JoyBridge Kids has its eyes on the autism industry’s Holy Grail: a harmonious marriage of clinical services and operations.
Mount Juliet, Tennessee-based multidisciplinary autism therapy company’s founders started a company intending to “offer the highest quality care, first and foremost,” JoyBridge Kids CEO and President Mike Cairnes told Behavioral Health Business.
The company was founded in 2020 by Rogers Clayton; Cairnes met and joined JoyBridge Kids in 2021 when it started treating patients. He joined to help solidify the company’s model and scale it — and the company is well underway doing just that.
Today, the company now has 12 locations. It operates five clinics in the Nashville, Tennessee area; five in the Savannah, Georgia area; and two in the Raleigh, North Carolina area. The latter are the company’s newest locations.
“Our trajectory is in the right area, and part of that magic has been our ability to get the marriage between operations and clinical right,” Cairnes told Autism Business News. “If you can operate really well, it allows the clinicians to focus on what they really care about.”
JoyBridge Kids’ de novo scale play is aided by private equity investment. The Charleston, South Carolina-based lower middle health care market firm Frontline Healthcare Partners invested in the company in 2022. The firm also invested in San Jose, California-based Bay Area Clinical Associates.
Strategic investments in structure and employee enrichment have helped aid the marriage between ops and clinical.
On one hand, each JoyBridge Kids has a clinic manager who “ensures that all the trains are running out of the station on time.” This person leads scheduling and coordination across each clinic’s various specialties and handles “baseline HR functions,” Cairnes said. JoyBridge Kids has also made major investments in scheduling software to aid local clinic managers and to get rich clinic-level data.
JoyBridge offers applied behavior analysis (ABA), speech therapy, occupational therapy and school readiness programs. It offers clinic-based services.
JoyBridge also invests in business-focused training for its clinical directors. Cairnes says he sees the clinical directors as entrepreneurs. These professionals are board-certified behavior analysts (BCBAs) who are skilled in their clinical field but often don’t have training in finance, leadership or business generally.
“We have really worked hard in developing our clinical directors — everything from teaching them to read a P&L, basic leadership skills and helping them build a framework for decisionmaking,” Cairnes said, adding that he marked the clinical directors training program as one of his company’s most significant accomplishments of 2024. “I can’t tell you the exact moment it happened or the day, but I looked up and I just really admire our clinical directors and how far they’ve come and developed as leaders.”
The challenges in fusing effective clinical services with operations can be seen across the industry, Cairnes said. On one hand, autism therapy companies scale so quickly that they “lose control of the operating handle.” On the other hand, small, clinician-founded and/or led clinics often lack the capital or operating know-how to make their vision come to life. Neither result in providing accessible, high-quality service.
Clinical directors in autism therapy generally have challenges that are unlike the managers of the other industries — retail, manufacturing, technology — that Cairnes has worked in. It’s not uncommon to have as many as 40, as Cairnes described it, direct reports. Often, there is no way to gradually put clinicians into those positions.
“The learning curve that they have gone through and their ability to step up has just been really awesome,” Cairnes said.
JoyBridge Kids aims to tackle other big-time challenges within the autism therapy field, namely, supporting patients once they graduate and addressing the BCBA shortage.
In 2025, it will begin testing a “bolt-on” service called Joyful Transitions, an in-home and in-school transition program for those graduating from services.
“We feel like they need some extra support and help as a transition into school, and we want to be able to provide that,” Cairnes said.
In 2025, the company will also work on deepening its graduate program with the goal of making it the “envy of the industry.” JoyBridge presently has 40 graduate students in masters-level classes seeking their BCBA certification. The company offers paid indirect hours, supervision and mentorship and recently added tuition assistance.
As of October 2024, the Behavior Analyst Certification Board (BACB), the nonprofit organization that certifies BCBA, registered behavior analysts (RBTs) and board-certified assistant behavior analysts (BCaBAs), said that it has certified 71,660 BCBAs and 187,034 RBTs since its launch.
However, demand for BCBAs vastly outstrips the absolute capacity of the industry’s workforce. Previous research finds that in 2023, the number of unduplicated job postings for BCBAs and the doctoral equivalent BCBA-D totaled 65,366. The total number of certificants ever granted those credentials by 2023 was 66,339.
“We realized we can’t depend on hiring from the outside. We’re going to have to basically home-grow our BCBAs, and that’s why the graduate program is so important,” Cairnes said. “They understand your clinical model and philosophy … I think that’s going to be important for the clinics who have the scale to do this to be able to take care of their learners.”
