Deciding to leave was not the hard part. The hard part was that nobody tells you how, and the people best placed to advise you are the people you are leaving.
This is the practical version, in the order I wish I had done it.
Before you tell anyone
- Line up the next thing first, if you can. A gap is harder on your child than a handover. We did not manage this perfectly and I would prioritise it now.
- Get your records. Request the full file: assessments, treatment plans, progress reports, session notes. Ask in writing. You are entitled to them and they are much harder to obtain once you are a former client.
- Get a fresh referral from your paediatrician for whatever you are moving toward. Ours was the lever that eventually forced the insurer to authorise speech and OT.
- Read your contract. Notice period, any fees, anything about minimum attendance. Know what you have agreed to before you give notice.
- Check your authorisation. Find out what is approved, through what date, and whether it transfers.
Telling the clinic
You do not owe anyone a debate. “We have decided to change direction and we would like to arrange a handover” is a complete sentence.
You may get pushback, and it will often be framed as concern about regression. If you want to engage with it, ask for a prediction rather than a warning: what specifically would you expect to change, and over what period? That is a claim you can check. A general warning is not.
You may also be offered a reduction as an alternative to leaving. That can be a genuinely good outcome, and it is worth considering on its merits rather than treating it as a trap.
Managing the transition for your child
This is the part I got most wrong.
When I told my son we were going to see someone new, he cried, and he stayed frightened, because he assumed it would be the same as ABA. He did not settle until he had been there long enough to see that it was different.
I had not anticipated that at all. I thought leaving would be a relief. What I had not understood was that the fear had generalised to the whole category of adults in rooms with toys, and the new provider had to spend our first weeks paying that down before any actual work could begin.
What I would do differently:
- Say explicitly and repeatedly that this is a different kind of place, and be concrete about how.
- Visit before the first session if the provider allows it, with no expectation of doing anything.
- Let the first appointments be genuinely low demand. Ours started with letting him play with different toys while they watched what he gravitated toward, which turned out to be both the assessment and the reassurance.
- Do not promise he will like it. Promise that you will listen if he does not.
About the guilt
I felt it for months, and the shape of it was specific: a fear that I was choosing my own comfort over my son’s development, and that if things went badly it would be my fault in a way it would not have been if I had simply followed the recommendation.
Two things helped. The first was learning that the evidence for the thing I was leaving is weaker than its confidence suggests. A 2024 meta-analysis in JAMA Pediatrics of 144 studies and 9,038 children found no significant positive association between the amount of intervention and outcomes. I had been treating the recommendation as settled science and it is not.
The second was that the change, when it came, was modest and real. Within about four weeks, more confidence, better impulse control, and one afternoon he invited another child to play. I am not going to inflate that into a transformation. It was more than I had seen in many hours of the other thing, and it was enough.
If you cannot leave right now
Plenty of families cannot, for reasons of cost, geography, waitlists, or a custody arrangement where this is not solely your decision. Leaving is not the only lever.
- You can reduce hours without ending services, and you can propose it as a time-limited trial.
- You can ask to reallocate hours toward speech or OT rather than removing them.
- You can insist on observing sessions.
- You can ask, in writing, what is being measured and what would count as this not working.
- You can push back on the plan while staying in it.
And if cost is what is holding it in place, the options are often wider than families are told. That is covered in the post on paying for therapy your insurance will not approve.
One last thing. Leaving a provider is not a verdict on everyone who works there, and it is not a permanent position on an entire field. It is one decision about one child, and you are allowed to make it and to change your mind later.
