Vicki Kroviak, CEO of Acorn Health, is taking a different approach to growth in the autism therapy space. Rejecting what she calls a “dots-on-a-map strategy”—the practice of opening locations wherever possible to quickly expand market presence—Kroviak has overseen a 47% expansion of Acorn Health’s footprint since 2018. This measured, strategic growth comes at a time when other ABA providers are facing significant challenges, including staff layoffs, office closures, and the abandonment of entire state markets. This approach serves as a strong example of effective autism therapy growth strategies in a competitive sector.
Most recently, Acorn Health acquired seven sites from Maitland, Florida-based Breakthrough Behavior in a deal that closed on September 19. While the terms of the acquisition were not disclosed, the move brings Acorn Health’s total number of locations to 75, offering both in-office and at-home ABA services. For Kroviak, the company’s ability to grow while others shrink is grounded in careful planning, rigorous market research, and leveraging existing infrastructure—key components of successful autism therapy growth strategies.
“We do our homework before we go into a new market,” Kroviak told Behavioral Health Business. “That’s a perfect example in Breakthrough Behavior. We understand what we’ve got. It’s highly unlikely we’re going to be surprised by what the labor market tells us in any of their facilities because we … already have an understanding of it.”
This deep local knowledge also provides insights into payer dynamics, reimbursement structures, and workforce availability, giving Acorn a strategic advantage in both planning and execution. Rather than expanding simply to add more “dots on the map,” Kroviak emphasizes growth in areas where the company already has insight, experience, and operational infrastructure. These tactics reflect the core of autism therapy growth strategies that balance market opportunity with operational sustainability.
Navigating Industry Challenges
The autism therapy space has faced two converging pressures in recent years that have caused significant disruption. First, private-equity-backed providers have aggressively acquired smaller offices to increase market share and gain leverage with payers. This trend has accelerated in recent years, creating a highly competitive environment.
Second, COVID-driven wage pressures have led to high turnover rates among registered behavior technicians (RBTs), the practitioners who most often work directly with patients. Combined with limited reimbursement increases, these challenges forced some of the largest autism therapy providers to downsize in order to stay financially viable. Companies that lacked clear autism therapy growth strategies found themselves closing offices or abandoning entire state markets.
“I think there’s a lot of risks when you’re approaching your growth in a dots-on-the-map kind of way, particularly in the year that we’ve had where the labor challenges were so great,” Kroviak said.
Industry examples highlight these pressures. Plano, Texas-based The Center for Autism and Related Disorders (CARD) is closing operations in 10 states, reducing its state market footprint from 24 to 14 states. Since December 2021, CARD has cut its office footprint by roughly 30%. Earlier in the year, CARD shuttered its Oregon office, while 360 Behavioral Health closed nine locations. These closures affected at least 665 employees, and it is not yet known how many additional workers will be impacted by CARD’s state footprint reduction.
A Strategic, Long-Term Approach
Acorn Health was founded in Coral Gables, Florida, in 2018 by Kroviak with the backing of private equity firm MBF Healthcare Partners. By 2021, the company operated 51 locations across Michigan, Illinois, Virginia, Florida, Maryland, Pennsylvania, and Tennessee. That same year, MBF Healthcare Partners sold Acorn Health to the Ontario Teachers’ Pension Plan Board (OTPP), a move that further reinforced the company’s long-term growth strategy.
The OTPP takes a multi-year view of its investments in ABA, allowing Acorn to strategically plan for the future rather than reacting to short-term market pressures. Kroviak points out that this long-term perspective is crucial, especially given the workforce challenges that have impacted the sector. This combination of investor support and thoughtful planning is a cornerstone of successful autism therapy growth strategies.
“That three- to five-year [holding period] in private equity pressure creates some impatience,” Kroviak explained. “OTPP understands the business and is in it for the long term, which allows us to be thoughtful and intentional with growth.”
Supporting the ABA Workforce
Acorn Health’s growth strategy extends beyond market expansion—it also prioritizes workforce development and retention. In an industry where women make up roughly 85% of certified BCBAs, RBTs, and other ABA professionals, and where 64% of certificate holders are between 18 and 45 years old, supporting employees’ professional and personal needs is essential.
Recognizing this, Acorn Health recently announced a new paid maternity leave policy, alongside professional development and mentorship programs. “So it’s women and it’s younger women,” Kroviak said. “We came to that decision by really doing the work to listen to our workforce.” Workforce retention, along with careful planning, is an integral part of autism therapy growth strategies that aim for sustainable expansion and quality care.
Paid maternity leave, professional growth opportunities, and structured mentorship programs signal Acorn’s commitment to building a sustainable workforce while simultaneously growing the company. In a sector often challenged by high turnover and staffing shortages, these efforts position Acorn Health as a leader not just in size, but in quality and employee satisfaction.
Looking Ahead
As Acorn Health continues to expand, the company’s approach remains rooted in research, preparation, and strategic planning. Rather than chasing quick growth by opening locations indiscriminately, Acorn prioritizes understanding local markets, assessing workforce needs, and considering payer dynamics. This approach has allowed the company to grow successfully even as competitors face closures and layoffs. By integrating careful workforce development with strategic planning, Acorn Health demonstrates best practices in autism therapy growth strategies.
With strong backing from OTPP and a focus on workforce development, Acorn Health is well-positioned to continue its growth trajectory, ensuring that children and families seeking ABA services have access to high-quality care across its expanding footprint. By rejecting the “dots-on-a-map” strategy and investing in knowledge, infrastructure, and people, Acorn Health sets a standard for sustainable growth in the ABA industry and provides a model for other providers seeking proven autism therapy growth strategies.
