The story
Founded by Doreen Granpeesheh in 1990.1
CARD was founded in 1990 by Doreen Granpeesheh, a former graduate student of Ole Ivar Løvaas, the UCLA psychology professor who popularized the use of ABA on autistic children.
Acquisition by Blackstone (2018–2019)
In May 2018, the Blackstone Group acquired CARD in a leveraged buyout valued at approximately US$600–700 million, one of the largest transactions in the behavioral-health sector.
Granpeesheh stepped down as CEO in 2019 but remained on the company’s board. Blackstone planned to scale CARD to over 500 clinics using data analytics and centralized management.
Former staff later reported that after the acquisition, corporate leadership reduced centralized clinical training and replaced experienced clinicians with managers from outside behavioral health, leading to concerns about quality of care and high employee turnover.
Growth and labor issues
By 2020, CARD operated around 230–250 centers nationwide. However, employees reported high turnover (over 150% annually) and low wages relative to workload.
Unionization efforts
In May 2019, while it was still under the ownership of Blackstone, employees at CARD's Portland East location voted to unionize, the first ABA clinic in the United States to do so. Prior to the vote, Granpeesheh appeared in person to plead with workers to vote against unionizing, and CARD hired anti-union consultants to intimidate staff. CARD permanently closed the Portland East location in January 2021, citing the impact of the COVID-19 pandemic. The company subsequently dismissed employee speculation that the Portland East location was targeted for closure because it had unionized.
Ethical and clinical concerns
The COVID-19 pandemic disrupted in-person services, and CARD’s telehealth expansion proved unsustainable. Critics and former staff alleged that under private equity ownership, clinical practices were increasingly standardized and profit-driven, reducing individualized care.
CARD’s practices under private equity ownership were criticized for:
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Inflating treatment hours to maximize billing.
Reducing supervision ratios (1 BCBA per 25–30 clients).
Prioritizing preschool-age clients with higher insurance reimbursement.
These trends reflected a broader pattern of “financialization of care” identified by a CEPR report
The 2023 Center for Economic and Policy Research (CEPR) report concluded that private equity buyouts in autism services, exemplified by CARD, resulted in “reduced staffing, increased debt loads, and lower quality of care.”
Clinic closures and bankruptcy (2022–2023)
Beginning in mid-2022, CARD abruptly closed operations in ten states—including Oregon, Michigan, Missouri, and Rhode Island—citing “unsustainable reimbursement rates.”
In June 2023, CARD filed for Chapter 11 bankruptcy protection, reporting US$82 million in losses and US$245 million in debt.
Under a court-approved stalking horse agreement, Granpeesheh’s company Pantogran LLC repurchased CARD’s remaining 130 centers for about US$25 million—less than 10% of its 2018 valuation.
The CEPR report concluded that Blackstone’s debt-loading and overexpansion turned CARD from a sustainable clinic network into “a cautionary example of financialized health care.”
From Wikipedia’s article on Center for Autism and Related Disorders, shared under CC BY-SA 4.0.4