cases you want to enroll will impact what your budget is and how many channels you choose to be active on. Like Happy Place Therapy (Scenario 2) above, you may not need a specific number of cases on a regular basis but rather be interested in a general improvement in client enrollment.

Practices with broader payor lists that include Medicaid and MCOs are typically well-advised to take advantage of Meta’s potential for a large volume of leads at a low cost per lead… unless you don’t have someone on the team who can follow up with leads consistently throughout the day.

Organizations that can only take younger cases (or morning/midday cases) should probably be thinking about Google. Though beware that some areas simply don’t have a lot of cases like those to acquire.

Practices that need to enroll cases quickly should be sure to include paid ads in their strategy because SEO takes longer to start working.

That said, SEO is an important investment for just about any practice. It’s particularly well-suited to those that don’t need a large volume of new cases each month in order to grow but do need new cases on a consistent basis to replace those that graduate services.

These are guidelines that work for most ABA therapy practices. However, your location, budget, or other factors can influence things. I can usually make a clear recommendation after one phone call with your team to review the relevant details.

Plus, some businesses are truly best served by covering all Meta Ads, Google Ads, and SEO rather than just choosing one or two of the options.

Chapter 3: Organic Traffic vs. Paid Traffic

Organic traffic is traffic that occurs without paying for it via advertising. Organic traffic generally occurs through:

1. Referrals to your website (e.g., someone sends their friend a link to your website via email).
2. Google Search
3. Social media

Common wisdom has it that businesses should be “on social media,” and that being “on social media” means making posts to your Facebook page or Instagram profile. In other words, social media is thought of as an avenue for organic traffic.

Yet Facebook and Instagram severely limit how much exposure your free posts can receive because they want you to pay to play.

Unless your organization excels at creating truly engaging content (no easy feat in a noisy online environment), it is unlikely to attract many new clients with organic social media efforts.

I view the primary benefit of posting to your Facebook and Instagram properties as being cosmetic, so that people who visit them see something there.

While it is difficult to see a meaningful return on investment from organic social media activities, the opposite is true of organic Search Engine Optimization (SEO) activities.

“SEO” is defined as a set of activities designed to get Google to rank your website higher in search engine results.

SEO should not be confused with Google Ads. I recorded a quick video reviewing a Google search to explain the difference:

Organic and paid traffic strategies have different strengths and weaknesses.

Here are some reasons to focus on SEO:

• You want to make sure your business is found in search.
• While there is a cost of time and/or money to engage in SEO activities, at least you don’t have to pay for clicks.
• SEO is sort of like buying a house, and Google Ads is sort of like renting. Stop paying for ads, and they no longer appear in search. Yet your SEO efforts have a degree of durability over time (beware, though… without any ongoing SEO activities, your website will eventually start to lose its rankings).

Here are some reasons to choose paid ads (whether Google Ads or Meta Ads):

• Get traffic right away (SEO takes a while to work).
• Fine-tuned targeting control.
• Ability to turn your marketing on and off (though doing so too frequently can mess up your ad performance).

If your practice can afford to invest in SEO, then it probably should. But if you need new cases now, or you have specific enrollment goals to achieve over a defined period of time, you should also invest in a paid ads strategy.

Chapter 4: Monitoring and Measuring Success

The only way to know what is working in your marketing strategy is to track your results.

It is vital to understand how many people are calling you, filling out contact forms, engaging with chatbots, etcetera on your website… and to know exactly where those clicks are coming from. You can then use the information you collect to optimize your marketing efforts for better performance.

Conversion tracking is a fairly technical topic and a “how-to” guide is beyond the scope of this work. However, I hope to equip you with the knowledge you need to know whether conversion tracking is being done correctly or not.

Let’s go through conversion tracking concepts for SEO, Google Ads, and Meta Ads…

Performance and Conversion Tracking for SEO

The most important metrics to track for SEO are:

• Keyword rankings (where are you appearing in search results for keywords that are important to you). This is done via 3^rd party paid software such as semrush.com.
• Search impressions and traffic via Google Search Console.
• Search traffic and conversions via Google Analytics or Google Tag Manager.

Conversion Tracking for Google Ads

Google Ads itself will provide you the data you need around:

• Impressions (how many times your ads are shown)
• Auction performance
• Clicks 
• Clickthrough rate
• Cost per click

However, you will need to set up conversion tracking on your website to track how many clicks turn into conversions. This can be done using Google Ads’ tracking code (with some other installation steps involved), Google Analytics, and Google Tag Manager.

Important note: the basic definition of conversion tracking for form submissions on your website is to count the fact that a form was filled out and send that information back to Google so Google can associate the form fill with a particular click on the relevant ad/keyword. However, that alone will not tell you which individuals came from which keywords. To capture that information, you’ll most likely need to use UTM parameters and invisible form fields. Your developer should understand what this means and be able to implement accordingly.

Additionally, it is vital to use a call tracking platform to track which phone calls come from which keywords and to record them so you can review the quality of the calls. 

If you settle for using Google Analytics or Google Tag Manager to track how many people click on the click-to-call buttons on your website, then you will miss people who either copy and paste that phone number into their dialer, or who simply read it from their computer screen and then manually enter it into their phone dialer. The only way to fully track phone calls is to use software dedicated to that purpose.

We use a HIPAA-compliant plan with calltrackingmetrics.com as of this writing, though we may be switching to our own solution found in our CRM and marketing automation platform soon.

Conversion Tracking for Meta Ads

If your strategy is to send Meta traffic to your website to generate leads, then you will need to use Meta’s Dataset embed code and follow Meta’s instructions to track form fills, chatbot engagements, etc. 

As with Google Ads, it is essential to use a 3^rd party call-tracking platform to measure and record phone call conversions.

Chapter 5: Content Strategy and SEO

Search Engine Optimization (SEO) is an important pillar of your digital marketing strategy. In case you missed it in Chapter 3, here is a link to a video I recorded reviewing the difference between Google Ads and SEO.

Have you ever wondered how Google decides what websites to list, and in what order, when you perform a Google search? Google uses a complicated algorithm to generate relevant search results and does not disclose exactly how its algorithm works. However, there is a lot that we can find out from analyses of search results, Google press releases and documentation, and trial and error.

A complete SEO strategy is comprised of the following components:

1. User experience: make sure your website works correctly, loads quickly, and helps visitors easily find what they need. Google takes note of searcher satisfaction and adjusts results accordingly.
2. Technical SEO: the process of optimizing a website’s infrastructure and architecture to help search engines access, crawl, interpret, and index the site more effectively. This includes tasks such as improving site speed, ensuring mobile-friendliness, setting up secure connections (HTTPS), creating XML sitemaps, and optimizing site structure and URLs. The goal of technical SEO is to enhance the technical aspects of a website to boost its visibility and ranking in search engine results.
3. Content: your website should not only describe your services, location, and contact information but also present a rich and ever-updated collection of blog posts or other resources about ABA therapy and autism. Additionally, you should have a page dedicated to each location that you provide services in.
4. Backlinks: when websites publish hyperlinks to your website, they signal to Google that your website is noteworthy. You can’t compete without a robust backlink profile. But beware – the wrong backlinks will result in penalties and hurt your results.
5. Google Business Profile: you should have a Google Business Profile for any physical address that clients can visit, or, for home-based practices, a Google Business Profile for any metropolitan area where your services are available. Note that setting up your profiles the wrong way can cause them to be rejected, so be sure to read on.

Let’s address each topic in detail…

User Experience (UX)

User experience (UX) plays a significant role in SEO results. Google increasingly prioritizes the satisfaction and usability of web pages for visitors. Here’s how UX impacts SEO:

Engagement Metrics: 

Positive user experiences can lead to better engagement metrics such as longer time on site, lower bounce rates, and more page views per session. Search engines use these metrics as signals to gauge the quality and relevance of a site to its visitors.

Mobile Usability: 

With the rise of mobile browsing, search engines have emphasized mobile-friendly designs. Websites that offer a smooth and responsive mobile experience are more likely to rank higher in search results.

Site Speed: 

The speed at which a webpage loads is crucial for a good user experience. Slow-loading pages can frustrate users, leading to a poor experience and increased bounce rates. Search engines prioritize faster websites as they provide a better user experience.

Ease of Navigation: 

Websites that are easy to navigate help users find information faster and more efficiently. Clear and intuitive site architecture not only helps users but also allows search engines to better understand the structure and content of the site, which can improve indexing and rankings.

Content Quality and Accessibility: 

Quality content that is well-structured and accessible contributes to a positive user experience. Content should be easy to read, relevant, and provide value to the visitor. Proper use of headings, subheadings, and alt text for images enhances accessibility and usability, which are factors in SEO.

In summary, optimizing for user experience is not just about making a site more enjoyable and easier to use. It directly impacts SEO by influencing how search engines perceive the quality of a site and how they rank it in search results. A focus on UX improvements aligns closely with SEO goals, as both aim to deliver the best content in the most accessible way.

Technical SEO

Technical SEO is critical for any ABA therapy practice website as it lays the foundation for search engines to properly access, crawl, index, and rank the site. Optimizing the technical aspects of SEO can directly impact your visibility in local search results, where proximity, relevance, and prominence play crucial roles. Here’s a more detailed look at some key technical SEO strategies for ABA therapy practices:

Mobile Optimization

Given that a significant number of local searches occur on mobile devices, it’s vital for local businesses to have a mobile-friendly website. This involves responsive design, which ensures the website adapts and looks good on different devices and screen sizes. Mobile optimization also means ensuring that the site loads quickly on mobile networks and has interactive elements that are easy to navigate on a touchscreen.

 Local Business Schema Markup

Schema markup is a form of structured data that you can add to your website to help search engines understand the content of your pages better. For local businesses, implementing Local Business Schema can provide search engines with specifics about your business such as the business type, address, phone number, opening hours, and more. This can enhance visibility in local search results and potentially enable rich snippets in SERPs, making your listing more attractive.

 XML Sitemaps and Robots.txt

An XML sitemap contains a list of all important pages of a website that search engines should know about. Having a well-structured sitemap makes it easier for search engines to find and index all relevant pages of a local business’s site. On the other hand, a robots.txt file tells search engines which parts of the site to crawl and which parts to ignore. Ensuring these are correctly set up can prevent search engines from wasting time and resources on irrelevant pages and focus on the content that improves local visibility.

Page Load Speed

Speed is a crucial factor, especially for local search, as users often look for quick answers while on the go. Optimizing page load speed by compressing images, leveraging browser caching, and minimizing the code can enhance user experience and contribute to better rankings. Tools like Google’s PageSpeed Insights can help identify areas for improvement.

Secure Sockets Layer (SSL)

Security is a top priority for users and search engines alike. Implementing SSL to switch your site to HTTPS is essential for protecting your users’ data. This is particularly important for local businesses that may handle transactions or collect personal information through their website. Search engines favor secure websites, and users are more likely to trust and complete transactions on HTTPS sites.

URL Structure

For local businesses, having a clear, descriptive URL structure can help search engines and users understand what each page is about. Including location-based keywords in URLs can further enhance local search optimization. For example, using URLs like www.example.com/aba-therapy-chicago can help in targeting local audiences.

Google My Business Integration

While technically part of broader local SEO, ensuring your website is linked correctly with your Google My Business profile can enhance how your business appears in both Maps and local search results. This includes managing accurate and up-to-date information on Google My Business and encouraging customers to review your local business.

By focusing on these areas of technical SEO, ABA practices can significantly improve their search engine visibility in local search queries, making it easier for parents in their locality to find them. 

Content

Developing an effective content strategy for an ABA therapy practice that targets both service-related and job-opening searches involves a comprehensive approach. Here’s a step-by-step guide to building a content strategy that can help the practice rank well for these keywords in local search results:

Keyword Research

Start with thorough keyword research to identify the terms your target audience (parents seeking ABA therapy and professionals looking for ABA jobs) are using. This includes general terms related to ABA therapy, specific services, local terms (e.g., “ABA therapy in [City Name]”), and job-related terms (e.g., “ABA therapist jobs near me”). Utilize tools like Google Keyword Planner (requires a Google Ads account), Moz, or SEMrush to find relevant keywords with good search volume and manageable competition.

Page Content Creation

Create detailed, informative, and engaging content that addresses the specific needs of both audiences:

– For ABA Therapy Services: Develop comprehensive pages on your website dedicated to explaining ABA therapy services, your therapy approach, insurance information, and anything that makes you special as an organization. For best results, create a dedicated page for each location you are in.

– For BCBA/RBT Job Openings: Create a dedicated career section on your site. Post detailed job descriptions, highlight benefits of working with your practice (e.g., training programs, career progression, supportive work environment), and feature testimonials from current employees. 

Blog Posts

The best way to show Google that your website is updated, relevant, and authoritative is to maintain a blog and publish multiple blog posts per month. While parents may peruse your blog from time to time, the main objective of keeping your blog updated is so that Google will prefer your website over others in the search results. 

Local SEO Optimization

Optimize your content for local search by including local keywords and ensuring your practice’s name, address, and phone number (NAP) are consistent across all platforms. Utilize Local Business Schema to help search engines understand your practice’s geographical and business details.

On-Page SEO Best Practices

Implement on-page SEO tactics such as using target keywords in title tags, meta descriptions, headers, and throughout the content where relevant. Optimize images with alt tags and ensure your website’s URL structure is clear and includes keywords where possible.

Backlinks

No SEO strategy is complete without attention to gaining backlinks – meaning, hyperlinks on other websites that point people to your websites.

Google considers backlinks important because they act as a form of endorsement or vote of confidence from one site to another. This perspective is rooted in the foundational algorithm that powered Google’s early search technology, known as PageRank. Here’s why backlinks remain a critical factor for Google:

Indicator of Content Quality

Backlinks from reputable websites are generally seen as a sign that the content is valuable. If multiple sites link to a page, it suggests that the content is worth referencing, which indicates quality and reliability. This is especially powerful when the backlinks come from established, authoritative sources in relevant fields.

Measure of Credibility and Authority

When a website receives links from other authoritative domains, it helps boost its own authority. For instance, if a major news outlet or an academic institution links to a website, it passes on some of its authoritative strength. Google uses this as a metric to assess the credibility of the content on your website, influencing how well it ranks in search results.

Discovery of New Content

Backlinks also assist Google’s crawlers in discovering new pages. When a site links to another, it leads Google’s bots to that new page, helping it to be indexed and included in search results. This is crucial for newer content or pages that aren’t easily discoverable through regular crawling processes.

Understanding Context and Relevance

Backlinks help Google understand the context of a page as well as its relevance to specific queries. The anchor text (the clickable text in a hyperlink) and the content around backlinks provide Google with clues about what the page is about. This helps Google serve the most relevant content to users based on their search queries.

Enhancing Search Result Quality and Reliability

Google aims to provide the most relevant, authoritative, and useful search results to its users. Backlinks serve to confirm the trustworthiness and quality of a webpage. Pages with a strong backlink profile are often considered more likely to offer valuable information, making them more suitable to be ranked higher in search results.

Because of these reasons, backlinks are a cornerstone of Search Engine Optimization (SEO) and play a significant role in how Google assesses and ranks web pages. However, Google also continually updates its algorithms to ensure that backlink quality and relevance are prioritized over sheer quantity, to prevent manipulative practices that can lead to skewed search results.

Based on the above, you might think the best way to get backlinks is to focus on obtaining them from the most important and influential websites out there.

However, an obsessive focus on just a handful of kinds of backlinks can be detrimental to your SEO presence. That’s because Google isn’t just looking at backlinks individually; it is analyzing the totality of your backlink profile.

A backlink profile is essentially a portfolio of all the links from other websites that point to your site. It’s one of the foundational components of SEO, reflecting the quantity, quality, and diversity of websites that link back to yours. The characteristics of your backlink profile can significantly influence how your site is perceived by search engines like Google, impacting your rankings in their search results.

A natural backlink profile will have links from a variety of sources, including blogs, news sites, and business directories, across different geographies and industries (as applicable). A diverse profile suggests that a wide range of sources endorse your website, which enhances your credibility and rankings.

To ensure your backlink profile appears natural to search engines, follow these guidelines:

1. Earn links through high-quality content: Produce high-quality, engaging, and informative content that naturally attracts backlinks. This includes comprehensive articles, original research, infographics, and resources that provide value to your audience.

2. Diverse anchor text: Use a variety of anchor text for the links pointing to your site. Overusing exact-match keywords can look manipulative. Natural backlink profiles typically include a mix of brand name, generic, and keyword-based anchor text.

3. Gradual link acquisition: Build links slowly and steadily. A sudden surge of backlinks can appear suspicious and may be indicative of manipulative practices.

Avoiding Spammy Backlinks

Spammy backlinks are links from low-quality or irrelevant sites, often created in an attempt to manipulate search rankings. Such practices can lead to penalties from Google, severely impacting your site’s ranking. Here’s how to avoid them:

1. Monitor your backlink profile: Regularly use tools like Google Search Console, SEMrush, Ahrefs, or Moz to monitor your backlink profile. Check for unusual spikes in backlink numbers or links from poor-quality sites.

2. Disavow bad links: If you identify spammy or harmful links you can’t get removed, use the Google Disavow Tool. This tool allows you to ask Google not to take certain links into account when assessing your site.

3. Focus on quality over quantity: Rather than trying to acquire as many backlinks as possible, focus on getting high-quality links from well-regarded websites. This means engaging in legitimate SEO strategies like content marketing, guest blogging, and public relations.

Google Business Profile

Every ABA practice needs to have at least one Google Business Profile. As mentioned above, you should have a Google Business Profile for any physical address that clients can visit, or, for home-based practices, a Google Business Profile for any metropolitan area where your services are available.

Google Business Profiles are a vital component of your search strategy because they give you more visibility in search results and communicate important information to Google about your business.

The search results below are all Google Business Profiles:

You can create your Google Business Profile for free here: https://business.google.com/

What You Need to Know When Setting Up a Google Business Profile

There are two kinds of Google Business Profiles: those with a location customers can visit, and those without:

If you are an in-home ABA practice, select “no.” If you select “yes,” Google will make you prove that you have a storefront by sending evidence (such as a video) of your location with clear signage and at the claimed address. 

Select the “no” option and click “next.” Now, you can add in the areas that you service one by one:

Your profile will be eligible to appear in searches by people in all of the locations that you list, and you won’t need to send proof that you have a storefront because you aren’t claiming to have one.

Optimizing Your Google Business Profile

The first step to optimizing your Google Business Profile is to accurately fill out all the information you can about your business.

Next, add some pictures. You can’t upload pictures of your patients without signed consent, but you can include pictures of staff, your location, or yourself. If that doesn’t work, look for some good stock photos to upload instead.

Be sure to post updates to your Google Business profile to give yourself an advantage over other profiles.

Lastly, find other directories to list your business name, address, and phone number.

Reputation Management

The BACB ethics code doesn’t allow BCBAs to ask parents to provide reviews or testimonials. This policy has two unintended negative side effects:

1. Practices owned by non-clinicians have a natural advantage over their clinician-owned competitors by virtue of being unconstrained by the ethics code.
2. The occasional unhappy parent can ruin your online reputation, without any counterbalance, as happy parents usually prefer not to leave reviews because they don’t want to mention publicly that their child has autism. This can cause even the best practices to have one- or two-star reputations online.

I encourage BCBAs to maintain a continued dialogue with BACB until they realize the unfortunate consequences of their well-intentioned policy. You can highlight that it is possible to largely avoid the problem of a two-way relationship or undue pressure by making review requests an automated administrative practice instead of something that therapists personally request of parents, thus making review requests no more threatening or pressuring than a sign in the local coffee shop encouraging you to leave a good review.

In the meantime, you can improve your reputation by asking happy employees to leave good reviews. This will insulate you from the occasional bad review and make you look good to people looking for services… and jobs!

Chapter 6: Google Ads

In 2023, Google’s ad revenue totaled $237,860,000,000, more than the Gross Domestic Product of all but 55 countries in the same year. 

Google search ads are incredibly powerful because they allow you to place your website right in front of consumers as they search for your services and compete for clicks through an instantaneous automated auction. 

Google also has a variety of other ad products available through its interface, such as display ads, Gmail ads, YouTube ads, and more. We find that these ad placements are sometimes (but not always) effective for ABA therapy practices.

For the purpose of this guide, we will focus on Google’s classic Search Ads.

Creating effective Google Ads campaigns for an ABA (Applied Behavior Analysis) therapy business involves several strategic steps to target the right audience, manage budget efficiently, and maximize conversions. Here is a guide to get you started in the right direction:

Research Keywords

Use keyword research tools like Google Keyword Planner to find relevant keywords that potential clients might use to search for ABA therapy services (or that job seekers might use to search for jobs). Focus on a mix of broad and specific keywords, including local terms like “ABA therapy in [City Name]” or “autism support near me” to attract local traffic.

Your keyword list can include:

– General terms (e.g., “ABA therapy”, “behavioral therapy for children”)

– Service-specific terms (e.g., “early intervention ABA therapy”, “ABA for teens”)

– Location-based terms (e.g., “ABA therapy in [City]”, “ABA services near me”)

– Symptoms or conditions-specific terms (e.g., “therapy for autism”, “help for children with ASD,” “ABA for hand waving”)

Organize Keywords into Ad Groups

An ad group is a container used to match keywords and ads together. Without ad groups, you would not be able to tailor your ad content to the nuances of intent implied by the specific searches different people make.

Using ad groups, someone who searches for “center-based ABA therapy” can be shown a different ad than someone who searches for “in-home ABA therapy.” 

Ad groups allow you to create more relevant ad copies and improve the overall performance of your campaigns. 

Looking at your keyword research, try to categorize the keywords based on user intent. For example, someone searching “what is ABA therapy” is looking for information, whereas someone searching for “ABA therapy near me” is looking for services. You may want to remove informational searches from your list altogether… or keep them to get cheaper clicks that may yet convert.

Next, divide your keywords into thematically consistent ad groups. We usually group keywords by the similarity of the words they contain. For example, “ABA therapy” and “ABA therapy near me” might be in one ad group, while “applied behavior analysis” and “applied behavior analysis services” might be in another. This makes it easy to write headlines that are highly relevant to all keywords in the ad group.

Within each ad group, consider using different match types to manage how broadly your ads will be triggered. Match types are beyond the scope of this guide but reference this help article for more information.

Utilize Negative Keywords

Add negative keywords to prevent your ads from appearing for unrelated searches. For instance, if your practice doesn’t offer assessment services, list keywords like “autism assessments” or “diagnosis” as negative keywords.

Craft Relevant Ads

Create ad texts that are directly relevant to the keywords in each ad group. This increases the relevance of your ads, improving both clickthrough rates (CTR) and conversion rates. Make sure that your landing page content is also aligned with these ad messages.

Google only allows 30 characters in headlines and 90 characters in descriptions (including spaces). This makes it challenging to get across everything you would like to about your services. 

Do the best you can with the space available, include multiple headline and description options for Google to optimize, and be sure to follow Google’s terms of service to avoid getting your ads disapproved. Include headlines that have calls to action, headlines that reference keywords in your ad group, and headlines that mention the advantages of your services over competing ABA practices.

Speaking of competitors, it is wise to perform some Google searches and observe how your competitors write their ads.

Continuous Optimization

Regularly review the performance of each ad group. Look for opportunities to split ad groups further if you find that some keywords perform significantly differently from others within the same group. This will help you refine your targeting and improve ad performance over time.

Utilize Ad Extensions

Ad extensions improve the visibility and effectiveness of your ads. Use location extensions to show your therapy center’s address, sitelink extensions to direct users to specific pages like testimonials or contact forms, and call extensions to allow instant phone calls directly from the ad.

Set Up Geo-Targeting

Carefully select the locations you want to target. You can target entire states, DMAs, cities, or zip codes. You can also place pins on the map with a desired radius.

If your areas overlap places you don’t service, be sure to exclude the locations you don’t service. For example, if you are near the border of the state you are located in, you can exclude the neighboring state so that you don’t waste your budget on clicks from across the border. (Though commercial insurances may actually allow you to service families across the border… check with your provider representatives.)

Determine Budget and Bidding

We recommend starting with a budget of at least $50/day per campaign on Google Ads so that you can get enough clicks to realize the benefits of data for optimization purposes. Setting your budget too low will result in poor results. While $50/day is the minimum we endorse, $80/day is much better.

In Google Ads, choosing the right bidding strategy is crucial as it directly impacts how your ad budget is spent and how effectively your ads can reach potential customers. Google offers various automated bidding strategies that optimize bids using machine learning according to specific goals. Here’s a detailed explanation of the three strategies most relevant to ABA practices: Max Clicks, Max Conversions, and CPA (Cost Per Acquisition) Bidding.

1. Max Clicks (Maximize Clicks)

– Objective: The primary goal of the Maximize Clicks strategy is to drive as much traffic to your website as possible within your set budget.

– How it works: This strategy automatically sets your bids to get the most clicks within your daily budget. It’s particularly useful if your main objective is to increase website visits without a specific focus on the quality or conversion potential of that traffic.

– Best used when: your campaigns are new, and Google doesn’t have enough data to maximize conversions. Get conversions going on a Max Clicks strategy, then upgrade to Max Conversions.

 2. Max Conversions (Maximize Conversions)

– Objective: Maximize Conversions aims to get the most conversions possible within your specified budget.

– How it works: This strategy uses advanced machine learning to automatically optimize bids and offers personalized bidding for each auction. The system analyzes various signals at auction time to find the bid likely to result in a conversion, adjusting to maximize conversion potential.

– Best used when: you have enough data for Google to know how to optimize your campaigns for conversions.

 3. CPA Bidding (Cost Per Acquisition, or Target CPA)

– Objective: Target CPA bidding focuses on acquiring new customers at a target cost per acquisition that you set.

– How it works: You set a target CPA, which is the average amount you want to pay for a conversion. Google Ads then automatically sets your bids to try to get as many conversions as possible at the specified CPA. This strategy also utilizes machine learning to optimize bids and adjusts bids based on the likelihood of conversion in each auction.

– Best used when: you have a significant volume of conversions that Google can use to feed its machine learning.

Sometimes we skip Maximize Clicks and go straight to Maximize Conversions as our bidding strategy… but we definitely do not endorse going straight to a Target CPA bid strategy.

Follow Regulations

Ensure that all your ad content complies with Google’s advertising policies and any legal requirements relevant to medical or therapy services advertising.

Google Ads is a complicated platform, and there is plenty more to learn, but the information above should get you heading in the right direction.

Chapter 7: Meta Ads for ABA Therapy Practices

Meta’s platforms are designed to be at least mildly addictive by providing people with hits of dopamine as they engage on Facebook and Instagram and enjoy likes, comments, and shares.

Thus, the mindset of people on Meta is very different from the mindset of people searching Google. A Google searcher is setting out to discover information or find a service/product.

A Meta user is getting their dopamine fix.

Thus, the goal when using Meta Ads is to get people to stop mindlessly scrolling for the next dopamine release and focus instead on what you have to offer, and then get in touch with you so you can start a conversation.

IMPORTANT: What to Know About Starting and Maintaining a New Meta Ads Account 

Most businesses whose services you buy try to treat you well because they want to make money from you. 

Meta is an exception. Meta doesn’t view itself as needing you. They view you as needing them. And they are often quite bureaucratic and even unfair in the enforcement of their many rules.

When you start a Meta Ads account, one of the first things you can expect is a big red banner saying that your account, which is about three minutes old, is already banned!

Click a few buttons, and you will be taken to a screen where you are asked to upload a photo of your ID. Make sure that all four corners of the ID are visible and that the background behind the ID is dark. Don’t try scanning your ID because scans are easier to modify to create images of fake IDs and Meta doesn’t like them.

Once you submit your ID, you won’t hear anything at all from Meta, even if your ID is accepted and your account is enabled. The only way to find out what is going on is to navigate to your account and find out.

If Meta rejects your ID, they will give you 30 days to upload a new picture. If you don’t, your account will be locked forever.

Meta TOS

Once you start creating Meta Ads, it is very important to follow their terms and conditions. If too many of your ads get disapproved, your account could get restricted.

The most important rule to be aware of as an ABA therapy practice is that healthcare businesses are not allowed to use the second person (“you”/“your”) in a sentence that also contains the name of a medical condition or treatment. For example, the sentence “Your child with autism will love our play-based therapy approach” would get automatically disapproved because it contains the words “Your” and “therapy” in the same sentence. The reason for this rule is so that people don’t think you have private data on them that you are using to deliver ads that say “you” or “your” in conjunction with something medical.

However, your ads can contain sentences with “you” or “your” that don’t mention anything medical, such as “Get your free consultation today!”

Meta uses an automatic system to review ads after they are published. The system sometimes makes mistakes, in which case you can appeal to customer support. 

One of the silliest disapprovals I got was because I had supposedly broken the policy against advertising tobacco policies by posting an ad with a stock video that looks like this:

I simply couldn’t convince Meta that the child in the picture is sucking on a lollipop, not smoking a cigarette.

Account Spend Limits

Most new Meta ad accounts come with a $25/day or $50/day spend limit. It takes two to three months of consistent advertising to get those limits raised.

A budget of $25/day to $50/day is way too low for our clients, whom we advise to spend at least $85/day (but preferably $125/day or more). 

One workaround to the problem of account spend limits is to operate more than one account, owned by different people. If there is someone in your organization or family you can trust and who is willing to help you out, you can guide them through the process of creating a Meta Ads account, giving you access to it, and putting your credit card number on it.

For our clients who would prefer not to ask others to open or lend accounts on their behalf, we have a partner that we work with to provide ad accounts for temporary use side-by-side with your own ad account so you can spend more on ads while waiting for the spend limit to be raised.

So Why Bother with Meta?

If Meta is so unreasonable and difficult to work with, why bother using Meta Ads?

I can’t speak for other agencies or advertisers, but our strategies yield leads at an average cost ranging from $15 to $45 each depending on a variety of factors. The ability to generate 100, 200, or more leads per month in this price range is a game changer and absolutely worth putting up with Meta’s poor manners to benefit from.

Meta Ad Account Structure

Let’s discuss how Meta Ad accounts are structured:

In Meta Ads (formerly known as Facebook Ads), understanding the structure of campaigns and ad sets is crucial for organizing and optimizing your advertising efforts. This platform structures its advertising hierarchy into three main levels: Campaigns, Ad Sets, and Ads. Here’s a detailed look at the first two levels: Campaigns and Ad Sets.

Campaigns

The campaign is the highest level in the Meta Ads structure. It defines your main advertising objective, which is what you want to achieve with your ad. Meta offers a variety of campaign objectives to match your marketing goals, such as:

– Brand Awareness: increasing awareness of your brand among a target audience.

– Traffic: driving traffic to a specific website, app, or Facebook event.

– Engagement: increasing engagement on your Facebook page or posts, including likes, shares, and comments.

– App Installs: encouraging downloads of a mobile app.

– Video Views: promoting video content to increase views.

– Lead Generation: collecting lead information, such as email addresses, from people interested in your product.

– Conversions: encouraging actions on your website, like purchasing a product or signing up for a newsletter.

– Sales and Catalog Promotions: linking ads to your product catalog to boost sales.

Each campaign houses one or more ad sets and is focused solely on achieving this chosen objective. This focus allows you to tailor your efforts and measure the success specific to your goal.

Ad Sets

Within each campaign, ad sets are where you make important decisions about how your ads are run:

– Target Audience: Here, you define who will see your ads. You can target based on demographics, interests, behaviors, and more. You can also use Custom Audiences to retarget people who have interacted with your business before or Lookalike Audiences to reach new people who are similar to your best customers.

– Budget and Schedule: You specify how much money you want to spend on the ad set and whether that budget is spent continuously or during a specified period. You can choose between a daily budget or a lifetime budget for the entire duration of the ad set.

– Placement: This refers to where your ads will appear. You can let Meta choose the most optimal placements with Automatic Placements or select specific locations like the Facebook News Feed, Instagram Stories, Messenger, Audience Network, and more.

– Bidding and Optimization: Choose how you want to bid for ad space and what event you want to optimize for. For example, if your campaign objective is conversions, you can set the ad set to optimize for conversion events like purchases.

Relationship Between Campaigns and Ad Sets

The relationship is hierarchical and strategic:

– Campaigns set the objective and serve as the umbrella under which all related advertising activities are grouped.

– Ad Sets within those campaigns allow for detailed control and targeting, ensuring that different segments of your audience can be reached effectively and efficiently according to the campaign’s overarching goal.

– Multiple ad sets can be used to test different audiences, budgets, and placements to see which combinations perform best towards the campaign’s objective.

This structure helps advertisers manage and organize their ads based on different parameters and goals at each level, allowing for detailed customization and optimization based on performance data.

Choosing a Campaign Objective

Conventional wisdom (and lots of SEO-optimized “content”) will tell you that Meta Ads campaigns should start with ads that are optimized to “build your audience.” Select “engagement” or “brand awareness” as your campaign objective and establish an audience interested in our content, feed them content, and then serve conversion ads.

This approach is great for Meta because you’ll have to buy more ad space to make such a strategy work. It’s also great for consultants who want to present themselves as strategic and well-thought-out.

Building an audience first, providing valuable content, and then serving ads is a strategy that may be appropriate for businesses that need prospects to warm up to them. 

I am convinced – and I have the numbers to back up my conviction – that there are more than enough parents of children on the spectrum out there who are willing to talk to therapy providers without much prior introduction to obviate the need for a prolonged and costly strategy of building relationship through ads before asking for parents to take action.

Why waste a fortune on extraneous and time-consuming creatives and advertising spend when you can advance straight to getting parents to contact you and then send them automated SMSs and marketing emails to build relationship and get people on the phone? 

(Yes, that’s a 42-word rhetorical question.)

We advise our clients to go straight for the “leads,” and it works. At least, for us it works.

Budgets and Scaling

As referenced above, we recommend that ABA therapy practices spend $85 or more per day on Meta Ads. We prefer a budget of $125/day if possible. Our reasoning for this is that $20/day is a good starting budget for each ad set (container of ads and audience), with the exception of remarketing ad sets which should have a budget of $1/day. $85/day allows for four primary ad sets with a budget of $20/day each and five remarketing ad sets of $1/day each.

Over time, we adjust budgets based on performance and various strategic factors. 

When our clients start getting leads, they sometimes get excited and want to drastically increase their budget. That isn’t always a good idea because any given local area has only a limited number of people. Raising your budget too high will oversaturate your audiences and make them annoyed with you because they will see your ads too frequently. It’s much better to take things at a reasonable pace.

One challenge you may encounter when scaling your budget up is that doing so too quickly can ruin your performance. We recommend thinking through how to scale up your budgets safely so you don’t lose steam. If a budget change is quite considerable, we will often duplicate the original ad set, pause the original ad set, and then raise the budget in the duplicate to our target budget. That way, if the budget change doesn’t work, we can just go back to the original.

Audience Management

Meta Ads are most effective across large populations (three million or more). Most ABA therapy practices don’t have the luxury of advertising to more than one million people per audience… and many have to make do with audiences smaller than a quarter million.

Smaller audiences have fewer people who may be interested in your services available to reach, making it harder for the Meta Ads algorithm to match your ads to the right people.

Additionally, Meta does not provide you with targeting options directly related to autism. The best you can do is try to discover proxies correlated with a likelihood that someone may have a child with autism.

Managing your audiences entails keeping a close eye on ad performance. Eventually, your ads will reach a point where they have been shown to so many people in your audiences that they no longer return good results. 

So remember – Meta Ads are not a “set it and forget it solution” except in rare circumstances. You need to be actively managing your account or performance will quickly fade.

Written Ad Content

Conventional wisdom holds that ads must be short, or people won’t read them. There is certainly a truth to that, but we find that long Meta ads often do very well.

One reason why we can go long with Meta ad content is that Meta hides your ad content past the first few sentences. This makes the ads appear short for long enough to get people to start reading – and get hooked.

Also, people can choose to simply not read the whole ad but click it anyway.

Your ads on Meta can be written in a straightforward manner, describing your services. Or they can be written very creatively, relating to parents’ emotions, hopes, and dreams… or introducing interesting and exciting ideas that get parents curious.

But to write good ad content, you’ll need to fully understand your target market.

What are common experiences that parents of children with autism have?

What are common challenges their children struggle with?

What are parents’ hopes and dreams for their children?

What do they want from a therapy program?

What are they seeing from other therapy providers – and how can you position yourself differently?

Start seriously thinking about these questions, and you’ll be on your way to ads that stand out and convert.

Visual Ad Content

Creating compelling images and videos for Meta Ads, especially for a specialized service like ABA (Applied Behavior Analysis) therapy, requires a thoughtful approach that respects the sensitivities of the audience while effectively conveying the message. Here’s a step-by-step guide to developing high-quality visuals that resonate with parents and caregivers of children with autism.

1. Focus on Authenticity

Choose imagery and video content that represents realistic scenarios rather than staged or overly polished visuals. Authenticity can help build trust with your audience, showing a true representation of what clients might expect from your therapy services.

2. Highlight Positive Outcomes

Use visuals that depict positive interactions and outcomes from ABA therapy. Images of children engaging happily with therapists, showing progress, or participating in activities can be powerful. 

3. Clear, Concise Text Overlays

When using text overlays in your images or videos, keep the text clear and concise. Use large, readable fonts and contrasting colors to ensure that your message is easy to understand at a glance. The text should reinforce the message conveyed by the visual content without overwhelming it.

4. Optimize for Mobile

Since many Meta ads are viewed on mobile devices, ensure your visuals look good on smaller screens. This means avoiding overly detailed images that can become lost on a small display and checking that text overlays are legible on mobile.

5. Get Creative

Consider using interesting or surprising visuals that prompt positive emotions or curiosity in your audience.

6. Standard Enhancements

Consider enabling Meta’s standard enhancements feature to allow Meta to modify images or videos for better results.

7. Test and Refine

Experiment with different types of images and videos to see what resonates best with your target audience. Use Meta’s ad performance tools to track which visuals are performing best and refine your strategy accordingly.

By carefully crafting your images and videos with these guidelines, you can effectively communicate the value of your ABA therapy services to the right audience through Meta Ads, thereby increasing engagement and attracting more clients to your practice.

Chapter 8: Ethical Considerations and Compliance

Section 5 of the Behavior Analyst Certification Board’s (BACB’s) ethics code includes ethical standards related to marketing. 

People tend to view advertising as a necessary evil and marketing professionals with a degree of distrust and skepticism – and for good reason! Firstly, nobody likes that we are bombarded by advertising every day. Many ads create desire for things people don’t need by preying on human frailty. Many ads are dishonest. A world full of advertising promotes material excess.

Therefore, some may be inclined to try and apply Section 5 of the code with stringent interpretations that would make it very hard to describe ABA therapy in a way that is at all appealing (as you may infer from a real-life example described below).

However, there are problems with taking an overly strict approach to the application of Section 5:

1. ABA therapy is much maligned by the anti-ABA therapy crowd. ABA therapy needs to speak up for itself effectively to explain the benefits it provides.
2. ABA therapy companies owned by non-practitioners do not have an ethical obligation to follow the BACB code. Section 5 puts clinician-owned practices at a disadvantage, and interpreting the code more strictly than necessary only exacerbates that disadvantage.
3. ABA therapy is medically necessary and effective for most recipients. Effective advertising helps more children receive the treatment they badly need. We need to be honest when advertising, but we also need to do a good job of it. Otherwise, people will needlessly suffer.

Some of the rules are standard in healthcare, such as 5.02 which requires that you maintain the confidentiality of your “clients, supervisees and trainees except when allowed.”

I have found that Rules 5.03, 5.04, 5.06, and 5.07 require some discussion.

Let’s go through each of them…

Rule 5.03

Rule 5.03 states: 

When providing public statements about their professional activities, or those of others with whom they are affiliated, behavior analysts take reasonable precautions to ensure that the statements are truthful and do not mislead or exaggerate either because of what they state, convey, suggest, or omit; and are based on existing research and a behavioral conceptualization. Behavior analysts do not provide specific advice related to a client’s needs in public forums.

Standard advertising practice includes exaggeration. Red Bull “gives you wings.” BMWs are “the Ultimate Driving Machine.” And so on…

The average person is skeptical about advertising claims and automatically interprets them in a watered-down way: Red Bull doesn’t really give you wings, it just makes you feel like you have lots of energy because it has lots of caffeine. BMWs probably aren’t the “Ultimate Driving Machine” (as Ferrari drivers can probably attest), but they do handle really well.

Given that some degree of exaggeration is the norm in commerce, one could say that BACB is asking BCBAs to go above and beyond basic ethical requirements with rule 5.03. But how strict is 5.03?

One organization I worked with had a clinical director who expressed concerns about ads that I wrote which stated that ABA therapy helps children in a number of ways. To protect the exact content I wrote, I am obscuring most of it in the representation below:

ABA therapy helps kids with autism:

• (Enjoy Benefit 1)
• (Enjoy Benefit 2)
• (Enjoy Benefit 3)

The therapist was concerned that this text exaggerates the efficacy of ABA therapy because not all children who receive ABA therapy will realize these benefits.

I countered that people will use common sense when reading this statement and understand that we don’t mean to say each and every child will get the benefits we are listing. Rather, people will understand that we are stating what will usually happen.

Another advertisement I wrote stated that ABA therapy helps children with autism enjoy greater happiness. 

I expressed this therapist’s concern to Dr. Jonathan Bailey, who operates the BACB Ethics Hotline. Dr. Bailey agreed with my position that the text I had written was not exaggerated.

What I learned from this interaction is that the BACB makes room for common sense and good judgment to be made. It does not expect advertising to be written with the scientific rigor of an academic paper. BACB allows for ads to be written in a natural, human way without over-complicating things.

Rule 5.04

Rule 5.04 states:

Behavior analysts are responsible for public statements that promote their professional activities or products, regardless of who creates or publishes the statements. Behavior analysts make reasonable efforts to prevent others (e.g., employers, marketers, clients, stakeholders) from making deceptive statements concerning their professional activities or products. If behavior analysts learn of such statements, they make reasonable efforts to correct them. Behavior analysts document all actions taken in this circumstance and the eventual outcomes.

Rule 5.04 appears to me to be an attempt to even the playing field between practitioner-owned ABA therapy practices and practices owned by non-practitioners.

BCBAs who own practices have to abide by the ethics code, and if they do not then they can be subject to various penalties.

Non-BCBAs owe no fealty to BACB. They are bound by the general rules of ethics (let’s leave aside what those rules actually are for the purpose of this guide), but they are not ethically bound to follow BACB. Furthermore, BACB cannot directly punish them other than by naming them in seminars as examples of companies violating the code.

This means that BCBA-owned practices may not always be able to advertise with the same persuasiveness as non-BCBA-owned practices.

By expecting BCBAs to pressure their employers to follow the code with regards to marketing, the BACB is trying to create a mechanism to make things fairer for practitioner-owned ABA therapy companies.

Having observed the marketing practices of a fair number of ABA therapy practices, I can state with confidence that many of them have various violations of the rules (including plenty of practitioner-owned practices!). And so, I believe 5.04 is only of limited efficacy.

In any event, a situation where rule 5.04 came to the fore was an SEO project. 

At Reputation Elevation, we create lots of written content for our SEO clients in order to get better search engine rankings. The purpose of that content is not so much for people to read lots of blog posts but for Google to see that your website has lots of blog posts and rank you higher.

We explain to clients that our writing isn’t Shakespeare. It won’t win any Pulitzer Prizes. But it will help you get found by more parents. And if a client doesn’t like something we write, we are always happy to correct it. 

It is inevitable that we are occasionally going to have factual errors in our writing because we are producing many tens of thousands of words of content monthly.

A BCBA working for one of our clients was concerned because she read a blog post stating:

ABA therapy teaches strategies to manage emotions, reduce meltdowns, and promote self-control.

She said that this statement was incorrect because ABA therapy does not directly teach “strategies to manage emotions.” Talking with other BCBAs, I believe it could be argued that ABA teaches such strategies at least indirectly. But having seen this one blog post, the BCBA was concerned that she would now need to read through and make corrections in 5,000 words of content or more per month.

I wasn’t privy to the actual conversation with Dr. Bailey. However, the outcome of that meeting was that we could keep writing as we please, and the BCBA needn’t review all of our work. 

I believe the reason for leniency in this case is that the code states:

Behavior analysts make reasonable efforts to prevent others (e.g., employers, marketers, clients, stakeholders) from making deceptive statements.

It is not reasonable to expect a BCBA to read over large amounts of content every month, so BACB doesn’t require it.

(Again, I will emphasize that we don’t try to make mistakes in our writing and we are happy to correct any that are found.)

Rule 5.06

Rule 5.06 states:

Behavior analysts do not advertise nonbehavioral services as behavioral services. If behavior analysts provide nonbehavioral services, those services must be clearly distinguished from their behavioral services and BACB certification with the following disclaimer: “These interventions are not behavioral in nature and are not covered by my BACB certification.” This disclaimer is placed alongside the names and descriptions of all nonbehavioral interventions. If a behavior analyst is employed by an organization that violates this Code standard, the behavior analyst makes reasonable efforts to remediate the situation, documenting all actions taken and the eventual outcomes.

I find rule 5.06 to be quite impractical because:

1. Disclaimers imply something is wrong or bad. If an ABA therapy practice also provides speech therapy but includes a disclaimer in its advertising that “speech therapy is non-behavioral”, this will mislead people to think something is wrong with it being non-behavioral. Speech therapy (and occupational therapy) are respected treatments considered medically necessary that help many millions of people. Why cast aspersions on them with disclaimers?
2. Many advertising formats simply don’t allow for disclaimers. For example, Google Search Ads allow for two to three headlines of 30 characters each, and a 90-character description. Adding a disclaimer to your OT or speech therapy services would take up too much space – and completely ruin your ad performance.

I also believe rule 5.06 is unreasonable. It seems to imply that people will be harmed by the mere misperception that a service is behavioral. 

You might be convinced that behaviorism is the best approach available in psychology and that mentalistic concepts are intrinsically flawed because they cannot be directly observed. You are entitled to your views.

Yet most of the field of psychology disagrees. 

That being the case, why base the code on a presumption that in the event a parent gets confused and thinks a non-behavioral service is behavioral, they will be harmed?

Do we think the average parent out there is a dedicated behaviorist, rejecting non-behavioral forms of therapy, yet doesn’t know enough about behaviorism to realize that OT, speech, and other services are non-behavioral? If a parent knows enough about psychology to have an opinion about behaviorism, they also have enough knowledge to know that OT and speech therapy are non-behavioral.

The reality is that most parents don’t know and don’t care what behaviorism is. They will not read an advertisement from ABC ABA Corp for speech therapy and muse to themselves, “Speech therapy must be a behavioral therapy because ABC ABA Corp offers it. Count me in!” Or, “I always wanted a speech therapist whose therapy is informed by their BACB certification!”

I do not understand who 5.06 is there to protect, or from what harm.

Now, the good news is that 5.06 is much more limited in scope than some may think.

We wrote an ad that quoted a peer-reviewed study about how having good relationships is correlated with greater happiness and said that ABA therapy can help people live happier lives because it helps people maintain better relationships.

A BCBA was concerned about this ad because the study quoted was non-behavioral in nature.

We brought this matter to Dr. Bailey’s attention, and he confirmed that it was no problem at all. 5.06 does not preclude BCBAs from referencing non-behavioral research or concepts. It just precludes them from implying that non-behavioral services are behavior and requires them to disclaim that non-behavioral services are non-behavioral… but I have never seen anyone actually do so.

With all due respect to the BACB, I believe 5.06 is quite impractical and superfluous. I encourage the BACB to reconsider it.

Rule 5.07

Rule 5.07 states:

Because of the possibility of undue influence and implicit coercion, behavior analysts do not solicit testimonials from current clients or stakeholders for use in advertisements designed to obtain new clients. This does not include unsolicited reviews on websites where behavior analysts cannot control content, but such content should not be used or shared by the behavior analyst. If a behavior analyst is employed by an organization that violates this Code standard, the behavior analyst makes reasonable efforts to remediate the situation, documenting all actions taken and the eventual outcomes.

BACB is concerned that a parent may share a testimonial because they feel pressured to by a desire to obtain or maintain favor in the eyes of their therapy provider.

Unfortunately, Rule 5.07 causes serious problems for therapy practices.

Is it fair to tell clinician-owned practices that they can only request reviews in particular circumstances (such as a former client), while practices owned by non-practitioners can request reviews at will?

All it takes is one upset parent to write a one-star review on your Google Business profile for a business to suffer serious reputational harm and lose out on cases. 

People get requests for reviews all the time. If you download an app from the app store and start using it, you will probably get a review request after a while. 

Review requests are part of ordinary life.

My suggestion to BACB is to state that review requests can only be made in ways that minimize the perception of pressure, such as by sending clearly templated emails from an office email that are easier to ignore than a direct request in person from a therapist.

This modification to the rule would better balance the practical needs of clinicians to protect their reputations, better level the playing field, and still protect parents from unwanted pressure.

In the meantime, the best course of action to take is to ask your employees to provide good reviews on your Google Business profile.

Speaking of reviews, you may be wondering what clients are saying about Reputation Elevation’s marketing services. I invite you to visit our reviews page. In keeping with rule 5.08, I must disclaim that they were mostly solicited.

Conclusion

ABA therapy has changed the lives of countless children across the country (and that’s no exaggeration, my dear ethics code-familiar friends!).

Yet marketing ABA practices is not always so straightforward because of the complications involved in finding cases with the right insurance, diagnosis, age, and availability. 

If you need help promoting your ABA therapy practice to attract cases and/or staff, I encourage you to book a free consultation with me right here. We will discuss your challenges and goals and explore whether our solutions can help you.