Autism therapy franchises may present a best-of-both-worlds scenario for clinicians and entrepreneurs. The fledgling model purports the vibe of a mom-and-pop clinic and the support of a strong corporate structure more reminiscent of private equity-backed companies.
This alternative to traditional ownership modes is burgeoning in the outpatient mental health space. For example, Mendota Heights, Minnesota-based Ellie Mental Health has received accolades for its meteoric revenue growth using the franchise model, posting 445% revenue growth from 2019 to 2022. The model has yet to make a similar splash in autism therapy.
The vision of the autism therapy franchise model looks something like this: increase access to high-quality services offered with intimate knowledge of the local market without what some perceive as the trade-offs that come with large, private equity-backed companies. All the while, a centralized corporate structure guides local operators and investors — who have an intimate connection to those affected by autism — to operational, clinical and financial success.
Two insiders working on autism franchising say this approach is as hands-on as it gets.
“That’s why I love that our CEOs are autistic parents,” Nichole Daher, CEO and founder of Success on the Spectrum and SOS Franchising, told Autism Business News. “They’re not investors that are looking to dump money and expect it to pump cash out.”
In 2015, Daher founded Success On The Spectrum (SOS), an autism therapy clinic, to get her daughter treatment after her stepdaughter was disinvited from treatment at age seven. She struggled to get past waitlists in Houston, Texas. The clinic “exploded” in growth, and she soon found herself on the other side of the conversations that prompted her entrepreneurial journey.
“Suddenly, I was the person on the other end of the phone saying, ‘I’m sorry we can’t take your kid; we’re full,’ and I hated myself for it,” Daher told ABN.
She opened a second clinic across town in 2018 and started the autism therapy franchise that same year, after the clinic also quickly filled its capacity.
SOS Franchising has sold 71 territories: 41 clinics are open. Daher expects franchisees to open 10 more clinics by the end of 2024. The company requires franchisees to be owner-operators, work onsite and participate in a community outreach program.
About half of the autism therapy franchises at SOS Franchising are owned by parents of children with autism.
The company also requires its franchisees to either be administrators or clinicians — they can’t be both.
“It takes two separate people for that to work,” Daher said, adding that the workload of treating patients and handling administrative work is too much for one person.
It costs between $400,000 and $500,000 to get an autism therapy franchise going with SOS Franchising, Daher said. The company helps franchisees obtain debt and other financing. The company also helps its franchisees through credentialing and getting payer contracts. While not centralized, franchises within SOS Franchising share contracting intel with one another to help get the highest rates possible.
Similar back-office challenges inspired Idris Demirci, CEO and founder of Able Autism Therapy Services, to franchise his clinic. Founded in Aug. 2021, he was surprised that contractors and consultants he hired, some of whom were clinicians, didn’t fully understand the specific aspects of things like billing and credentialing.
“We realized that not many people really know what they are doing in this field,” Demirci told ABN. “We thought if we franchised this out, we could help other people succeed and make money as well.”
Able Autism Therapy Services wasn’t originally started as a franchise business, as was the case with Success on the Spectrum. Able Autism began developing franchising in 2023. Able Autism directly owns and operates two clinics in Georgia and in-home services in Tennessee. It has not yet sold a territory.
Demirci says Able Autism Therapy Services has a strong pipeline of potential franchisees but is being “extremely careful” in selecting its first partners. The ideal franchisee would have similar experiences to Demirci: his son was diagnosed with autism, and he considers his family a “success story” of applied behavior analysis (ABA). His son is now able to attend a general education class.
Franchisees must also have business acumen and financial means. Demirci previously made his career and work in academia as a professor of international business. He also does not want passive investors.
For Demirci, franchising the business is ideal for where he is in his life and career. He would rather develop businesses with franchisees than grow the business himself.
“Sure, if I keep opening more centers, we’re going to make more money, but that’s not really our goal here,” Demirci said. “Our goal is to work with other people so they can grow. We can help them.”
Able Autism Therapy Services aims to sell two franchises by the end of the year and accelerate rapid franchise expansion in 2025 or 2026. The goal is to have 50 franchises sold in five years.
Both Daher and Demirci say they are considering expanding franchises outside of the U.S.
While interesting, the franchise model is not a panacea. The hands-on nature of franchising may limit interest. Daher said the engagement with SOS Franchising and the clinics is a full-time call. SOS Franchise also encourages smaller caseloads and maintains high clinical standards at their clinics. Franchisees trade off higher revenue and potential profits.
“We’re not as profitable as these big private equity groups,” Daher said. “The trade-off is that we are going to do this the right way, and you’re going to make a little less money.”
Both Daher and Demirci say their clinics are full when they have about 25 patients.
For whatever appeal the autism therapy franchise model has, it’s still a for-profit model with all the same underlying motivations and challenges. The fundamental difference is the role of the central structure and spreading the equity, risk and capital demands of the business across several independent investors.
