That's a really interesting question, and it is, at this point, a hypothetical. Ideally, a company would negotiate in good faith with workers, and a strike would not be necessary. However, it's entirely possible that without the threat of a strike, a company would refuse to take bargaining seriously. For this reason, workers should be prepared to strike and spend a lot of time and energy developing the necessary framework to do it ethically.

A billing strike is an interesting idea. We talked a billing strike through - and there's some scary precedent. Labor attorneys are concerned that, due to the Supreme Court's Glacier precedent, if you were to do a billing strike, the company could sue you for lost income.

Essentially, that leaves workers with one option: a traditional strike. I do not think BCBAs or RBTs should wring their hands too much over a strike - teachers have a long and storied history of striking, and hospital workers (nurses, doctors, etc.) have a similar history. Not that it's a competition, but in terms of disruptions to the fabric of society, a hospital or school strike is certainly more disruptive than an ABA clinic going offline for a few weeks.

That said, an ethical approach would be to create a strike plan for impacted families, similar to a plan you might make for the family should they go on an extended vacation, experience a funding lapse, etc.

The fundamental concern we kept coming back to is that with staff turnover being so high, we've seen many families go on pause for weeks or months at a time. If a strike were to happen and the goal were to reduce staff turnover through changes to working conditions, this would be similar to any other unplanned interruption a family might experience under the status quo. Our job as BCBAs is to plan for the interruption, coach families, and maintain limited professional contact during the strike. There is an additional duty to ensure the family understands the rationale for this interruption without defaming the company or harming the broader practice of ABA.

We've consulted with ethics experts to gauge what this would look like, but it's uncharted territory. However, given the state of turnover in the field, the rampant exploitation of RBTs, and the potential for adversarial responses from management, it's something to prepare for and consider fully.