Where is there room for improvement in the ABA industry? A sit-down with Meaghan Timko

SPECIAL NEEDS CARE NETWORK | INDUSTRY SPOTLIGHT

Where is there room for improvement in the ABA industry? A sit-down with Meaghan Timko A conversation with Meaghan Timko, Chief Operating Officer at Gradual Behavioral Health, on ethics, industry accountability, and how families can navigate their options. By Special Needs Care Network | 

Meaghan Timko did not expect much when she made a post on LinkedIn. A colleague texted her shortly after to let her know it had gained widespread attention.

The timing reflected a broader moment. A Wall Street Journal investigation into ABA billing practices had recently been published. A network of clinics in Alabama had been shut down. And conversations that had been happening quietly among parents, providers, and industry insiders were becoming more public.

Meaghan has worked in the ABA field since 2003. She trained under Dr. John Bailey at Florida State University and serves as Chief Operating Officer at Gradual Behavioral Health in North Atlanta. The Special Needs Care Network team sat down with her to discuss what families should know, what she observes in the industry, and why she believes the field is moving toward stronger accountability.

The Special Needs Care Network Team sat down with Meaghan to find out her perspective on what might be changing in the industry. 

There has been increased attention on the ABA industry lately. What is your read on the current landscape?

It is important to start by acknowledging that many providers are doing genuinely good, ethical work. That is the foundation of this field. At the same time, there are structural issues worth understanding, and I think it helps to hear them from someone who has watched this field evolve over time.

The way insurance reimbursement is structured has created incentives that do not always align with what is best for an individual child. In some cases, high therapy hours are recommended without clear individualized justification. The clinic model became more prominent after insurance mandates passed, and not every organization has managed that growth carefully. That is worth being transparent about.

When I returned to the field after a time working at Emory, I had to learn quickly how the landscape had changed and who was operating responsibly. The average parent is navigating this without that background, which is not a criticism of families. It is simply the reality of how complex the system has become.

"The average parent is navigating this without that background, which is not a criticism of families. It is simply the reality of how complex the system has become.”

What should parents keep in mind when evaluating a provider?

One of the first things to look at is how hours are being recommended. If a clinic suggests a high number of weekly hours without first taking time to understand your child's specific needs, that warrants a closer look. Not every child needs a clinic-based setting at all. A strong provider will explain their rationale clearly and tailor recommendations accordingly.

Staffing is also worth attention. There is currently a shortage of experienced clinicians, and some clinics are pairing newer BCBAs with newer RBTs. To explain the roles: a BCBA (Board Certified Behavior Analyst) is the licensed clinician who designs and oversees your child's therapy program. An RBT (Registered Behavior Technician) is the person who works directly with your child day to day. Experience matters at both levels, and it is reasonable to ask about it.

Other things to consider: how well a provider communicates with parents, whether staff turnover is high, and whether your child's program feels genuinely individualized or more like a standard template.

You mentioned the Alabama clinic shutdown. How significant is this moment for the industry?

I think it signals that scrutiny of the field is increasing, and that is not entirely a bad thing. Billing fraud, particularly involving Medicaid, is taken seriously by federal and state agencies. Other industries have gone through similar accountability moments. My sense is that the ABA field is entering one now. Providers operating responsibly have little to worry about. Those who are not will face consequences.

What does a strong ABA provider look like in practice?

A good provider completes a thorough assessment before making any recommendations. They can clearly explain their reasoning. Parents should feel like active participants, not recipients of a predetermined plan. The program should be reviewed and updated as the child grows and progresses.

Meaningful outcomes should be the focus, not hours billed. And community presence matters. A provider embedded in the local community, with visible leadership and accountability, is generally a different operation from one that is remotely managed with limited local oversight.

“A provider embedded in the local community, with visible leadership and accountability, is generally a different operation from one that is remotely managed with limited local oversight.”

What questions should families ask before starting services?

Ask about the clinic's leadership and their involvement. Ask the BCBA about their experience, including whether they have worked with children presenting similar needs to your child. Ask how frequently the program is reviewed, what parent involvement looks like, and what outcomes they have achieved with comparable cases.

A good provider will answer those questions directly and welcome the conversation. Vague or evasive responses are worth paying attention to.

Can you speak to the difference between clinic-based and community-based therapy?

Both have their place, and that is an important distinction. Early in my career, therapy was often delivered in homes, schools, and community settings, which allowed us to work with the child in their natural environment and to support the family directly. That model still has real value.

Clinic-based settings are appropriate for certain goals, such as social skills development, adaptive daily living skills, and structured learning activities. The concern is when clinic-based therapy becomes the default for every child regardless of fit. Families deserve options and clear reasoning for what is recommended.

What is your view on telehealth in ABA?

For RBTs providing direct therapy, telehealth is generally not clinically appropriate outside of exceptional circumstances like the COVID period. There is simply too much that is lost without in-person interaction.

For BCBAs, I see it differently depending on the context. There are families in rural areas with limited local access to qualified clinicians. In those cases, telehealth supervision or parent training can be a reasonable option.

What matters most in telehealth is experience. A BCBA working remotely needs a strong clinical foundation. Virtual interaction removes a lot of contextual information that a skilled clinician would typically rely on, and that gap becomes more significant with less experience.

How should parents approach finding a provider in a crowded market?

Look for transparency. A quality provider will tell you who is on their team, what their training and experience levels are, how they measure outcomes, and how they involve families in the process. They will not make you feel like asking those questions is a burden.

The field is going through a period of change, but I believe what comes out on the other side will be stronger. Providers who operate with integrity, clinical rigor, and real accountability are the ones who will continue to serve families well. And the majority of people in this field genuinely care about the children they work with. That matters, and it is worth saying clearly.

Final Thoughts

The ABA field includes many dedicated professionals who are making a meaningful difference. That is the foundation.

At the same time, families are best served when they feel comfortable asking questions, understanding what is being recommended and why, and trusting their instincts when something does not feel right. An informed family is a stronger advocate for their child.

About Meaghan Timko 

Meaghan Timko, MS, BCBA, LBA is the Chief Operating Officer of Gradual Behavioral Health in Atlanta, Georgia. With more than 25 years of experience in Applied Behavior Analysis, Meaghan has built her career at the intersection of clinical excellence, systems leadership, and sustainable business practice.

Before joining GBH, Meaghan founded Parallel, a neurodiversity consulting practice focused on advising families navigating the transition to adulthood. She is the co-author of the Amazon bestselling book The RoadMap Lab, and has led projects at the Emory University Autism Center. She continues to work with families around the globe on best practices for inclusion and transition planning.

A recognized voice in the ABA community on topics including values-based care, ethical practice, and the evolving role of private equity in behavioral health, Meaghan writes and speaks at the edge of where clinical integrity meets business reality. Off the clock, she can be found disappearing into the wilderness and climbing mountains. She is an avid traveler, an accomplished pianist, and — most importantly — a proud wife and mother to two wonderful daughters.

Disclosure: Special Needs Care Network (SPCN) is not affiliated with Gradual Behavioral Health and does not endorse or partner with Meaghan Timko's clinic or any specific ABA provider. This interview is published for informational purposes only as part of SPCN's ongoing effort to help families ask better questions when navigating special needs services. Opinions expressed do not necessarily reflect SPCN's.

Special Needs Care Network | specialneedsusa.com | Published March 2026