David Minot, Executive Director of Mental Health News Education, the non-profit organization that publishes Autism Spectrum News, interviewed Rita Gardner, President and CEO of Melmark, a multi-state, non-profit human service provider with premier private special education schools, professional development, training, and research centers across the country.
This transcript has been lightly edited for clarity.
David Minot: Hi, my name is David Minot, and I am the Executive Director of Mental Health News Education and the founder and publisher of Autism Spectrum News, where our mission is devoted to improving lives and the delivery of care for young and adult autistic individuals while supporting their families and the professional communities that serve them by providing a trusted source of science-based education, information, advocacy, and resources. Today we’re speaking with Rita Gardner, President and CEO of Melmark, a multi-state human service provider with premier private special education schools, professional development, training, and research centers across the country. Melmark is committed to enhancing the lives of individuals within diverse communities with autism, intellectual and developmental disabilities, and their families by providing exceptional, evidence-based, and applied behavior analytic services to every individual every day.
In her role as president and CEO, Rita leads operations and management of Melmark service divisions in New England, Pennsylvania, and the Carolinas. Prior to her appointment as president and CEO in 2015, Ms. Gardner served as executive director of Melmark, New England, based in Andover, Massachusetts, which she co-founded in 1998. She also founded Melmark Carolinas in 2018 and a second New England day school in 2022.
Ms. Gardner and Melmark New England were honored to be named the Women’s Edges list of the Top 100 Women-Led Businesses in Massachusetts for five consecutive years from 2018 to 2022. Ms. Gardner was honored with the CBIZ National Women Transforming Business Financial Strength Award, as well as the CBIZ Overall Winner Award in 2022. She is a Board-Certified Behavioral Analyst, a trained public health professional, and has devoted over 40 years of her professional career to the field of community-based services for children and adults with a diagnosis of autism spectrum disorder, intellectual and developmental disabilities, acquired brain injuries, severe challenging behaviors, and medical fragility.
Ms. Gardner is also an accomplished and persistent legislative advocate. Her public policy work has positively impacted services for individuals diagnosed with autism and developmental disabilities across the United States. It is my pleasure to introduce Rita Gardner. Thanks so much for being here with us today.
Rita Gardner: Thanks so much for inviting me, David. I really appreciate it.
David: I also want to mention that Melmark has been partnering with Autism Spectrum News for over 10 years and has contributed almost 40 articles to our library, which is provided online to access without a paywall thanks in part to advertising support from Melmark.
How about we begin by talking about Melmark, New England, which you co-founded in 1998. Melmark, New England is celebrating its 25-year anniversary this May of 2023. What are you most proud of over the past 25 years?
Rita: I think it’s really hard, David, to pick just one thing that I’m most proud of. I think at the outset we certainly had a vision of what we wanted to accomplish, and the first part of that was really replicating Melmark’s mission at the outset. We are very lucky to have partnered early on with Melmark, Pennsylvania, which really was committed to the mission of serving individuals with developmental disabilities in a way that was close to home and of high quality. And we wanted to apply an evidence-based and applied behavior analytic framework to that. I think we’re very proud of the fact that we’ve met both of those goals and we work every day to continue making sure we hit those goals.
David: Care and compassion is the first core commitment that is identified throughout the Melmark web site and publications. Can you tell us how this and the other five core commitments are woven into your day-to-day operations?
Rita: Yes, those core commitments come from Melmark’s original mission and certainly they’ve been changed a little bit over the years and have been updated. But what we’re really looking at is how those core commitments are reflected in everyday practice at the point of care. What make sure that we weave supports into the design of our systems of care that ensure those things can actually have outcomes in the delivery of services. In every meeting that we have, we begin with mission moments, talk about our compassionate care, and someone will talk about how something is tied to a core commitment. An example of this could be a best outcome for a student who achieved 90% of their goals on an IEP. Another example might be a situation where multiple staff had to work together on an unusual problem that reflected a unified culture. What we’re doing at each of those core commitments is creating an opportunity over and over that the resources support the weaving of those core commitments into our daily mission of care.
David: I noticed that Melmark has established a strong organizational commitment for a Diversity, Equity, and Inclusion initiative. Can you explain the thought process that led you to take this particular action?
Rita: I would actually say that plan articulates ongoing actions. So, as you said in describing my background, as I’m trained in public health, which is a bit different than a behavior analyst, special education teacher, or a psychologist. Public health is always about equity, access, inclusion, and how people get services. From the time that we defined and built the original Melmark location in New England, we were looking at who gets access to our service and how do we partner with other stakeholders. Early on in the late 1990s and early 2000s, we were working with the government around legislative bills; for example, in Massachusetts, a Medicaid waiver to access applied behavioral analysis (ABA) services. And within that language, we worked to answer the questions: How do people get access? Is the bill in multiple languages when you apply? Those kinds of things. We’ve been doing that since the 1990s and we’ve done it on multiple levels of bills. We evaluate what the demographic makeup of our students is, what schools come to us, and what staff do we serve. And then, with the horrific issue of George Floyd, it wasn’t just enough to just do it. We had a very bright staff member who came to me and said, “What did you do?” I met with him for about two hours, and we talked about all the things we did. He then asks, “Why do we, the staff, not know any of that?” And I said, “Sure, we need to articulate that in a DEI plan.” That was the impetus. This well-spoken young black man who worked for us said, “Wow, that’s why you do all of that.” We were able to articulate that into a very comprehensive DEI plan, some of which is reflective of decades of work, and other parts of it are advancing that work. So, I’d like to think we set the foundations and continue to do that. And if you think about Melmark’s original mission, it was about not separating individuals with disabilities and providing some social justice for a disability community that has been excluded from everything. I do think it falls naturally with the Founders’ vision of how the world should operate.
David: Melmark has influenced the quality of human service delivery in Pennsylvania, Massachusetts and most recently in North Carolina and South Carolina. Going forward, what is your vision to effect change for other states in need?
Rita: We would like to continue to expand our public policy work. Across the country, we’ve seen the access that insurance-based services have given to individuals for ABA care. But with that, there are some concerns in terms of how those services are run – how profits are being made. I would argue that, as important as ABA insurance services are, the focus should be on the full implementation of the Individuals with Disabilities Education Act (IDEA) under a free and appropriate public education. For many individuals in the United States, that is the only entitlement a child will get. It’s an entitlement for inappropriate public education.
When I look at individuals in special education or with disabilities and particularly the autism population, I’m concerned that the implementation is so inconsistent across the United States. And so, we’re trying to work at the federal level with other stakeholders, because right now under faith, it’s individual cases that make up case law. We really need the Department of Education at the federal level and the Office of Special Education Programs (OSEP) to do their job in terms of monitoring our states really implementing faith, or else we are writing off a generation of children. And I hate the idea that we see people pulling their kids from school to go to ABA clinics. And then when insurance runs out, we’re still right back where we started.
I think ABA insurance is an incredible accomplishment and would be great for after school care and weekends. But I still think primarily special education and interdisciplinary teams should be at the core of every child’s services. And it shouldn’t be just that you’re born in Massachusetts or you’re born in a state that provides good special services. It’s a federal law and the implementation should be consistent across the United States.
David: Absolutely, I agree. Let’s talk about your staff for a moment. I recognize that you have over 1,000 staff across Melmark divisions. With human services currently undergoing a huge staffing crisis, how do you respond to ensure quality delivery of services?
Rita: We have probably closer to 1,200 staff members and we should probably have 1,400. So that tells you where we are. We’re seeing that across the United States and I think, certainly pre-pandemic, we saw these staffing trends where the workforce was increasingly becoming smaller and smaller. If you think about the demographic of the United States, we have so many people aging who will actually require people from the care community to take care of them. The bucket of people coming into college is dramatically smaller. Some of us knew this demographic data before the pandemic that we’re going to hit six to eight years of very difficult demographics in terms of people graduating from college to work in the care industry. I think one of the things we’re concerned about is that we don’t value our care employees.
During the pandemic across the United States, we heard that the care workers were all heroes. But we work across states, and they didn’t seem to be heroes when the budgets came out. They are some of the lowest paid employees in the United States. You can make more making coffee at Dunkin Donuts or Wawa than you do working in a direct care position. Again, I think it comes back to an advocacy community and working towards getting better funding. For us, it means trying to make our administration as lean as possible to make sure as much funding goes to point of care salaries. In addition to that, we do a significant amount of fundraising, quite frankly, and pay our staff more than what the state pays us. In one of our states, we have a gap of every dollar of services we provide, we lose seven to eight cents on the dollar because we pay our staff more. And we refuse to not do that because we want the quality of care. In the short staffing, we’ve built such strong infrastructure with direct personnel supervision, then another level above that, all of those staff fall into direct care roles when we’re short staffed. If we did not have those roles, there is no way we could sustain the organization’s quality. And in addition to which, because turnover continues to be so high in this area, those people are also our trainers. So, they’re doing side-by-side training at the point of care, and that’s helping us maintain our quality of service.
David: This is an issue everyone is facing, and it sounds like you’re doing a lot to really support your staff. It is clear that you are an important voice beyond Melmark and you are leading the charge for change across the country for legislative action. What are the challenges you are facing in your role as a legislative advocate?
Rita: I think the understanding of the wide spectrum of autism services in terms of how we compare, for example, in the care community where everybody is competing for staff, childcare, elder care, school instructional assistance, those kinds of things – we’re competing. But Melmark serves a higher acuity population that really needs technical supports to get their best outcomes. We actually had a legislative panel in Pennsylvania last week. And one of the set of senators said, “Well, childcare workers have the same issue.” And I responded, “Oh, no, no, no. Serving a 16-year-old who’s struggling with toileting, maybe aggression, self-injury, and communication, is not the same as managing a six-year-old who’s having a temper tantrum.” And the skillset needed of that staff has to be different, and that’s not disrespecting child children who have childcare. But I think the reality is, there is a difference in different levels in the care community, and we need to recognize that better. We’re trying to train or teach legislators that the population we serve is often hidden because they do have such high support needs. It’s not someone who’s going to be on TV playing the piano. It’s not someone who’s going to be at the very high end of an individual with autism or an autistic individual. So we have to then retrain and ask them to come tour Melmark facilities – come see our individuals and talk to their families. It’s really about educating the nature of the spectrum. And I think sometimes for those individuals who cannot speak, voices are getting lost. I think that often their families or their guardians are elbow to elbow with them making sure they’re okay every single day, and they almost have fatigue about advocacy because they’re just trying to get through the next day. I think the challenge for us is the education of the wide range and needs of individuals and what the workforce also has to reflect that range and those needs.
David: Absolutely. How about we switch gears and talk about COVID. You mentioned earlier that you successfully led Melmark through the COVID pandemic by maintaining the delivery of services while prioritizing the safety of both your clients and staff. Where does your drive and resiliency come from?
Rita: That’s a good question because I would say COVID tested me both personally and professionally in ways I could never have imagined. On March 14th, 2020, the governors announced the pandemic procedures and closing of many, many businesses. My mother died of COVID, and I was on the job about an hour after I buried her, begging staff to stay on the job. Even during the weeks leading up to COVID, I knew I couldn’t give my family the time I needed to give them because I was responsible for almost 1,000 individuals with very vulnerable issues and that we were going to quickly have to pivot from a long-term care system to a medical system. I have never been so grateful for picking a public health degree from Boston University in my life, and I will sing their praises forever. When I started to meet with the state legislators or some of the governor’s team, people were saying, “It’s going to be over in three weeks.” And I thought, “Oh no it’s not.” I was able to pull out my textbooks from 20 years ago and say this is what a morning is going to look like as you transition children into early intervention or into school. You have 68 exposures, immediately within two hours.
You asked me about where my resilience comes from. I like to consider myself a behind-the-scenes fixer. Doing these interviews are very difficult for me – I prefer to work behind the scenes. I’m a grinder. If you’re familiar with hockey, I’d be the player in the corner, figuring out solutions. I knew right away what we needed and I called in my siblings – I have 13 siblings, some of them are who are at high levels in healthcare – and said, “I need PPE, I need this, how can I get it?” I told my CFO that we’re going to wire funds to China to get PPE and he thought I was out of my mind. And we got them through a supplier who supplied NASCAR in Charlotte, North Carolina, because they used them in the pits and NASCAR wasn’t going to be running. I pulled out everything I’d done for 42 years. I had no problem going across the street to my neighbors who worked in the pharmaceutical industry. It was a very difficult period of time for Melmark, but we had full PPE for every staff before we ever had a case of COVID. We had on-site testing by April 7th of 2020 before some hospitals did.
But during that period of time, I had lost my mother to COVID, my sister died weeks later of cancer, and I was working 20 hours a day. I had a friend at McLean Hospital and said to them, “I’m not sure I’m going to survive being CEO of a multi-state organization during a pandemic.” Also, a couple of my own children were struggling. The work stoppage during the pandemic meant that their careers, which are athletically-based, suddenly stopped a career that had been very difficult for them get to that point professionally, in terms of athletics. We had so many issues going on. I went from an empty nest syndrome to five children being at my home, including a student from Canada. So, I reached out and I got a professional coach. This was the first time that I’ve ever seriously had a mentor. This professional coach is still my coach today and we worked on establishing some balance, telling myself that you’re not going to fix COVID.
We had leadership teams at Melmark that stepped up across three states. We had done a lot of work since our 2017 strategic plan. We have incredible training systems that I would tell you are probably state of the art in the United States, and we pivoted. We used those same training systems to develop medical care. We developed COVID-positive units. Nursing taught us how to do things. We did testing, we became clinic-based, we got approval for clinics to do onsite testing, and we did it fast.
While we looked very resilient and we bounced, I would say a leadership team worked every single day during a COVID meeting in the morning, talking about cases and we ended every meeting with a bad dad joke from Sean Quigley, our COO. We tried to keep balanced and lighthearted about it, and in November of 2022, we had another surge where we lost about 20% of our workforce and I thought, “We are never going to ever see the end of this.” It was devastating. It was right before Thanksgiving. Staff could never get a break and we did it again. And then we went through that and here we are today.
I think very often when people talk about these care systems, we don’t really talk about the leadership teams who, at great personal cost, kept these organizations open. And even I can hardly talk about it because it’s so emotional for me. I think my point of making it so detailed is to remember those people across the United States who took care of our most vulnerable individuals in nursing homes and very, very disabled individuals in long-term care programs. We’ve kind of forgotten them in the next legislative budget process. As inflation has gone up 14%, many states have given zero increases to long-term care services. That’s a problem.
David: Yes it is. It sounds like you used all the resources you had and got creative and, with your tremendous staff, Melmark made it through COVID successfully, even given such a terrible situation. As we come to the end of our conversation, can you share what inspires and motivates you to persevere through challenges and achieve your high standards of excellence?
Rita: Absolutely. I think as a young clinician, I was a good clinician, but self-injury, aggression, those kind of things really always broke my heart every single day. And then I saw clinicians and educators and folks like our Chief Clinical Officer, Frank Bird or Helena McGuire, our head of the Massachusetts divisions, do work that was incredible. And I always felt that I’m not as skilled in that area, but I can build systems of care and will beg anyone for money for disabled individuals. I will do anything to get the right care for individuals with disabilities so that those clinicians and educators should do their work.
So, the inspiration for me is every meeting that we lead with mission moments that talk about our core commitments and some successes. Every time I hear about what our staff has done to improve the lives of individuals, I can’t imagine that I was ever going to be that good, right, in terms of that kind of work. And then I’m inspired by the staff that do it. You know, we met recently with our founding team in Stoughton, Massachusetts, for our new day school and the skill level at a fairly young age, married with the mission of Melmark – I can’t wait to see what they can do. It’s inspiring. They’re going to bring the next generation of Melmark to a whole new set of individuals just like our staff in the Carolinas. I think about if it was my son or daughter, or my brother or sister, and they needed care, are we good enough? I think that inspires me to work very, very hard. And quite frankly, I think our leadership team across the three states is unmatched. They’re just so committed to the mission and the core commitments. And then they just happen to have incredible technical expertise. So, what inspires me every single day is our work and the outcomes that our incredible staff achieve.
David: You know, I have visited Melmark, New England, toured the facility, and met some of your wonderful staff and I think “inspiration” is a great word. You just feel it from their energy and camaraderie, and as you said, it’s the staff that really do the hard work to keep operations going.
Rita: There is no question. The care point of contact is exceptional, and it’s the thing that matters the most. Absolutely.
David: Rita, I want to thank you so much for your time. It’s been such a pleasure to speak with you to learn more about Melmark and your role as a leader and advocate for people living with autism and developmental disabilities.
Rita: Thank you, David!
David: To those watching, for more information about Melmark, please visit Melmark.org. And be sure to also visit AutismSpectrumNews.org and browse our free online library to find information you can trust and get connected to quality resources in the community, just like Melmark!