Episode 72: Burnout and Turnover with Sarah Trautman

There is a moral and ethical imperative to address burnout in physicians." So says the Mayo Clinic and such is Sarah's passion for addressing burnout in our own ABA field. This isn't a 'nice to have' for ABA organizations, it's a must. Sarah's a lively and engaging breath of fresh air: though she's self-admittedly from "the Jurassic Age" as the 1,000th-ish BCBA, she brings a very direct perspective and message to ABA owners to get this right. But she also has a powerful message for individual BCBAs, RBTs, leaders, and owners that we must "recognize our own blind spots" and be part of the solution, not part of the problem. Enjoy, kind listener!

Resources

• Sarah on Linkedin: https://www.linkedin.com/in/sarah-trautman-6404883/
• Defy: https://www.defy.community/
• "You Quit Your Job, but You’re Still Miserable. Now What?" (New York Times): https://www.nytimes.com/2023/01/23/business/quitting-burnout-miserable-reasons.html
• Book: Burnout, the Secret to Unlocking the Stress Cycle: https://www.amazon.com/Burnout-Secret-Unlocking-Stress-Cycle/dp/1984818325/ref=sr_1_1?hvadid=5806894...
• September 26th Project: https://www.september26.org/
• Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout (Mayo Clinic Proceedings): https://www.sciencedirect.com/science/article/abs/pii/S0025619616306255

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Transcript

Jonathan: 0:30

My guest today is Sarah Troutman. Sarah's been in love with behavior analysis since she took her first intro to ABA classes in undergrad at Gonzaga University. Sarah's been a BCBA since 2004. She even took the exam using real paper and a pencil. The true story. Sarah's the co-founder. And CEO of Defy community and Defy's committed to helping behavior analysis professionals decrease the impact of burnout using evidence-based interventions and tools. Sarah has served as the president of CalABA and was a founding board member of the Council of Autism Service Providers. Sarah's also a published author and loves public speaking, hiphop and caffeine. In that order. Sarah, welcome to the pod.

Sarah Trautman: 1:10

Hello. Thank you for having me.

Jonathan: 1:12

It is so great to have you. You know, I've been, so eager for this conversation going back to, I think maybe when we first met, which you probably don't remember, but at the Autism Investor Summit in 2019, like pre covid and my business partner and I happened to sit at the round table that you were at and I was like, oh shit, that's Sarah Truman. And I was like, wow. So I'm just like fanboy excited to talk to you about all things that are you. But let's start with your STE journey. Tell me more about,

Sarah Trautman: 1:37

Oh my gosh. Yeah. I mean, you know, like you were saying in the intro, when I think about the fact that, I've been board certified for almost 20 years. I was the 1642nd behavior. Yeah, that's, that's a fact, Jonathan. I know. So I always tell people I'm from like the Jurassic era of my behavior analysts and I'm like, I don't even feel that old. I'm only 46. for God's sake. but you know, when I was, early in my career, I was living in the San Francisco Bay area. I had to have the chance to work for. a great, organization that provided support for, school aged students that had developmental disabilities and severe behavior challenges. I'd worked for another kind of private organization that provided consultative support to all different types of students with IEPs in schools, and I think for. So many people that kind of have like that entrepreneurial mindset. You know, there was stuff that I really enjoyed about the places that I had worked and there was other stuff that I was like, man, I think I can do that better. and so, I had the audacity to just kind of, Try it. And I started, you know, STE out of my kitchen in East Oakland in 2004. this is way before there were any autism health insurance mandates. So our funding came from either, public schools that contracted with us, because California has this, cool thing called, non-public agencies and non-public schools where you can get certified by the California Department of Eds and to work with public school districts. And we also worked at the regional center. um, there's regional centers all over California as part of the LANTERMAN Act, which is an entitlement law for folks with developmental disabilities in California, which is actually pretty awesome. and started doing some consultation and then, heard about more families needing support for those young kids that were, you know, getting diagnosed and. Added all these, you know, different kind of service verticals. And we were really one of the first organizations in California that started taking our cases to independent medical review prior to autism health insurance being passed in California, it was actually the 10 year anniversary of SB 9 46. And we worked with a great, autism parent and advocate and we won every single case. and then we ended up like flipping our revenue from regional centers and public school districts to being commercial or medical funded in a matter of like three or four years. And we expanded and some of those expansions were great. Some of those were epic dumpster fires. Um, so, you know, I am never gonna be the type of person that's gonna be like, I have had only successes in my life. Like, oh no, there's been some shit shows, and all of this kind of culminated in me selling my business, to Kadiant Behavioral Health in June of 2019. you know, I did it for 15 years. It was awesome. but your girl was tired. Your girl was tired. And I knew that there were some kind of market forces, especially in California, that we would not be able to compete with unless we either brought in additional capital or were acquired by a larger company that would have more resources. And so, you know, I was really mindful. And spent many, many years just kind of learning what it might be. how can I identify a good partner? For my group, how can I identify what I think is like a decent culture fit? what is all of these transactions? I mean, this is like scary stuff, for a behavior analyst where you're sitting in, uh, I remember visiting, Texas specific group was the primary, private equity firm that backed Kadiant. And they have this like, you know, Insane office on like the, 50th floor of a downtown San Francisco office building. I mean, I think like their coffee table costs more than my house. And just trying to like, be like, how did I get here? I'm just gonna pretend I know what I'm doing and we're gonna see. so yeah, I mean, you know, like this. Huge important, amazing period in my life where, I was just like, Hey, I love this. I think I can, maybe do some things differently. And I'm really, really proud of the blueprint that STE was able to have, not just with obviously the families that we served. but there's been so many, companies that have, emerged as like offshoots, from people that I've worked with me. I was just at the California Association for a behavior analysis conference, in March of this year, and I saw a bunch of my, former, kinda like clinical directors and man, you know, hugs. And I just, I miss those, those ladies, uh, tremendously. But that's, I think the best part about doing good work is, you know, you have a very deep, deep love and attachment to the folks that you do the good work with. Frankly, to me has been the best part, of running a business is being able to grow and make something and then just kind of watch it, like the, it's like the ripple effect and, and that makes me happy.

Jonathan: 6:18

Oh, that's far away. Me too. Like the best part of starting and, and being part of growth in an organization are the people around you, right? And building like intentionality and values aligned people with growth mindsets and then, and taking things the next direction. So I wanna come back to the, the sale to TPG and Kadiant in a moment, but tell me like, it's not all roses. You know, over the course of the 2004, like you're an OG Sarah, 2000, the hardest part of the journey. what were the things that just kept you up most nights?

Sarah Trautman: 6:47

I think the hardest part of the journey is recognizing that you have blind spots and I don't know what I don't know, and really understanding the value of bringing people into your circle, whether these are advisors, or consultants that you work with to really help you figure out this stuff that you are not great at. And I think for a lot of us, You know, we can have people in our lives say like, Hey, maybe you should consider this, or, you know, here's been my experience. But often, uh, natural consequences are powerful teachers. And so for me, I think the hardest thing was really making some, pretty incredible errors and, you know, Learning so much from those, but in, in the midst of them happening. And at that time, it was just like, oh my gosh. I mean, I remember I have some couple nights where it's like I was waking up like, just drenched in sweat. and. And so I think, just always wanting to feel like I wanna do the right thing and then knowing when I didn't, and not because of that was purposeful, but that was more because I of my own, like maybe ignorance. I've, you know, had many sleepless nights and frankly, relationships that were compromised and never recovered, from some of those errors.

Jonathan: 7:58

there's this sense that starting an organization, being an entrepreneur is oh, it's just glamorized. Right? And I think that's what you tend to sometimes read about online and elsewhere, but it's like I, it's like an iceberg, right? people see that top 10% of it. It's like, ooh, it looks all cool and fancy and this is a cool thing, but there's so much going on underneath the surface. And I wonder, you know, to your point around. Building this like circle, bringing people into your circle and helping you see blind spots that takes vulnerability as a leader. Sarah, how do you cultivate a practice of vulnerability and being open to your blind spots?

Sarah Trautman: 8:31

I think from my perspective, the way I view it is like there's no other. Way to be because if you're not willing to acknowledge, you know, kind of your own deficits, how are you ever going to grow your organization? and whether, you know, your growth is revenue growth or adding different, service lines or, you know, different location. Um, I think it's. Been incredibly important for me to always be just really grounded I think part of why I have been able to resonate with people over time, and resonate with my staff and I think continue to have, a voice that is, listened to by some people sometimes is because I understand that I can only be myself. we're all humans, we all are flawed and to the extent that we can extend. Like compassion to ourselves and also just own our humanity that allows other people to do the same. And in my experience, you know, that's been like when the good stuff happens, but I think so much of that is just kind of grounded in. My own values and those are values that I grew up with, with my family. Um, and I think as I've gotten older and frankly had, you know, failures and done things not the right way, it's actually been a great SD for me to like lean back into the values and really understand that at the end of the day, I really wanna do good work. I wanna care about the people I work with in service to the very vulnerable population that most of us work with. And, and that to me is a life well lived. And so if I can just continue to do that and sometimes I'm gonna screw it up, um, that it makes the journey a lot more enjoyable, even in the midst of the crap.

Jonathan: 10:17

Yes it does. And anyone who tries to say like, oh yeah, it's an entrepreneur. I've never had any failures. Nah, you, you like dig deeper, right?

Sarah Trautman: 10:25

well, right, and it's also just like run for the hills. I think we see this play out so much in technology, for example. I mean, you know, like, what is that Sam Bakeman Fried?

Jonathan: 10:36

Or scam Bankman fraud, as I like to call him, the the founder of ftx, which had this spectacular conation and bankruptcy just last November.

Sarah Trautman: 10:45

Yeah. and, but also I will say, I will say that I think that there is a unique place, especially for women that are entrepreneurs because I think that we have been socialized really to kind of understand. Our value, not as much centered around like our own selves or ego, but really about what we bring to others. And obviously that can sometimes be to our detriment. And there's a lot of, you know, don't get me started on all of the, invisible labor that the ladies are doing all the time. Everywhere. Um, but I also think, uh, it has allowed me to be a little more humble because of just how I have been socialized to have a conceptualization of who I am in the world and, and what the world expects of me. And I think sometimes for. Uh, dudes, that's not the same thing. And I think, you know, especially in this day and age, I think one of the most dangerous things that are, you know, out there right now is the fact that if you don't wanna come in contact with people that think differently, then you, you don't have to, you know, like you can stay in your own little echo chambers and whatever little, you know, social media or news platforms you wanna to be in and, you know, And when you start to get so much power, even look at like Elon Musk, like he's brilliant and also kind of seems like an asshole. but when you get into that rarefied air, no one's gonna tell you something you don't want to hear. and I think in behavior analysis, Everyone will continue to tell you things that you, you need to hear. And so I think that makes it like a little easier. But yeah, I mean, anyone that's like, oh no, I haven't made errors, or isn't willing, to have that kind of like humility, I'm just like, hmm, probably not the person you wanna be working for. because that also means that, that they're like not seeing life clearly. Cuz man, we're making mistakes on the daily.

Jonathan: 12:25

On the daily, and the important thing is how we learn from them. Right. As long, it's not a catastrophic mistake. It's how we learn from get better. Well, let's fast back forward to what it was like to sell STE right? So you're sitting in this, um, in front of this coffee table, right? And, uh, in TBG's offices. But like, what do you feel like you learned that you wish you knew at the time in going through the sale process?

Sarah Trautman: 12:46

let me back up and say that I took. About five years to really get a better understanding of what would a potential exit. Look like. What is that? what could that mean for me? what are the different types of, you know, sales? Uh, because this is all foreign, right? And you know, you've spent time in rooms with investors. I mean, they get on like their investors speak and just like we have our jargon, I'm sitting in the room and I'm just like, there's a tailwind and. Multiples. Um, and there's the ebitda and I'm just like, oh man, like I gotta educate myself. So I spent a lot of time educating myself. I took every call from investors just to learn something and I was patient. And I looked for the right opportunity for my company that would be the best, fit for who we are, what we were trying to do. And uh, you know, Kadiant, it was started by Lani Fritz and he was someone that I'd known for 10 years. Um, and we had been friends and colleagues and so I had a very long vetting period. and so I felt really good about doing that. The number one thing that I wish I would've known going into this was how much it was going to disrupt how I think about myself, because my self identity was so rooted in being this business owner and doing this thing, and once I stopped doing this thing, I had to relearn who I am and like what is the value that I bring, uh, and what are the things that I'm interested in because like I've spent 15 years of my life, like in it, like all the time, blinders. and It was shocking for me, how much this threw me for a loop on a personal level.

Jonathan: 14:35

Oh, I, I wanna highlight a couple really important things. So one, like you took time and intention to get smarter, right? Like you said, five years to figure out who the right partner was, what the potential exit was. Look, I'm a firm believer whether or not, you know, as a, as an owner operator of an ABA organization, do you ever wanna sell your business like, To have the optionality to, which generally means you're just, you're, you're dialed in and you're doing the right thing. But that also that I idea of take every investor call, you can, I know a lot of people probably get inundated, right? Like LinkedIn messages and elsewhere saying, Hey, can we chat? And just to reinforce it is so important. And when getting on those calls, it's like what you were describing doing. Like learn, ask lots of questions. and generally investors at least, you know, at this stage, Wanna feel like they're helping, wanna feel like they're answering questions. So like getting smart is so important. Also, I recommend Sarah, I don't know if you ever did this, I don't think I've ever admitted this actually on the pod before. Um, playing investor bingo is really fun. So you have like a bingo board and like every time say EBITDA boo, check it off your customer lifetime value. Check it off. Anyway, that's fun too.

Sarah Trautman: 15:40

Oh, I know. It's like the corporate speak. I, I think like, there's definitely been a couple calls where, you know, as you know, uh, I don't mind being direct and I think I said to some guys, I'm like, I'm gonna need you to just like drop, your business talk. And cuz I'm a human person, I am confused. You're clearly not understanding. Like, I'm looking like deer in the headlights. I'm like, can you just speak to me? Like, you are my friend. Like, what are you trying to say?

Jonathan: 16:11

Oh, I love it. It's like that show. Why are you smarter than fifth grader? Hey, talk to me in fifth grade, Mike. Or maybe that's like, that's what, that's the level at which you should write an email. Maybe that's where I read somewhere. Same thing. I love it. I love it. Well, and alright, so, so now you've sold STE, um, as I understand you exited completely. Um,

Sarah Trautman: 16:28

Yep.

Jonathan: 16:29

and then you started Defy. What, what was the inspiration for that?

Sarah Trautman: 16:34

Yeah. Well, okay, so there's some like important Things that happened in time between that, uh, little did I know or did any of us know in June of 2019 what the next year would have in store for all of us? So picture it, you know, like I'm living like my best, new life, trying to figure out who I am in California I was doing a lot of consultative work for association. So Calaba was, you know, a primary client of mine. I was speaking just kind of doing my thing. and then I was. the first person, at the Cali conference in March of 2020, uh, that was like, um, I think we're gonna have to shut this down. because at that point, like Santa Clara, which is where the conference was, was like, ground zero for Covid in the United States. And at that point there was 14 cases. Can you imagine that? And people were just freaking out, like, speakers are dropping off left and right. Literally as we're getting all of like the exhibitor booths together, someone pinged me on my phone, they're like, Hey, you should kind of probably watch this like press conference that's happening right now. And it was Dr. Sarah Healy who was like the, health officer for Santa Clara County saying, yeah, we don't want anyone gathering, uh, in large groups. And we were about to have a conference with three. Thousand plus folks. so we canceled that conference on site. That was very traumatizing and just kind of the after effects of all of that. you know, California and the Bay Area went into this like lockdown. I mean, I don't know if you realize this, uh, governor Newsom just removed the emergency order in California three weeks ago. It was three years. Three years. So, So I'm trying to set the stage here so there's Covid, um, all of this stuff goes wrong. All the work that I'm doing is all about events, conferences, and traveling. So all of that goes away. and then I was like, what do I do with myself? And I'm like, I, and, and I like to podcast. That's why I like today. we both have our Yeti microphones. I had to wipe some dust off of mine. but I was like, Hey, I wanna like do something creative. And so I reached out to one of my oldest friends, feta, um, who we've been friends for like 10 years and she was a huge, parent advocate in California. She successfully sued Kaiser Permanente to get, um, ABA coverage for her son Mohamed prior to, health insurance mandates. she also has, had a very intensive love for like hip hop, just like me. And I was like, we should do something fun. She's like, okay girl. So we start this podcast. Um, called the Scoop. and of course our intro song is Rob Bass. Uh, it takes two, uh, one of the best hip hop songs of all time. and we start this podcast and this is like summer 2020. It's pretty gnarly. Um, there's all these like terrible, weird, like I don't, do you remember like the Orange Day in California? Because of all like the, the fires and it was, you know, yeah. It was like super funky. And then, theta was, uh, at a fundraiser for a friend one night, this is in September of 2020. She comes home, um, I think they like, you know, warmed up like some pizza in the oven and, her house catches on fire and she gets out. but her son who had very severe autism wasn't out. He was on the second floor. And so just like any mom would, she ran back to go get him. And she couldn't, Moe was like, uh, I don't know, 6'1", 225 and feta was a little taller than me, but, you know, I could still take her in a bench press. Um, and so they both died and this was like the most bizarre, out of body. trauma of my life. Um, and I don't really talk about it very much. Uh, I'm pretty private about how I feel about it. I've not been, you know, someone to really speak that much, outwardly about it. But it really, you know, all of us have defining moments. In our lives that, make us like really reflect and they're just like, oh shit. Like life is fleeting. And what do I wanna do with myself? And that doesn't mean you have to do something grandiose gesture. You're like, I am gonna start a foundation, raise millions of dollars. But it's just like, you know, hey, I'm one person. I'm one human in this planet. whoa. and so I thought about it for a long time and I was like, man, I really. You know, especially with Covid and just all of the changes in our field, especially as we work in like behavioral health now, I'm like, the vibe is not great. Um, and there's so many to me, amazing things about, the science of behavior and behavior analysis that could really. Be brought to bear to help people live better lives. and especially, for women or, folks that are, gender nonconforming and just kind of like, that aren't in that dude box. Um, Gosh, I wanna kind of like figure something out. And so I posted something random on Instagram and my now business partner Carol, um, uh, she and I are both the co-founders, um, of Defi responded to me and I'd met her in like Houston at a conference a couple years ago and we just started talking and, we tried a bunch of things and eventually it always kept coming back to the same thing, which is really was burnout in behavior analysis and what. Do about this. And so we've focused for the last, two years on how can we help the folks that are doing this work, um, to have wellness for themselves, to experience more joy in, in what they're doing, to have resiliency, in their careers. And, we're doing that by bringing a lot of research that's been done in nursing, which is a really closely aligned profession for us. And nursing is just so much more mature and it's so much larger. Um, so there's incredible research in nursing. There's great research in industrial organizational psychology, but you know, like Covid selling my business, losing feta mood, like all of those things just like really kind of galvanize me to just hold a mirror up to my face and just have some hard conversations about who am I, what do I wanna do? Um, and to me, I'm someone that loves to be connected to humans and I think we do this work that is so, uh, I think life changing for humans, but I think we've. Kind of lost, um, kind of lost our way, or I think we, the field has just grown so fast. It's been challenging for us to keep pace with what are the needs of the humans that do this work, and then how can we help them to be really more well-rounded people in applied settings to be able to do great work. And, and that involves a lot more than, than just understanding, task and dispersal and the difference between differential schedules of reinforc.

Jonathan: 22:43

I want to give a shout out to Feta and and Mu, um, and the September 26th project, which. You know what it talks about the importance of studying just 10 minutes a year, right? And fire safety and going through your fire safety checklist. And look, every family should do it, and particularly families who have kiddos with autism. This is just so important. So I'll drop a link in the show notes to that. Thank you for honoring.

Sarah Trautman: 23:05

Yeah.

Jonathan: 23:07

So I love your perspective that, look, there are adjacent healthcare disciplines like nursing that we can learn from that have been around longer. Um, cuz I know in the ABA field we can feel like we're unique and different from everyone else and We are in certain ways, but you know what, we're just, we, this has happened. There're those who have tread for us. So tell me, and, and I'd love to hear maybe a little bit more about some of the research you saw there, or I know there's research and surveys you're doing. Like, how the hell do we solve this burnout and turnover challenge in our.

Sarah Trautman: 23:35

mean, and, and, and let me be clear, I wanna choose words carefully. Burnout is not something. To solve specifically, it's more something that you gotta learn how to move through it, right? I mean, burnout is, you know, in the ICD 11 as an occupational phenomenon. This was first started being studied in the medical field in the sixties, and it's like, yo, if you're working. With humans and doing things that are emotionally, physically, and mentally exhausting, and you are coming into contact with like secondary trauma, you're gonna have compassion fatigue. You're gonna have exhaustion, negativism. Like that's, that's going to happen. And I, and I think it's not an issue of oh my gosh, let's, you know, avoid it. It's more like, Let's recognize what it is. Uh, let's look at how, when this happens to us, cuz it will at some point. What do we do to kind of like mitigate the impact and move through it? And I, I love, this whole concept, one of my favorite books is called Burnout Secrets to Unlocking the Stress Cycle by, uh, the two sisters, um, Emily and Amy Kowski. And they have this really, salient, sentence in the book that. Listen, like wellness isn't about, you know, avoiding states of adversity and risk. It's about being able to move through those and back to calm and safety again. And I think that especially for early career behavior analysts, I see this all the time. I'm sure you do too. It's like everything that goes wrong. It's a crisis and everything is horrible and the world is crumbling around us. And you know, the gift of experience and wisdom is to understand that you're like, it might feel like that and your feelings are valid, but like it's, trust me, the world is gonna. Still keep on turning. Um, and so how do you understand how you can move through this right? And have more fluidity and, this is also something, in terms of like nursing, like they haven't hacked this either. I mean, there's incredible nursing shortages. In the entire United States. And a lot of the challenges that nursing is having are the same challenges that we're having, which is ratio strain, um, in terms of the number of patients they have, uh, relative to the number of staff they have. Looking at, working with patients with very severe acuity, which is much more effortful for nurses. I think sometimes people don't realize that most of the healthcare provided in the United States is provided by nurses, uh, not doctors. It's nurses. and so the Mayo Clinic has this great book, that is a kind of a summarization of research that they've done than in research that other groups and hospitals have done to really kinda see like, how do we build better wellness and wellbeing for our staff? Because part of what I think. Is the most essential thing for behavior analysts to understand about this. And, and Julie Slovak has talked about this in some of her research, and I'm obsessed with this, is the whole idea of like being well is actually like a moral and ethical imperative. And healthcare understands this. Like, if you are someone that has not slept in three days, you are eating Snickers, you're jacked up on caffeine, and you have like incredible, strife going on at home, whether it's with like your partner or kids or whatever. Are you in the most optimal place to be providing clinical or medical services to other individuals? No. And, and so we actually have the, this little piece of our ethics code, I think it's 1.10 that says like, Hey girl, uh, or a guy, or whoever, you know, if there's stuff going on in your life, you have an obligation to sort that shit out. so you can like be effective. I mean, I'm. Obviously paraphrasing. I would, by the way, love, if our ethics code said, you need to sort your shit out. I would like, I, that's it. Like, I'm gonna drop the microphone. I'm never working again in this field. Like that would, that would make me so happy. but, I think the thing is like, there's not gonna be enough humans to do this work. There isn't. Um, and that is because there are much larger issues that are happening in the United States. There are historical low birth rates. Um, I can't, overstate the impact that the opioid crisis and drug abuse has had on the number of people that are available to it, be in the workforce. in this age of I wanna be in a hybrid position or work from home. Like we, the stuff we do isn't a work from home stuff. It's work with people. Face-to-face. And so those, there's gonna be those continued labor issues and pressures. And I don't believe that they're going to be debating, which is why we gotta get like real sexy and interested in leveraging technology. How do we create like automation? How do we make this work easier to try to bring people in? but the burnout stuff to me is just, it's a ever, evolv. Uh, and ever, you know, necessary kind of like question to ask. and I think sometimes like burnout is the catch-all term for everything. it might be Hey, guess what? You're actually, you're not burned out. You just don't really have a lot of experience, so you don't have a lot of skill fluency. So this stuff feels really effortful cuz it is. Or like, maybe you're really stressed out. But it kind of doesn't matter. because if people are just really not in a great place personally, they're not gonna be able to provide optimal, clinical services and be the best person, you know, as like a supervisor or as a mentor or as a, a parent or a friend. and I think that for a field that basically, you know, Deals very intimately, uh, with alleviating human suffering. We've not really done a good job of turning that mirror towards ourselves and how we support the folks that do this. Um, and you know, like you said, it's not rocket science and there's no magical answers, but there are things that have been shown to be highly effective. And there's so much research in the medical community because they also understand that this is imperative. you don't want nurses and medical doctors making mistakes. Kill people and neither do nurses and doctors. They wanna also be really well functioning. And we're in the American healthcare system. And man, that system is not awesome. And we are in the business, in our system of, you know, keeping people sick, not making people well. And there's a lot of, competing contingencies around who gets to make decisions. And how do lobbying efforts get to influence those decisions and money? But I do believe that there's hope in the midst of that. And, and there's, again, research to show that there's little things that you can do that really make a difference. And it doesn't also have to be really expensive, which I think sometimes people think taking care of your staff is just, giving them a pizza party and a hug. Um, but I'll highlight one thing that I really love. So there's this, whole, research around in nursing called Code Lavender. And there have been, um, really cool, studies to show that in different nursing units, maybe you work on the emergency floor or somewhere else, but if nurses experience like a kind of a traumatizing event, maybe it's a death of a patient. Um, or something. They can do what is called a code lavender. And if they have this system within their nursing unit, it means that they're immediately relieved of duty and they get to go, maybe like sit in a quiet room. Maybe there's a rocking chair, maybe they can have some tea. Maybe there's someone that they can talk to. But it's the understanding of when hard things happen, it can't always be the expectation that the professionals don't feel. and that in order for us to actually be able to. Do great work. We need to be allowed to feel. And sometimes you gotta feel big because it's sad if you work, you know, like my mom used to volunteer at, Fred Hutchinson Cancer Research Center in Seattle, in their children's cancer department. And every child and family she ever worked with, the child died and they were little. You know, and so you gotta be able to feel that. And I think there's something that's like incredibly and amazing about bearing witness to different humans experiences. Um, and you know, we bear witness to so many different experiences, but also to acknowledge that like, uh, we're also still human. And so just little things like that, how do we honor that hard stuff happens. Um, and that doesn't mean you have to get stuck in it, but you gotta acknowledge it and you gotta feel it or else. It's gonna each up. And I think that those are some of the missing conversations, um, that we have.

Jonathan: 31:04

Those are missing conversations. I, I really like this idea of, like you described, burnout. Is this catch all term? So number one, we gotta feel the feels right and we've gotta label it as is and we have to socialize it and talk about it. Uh, but number two, we gotta pinpoint then

Sarah Trautman: 31:19

You we have to Precision. Yeah, we have to precision. I mean, it. It's behavior analysis, right? And so what we did a year and a half ago is we took standardized, or previously validated assessments in like industrial and organizational psychology. And we're like, okay, so these have been validated in terms of measuring burnout. We kind of crosswalked them into behavior analytic terminology so we could like, make sense of it. Um, but the idea is okay, if you tell someone, like if you're working for me and you're like, Sarah, I just feel so burned out. That's actually really imprecise and I, I don't know what that means, but it's very different. If someone came to me and said, Sarah, I have really been struggling, with not overcommitting to work tasks. and I took some data and I've noticed that, you know, here are like the 10 job duties that I have. I'm actually been doing 20, this is translating into me working like 60 hours a week and it's impacting my ability to put my kid to sleep at night. And this is really, it's bothering me. That I can do something about. it's basically just like, how do we talk about this using like conceptually systematic language and approach it from an analytic standpoint, just like we would a kid that we serve. you wouldn't just have someone come to your center and be like, well, you know, he's cute, so maybe we can work on these skills. I don't know. You know, like you would have an assessment and then you would have assessment results, and then you would create treatment goals based on those assessment. And then you would have, uh, interventions and tools that you would use to be able to teach, these skills that you want. And you would be taking data to evaluate the efficacy of your efforts, and you would make modifications as you. It's the same thing. Um, and so what, uh, we've been working on for the last nine months actually is an app, that will allow behavior analysts to consume. Kind of a more truncated version of, uh, our behavior analyst burnout assessment. they'll be given scores in different domains, and then based on where they lie within domains, we will suggest a personalized and individualized treatment plan for people to use evidence-based tools. To help support them where they need it most. And then there'll also be a community component where they can talk to other people that are doing this. And then we have a really, um, robust analytics platform will be collecting de-identified data and then sharing this back to the community of like, Hey, 90% of the people, if they were struggling with this thing, they did this thing and they've reported that as really effective. You'll be able to track your progress through graphing. We'll also like have fun stuff that makes it. You wanna be a part of, it's like a community. And so when Carol and I started Defi, I mean we always knew this was gonna be at some point like a technology play cuz we're both like tech people. And also because people need solutions now. They need to be readily available. They can't be cost prohibitive and they have to be fun. And I think that that's one thing sometimes we also miss in behavior analysis is we're like, so like serious and it's like goddamn, Just chill out, eat some chocolate, and like we, this has to be fun. Like it has to be reinforcing and if we're like, so like about everything all the time, no one wants to be in that kind of environment. And so, uh, we're really excited for this to, to come out, which hopefully will be at, some point in early summer.

Jonathan: 34:22

Outstanding. We'll make sure to drop a link in the show notes, certainly to Defy and, and then, uh, for when that app comes out. I love that you're taking a behavior analytic approach to like, pinpointing and understanding function of the burnout and all of that, but, Can you promise me something, Sarah, um, sort your shit out. That's a good enough operational definition for me. And that's gotta go somewhere in the app. gotta be the intervention,

Sarah Trautman: 34:46

no. Or like my favorite thing. Uh, when I public speak, I love using the Taylor Swift, song. It's, It. Me. Hi. I'm the problem. It's me. Because sometimes it is, right? It's the whole idea of like, okay, you know, it's like this. I just did a presentation yesterday talking about. the Great resignation and the New York Times have this great article in January of this year that basically was like, you know, the title was a was Hey, I quit my job and I'm still miserable. And one of the psychologists, uh, that they interviewed for this article, was just like, Hey, newsflash, uh, chances are part of the reason you're miserable is cuz some of the reasons that you're miserable. It's your own shit. Um, and if you don't sort through your own shit, it doesn't matter where you work. And so I think, it's sometimes easy to look externally and say, well, this, this job is wack, and so if I go to this other job, you know, I'm gonna look magical. feel better, but like, you're still the same you, and if you don't deal with your You-ness, um, then it doesn't matter where you work. And, I think for so many folks that are just like, yeah, the job, it's always the job. It's like, well, no, you know, I mean, sometimes it is, but sometimes it's not. And so again, really applying the same, you know, Analytic, and like scientific mind to things like, well, I think this might be this thing. How do I test this hypothesis? Uh, like all of those things, We can do these for ourselves. Um, and, and there's no part of being in this life, that isn't gonna require you to really think about the, maybe the assumptions you have about you or that you have about other people and maybe being willing to rethink things that you thought were true but maybe aren't. Um, and that's the hard stuff. And it's like the uncomfortable stuff, but it's also, super interesting and. At the end of the day, you know, that's the kind of thing that allows you to live a better life. Like, there's no amount of money that's gonna make you happier. There's no amount of, you know, chocolate. Trust me, I've tried, I love all of the chocolate, especially this time of year. give me all of the Cadbury eggs, you know, cuz they come out like in January. Um, and I've been eating one a week for the last like, couple months and I apologize for nothing, Jonathan. Um, but yeah, the idea of just. Hey, yes, you need to, you know, work in the places, aligned with your values and understanding what even your values are. All of those things are important, but like also like, hmm, you're gonna have to do some internal work too, and that's just as valuable.

Jonathan: 37:03

Right on. What's one thing, Sarah, that every ABA business owner should start doing? One thing, they should stop.

Sarah Trautman: 37:09

Um, one thing that every ABA business owner should start doing is, Asking questions, to identify problems. I think a lot of business owners feel that they get blindsided by issues, um, because they didn't know about it. But I always tell everybody, especially when you're in a leadership position, like bro, all you do all day is solve problems, but you can't solve problems that you don't know about and you need to actively. Be asking questions to figure out the problems. Um, this is so important because often when things go off the rails in businesses, it's not that, you know, it didn't have to be. So crazy. and I think, you know, again, if, if it was like something that happened, it's like, oh my gosh, this is like this catastrophic event. Chances are, if you were out there really trying to figure out, find the problems and like actively addressing them, you could have prevented a lot of the collateral damage that likely caused, you know, harm, time, resources, stress, energy, um, that none of us have, an extra supply of. So that would be the thing. What is that? That the thing that people need to start doing is solve the problems. Um, and the thing that people need to stop doing. Um, not getting feedback, from the folks that are doing the work when, new policies and decisions are being made. this is, again, these, the silo between like clinical and operations is in no way, shape or form unique to behavior analysis. A lot of these same friction, uh, Exist in other, healthcare disciplines. But I cannot tell you how many times I've worked with companies where they're making decisions in silos and they have no idea how this impacts the people that are doing the work. Cuz they never ask them and they have a theory And maybe it's right and, and maybe it isn't, but really involving, or, vetting these, these theories, before you issue, these grand kind of policy changes, uh, I think would go a long way in helping people feel more seen and heard at work. And frankly, for people to make better decisions.

Jonathan: 39:11

Hmm, Sage advice, Sarah. So where can people find you?

Sarah Trautman: 39:15

Oh gosh. Where can people find me online? Um, well I'm on LinkedIn. We all are. Uh, it's so funny because, you know, remember I don't know if it was like a year or two ago, there was like this thing going around where like people had four different pictures of themselves and it was like their different personas based on like, yeah. So it's like I have like, oh, this is my LinkedIn. It's very professional. Uh, and then there's like Instagram and like I have like a private personal Instagram, but most of the stuff I do on Defi, um, like I just posted this like really funny video yesterday for like comic relief. So we're, you know, you can find Defi on Instagram. You can find me personally on, on LinkedIn. I went off Facebook like a year and a half ago and I've never been back. Yeah. Bye. Mm-hmm. Yeah, I was just like, this is just like a place where all of my, like, very conservative, like family members from the Midwest that make very questionable political decisions are, and I've just felt like it was just kind of this like, shame spiral. And I'm like, this is not bringing me joy. Bye. That was it. Yeah.

Jonathan: 40:17

Imagine the power of that coming back to like look at the mirror, the power of saying, oh, I'm turning it off, and then it's done.

Sarah Trautman: 40:22

Yeah. Well, and it's so funny cuz I think like sometimes like I've, you know, been excoriated especially by, colleagues that are like older than me, they're just like, Sarah, you idiot. you like to do stuff like in social media, like who do you think you are? And I think I realized a long time ago that that's actually, that's where. The folks are in our field, right? I mean, they are, they're digital natives. This is where they consume information, this is where they live, and you gotta meet people where they're at. And I also don't do things in my life that don't bring me joy. And Facebook was not bringing me joy. So I was like, bye. Uh, and that was that?

Jonathan: 40:52

Ah, I love it that that's a perfect bifurcation. Bringing joy. Do more of it. No joy. Do less.

Sarah Trautman: 40:59

Yep.

Jonathan: 41:00

All right. Are you ready for the rapid fire? Hot. Take questions.

Sarah Trautman: 41:04

Yes. Okay.

Jonathan: 41:06

You're on your deathbed. What's the one thing you wanna be remembered for?

Sarah Trautman: 41:11

Compassion towards others and kindness. Compassion and kindness. That's it.

Jonathan: 41:18

What's your most important self-care practice?

Sarah Trautman: 41:21

Naps. I've been like, oh yeah. Rest,

Jonathan: 41:25

When you say power naps versus like long naps versus

Sarah Trautman: 41:28

Depends. It depends, depends on the situation. Um, but as you know, I am someone that has often thought that being busy means that I'm doing something valuable. And as I get older I recognize that's not it. And often being really busy is a great numbing behavior to not have to pay attention to all this other stuff that's going on in your life. And when I am rested, uh, I can make better decision. I can slow down, I can have more capacity for love and compassion. Um, and so yeah, rest, sometimes it's a 20 minute nap. Sometimes I need to sleep for nine hours. Sometimes it just like laying down and reading the book. But that has been like a huge, huge radical practice for me is when I need rest, taking it, um, and not shaming myself around if I need it to be more or less. And, and all of it's okay.

Jonathan: 42:18

Sleep and focusing on my sleep in the last six months has been far away. The biggest game changer in

Sarah Trautman: 42:23

Oh yeah. I mean, I will say I have a sleep schedule. It's programmed into my iPhone. I have all of the do not disturbs. Um, and that's, yeah, I mean, it's been a really big deal and the, data around how critically important good sleep is and frankly, how so many people don't have it. Um, and like good sleep hygiene practices is, you know, it's, yeah, it's robust because that's how important it's.

Jonathan: 42:46

Right. It. It's a game changer. All right. What's your favorite song and or music genre?

Sarah Trautman: 42:51

I mean hip hop, this is, you know, uh, and I would say probably one of my favorite songs, LL Cool J Around the Way Girl. I mean, I know every single, uh, lyric to that song. Um, yeah, I mean, I've loved, hip hop since I was like a young. Kid in before I really understood, you know, some of like the origins and the, political messages around it. But I, I just, I loved the, the beats and the rhymes and the swagger and everything. And especially like to look at someone like Ella, cool. J or like, I look like Ice Cube too, because like they're just a little older than me or Snoop, right. And now like who's Snoop's best? It's Martha Stewart. You know, I mean, ice cubes hat is like awesome, acting career. Same with LL Cool J and like, I love how like they've been able to kinda like move into like their grandpa era. Um, but yeah. The, you know, around the way Girl is still, yeah. I mean it's the, it's the best.

Jonathan: 43:42

Oh, I love it. You're speaking to my generation for Dar Shore, and I love that Snoop and Martha are besties. I mean, E, everything Snoop does, he

Sarah Trautman: 43:50

Yeah. No, but, but it also, I think like that's a great like reminder of man, we're more similar than we are different. And like you might think oh, these are, people that are in diametric opposition to each other. But there are those points of connection and I think that's one thing I really enjoy as I see myself, my friends and like even people you know, that are like celebrities kind of move through different faces of age. I think you just get. This kind of softness, of understanding You actually l you know, way less than you think, you know? Uh, and you're never gonna know all of the things. And having like really awesome humans in your life. And those humans might look really different than what you think they might look like when you're younger is like pretty, uh, you know, It's, it's the good stuff, right? And I appreciate that. Um, and so I think Snoop Dogg and, and Martha Stewart are, are great, uh, examples of an unlikely pairing, but, you know, human beings,

Jonathan: 44:41

Uh, when we zoom out and concentrate on our humanity, then all of the commonality

Sarah Trautman: 44:45

Totally. Yes.

Jonathan: 44:48

What's one thing you tell your 18 year old self?

Sarah Trautman: 44:51

Crimping was not a hairstyle for you. I would, I have naturally curly hair and I was like, let me put a crimping iron on top of this hair. there are some pictures that are still out there. Um, I have requested from my parents, I'm like, these can never be digitized, because it was not a good look then. And it's definitively not a good look now.

Jonathan: 45:17

If you could only wear one style of footwear, what would it be?

Sarah Trautman: 45:20

Oh, uh, air Jordans like, yeah, I'm a sneakerhead. Yeah. This is also functionally for my back. Like, people were just like, oh, you're so cool, Sarah. You like to wear sneakers when you present. I'm like, I'm a middle-aged mom, and my back hurts. I'm not wearing any of this. Like, uncomfortable footwear. Are you crazy? So I did this out of necessity, but just like a low key. Tried to play it off like it was fashion. Um, and so now a lot of people wear sneakers. Yeah. But yeah. Air Jordans.

Jonathan: 45:46

Oh, clearly, air Jordans. Sarah, thank you so much for coming on the pod. This has been an absolute pleasure.

Sarah Trautman: 45:52

Well, the pleasure is all mine, and this was really fun. It was like the highlight of my day. I was like circled into my calendar. I'm like, oh, it's podcast time. Let's do it.