Computers may be fueled by binary code, but human behavior is not.
Professionally, Mandy Ralston has been sitting near the intersection of those entities for years. Her latest startup, NonBinary Solutions, can perhaps best be described as a culmination of all that she has learned in the last 20-plus years within the realm of applied behavior analysis (ABA) in the form of clinical decision support systems (CDSS) software to better train autism service providers.
“I can funnel everything that I learned into a software system now to help mentor and train people about how to think about all this stuff,” said Ralston of the Lexington, Kentucky-based operation that began in May. “And the reason I know how to think about it, is because I made all the mistakes that happened as a result of not asking these questions early on.”
Ralston first became board certified by the Behavior Analyst Certification Board as an assistant behavior analyst in 2002 — three years after certification began — before getting her full certification in 2014.
She co-founded/founded and helped run two different clinics that provided applied behavior analysis services. The first, Behavioral Intervention for Autistic Children (BIFAC), ran from 1999 to 2004 with offices in Louisville, Lexington and Covington, Kentucky. Most recently she founded the Lexington-based Verbal Behavior Consulting Inc. in 2007 and served as president before having an exit with BlueSprig in 2019.
NonBinary Solutions was largely born out of a “collision,” as she called it, caused by a 500% increase in autism spectrum providers in the space over the last 10 years — with half the field of board-certified behavior analysts having less than five years of experience to provide treatment plans.
According to the National Autism Association, one in 44 children are on the spectrum.
“There’s not enough dinosaurs like me to help mentor or train them on the way to think about all these treatment decisions and so the software is a way to help solve that problem,” Ralston told me.
Ralston said the current scene in the autism treatment field — at the ABA level — was akin to a scene in the popular 2022 movie “Catch Me If You Can” when Leonardo DiCaprio’s character successfully mimics being a doctor. From previous knowledge of watching TV shows, he can begin to translate what is happening to a patient, but that is the extent of his capabilities.
“That's sort of what happens when you don't have proper mentorship, or a lot of support ... You literally are just sort of taking what you saw somebody else do, and applying it to something similar,” Ralston said. “So there's just no way with the amount of information that people have to think about these days to have all that in your head at the same time.”
How it works
NonBinary Solutions makes clinical decision support software that runs on a similar cadence of the CDSS-based framework used by a variety of medical providers wherever they ask a patient a series of questions.
Due to several reasons, Ralston said, such software has not yet been developed in the ABA and autism space. She learned about the technology that powers her startup during the period after she sold Verbal Behavior Consulting.
The software will ask providers a series of questions that correspond to internal algorithms to serve as a guide along the process, while offering the provider a list of reference materials (articles, websites) and other recommendations to help better inform his or her decision, while providing insurance companies a report that documents their entire work with a particular patient — and the decisions they made to reach their treatment plan.
“You can get 25 different behavior analysts in the same room and have one kid to look at and say, ‘OK, how are we going to treat this person?’ And you will have 25 different approaches,” Ralston said. “And most of them cannot tell you why, other than ‘That’s how I always do it.’”
Ralston — who self-identified as being neurodivergent — said that her software is not a “decision tree.”
“It’s not driving you to a singular answer [such as] yes or no. And that's why I call it NonBinary Solutions. It’s not a yes or no,” Ralston said. “Sometimes it’s yes — and. And sometimes it’s no — but, because people are not binary, right? There’s not ones and zeros.
"People are not black and white. There’s lots of shades of gray that go into understanding and treating people properly."
Ralston added her company’s name also originates from the fact that individuals on the autism spectrum are six times more likely to not identify with the gender they were assigned to when they were born.
The path forward
The company is currently working on building two different revenue tracks. The first involves designing custom intake models for large beta clients, taking into consideration a number of factors, such as the overall demographics of the patients, types of referrals needed and the types of assessments needed.
The second track is that of a subscription-based B2B SaaS (business-to-business, software-as-a-service) platform. It is currently being developed with the hope of having a minimum viable product (MVP) by May. There are also plans for a B2C (business-to-consumer) version down the road once the B2B version is established.
In its early stage of development, Ralston's company is currently taking part in the Launch Blue incubator. As of a recent date, Ralston has raised $90,000 from combined contributions from Keyhorse Capital ($50,000) and two undisclosed local angel investors, while also being bootstrapped with her personal capital.
Going forward, Ralston has several speaking engagements in the upcoming months at major conferences tied to her field, including the Association of Professional Behavior Analysts in Seattle in March and the Autism Investor Summit in Los Angeles in April. She has also been selected to pitch her company at the Startup Grind Global Conference in Redwood City, California in April.
Ralston is about to launch a podcast called “Decisions, Decisions” later in the spring. To round out her busy schedule, she also recently became vice chair of Queer Kentucky, a Louisville-based nonprofit that supports the LGBTQ+ community.
