Who says you can’t go home? Kristin Hanson did, and now she and her brother, Eric Plunckett, are fostering the growth of their family-owned autism therapy company, Axis Therapy Centers.

Hanson moved away from her and Eric’s hometown of Maxwell, Iowa — a tiny town northeast of Des Moines — for education, work and family reasons. Hanson, a board-certified behavior analyst (BCBA), eventually moved her family back to her old stomping grounds in 2017. With the encouragement and support of Eric and other family members, Axis Therapy Centers was born later that year.

Hanson and Plunckett headquartered the company in Ankeny, Iowa, not far from their home town, in 2017 with a small team. At first, it was just the brother-sister duo, a few behavioral techs and a friend who was in training to become an occupational therapist. The enterprise now operates four clinics and a day camp and employs 106 people, including 15 board-certified behavior analysts (BCBAs).

Hanson and Plunkett bootstrapped funding the company’s startup costs, even borrowing capital from loved ones. This included the family-funded $80,000 loan from their grandparents at a 2% interest rate.

“They were so adamant about helping us because they’re so proud of us as their grandkids,” Plunkett told Autism Business News. “That was actually the majority of the startup capital that we needed.”

Hanson added: “After seven years, I still strongly believe they have no idea what we do.”

Axis offers ABA, speech and occupational therapy that’s mostly performed in its centers, along with some in-school or community-based care. The provider works largely with patients who are covered by Medicaid. About 60% of its revenue comes from that payer source, 35% from commercial insurance and the last 5% from private pay. Its revenue has grown by approximately 20% to 25% over the last few years to reach annual revenue of about $4.7 million in 2023.

Hanson and Plunkett co-own the company with Eric and Kristen’s mother, Sonja Plunkett, and Eric’s wife, Rachael Plunkett.

Axis Therapy Centers finds itself in a familiar position to many of its peers: balancing its founding legacy and ideals with the constantly evolving realities of a burgeoning venture.

Hanson and Plunkett’s roles have changed to meet those realities several times. Each change usually arises after a “defining conversation” between the two that typically leads to one of the pair changing roles to meet the organization’s current needs as it transforms from a family affair to an increasingly sophisticated operation.

One of these defining conversations included moving Hanson away from working directly with patients. That transition was challenging but necessary, she said, to meet the needs of the organization serving an ever-increasing number of patients, according to Hanson.

“Every time it happens, it gets scary, and it’s a hard transition,” Hanson said. “But when I get into that new role, it’s such a great feeling.”

Transitioning from clinical work to entrepreneurship and management necessitated a self-created, self-instructed course of studying business and corporate leadership, Hanson said. Hanson found that the teaching and mentorship aspects of leadership resonated with her.

“I found my true passion in doing that,” Hanson added.

Plunkett has dabbled in several varied ventures. Previous endeavors, some of which he is still involved in, include his own marketing and coaching firms, multiple franchise entities, a seed and chemical company, a barbershop and a whiskey bar.

“I always joke with people when they ask, ‘What did you do?’” Plunkett said. “I say, ‘Anything I could do to not have to have a boss, quite honestly.’”

After another “defining conversation,” Plunckett dove into the world of autism therapy and health insurance, a change from his previous role as the “business guy.”

These conversations and role transformations have been difficult, even unpleasant, both Hanson and Plunkett said, but they have led to healthy company growth and a firm connection to their founding ideals.

Hanson and Plunkett’s required learnings of each other’s worlds as clinician and businessperson are a microcosm of a fundamental tension in the autism therapy industry — clinicians struggling to move into management positions and management understanding the clinical aspects of their operations.