An autism therapy company abruptly shuts down childcare as it lays off workers

An autism therapy company abruptly shuts down childcare as it lays off workers


SoftBank-backed Elemy, last valued at $1.15 billion, laid off employees and abruptly stopped offering personal services to children in Illinois and Georgia.


LIssa Rudisel’s 7-year-old son, who has a dual diagnosis of autism and Down syndrome, met with a specialist for three hours each week to help him learn everyday tasks such as eating and using the toilet. “They helped us figure out how to motivate him to get things done,” Rudisel said. She says autism therapy provided by Miami-based startup Elemi is crucial for her child, who is nonverbal and communicates with a tablet device, especially given the disruptions of the Covid-19 pandemic.

Last week, without warning, these services ended abruptly, exactly one year after they began. On July 14 Rudisel Dr Forbes About 15 minutes before her son’s daily private session was to begin, she received an email from Elemi. Last year the $1.15 billion SoftBank-backed startup wrote that it was suspending in-person services in Illinois immediately, citing “market conditions” that required a “refined focus on the states we serve.” The move stunned Rudisel. “We’ve made all this progress and now it’s like the rug has been pulled out from under us,” she says.

Rudisel wasn’t the only one blind. Former employees have spoken Forbes said that on the same day, they were terminated in a brief video meeting with their work accounts immediately deactivated. The company declined to answer a question about the total number of Elemi workers laid off this month or how many employees were let go during the previous round of layoffs in March. Elemi’s management said it is restructuring to focus on three key states: Florida, Texas and California. That meant personal services were abruptly cut off for children in Illinois and Georgia, as well as those who were grandfathered in from other markets after the March reorganization, according to seven current and former employees who asked not to be named out of fear. Revenge.

“Over the past few months, we’ve begun to feel a seismic shift in the global economy,” Elimir CEO Yuri Yakubchik, who co-founded the company because of his own experience navigating the challenges of a severe ADHD diagnosis as a child, wrote in a Slack message to remaining employees. “While we can’t do much about rising inflation, the tragic war in Europe, the investment landscape or overall financial market uncertainty, we can work to strengthen our business today, so we can serve more families tomorrow.”

In an emailed statement, Yakubczyk said “87 families in active care” were affected by the change, which was a “single-digit percentage” of total families. The company declined to provide the total number of households it serves.

“I believe every physician knows deep down that it is absolutely wrong to stop services without any notice. It’s the exact opposite of what a child with autism needs.”

ELemmy offers a combination In-person and virtual therapy called Applied Behavior Analysis for autism patients is delivered by two people: a board-certified behavior analyst who virtually creates a care plan and a registered behavior technician who works with the child. Go home- person to implement it. In May, the company’s services were recognized by the Behavioral Health Center of Excellence.

For Rudisel and her son, the technician comes to their home every day, while the analyst joins in via video to check progress and recommend different interventions. The therapy, which relies on repetition to strengthen skills, was covered by their health insurance plan. For example, her son struggled with eating new foods, so they created a system where he would get “tokens” for biting them. These tokens will earn him rewards like playing with the iPad. Rudisel said his son is improving and has developed a special bond with his technicians after a year of working together.

This made the sudden cessation of personal services for her son worse. In the initial email, Elemi promised a “smooth transition,” which would include a list of other local providers and a copy of the child’s discharge report. In a follow-up email sent this week, Elemi said families can virtually receive “ongoing clinical support” from a behavior analyst, which will be “free of charge” until the end of the year or when a family finds a new provider. . The email also said a virtual “family support team” would provide assistance in finding and calling new providers. Rudisel was skeptical. “If we don’t do applied behavior analysis at my house, it doesn’t help us,” she says.

Elemi employees across the department were also shocked by the way in-person services were suddenly stopped. Employees described phone calls to parents saying their child’s services were ending, who met the news with tears and disbelief. “I believe every physician knows deep down that terminating services without any notice is completely wrong,” said an employee Forbes. “It’s the exact opposite of what a child with autism needs.”

The Code of Ethics of the Behavior Analyst Certification Board, a nonprofit organization that certifies behavior analysts and technicians, does not specify a specific number of days or weeks for a change of services. It broadly requires “adequate efforts to manage transitions effectively,” including a written transition plan and timeline for families, steps to minimize barriers, and collaboration with new providers.

“It’s not like there’s a roadmap that says you have to do this, then this, then that. It’s like, these are elements of a transition plan and they’re the process that guided us through this,” said Henry Rowen, who Elimir leads the clinical team and previously served on the Board of Directors of the Behavior Analyst Certification Board, said Forbes In a phone interview.

Rowen says the specific number of days depends on the child’s individual circumstances. When asked if stopping services the day the family was informed was the best way to go about it, he replied, “I don’t think it’s ideal, of course not. … I’m not the only voice when it comes to business decisions, obviously, you understand? He Adds that the “ongoing clinical support” the agency is actually providing is not required by ethics.

Chief Communications Officer Amanda Taggart said the company has identified “82 open spaces with local providers” to help affected families relocate; However, none of these are guaranteed to result in a complete conversion. Rudisel said Elemi has not contacted him about any openings and, based on his own research, it would take at least three months to find a new team to work in his area.

Four employees of Elemi Forbes The industry standard, even if not explicitly stated in the guidelines, is to have a 30-day transition period whenever possible. This was echoed by John Bailey, founder of the volunteer group Applied Behavior Analysis Ethics Hotline and a professor emeritus of psychology at Florida State University. “In cases where service interruption is intentional, there is a moral obligation to provide support to the family for the next 30 days,” he said. Although he could not directly comment on Elemi’s practice, he said Forbes Virtual support alone is insufficient during a transition. “It’s very impersonal,” he says.

“The child becomes attached to that therapist and suddenly it’s like a death in the family. Some sympathy and consolation and forgiveness must be sought. I don’t think you can do it in a zoom.”

LIn October, these layoffs and care disruptions seemed unthinkable for the then-San Francisco-based company. That month, Elemi raised a $219 million round led by SoftBank Vision Fund 2, vaulting the 3-year-old company to unicorn status. “Today is an incredible moment for Elemi as our Series B underscores our growth momentum,” Yakubczyk said in a press release at the time. This rapid growth, in the case of several digital healthcare unicorns, including Carbon Health and Olive, has proven to be sustainable.

Yakubczyk co-founded Elemi (then known as Sprout Therapy) in 2019 with Michael Rageb. Yakubczyk previously founded a boutique hotel company called Life House Hotels (which he Forbes 2019 30 Under 30 Consumer Tech List) and prepaid phone company Wing Wireless. Investors have bought into this serial entrepreneur’s vision of helping kids get better mental health care because of his own struggles – Elimi has so far raised $270 million from firms including Goodwater Capital, Premji Invest (Indian tycoon Azim Premji’s private investment firm), General Catalyst, among others. Founders Fund, Table Management (billionaire Bill Ackman’s private investment firm) and Metrodora Ventures (venture capital firm founded by Chelsea Clinton).

Armed with new capital, the plan for Elemi was to “expand its national reach.” The press release states that the company “already cares and transitions children in 14 states.” Other markets included Colorado, Indiana, Massachusetts, Missouri, New Jersey, Ohio, Pennsylvania and Washington, according to an archive on its webpage.

Six months later came the first signs of limitations on the company’s growth strategy. In March, the company laid off workers. These roles were the first point of contact for families who used Elemy to help them fill out forms and navigate insurance coverage. For now, the company has also held back on accepting new patients in specific markets and has instead decided to focus on five states—Georgia, Illinois, California, Florida and Texas, according to four current and former employees. Existing patients in other markets may continue to receive the services, but the company has stopped actively advertising them.

The July layoffs affected more people in operations but expanded other teams as well as behavior technicians and analysts who work directly with children. Elemi also told the remaining behavior analysts that their employment status was changing from salaried to hourly, with benefits hitting 30 billable hours a week, according to two employees familiar with the changes. (Billable hours are time spent seeing clients rather than administrative work, making it a tough target to hit, especially if families cancel or are on vacation.) It was similar to a move by another SoftBank-backed mental health care company, Cerebral, last year. That changed hundreds of therapists from salaried to hourly and benefits tied to fixed quotas.

The main concern of employees across the team was not just losing their jobs, but how all these changes were affecting their families and the children they were meant to serve. “I hope this will be an eye-opener for other applied behavior analysis firms who are hungry for growth,” said one employee Forbes.

Bailey, the ethics expert, says one of the hardest things for children is losing a personal connection with their care team. “The child becomes attached to that therapist and suddenly it’s like a death in the family,” she says. “Some sympathy and consolation and an apology are needed. I don’t think you can do it in a zoom.”

It is now running at the Rudisel House in Illinois. Since losing Elemi’s service, she says her son asks every day if her technician is coming. “He doesn’t understand the idea of ​​never doing it again, you know? He realizes he is not coming today,” he says. “Eventually he just gets the idea, but he doesn’t understand it cognitively. I cannot understand him the way he understands.”

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