We caught up with the brilliant and insightful Cristina Busu a few weeks ago and have shared our conversation below.

Hi Cristina, thanks for joining us today. We’d love to hear about how you went about setting up your own practice and if you have any advice for professionals who might be considering starting their own?

As a fresh graduate looking for some extra experience with children with autism, I stumbled into the profession of behavior analyst almost by accident. As an Early Intervention Specialist I had the opportunity to work with children with different abilities providing developmental therapy to address developmental delays. During this time, I was introduced to autism and I became fascinated with its complexity. While my job offered some opportunities to work with children with autism, I felt I needed more experience so decided to look for more ways to gain more experience. After doing a quick internet search for jobs with children with autism, an online directory of families looking for ABA therapists popped up. Although I didn’t know much about ABA I was willing to learn, to gain more experience by working with several amazing families who subsequently encouraged me to pursue this career. As I got more experience and realized how amazing this profession is, I decided to get the proper education, so I applied for a post graduate certification in Applied Behavior Analysis. The degree required 2 years of classes and 1500 of supervised field experience which I received from an ABA center. During this time, I learned a lot about behavior analysis, and I realized that my past experience as an early intervention specialist combined with my ABA training gave me a unique perspective on helping children gain skills to bridge the developmental gaps between them and their peers. After passing the board exam and becoming a Board Certified Behavior Analyst, I opened HHS in 2007. Starting a new business was scary but exciting. Because our field was fairly new at that time, and services were not covered by insurance, client enrollment was difficult so, for the first year, I took advantage of the low caseload and developed a lot of the curriculum and materials I needed. After the first year, as the client number grew, I leased a very small space to run social skills groups and hired my very first staff member. From there I built my clientele through “word of mouth” and by providing free parent training classes to the community to help more parents understand the need for therapy and the impact it has on a child’s learning. During the next decade laws changed and insurance started covering ABA therapy for children with autism which opened the door for more children to get the services they deserved. While it was so exciting to be able to serve more children, insurance contracts came with a lot of new obstacles. I had to learn how to code and how to bill, how to fight with insurance carriers to preapprove services, how to fight with them to pay for services that they pre-approved, and how to deal with denied claims. I think of all the obstacles I had to tackle over the years, dealing with insurance has been and continues to be the biggest challenge. Over the last 15 years we continued to grow, and today HHS has almost 100 employees and serves anywhere between 50-70 clients every day.

As always, we appreciate you sharing your insights and we’ve got a few more questions for you, but before we get to all of that can you take a minute to introduce yourself and give our readers some of your back background and context?

I moved to the US, from Romania, in 2000 to pursue a Master’s Degree in Early Childhood Disorders at UTD. I always loved working with children and this graduate program gave me an opportunity to learn about children with special needs and many ways to help them meet different developmental milestones. After graduation I worked for a year for Early Childhood Intervention, a program that provides developmental therapies to children with different types of abilities. During this time, I had an opportunity to work with a few children on the autism spectrum and I became fascinated with their uniqueness. Engaging and teaching children with autism presented a different type of challenge that I’ve never faced before because it required a different way of thinking about how learning needed to be approached. As my interest in autism grew, I wanted to learn more about it and find the best way to help. In my quest for new opportunities, I found ABA and fell in love with the approach and results it was providing. The first thing I loved about ABA was how the approach was setting the kids up for success thorough breaking developmental skills into small pieces so the kids can learn easier and be successful. I felt so impowered seeing how a lot of the maladaptive behaviors (aka bad behaviors) were replaced by appropriate communication and interactions by making some adjustments to the way we teach and arrange the environment. ABA was such a new field at that time, and although it did so many good things for children with autism, it also brought a lot of criticism from people who were just looking at old research or therapy provided by untrained individuals. One of the things I found difficult at the time, was the misinformation about what ABA can and cannot do, and how the therapy was implemented. I was so in love with the profession and saw firsthand what a difference it made in the life of many, I found it so frustrating to hear so much criticism related to teaching methods, skills targeted and the value of ABA. Because I believed so much in the power of ABA I made it a mission to show everyone what I was seeing so I used my experience to create an ABA curriculum that helped children gain skills in all developmental areas. I used all my previous experience and attended as many trainings as I could to learn how to help children learn how to talk, how to play appropriately with toys and with other children, how to have conversations, organize their thoughts and their school work, to self-manage intense emotions, and many other important life skills. That curriculum, that focusses on individualized teaching to address deficits in a unique way, became the HHS philosophy and it helped most of my clients get integrated in mainstream school classes. Some of those clients are now doing great in college and pursuing careers in majors they love, while others gained skills towards functioning independently with minimal support. The HHS curriculum was developed and improved over years to help children across different levels on the spectrum, verbal and nonverbal, to become independent, and overall improve their quality of life. Today, it makes me happy to see potential clients come to us because they “heard” that our approach helps children gain communication, social, and independent living skills that they can use in a meaningful way. As we grew over the years, I have been so fortunate to employ and train so many amazing staff who share my passion to help children grow into the best version of themselves, understand that every child matters, and dedicate so much to ensure that our clients receive the high-quality intervention they deserve. Over the years, one of my favorite things is seeing the awe and pride in my staffs’ eyes when a client reaches a milestone and, for some, the realization that they want to pursue a career in behavior analysis because they see what a difference our intervention makes in our clients’ lives. This year is HHS’ 15th anniversary and I am so proud of how much HHS accomplished, how many children we helped, and how many lives we changed over these years.

Can you tell us about a time you’ve had to pivot?

Running a business requires balancing so many aspects. When I initially opened HHS in 2007 none of our services were covered by insurance which made services hard to access for many families. When Texas passed a mandate that insurance must cover ABA (under certain conditions) for individuals with autism, I took the opportunity to become a network provider for some insurance companies, which opened the door to serve more families who did not have access before. This was such a crucial point in HHS path and it put me almost instantly in the driver seat of a car I knew nothing about. Almost overnight I found myself in a position where I had to do 2 full time jobs, one that I was an expert in, and one that I had absolutely no clue about. Moving from a cash only model that provides almost immediate funding for the company needs, to a model that takes up to 90 days to reimburse for services already provided, IF you did everything insurance related correctly, was a turn that I didn’t know how unprepared for I was. There were so many things that I did not know about insurance that really impacted the daily operations and my overall workload. Insurance comes with so many requirements that are not given to you in welcome packet, like you would expect. There is absolutely no help either! There is no one to call who can tell you how you should be doing things correctly! You must research and find answers on your own. There are many steps from the time you first see a patient till the time you get funded, such as checking patient benefits, obtaining preauthorization, bill correctly, and documenting service delivery in a way that ensures that you will be paid for services. Not only there are many steps you must complete, but you must also do it all correctly or the claims get denied, with poor explanation, if any, of what you did wrong. There were so many times we did not get reimbursed because we did not do some steps correctly or funding was recouped for services already delivered because they weren’t documented according to guidelines that nobody provided. Accepting insurance completely disrupted our funding, and changed the way the company is structured, the way we document things, and, to some extent, the way we deliver services.

Can you share a story from your journey that illustrates your resilience?

Resilience is one of those attributes you don’t know you have until you go through a challenging life experience and come out ok. Before moving to the US, I had almost everything I needed back home, a profession I worked hard to learn, a home, friends, and of course my amazing family. When I got accepted to the graduate program I applied to, I was so happy for the opportunity to learn, I didn’t even stop to think about the huge change that opportunity would bring into my life. At that time, moving 6000 miles away from everything I knew was not scary, but exciting! Once here, and the initial excitement faded away, being on my own got a whole different meaning, and I found myself so lonely. The first few years were very hard, as I had to start over in every single way: no family, no friends, no way to be employed in the profession I loved, no stability in any way. Things here were not only new, but completely different than what I lived my entire life. Although I learned English in school, conversing with people was difficult, so talking to others made me very nervous. The little things such as leaving a voice mail or making an appointment were so scary because they required skills, I was not able to use fluently. In school I recorded all the lectures and replayed them at home so I could make sure I didn’t miss any information that would affect my grade. In addition to school, I had to get a couple of extra jobs to be able to pay for school, and basic living needs. When I moved in my first apartment, I had a mattress and a TV that had either sound or picture but could not get both. Slowly, with the income from all my jobs, and some help from my amazing parents, I added to my belongings and became a more financially stable. Making friends became easier and my life started coming together in the best way I could have imagined. I learned so many valuable lessons during those years, lessons that shaped me into the person I am today. I worked towards my dreams and had the fortune to meet so many amazing people who supported me through the toughest challenges. Over the years, life threw some curve balls my way, but through all of it, I built HHS into the business that is today, made many friends, became a mom to my amazing daughters, and many more things in between. 20 years later I am so happy with the life I built here and wouldn’t change a single thing!

Contact Info:

• Website: www.helphopesolutions.com
• Instagram: helphopesolutions
• Facebook: Help, Hope, Solutions
• Linkedin: Help, Hope, Solutions LLC

Image Credits
Reba Faye Imagery