The Center for Autism & Related Disorders (CARD) is currently the largest autism treatment provider in the world, with 235 locations across 27 states. But the 30-year-old company wasn’t always the behemoth that it is today.
In fact, CARD founder and executive director Doreen Granpeesheh attributes much of the company’s success to being in the right place at the right time, with a mission-driven mindset.
“Back then, [parents] really had no options,” Granpeesheh told Behavioral Health Business. “If you wanted your child to have a chance at recovery … you essentially had to try to get them into [the autism program at] UCLA or come see me at CARD.”
Granpeesheh founded the company with just a couple employees back in 1990. Since then, she’s grown CARD into a private equity-backed autism treatment powerhouse, which boasts a bevy of service offerings, a research arm and financial backing from Blackstone. In 2021 and beyond, CARD’s goal is to become even bigger and better.
“We honestly find ourselves in a much better place than we did a year ago,” Granpeesheh said. “Our goal is that over the next three years, we will be opening rapidly across many states. In fact, for next year, we’re hoping to open about 50 sites, and hopefully we’ll keep going at that pace.”
Granpeesheh started working in the autism field back in 1978, when she enrolled at UCLA. She attended the university until 1990, obtaining her bachelor’s, master’s and doctoral degrees there.
During that time, Granpeesheh studied under Psychology Professor Ivar Lovaas, a pioneer in the autism space who is widely credited with first applying applied behavioral analysis (ABA) to autism treatment.
“In 1987, just three years before I left UCLA, we published a paper that ended up being kind of the seminal study in the field of autism and behavioral intervention,” Granpeesheh said.
That paper — Behavioral Treatment and Normal Educational and Intellectual Functioning in Young Autistic Children — would end up shaping the field of autism treatment for years to come.
For the study, Lovaas, Granpeesheh and their colleagues developed intensive one-on-one behavioral interventions for children with autism. Those in the test group received 40 hours per week of treatment at UCLA, in addition to 10 to 15 hours of home-based intervention led by their parents.
“It was the basis of everything we do today,” Granpeesheh said. “Students at UCLA were trained, and they would work with the children to teach them everything they were not able to do, whether it was language or paying attention or play.”
In addition to that test group, the study had two control groups.
One control group lived too far from UCLA to receive 40 hours of center-based intervention. Instead, they got only 10. Meanwhile, the second control group received different types of treatment from doctors at what is today known as UCLA’s Semel Institute for Neuroscience and Human Behavior.
After about two and a half years, researchers found that nearly 50% of the children in the intensive treatment test group “recovered” from their autism symptoms, seeing drastic IQ test score increases and gaining the ability to integrate into the normal educational system.
Comparatively, in the other two control groups, only 2% of children were able to complete first grade on their own.
“That study became a very, very important study, because it identified … three things,” Granpeesheh said. “One was that ABA works. The second was that kids with autism can actually come out of the diagnosis — or lose the symptoms that got them the diagnosis. And the third was that intensity matters.”
At the time, those concepts were novel. So when Granpeesheh used them to found CARD in 1990, she was one of the only autism treatment providers in the nation to offer intensive ABA interventions.
Driven by demand
In its early days, CARD consisted only of Granpeesheh and a few former students who had worked under her at UCLA. They became her therapists, and a rented 780-square-foot suite in Los Angeles became the company’s home base.
While CARD’s set-up was modest, demand for its services was anything but.
“In 1987, we had just published this study, and in 1990, I opened a clinic,” Granpeesheh said. “So believe me: It was not hard. Parents from all over the country were trying to get in touch with me to try to come in and get their children treated.”
That demand only accelerated in 1993, when the mother of two children Granpeesheh had worked with published a book. Titled Let Me Hear Your Voice and penned by Catherine Maurice, it detailed how the author’s children overcame the symptoms of autism with ABA techniques, and it called out Granpeesheh by name.
“The book had just come out, and now hundreds of people were contacting me and saying, ‘Can you help us?’” Granpeesheh said.
At first, CARD could only help a few dozen children at a time because of the way the business was set up. Back then, Granpeesheh was the only person equipped to train and supervise therapists, who provided the direct client care. On top of all that, she also handled all the company’s administrative tasks.
As such, the company was limited to a capacity of about 40 children, she said.
But in 1994, when Granpeesheh was pregnant with her first child, she realized she would have to find another supervisor to take over for her while she was out. She trained then-therapist Evelyn Kung — who is currently CARD’s Clinical Director — for the job.
“From there, we realized, ‘Hey, we can train supervisors as well,’” She said. “So then we were able to open a second office in New York and send a supervisor there, and then a third office in San Jose.”
That’s when CARD hit its first big turning point. The father of an autistic child in San Jose really got the ball rolling. In the mid-90s, Granpeesheh told him she’d open a location in his area if he could find 25 families committed to receiving CARD services.
The man posted those terms online in an autism chat room, and the rest is history.
“As soon as he put that out, I got notices and requests from all over the world,” Granpeesheh said. “I went and opened one in North Carolina. Next it was London, England. After that, it was Australia. All over the world, parents were gathering and asking for help.”
CARD added about 10 clinics that way, Granpeesheh said. Plus, for several years after that, the company successfully opened two to five clinics per year using only word-of-mouth advertising.
In 2000, CARD intentionally slowed down its growth trajectory to centralize and reorganize management and business operations.
“Every four or five years, we slow down a little bit,” Granpeesheh said. “We did that again in 2020. You have to constantly change your policies and procedures and actually add departments if you really want to stay stable as you grow. Otherwise, it becomes very chaotic.”
CARD today and beyond
By the end of 2016, CARD had grown to about 100 clinics and developed a tried-and-true methodology to open new locations. A year later, going into 2018, the company had doubled in size.
At that point, after 10 years of being courted by private equity buyers, Granpeesheh finally made the decision to sell part of the company to a PE group. That year, in 2018, the company entered into a record-setting $700 million deal with Blackstone.
“I chose Blackstone as the partner that I wanted to go with because everything about Blackstone reminded me of CARD,” Granpeesheh said. “They were the largest and strongest in their field, and I felt like it really went parallel with us.”
Today, Blackstone owns about 75% of CARD, while Granpeesheh owns around 25% of the company. As part of the deal, she also gifted part of the company to long-time CARD employees who helped found the company.
“We still have about 50 people who’ve been at CARD for over 25 years,” Granpeesheh said.
Since entering into the deal with Blackstone, CARD has welcomed plenty of new team members, too, especially on the leadership front. Since the beginning of 2019, the company has hired a new CFO, a new CEO, a new COO and a new chief HR officer.
“We agreed … with Blackstone that I would continue doing this for a couple of years. And ultimately, we wanted to bring in a new leadership group who could help take it to the next level, which would be, let’s say, 500 or 1000 clinics. And that would also give me an opportunity to finally retire [in a few years].”
Granpeesheh said she believes the new leadership team will help position the company for growth in 2021 and beyond.
“It was a good year for CARD because it helped us reorganize and slow down enough to allow us to make better plans and do that kind of shuffling we have to do every few years.”
In addition to adding about 50 new locations per year for the next few years, CARD is also looking to expand its adult offerings, as well as the number of academies and schools it operates. Another goal is to develop phenotypes to make autism treatment more efficient and effective.
“We have to do better because our hours of therapy are limited … as we are funded through health insurance,” she said.