Precision, Passion, and a Pint with Dr. Kerri Milyko, BCBA-D (Part II)

In this second part of their interview with Dr. Kerri Milyko, BCBA-D, Mike Rubio and Dan Lowry dive deep into the systemic challenges facing the ABA field, particularly around the tension between clinical innovation and administrative efficiency. Dr. Milyko critiques how electronic health records (EHRs) and insurance-driven models have prioritized operational metrics over clinical quality, leading to a situation where clinicians are forced to adapt their care to fit software and reimbursement requirements rather than the other way around. She argues that the field has been paralyzed by perfectionism, delaying the creation of standardized, measurable outcomes that could enable scalable, defensible care. Drawing on metaphors like 'temperature of the butter' and 'seeds in different climates,' she emphasizes the need for a standardized framework—what she calls 'meso data'—to track progress across micro-level interventions and macro-level outcomes, allowing for both personalization and accountability. The conversation also explores the role of private equity, the importance of partnerships between small clinics and large organizations, and the transformative potential of AI to automate data collection, freeing clinicians to focus on meaningful client connections. Ultimately, Dr. Milyko envisions a future where technology serves clinical excellence, not the other way around, and where ABA can prove its value across diagnoses through reliable, predictive models of care. Key takeaways include: 1) Standardization of outcomes and procedures (not rigid protocols) is essential for scalability and accountability; 2) Meso-level data tracking—bridging micro-interventions and macro-outcomes—is critical for measuring real progress; 3) AI and automation should free clinicians from administrative burdens so they can focus on connection and innovation; 4) The field must move beyond perfectionism and start with 'good enough' models to learn and improve; 5) Insurance companies and clinicians must partner to create flexible, data-driven frameworks that reflect the complexity of behavior change; 6) The future of ABA lies in being a 'center of the future'—where technology handles data, and humans focus on relationship and impact. The tone is urgent yet hopeful, calling for collective action and systemic change.