How to Start an ABA Practice: A Clear Roadmap for Clinicians

Written By Nandi Nelson

Starting an ABA practice is one of the most meaningful steps you can take as a clinician — and also one of the most intimidating. You’re highly trained in assessment, treatment planning, and behavior change, but no one really sat you down and said, “Here’s how to open and run a business.”

If you’ve ever thought, “I know I can help people, I just don’t know how to build the structure around it,” this roadmap is for you.

This is a clear, clinician-friendly guide to help you think through the major phases of starting an ABA practice with intention and alignment.

1. Clarify Your Service Model

Before you apply for anything or build anything, you need to know what kind of services you actually want to provide.

Common ABA service models include:

  • Home-based ABA

  • Center-based ABA

  • School-based contracts

  • Parent training and coaching

  • Social skills groups

  • Early intervention services

  • Consultation-only or supervision services

You don’t need to offer everything at once. In fact, trying to do it all in the beginning is one of the fastest paths to burnout.

Ask yourself:

  • What type of work do I enjoy most?

  • Where do I do my best clinical work?

  • What resources do I realistically have right now?

  • What is needed in my local community?

Pick one primary service model to start. You can always expand later.

2. Understand the Legal & Compliance Basics

This will look different depending on your state and country, but in general, most ABA practices will need:

  • A legal business entity (LLC, PLLC, S-Corp, etc.)

  • An EIN/Tax ID

  • An NPI (individual and/or organizational)

  • Liability insurance

  • A business bank account

  • Compliance with HIPAA and privacy standards

  • Policies and procedures that match funding source requirements

  • If center-based: zoning, lease terms, safety requirements, and local regulations

You do not have to figure all of this out in one week. Create a checklist. Talk with:

  • An attorney for entity structure and contracts

  • A CPA for tax and payroll guidance

  • An insurance broker for liability and property needs

When you treat this as a series of steps instead of one giant, mysterious process, it becomes manageable.

3. Build Your Core Systems Early

Many clinicians wait to build systems until they’re “busy.” The truth is: you’re going to be busy the moment you open your doors.

Some of the essential systems you’ll want to outline from the start:

  • Intake & Referral

    • How do families find you?

    • What happens after an inquiry?

    • How do you collect intake information?

  • Assessment & Treatment Planning

    • What tools do you use?

    • How do you document your findings?

    • How do you communicate treatment plans to families?

  • Scheduling & Session Management

    • How will you schedule staff and clients?

    • What’s your cancellation policy?

    • How will you prevent double-bookings?

  • Documentation

    • Session notes

    • Progress reports

    • Authorizations and re-authorizations

    • Incident reports

  • Billing & Revenue

    • Who handles claims?

    • How are payments tracked?

    • What happens if a claim is denied?

These do not need to be perfect. They just need to be clear, consistent, and repeatable.

4. Choose Your Payers and Revenue Model

Not every ABA practice has to accept every payer. You can choose:

  • Private pay only

  • Private insurance only

  • Medicaid

  • A combination of the above

Each path has pros and cons in terms of:

  • Reimbursement rates

  • Administrative load

  • Documentation requirements

  • Access for certain families

Before you start credentialing “just because,” ask:

  • What does cash flow look like for each payer?

  • What are the documentation and audit expectations?

  • What timeline can I realistically manage?

Understanding how money flows into your business is part of stepping into your CEO role. It doesn’t have to be complicated, but it does have to be intentional.

5. Hire Slowly and Strategically

In the early stages, your “team” may be:

  • You (clinician/owner)

  • One RBT or behavior technician

  • Contract help for admin, billing, or bookkeeping

As you grow, you can add:

  • Clinical supervisors

  • Additional technicians

  • Operations/admin staff

  • Intake coordinators

What matters most is that your team is:

  • Properly trained

  • Clear on expectations

  • Supported with structure

  • A good fit for your values and mission

It’s better to build slowly with the right people than quickly with the wrong ones.

6. Shift From Clinician Thinking to CEO Thinking

Starting an ABA practice isn’t just about doing more of what you already do. It’s about learning how to:

  • Make decisions with incomplete information

  • Plan ahead instead of always reacting

  • Say no when something doesn’t align

  • Build systems instead of solving every problem manually

  • Protect your time and energy

You’re not abandoning your clinical identity — you’re expanding it. CEO is not “better” than clinician; it’s simply a different role with a different set of responsibilities.

7. Start From Alignment, Not Anxiety

The most sustainable practices are built from a place of:

  • Clarity

  • Intention

  • Ethics

  • Realistic capacity

You don’t have to rush. You don’t have to copy everyone else’s model. You don’t have to know everything today.

You can take one aligned step at a time — and still build something powerful.

If starting an ABA practice feels overwhelming, remember: you already have the hardest part — the ability to help people.

Everything else is “learnable”.

Nandi Nelson