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Private ABA Services?
nyc30731 wrote in autism
Hi. I'm a special ed teacher and ABA therapist in NYC. I was wondering if anyone here has experience with either hiring or providing private autism services in NYC or other big cities. I'm wondering about the financial and ethical logistics of taking on private family cases. Basically, to sum up my experience, I worked as a special ed teacher in NYC public schools for 3 years, and for the past two years, I've been doing full-time, home-based ABA and school-based SEIT work with preschool kids with autism through two special needs agencies. Although I'm making a good hourly rate overall (for a teacher), I know that these agencies are also taking huge cuts of my earnings b/c they have very lucrative contracts with the NYC Dept of Ed. (Basically, for every dollar I make, my agency takes 50 cents). I also have to pay for my own health care ($400/month for my health insurance in NYC).

So I'm wondering if it's time to branch out on my own and become self-employed as an "educational consultant" in this field. I know that I am a top-notch, caring special needs teacher - I received excellent ABA training, and all of the parents I've worked with have been very loving, happy and supportive of my work with their kids. Two families have recently approached me to work privately with their sons (who have not yet been diagnosed, but who have pretty clear autistic symptoms). A general ed preschool teacher I work with referred these parents to me w/out me soliciting any work. Would it be ethical for me to take these cases privately?

I'm thinking if I do take these cases, I should have the families provide me with 1099 forms for tax purposes, and I would ask them for the same hourly rate I'm getting from my agency, if not more. It seems that some parents in Manhattan, for whom money doesn't seem to be much of an issue, would rather hire someone privately than subject their children to the stigma and politics of being officially classified as "special ed" student in NYC. They could of course get the NYC Dept of Ed to pay for my services, but they'd rather just pay me privately.

So what do parents and others here think of this? Is it ethical for me to take these cases? Personally, I think I would prefer being self-employed, b/c I don't think the agencies I'm working for are particularly respectful of their teachers, and I think it's ridiculous that they don't offer us better health care. (I've only gotten about 20 colds, 5 cases of the stomach flu and strep throat from the kids this year!)

I do have an accountant, and I think I could officially and legitimately become and "educational consultant." I also know that autism is such a personal and sometimes painful issue for parents, and I don't know how comfortable I feel profiting as a private "business person" in this field.

Hmm. We are about to hire a woman to help us set up an ABA programme. We live in London.

Personally, I'm grateful she exists to help us out. Her prices are very reasonable -- I've explored a few options and some people charge very large amounts of money which we couldn't afford.

The idea of getting training, setting up a programme, finding therapists all on my own is incredibly daunting. She will, I hope, make it all much easier.

I think if you charge reasonable rates then it would be a great and fulfilling way to make a living. You could always do some free or non-profit work on the side so families without much money could benefit, too.

I dont think its profiting to make a decent wage and benefits at your job, and you want to continue with the work, I am sure a lot of teachers drop out in frustration, and that certainly doesn't help families. The only issue you would have is if the parents have difficulty paying for your servicies, either convincing their disability programs to cover you up front, or having to pay you and get reimbursed.

Honestly I don't see where the problem could be. Private therapy is great and eliminating the "middle man" that makes it more expensive for everyone only makes sense to me !
In the end you would make more money but the parents would pay less than what they are paying now.
As long as you are able to find enough patients on your own, why not do it ?
After a while word of mouth kicks in...

Now I don't see why all of this would be unethical. A lot of people do private therapy, it's convenient foe everyone.

Good luck with your project.

We loved our private therapist. When my son turned 3 the stae would not pay for her anymore. I can not afford her or We would still be using her services...not sure if that helps.

There might be a conflict of interest here. I'd review your contract with the agency you work for/with now. I know that if I were to leave, there is a clause that states I cannot do similar work within the autism field in the service area my employer serves for a year (basically meaning I cannot take on families of whom I know through my current employer).

It may mean that you just have to be careful about how you put yourself out there and to avoid soliciting current families

thanks. i know one of my old agencies had such a clause in their contract. I would not solicit any of my current clients through the agencies.

Thanks for all your comments. Right now, through my agency I get $60/hr, which may sound like a lot, but after health care and taxes, I end up taking home $35/hr. Considering my high rent in Manhattan, that's enough, but not exactly living the high life. I don't get paid for travel time btwn clients, and I end up traveling about 1.5 hrs per day btwn clients. The nyc dept of ed pays my current agency something like $115/hr for pre-school cases, and the dept of health pays about $130/hr for early intervention cases. The dept of ed could obviously save money by hiring someone like me directly for like $80/hr, but that's just not the way they function.

One family that approached me is fine w/ paying me $60/hr, and I think that is generally the range I will ask for. Does that sound like a ridiculously high rate? Remember, I live in Manhattan where cost of living is crazy, probably comparable to London.

Right now, I also work with one single mom in Harlem, who I know could never afford that rate, so I would keep her case through my agency to allow her to keep getting my services funded through the city. I know some private agencies here charge upwards of $150/hr. One of my friends thought she was getting a good deal by taking on a an aba case for $70/hr, until she found out that the woman running the agency was charging the parents $260/hr! I think that is totally unethical. The woman running the agency new very little about aba.

So I am thinking that with my two Master's degrees, top-quality aba training, and almost 5 yrs special ed teaching experience, $60/hr in Manhattan is reasonable. What do you guys think? I would pay taxes on it through 1099 forms, but I would also be able to write off quite a bit for self-employment costs, so hopefully my taxes wouldn't be too high. This is all totally new for me! Down the road, I may try to contract directly with the Dept of Ed, which would make sense for everyone.

outside Boston I did respite for $20/hr, and some people got $30/hr...but Manhattan is so expensive that $60/hr doesn't sound completely terribly unreasonable...unless you're doing TONS of hours per week for a single family. In that case, it might be an unreasonable financial burden and you could ask them to pay you by the week or day instead of by the hour.

The ABA therapist who works with a 4 year old that I know charges mom $50/hour, which seems pretty fair to me.
If you are a self employed/independent contractor (and even if you're not) you can write off a lot of your mileage as a tax deduction. Check with your accountant on that one- I keep track of all of my unreimbursed work mileage for tax purposes.

Interested in training a parent?

(Anonymous)

2007-07-29 12:10 am (UTC)

My e-mail is jabo_a@yahoo.com. Please contact me if you're able to train parents. Thanks!

With some comparable info.

I'm a software freelancer, in my field broker/agencies routinely take 50%+ of the bill rate. One of the agencies in the DC area advertises as a positive that they "only" take 25% of the bill rate. In that context the
ratio of your rate and the company rate is a little high but not absurdly so (given that contrating with gov't agencies works out that they end up having a pseudo-monopoly on those contract it's not surprising).

Broadly speaking that seems horrendous, but I've been looking at moving towards becoming a contract 'broker' so have needed to run the figures...
and discovered that to break even on a W2 contractor, I need to be collecting 34% of the bill rate, thats with no real benefits for the employee, and no profit for the company - just required expenses ( work comp, unemployment, FICA etc. ) and sales support. So for a small contract broker the numbers aren't nice. On the other hand my calculation indicate that once I had 15 people working on contract some economies of scale kick in and I could afford to decrease that percentage significantly, which would make room for benefits and profit and such. Which means if the broker is handling dozens and dozens of people like you for the entire NYC DoE/H then I'd say they're probably not being terribly fair (to be polite).

If you're already working as a 1099 contractor (it sounds like you might be), then you are already most of the way towards going independent. Contrating with gov't agencies is a real pain, so if you go independant you probably won't be able to access that market, but by working with the clients directly rather than through the broker you will have better control over 'fair' pricing.

Good luck.

Grateful parent

(Anonymous)

2007-07-29 12:07 am (UTC)

I have a child, now 5, who didn't get ABA. I would love to discuss becoming an ABA specialist like you. Are you interested in training parents? I fully intend to work with an agency, and become an independent contractor like you. NYC is where all skilled professionals eventually establish themselves and build connections. Most of them though, do not help children, and are only dedicated to their own ambitions and greed. Good luck and thank you.