Electronic health record provider CentralReach has released data quantifying COVID-19’s substantial impact on autism treatment providers while revealing how the pandemic has fundamentally transformed service delivery models through accelerated telehealth adoption that CEO Chris Sullens expects will permanently alter how organizations provide applied behavioral analysis therapy. The Fort Lauderdale, Florida-based company, which builds ABA practice management and clinical data collection software serving approximately 1,400 provider clients with 100,000 employee users treating roughly 200,000 learners, documented dramatic shifts in treatment patterns as the pandemic forced rapid pivots from predominantly in-person care delivery to remote services before evolving toward hybrid models strategically combining telehealth and face-to-face interventions. The data illustrates both the devastating initial disruption that autism providers experienced when pandemic-related closures decimated census and the remarkable adaptation that organizations achieved through implementing telehealth capabilities, adjusting operational protocols, and developing flexible service delivery approaches enabling continued patient engagement despite ongoing pandemic uncertainty.
The quantitative evidence validates anecdotal reports from autism services providers who described pandemic-related operational chaos during initial lockdown periods followed by gradual stabilization as organizations mastered remote care delivery, implemented safety protocols enabling facility reopening, and discovered which therapeutic activities could effectively translate to virtual formats versus those requiring in-person interaction. While autism treatment has historically relied almost exclusively on face-to-face service delivery due to ABA therapy’s hands-on nature focusing on helping children improve specific behaviors including communication, social skills, and adaptive functioning through intensive direct instruction and behavioral modification, the pandemic demonstrated that certain components of comprehensive autism treatment programs can occur effectively through telehealth when clinical necessity demands remote alternatives.
Telehealth Adoption Surges Then Stabilizes at Elevated Levels
CentralReach’s data reveals extraordinary telehealth utilization acceleration, with monthly billable entries submitted to telehealth payers jumping from approximately 3,000 pre-COVID representing minimal virtual care penetration to nearly 400,000 at peak levels during pandemic lockdowns when in-person service delivery became largely infeasible. This more than 130-fold increase illustrates the dramatic operational transformation that autism providers executed within compressed timeframes, implementing telehealth technology infrastructure, training staff on virtual care delivery techniques, securing payer authorization for remote services, and educating families about participating in home-based therapy sessions guided by clinicians through video platforms.
The surge required providers to overcome substantial obstacles including technology barriers for families lacking reliable internet connectivity or appropriate devices, clinical adaptations translating in-person ABA techniques to virtual formats, reimbursement uncertainty as payers developed telehealth coverage policies for autism services, regulatory compliance with state licensure and supervision requirements, and staff training preparing behavior technicians and analysts to deliver effective intervention through screens rather than direct physical interaction. Organizations that successfully navigated these challenges maintained patient engagement and revenue streams during periods when facility-based operations were impossible, while those unable to implement telehealth quickly experienced devastating census declines and financial distress.
Current telehealth utilization remains at approximately 80% of peak pandemic levels according to Sullens, indicating that virtual care has stabilized at substantially elevated rates compared to pre-pandemic baselines rather than reverting to minimal adoption as restrictions have eased and in-person services have resumed. This sustained telehealth engagement suggests that providers and families discovered genuine value in remote service delivery for specific clinical activities, with hybrid models combining in-person and virtual components offering flexibility, convenience, and clinical benefits that pure facility-based or home-based models cannot provide.
Hybrid Care Models Emerge as Permanent Service Delivery Approach
Autism providers are increasingly implementing hybrid care models strategically providing clients with customized combinations of in-person and telehealth services based on individual needs, treatment goals, family preferences, and clinical appropriateness according to CentralReach Marketing SVP Karen Parisi. These blended approaches enable organizations to leverage telehealth’s advantages including improved access for geographically distant families, flexible scheduling accommodating parent work obligations, reduced disease transmission risk during ongoing pandemic concerns, and efficient use of clinician time without requiring travel between locations, while preserving in-person sessions for activities where direct physical interaction proves essential for effective skill acquisition.
Organizations have evolved their operational processes enabling navigation through successive pandemic waves with greater resilience than initial disruptions generated, developing protocols for rapidly transitioning between service delivery modalities as public health conditions change, maintaining patient engagement despite ongoing uncertainty, and balancing clinical effectiveness against safety imperatives and family comfort levels. Parisi expects these adaptive capabilities will continue proving valuable through 2021 as pandemic conditions remain fluid and vaccination rollout proceeds gradually, with providers maintaining operational flexibility responding to evolving circumstances rather than assuming permanent return to pre-pandemic norms.
The hybrid model development represents meaningful innovation in autism treatment delivery that extends beyond pandemic necessity to offer legitimate long-term advantages. Kadiant CEO Lani Fritts previously described how telehealth enables behavior analysts to remotely supervise ABA technicians who provide direct therapy, with program design and supervision activities that traditionally required analysts to drive between multiple locations now occurring efficiently through virtual observation and consultation. This model enhances behavior analyst productivity by enabling them to be in many places virtually simultaneously rather than spending substantial time commuting, potentially improving supervision quality through enabling more frequent check-ins while expanding the number of technicians and patients that individual analysts can effectively oversee.
Center-Based Providers Experienced Disproportionate Disruption
CentralReach data reveals that center-based autism treatment providers experienced substantially more severe disruption than home-based service delivery models, with center-based organizations seeing business decline approximately 68% following pandemic onset compared to 36% average decreases for in-home providers. This disparity reflects fundamental differences in how pandemic-related closures, infection concerns, and family risk tolerance affected different service settings, with families demonstrating greater willingness to continue home-based therapy occurring in controlled environments compared to facility-based services requiring children to enter shared spaces with potential exposure to other families, staff members, and environmental contamination.
Center-based providers faced unique challenges including facility closure mandates in many jurisdictions during initial lockdown periods, substantial fixed costs for rent and facility maintenance continuing despite census collapse, difficulty implementing social distancing and infection control protocols in settings designed for active child engagement with shared toys and materials, and family hesitancy about facility-based services persisting even after regulatory permission for reopening. Many center-based organizations implemented extensive safety protocols including reduced capacity to enable distancing, enhanced cleaning procedures, health screening for all entrants, modified programming limiting shared materials, and physical barriers separating therapy spaces, though these measures generated additional costs while constraining census capacity below pre-pandemic levels.
Home-based providers maintained advantages during pandemic disruption by occurring in family residences where infection control remained under family management rather than depending on facility protocols, avoiding commute and facility exposure that concerned many parents, and more easily transitioning to telehealth formats where behavior technicians coached parents implementing interventions rather than providing direct therapy. However, home-based services faced distinct challenges including family reluctance to allow staff into homes during periods of elevated community transmission, disruption to household routines and parent work-from-home arrangements, and difficulty maintaining professional therapeutic boundaries when services occur in intimate family settings.
Overall Business Impact Reflects Substantial Revenue Decline
ABA organizations using CentralReach experienced billable charges decreasing between 48% and 52% when the coronavirus hit in March, representing devastating revenue collapse that threatened organizational viability for providers lacking substantial financial reserves, access to emergency funding, or operational flexibility enabling rapid cost reductions. Medium-sized providers typically experienced the largest declines, potentially reflecting that these organizations lacked the resources, infrastructure, and operational sophistication of large platforms while facing greater fixed cost burdens and less financial cushion than small owner-operated practices that could quickly reduce expenses by furloughing staff and suspending facility leases.
The magnitude of revenue decline required dramatic organizational responses including staff furloughs or layoffs, temporary facility closures, emergency financing through Paycheck Protection Program loans and other relief programs, rapid telehealth implementation attempting to maintain some patient engagement and revenue, and difficult decisions about whether to continue operations hoping for eventual recovery or close permanently recognizing that prolonged disruption might prove financially insurmountable. Many smaller independent providers permanently closed during pandemic disruption, accelerating industry consolidation as private equity-backed platforms with substantial capital reserves acquired distressed practices or recruited their staff and patients as independent operations failed.
Workforce Hiring Rebounds Despite Ongoing Challenges
Notably, hiring has increased even in heavily impacted states including California which experienced 8.3% employment growth since April according to CentralReach data, suggesting that autism providers have substantially recovered from initial workforce reductions and are now expanding staffing in anticipation of continued demand growth or to address workforce shortages constraining service capacity. This hiring rebound reflects improving census as families have become more comfortable with in-person services, expanded telehealth capabilities enabling providers to serve larger geographic areas without proportional facility investment, and underlying autism treatment demand continuing to grow through diagnosis rate increases and insurance coverage expansion regardless of pandemic disruption.
However, autism providers continue facing significant workforce challenges including competition for qualified behavior analysts and technicians amid national shortages, burnout and turnover accelerated by pandemic-related stress and operational instability, compensation pressures as competing employers offer higher wages in tight labor markets, and training needs as organizations hire less experienced staff requiring extensive supervision and skill development. Successful providers are investing in recruitment marketing, competitive compensation and benefits, professional development and career advancement pathways, supportive workplace cultures, and technology tools reducing administrative burden and enhancing clinical practice to attract and retain quality staff in challenging employment markets.
Strategic Implications for Autism Services Sector
The pandemic’s impact on autism treatment delivery will likely generate permanent changes in how providers structure operations, deliver services, and position themselves competitively in markets where families now expect telehealth availability, flexible scheduling, and hybrid care options that few organizations offered pre-pandemic. Providers that successfully integrated telehealth into comprehensive service models while maintaining clinical quality and family satisfaction have developed competitive advantages over organizations that struggled with technology implementation or resisted virtual care adoption, with these capabilities likely influencing family choice decisions and payer network selection as autism treatment markets become increasingly competitive.
The data documenting center-based providers’ disproportionate vulnerability may accelerate diversification strategies where organizations develop multiple service delivery models including home-based, center-based, school-based, and telehealth components rather than concentrating exclusively in single settings, spreading risk while providing families comprehensive options matching their preferences and circumstances. This diversification requires substantial operational complexity managing multiple service modalities with distinct staffing models, reimbursement structures, and regulatory requirements, though potentially generating more resilient business models less vulnerable to disruptions affecting specific settings.
As the autism services sector continues recovering from pandemic disruption while incorporating lessons learned about operational flexibility, telehealth integration, and crisis response capabilities, the CentralReach data provides valuable quantitative evidence documenting the challenges providers faced and the adaptations that enabled survival and recovery, informing strategic planning for organizations preparing for whatever challenges future public health emergencies or market disruptions may generate.
