When private equity came for the clinic where I worked | RACHEL ASHCRAFT

Rachel Ashcraft, a licensed and registered occupational therapist, writes in a first-person opinion piece published October 17, 2026, by the Miami Herald (originally appearing via Alabama Reflector and the Montgomery Advertiser) about her experience at a pediatric therapy practice serving families across Alabama. She joined the practice because it was clinician-owned, and she developed a commitment to trauma-informed and neurodiversity-affirming care. The practice was later sold to a private-equity-backed company that described itself as a public benefit corporation, promised that clinical leadership would remain important, and invited Ashcraft to serve on an advisory board.

Ashcraft says she opposed adding Applied Behavior Analysis (ABA) to the services, but ABA was added over her recommendation and soon appeared to drive the company's clinical direction. She resigned because she did not believe that direction served children. She writes that she remains unconvinced that any version of ABA she has encountered meets a basic ethical standard, noting that autistic adults and self-advocacy groups have described harm from approaches that reward compliance. She also addresses newer models marketed as "new ABA" or "trauma-sensitive," arguing that such language does not resolve ABA's history.

The article frames the situation as part of a broader national trend. It cites figures that between 2017 and 2022, private equity firms accounted for 85% of mergers and acquisitions in the autism-services industry. Ashcraft contends that the financial model is a central reason for this investment: traditional therapy may involve one to three hours a week, while intensive ABA can involve dozens of hours, largely delivered by lower-paid behavior technicians under a behavior analyst's oversight. Citing researchers, she reports that investors entered most heavily in states with higher autism prevalence and more generous insurance mandates.

Ashcraft stresses that the piece does not claim every ABA recommendation is financially motivated, but argues that families deserve transparency when a recommended treatment is also a company's most profitable service. She recommends that families ask who owns the practice, why certain services are promoted, how recommended hours are determined, and who benefits financially, and she emphasizes that autistic people's lived experience should carry significant weight in these decisions.