Growing with Purpose: A Conversation with Noreen Zulaica, Owner & Founder of Tender Ones Therapy Services

In this episode, Rachael sits down with Noreen Zulaica, PT, MA, and owner/founder of Tender Ones Therapy Services (TOTS), which has been proudly serving families for over 20 years with offices in Atlanta, Dacula, and Gainesville. Noreen shares her inspiring journey into business ownership, the growth of TOTS, and what led her to begin offering intensive therapy programs for patients.

Rachael and Noreen also discuss how Alliance Prosthetics & Orthotics and TOTS connected, and the shared mission and vision that guide both teams, providing compassionate, patient-centered care that helps individuals reach their fullest potential.

We’re so grateful to Noreen for joining us and for the incredible partnership we share with Tender Ones Therapy Services!

TOTS Contact Information:

Phone: 770-904-6009

Email: TOTSOFFICE@TENDERONES.COM

Website: https://tenderonestherapy.com/

Instagram: https://www.instagram.com/tender_ones/

Facebook: https://facebook.com/tenderones

Follow Alliance Prosthetics and Orthotics below!

Website: https://www.alliancepo.com/

Instagram: https://www.instagram.com/alliance_po/

Facebook: https://facebook.com/alliancepo

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Questions? Email us! Info@alliancepo.com

Guest: Noreen Zulaica, PT, MA, Owner & Founder of Tender Ones Therapy Services

Host: Rachael Auyer, Co-Owner of Alliance Prosthetics and Orthotics

Producer: Laine Johnson, Alliance Prosthetics and Orthotics, Marketing Assistant

Transcript

SPEAKER_05 0:01

Welcome back to the Alliance Goldiger Podcast. I'm your host, Rachel Oyer, co-owner of Alliance Prosthetics and Orthotics. Today I'm thrilled to have Noreen Zaleika, a dedicated pediatric therapist and the founder and owner of Tender Ones Therapy, a highly respected practice that's been serving families for more than 20 years. With offices in Atlanta, Tekula, and Gainesville, Tender Ones has built a reputation for patient-centered care, innovative programs, and a compassionate team committed to helping every child reach their highest potential. Thanks for joining us, Noreen. We're so glad you're here. Thank you, Rachel. It's great to be here with you. Well, I'm really excited because Noreen and I have known each other since we started, and we have had this beautiful relationship that's really founded off of Jason and I bringing baked potatoes to their office, which is kind of a wild story. But when we started our company, we had two pennies to rub together and we were trying to serve our referral sources. And I made salad and baked potato, and your office allowed me to come in and serve you all this baked potato bar and salad and cookies. And cookies. And it just developed a strong relationship of caring for kiddos in the heat of orthotic intervention. And I wondered if you could tell us how you started TOTS.

SPEAKER_00 1:22

Sure. Um, just to give you a little background information about me. Don't know if you know, I was born and raised in the Bronx, and I graduated from NYU in 1988 with a bachelor's in physical therapy. And um at that time, a few years later, um my family we decided to move to Georgia. So that was in 1998, and my two children, I have two sons, Brandon and Nicholas, and they were one and three at that time. So they're really Georgia boys now. And I've loved Georgia since the moment I stepped off the plane. So uh Brandon lives in Arizona, and Nicholas is actually living in Germany right now, and um I live in Brazzelton with my husband Brian and our two dogs, Missy and Coco, and they come to work with me, and they're a real inspiration to the children. And um, Brian is a big help administratively with me in running Tender Ones. Yeah. So, and we love to go out on the lake, play golf. So that's just a little bat background about me. Um, I started Tender Ones in 2003. At that time, my children were getting older, they were going into school full-time, and I was thinking, okay, you know, I love pediatric therapy. I was working for a private practice all about kids in Lawrenceville, and I have great respect for the owners, Amy Eblin and Amy Lucicero, and they really inspired me and motivated me to start my own practice. So um I did that in 2003, and the reason is I think that I love to know how something is done from start to finish. And I wanted to know every in and out of providing high-quality therapy to children with special needs. And I wanted to be able to do that on my own terms, and my mission was to create a company that if I had a child with special needs, that this is where I would want to bring my child. That the the company supported their therapists, motivated them, encouraged them to learn the latest techniques, use the best equipment, whatever a child with special needs needs to reach their goals, I wanted to make sure that that's the company that we were building. So that was what my mission, my mission was.

SPEAKER_05 3:58

That's beautiful. I love that because that's how Jason and I started is very similar. We wanted to do it in a way that if our child needed orthotics or prosthetics, this is how they would be treated and what would matter to us. And uh, I don't think people know all of the ins and outs of starting a company. Right. Uh in 1998, it might have been a little different than 2016 when we started. What were kind of the first obstacles you had to go through?

SPEAKER_00 4:28

Well, you know, fortunately, I feel like God really leads me in a direction of what I can handle and build at a steady pace. So I started with myself and then I was introduced to a therapist that um was an OT, and the child that one of the child I was treating needed OT. So she became my first independent contractor. And we just started to build like that. So I think controlled growth is really important and and managing the growth and because you need to know every in and out of running the company. And I that was always very important to me. So I had to learn how do you do authorizations, how do you do credentialing, and I did all of that backbone of of the company so that I know exactly what needs to be done as I hire someone to help me do those things. So I think that's really important when you're growing a company. And I've spoken to some owners who never knew even how to do an authorization. And I think that can that can be uh not good because if that person walks out the door, you you don't you need to know how to do every port part of your company. So it's real that it it is also means a lot to me because then I know what they're dealing with through their day. Right. The difficulties of scheduling patients, the difficulties of following up with appointments and confirmation, the difficulty with authorizations, the frustration with insurance companies and denials. So I can I I have learned how to do all of those tasks so that I can assist them and support them and also know where they're coming from.

SPEAKER_05 6:26

So that's an amazing testimony, and it is detrimental if you don't understand the business that you've been entrusted to serve and care for patients because really it's all about patients and their outcomes, and it helps you understand what the patients need and developing a practice that supports them. I wondered, I I know anecdotally that you started in your basement. Yep. Tell me what and one of your passions is intensives. Where did that come from and how did you start in your basement? And then uh for our audience, there's these amazing, beautiful buildings that we get the privilege to be next door to one of them. They're incredible. Tell us about building spaces for your people.

SPEAKER_00 7:09

So I always was open to ideas from parents and suggestions, and I feel like many of the parents of the children I was treating early on in my practice, I learned so much from them. And parents who have a newly diagnosed child with special needs, they start doing research and they find out how I can help my child. And they would bring different programs or equipment to me, and I would say, I've never heard of that, but let me look, let me do some research and see what that is that all about. So I was treating this little boy, Brandon. He was about four years old, and his mother, Melanie, told me that she had found out about intensive therapy programs and that there was one in Florida. And I said, This sounds like a great concept. Why don't you go? This sounds wonderful. I looked up the company, what was the program about? I said, it can't hurt, it can only help in his in his progress. So Melanie took Brandon to Florida and um she came back and she said, You can do this, you need to just go get trained. So I said, Okay, I fine because it was dropped in my path, and I felt like when those things happen, that that's what I need to follow. So I looked up a this um a company that did that did the program, they're called Therasuit, and they're located in Michigan, and I went to Michigan for a week. I was trained in suit therapy, an intensive therapy program, and I came back to Georgia. I bought all of the equipment that I needed to do the program, the universal exercise unit, and um I put it up in set it up in my basement. So I had this one room of therapy, and I started doing intensive with my patients that I had on my caseload. And Brandon was one of them. And then Melanie told her friend Anna Marie, who told her friend, who told her friend, and I had these families coming to me for the intensive program, and I said, Well, um, it looks like I need a real office space because I've been doing this for six months and they're scheduling out for a year. So I opened um uh my first clinic, which was only 1,400 square feet um in Dekula and started adding more therapists who were working with me, and we outgrew our space within four years and realized we really need to double our space. So we just we moved over to Terran Trace, which was our um 3,500 square feet clinic at that time, and we just started adding more therapists who were had the same mission and vision of us of to provide good quality therapy. And um we now we hold uh probably about 12 intensive therapy programs every week, and we do it 52 weeks a year, and we are scheduling into 2026, even into early 2027 shortly. So it it's and I think the um the reason for that is because we have all had a passion for intensive, and uh the beauty of an intensive program is that these children are coming to to get therapy three hours a day, five days a week for two to three weeks. But sometimes they even do a four-week program.

SPEAKER_02 10:54

Wow.

SPEAKER_00 10:54

And when you have a child with special needs, for them to learn a skill, they need a much higher repetition to learn that skill than a typical child. So if your typical child practices doing a skill a hundred times, the child with special needs is going to need to practice it a thousand times. So when you're providing therapy on a weekly basis and you're only seeing that child for one hour, then another week goes by, they've lost some of the knowledge of the skill that you worked on last week. It's like the summer slide for children going to school over the summer, right? So that's what happens to that child week to week in regular therapy. So you you have them only for that hour. And there's so many portions of therapy that you want to work on to build the skills that the hour, there's just not enough time. So the beauty of the intensive, and this is why I fell in love with it in the beginning, is that I had that child for three hours, and I could focus on every little portion of therapy that that I knew would help this child. So we we have a very structured program, and it's it is tailored to what a child needs, but each therapist follows a program of we start off with heat and massage and stretching, and then we move into the developmental sequence, and we can practice every single position that we need to because we have the time. So we'll work on rolling and sitting up and um hands and knees, and so we progress it, and then we'll move to strengthening exercises using the universal exercise unit and doing strengthening exercise because children with special needs are typically very weak and they don't get the repetition to build the strength through the muscles. So now in the intensive program, we are really exercising and building strength, and then we progress to standing activities in the cage. And we love the cage for doing supported standing because a child who cannot stand at all, we can put them and suspend them in the in the universal exercise unit, put splints on their legs, attach bungees to the pelvic band, and they get to experience upright standing without someone holding them. So this is sometimes a very unique experience for a child who has never stood on their own. And you can really then give them the freedom of movement in standing in the cage, and they have a they love it. Kids love to jump in the cage, so it makes therapy fun. And we're very play-based. We as we're doing all these exercises and activities, it's all play-based centered therapy to encourage the child and motivate them. So we have them for those three hours and then they come back tomorrow, and we're able to repeat it and repeat it five days a week for two to three weeks. And and parents love the program, we love the program, and parents have bought into the program because they see progress that would typically take six months for their child to make, they'll see it in two weeks. That's incredible.

SPEAKER_05 14:17

Yeah, I I don't think our audience realizes though that you treat people all over our nation. They come into your offices and kind of how that even started and what the word of mouth, I would love for you to talk about that.

SPEAKER_00 14:32

Um, it is a lot of word of mouth, it is also um our presence on social media, but I I will tell you, um, I've also treated a child that came from South Africa. Oh my gosh. I didn't know that. Yeah, of course you did. Yes. And it was about 10 years ago, and the parent was just doing research on the internet, came across our website and and a YouTube video, called up our front office, and um said, I'm from South Africa. How can I get my child into this program? So, of course, we were a little concerned, like, okay, is this real? Is someone really going to travel from South Africa? And we had a phone call with the with the parent, and and it was it was, and they came. The parent, they brought their four-year-old daughter at that time, and she did an intensive program with us, and then we made some recommendations to see some specialists here in the United States, and um, she ended up coming back the next year, having surgery, doing more intensive with us, and um, we've actually heard back from them very recently, and they would like to come back for an intensive, and we're also going to try um a kind of a hybrid program of doing a consulting with their physiotherapist in South Africa to try to do a virtual intensive program with her.

SPEAKER_05 16:05

That's incredible.

SPEAKER_00 16:06

Yeah. So we are finding, we're figuring out the logistics of that, but that should be happening over the next few months.

SPEAKER_05 16:13

I love this. I love that you are always willing to collaborate. That is just a gift that you give our professional per relationship as well as those around us. And so I know um there's other organizations that you work with to ensure parents have a great experience. I didn't know if you wanted to talk about the heartbeat behind collaboration and why that is so essential to tender ones.

SPEAKER_00 16:38

Well, I feel that collab the okay, the parents of special needs children are taxed so much by appointments and going to specialists. And they look towards us to find out who do they who do we recommend they go see. And they're taxed with a with a very unknown future for their child. So it's really important that we can give them the information and the professionals to collaborate with so that their child gets all the services that they need. So it's really important and has always been very important for me to develop relationships with doctors, orthodists, other specialists, because when I have that relationship with them and I understand what they're doing and they have they provide quite high-quality service, then I can support that parent and saying, yes, this is the specialist that you should go see. This is the orthodist that you should go see. And it also opens the doors to communication with that specialist. When I can get on the phone and talk to the orthodist about what type of bracing I feel the child needs and what their recommendation is, that makes providing that service so much more efficient to the parent. They're trusting the specialist knowledge on who they're going to. And you just end up with better consistency with the parent and the therapist of and the child, and and you know that you're giving all the information that that parent needs. If I was a parent of special needs child, I would hope that the therapist would tell me this is what's out there, these are your options. And I can't give that information to a parent if I don't know and I haven't made those relationships and I have it with all of those partners.

SPEAKER_05 18:40

Um that's such a positive add-on that you give patients, and one of our uniques is that that is our same heartbeat. So when we started, Jason and I actually our oldest had um a really difficult medical diagnosis, and we ended up going to a lot of specialists, and you go to so many appointments. It is very taxing. And so, if you can couple appointments, PT, speech, everything together, and then you just walk over and get your orthotics, or you have uh, I know you do a lot of feeding tube stuff and wheelchair fitting and different making sure people know their resources. You do a great job on your website as well as your all of your staff has been incredible at helping people know how do you get connected and then the support. You are I think Tender Ones supports every single nonprofit that your patients are a part of. And I see it because we share a lot of mutual patience, and of course, Tender Ones is there. Of course, Tender Ones is there, and I love that about you. Right. Um, is that from the same vein that you want to be wherever your patients are?

SPEAKER_00 19:45

Yes, yes, definitely, because um we want to show that we support them, we support all of the different communities. We we have awareness days at the office, yeah. And we when parents bring an organization to us, we want to support them and show and show up when that walk is. We have many therapists who go who support the Kyle Pease Foundation, yeah. And we then support Kyle Pease and other organizations and walks, and and I think it makes a big difference to a parent when they see their therapist showing up at that spina bifida walk. And when we get to see those patients there, and they get to see the therapist out of context. Not you, you know, they're not in therapy. And you know, sometimes it's funny that the patient may the child may go, oh no, why are you here? You know, but it's like, no, no, we're here to support you. We're we're running in this also. Um, we're not gonna do therapy today. It's okay. Relax. You're not going in the cage. But yes, we really feel that there's so many organizations that are trying to help our parents, like the Love Your Story or organization. And we've really partnered with them because we they they found that there was a need to provide housing for children and families when they come to Intensive. So our coordinator has a great relationship with the um owners, the founders of Love Your Story, and she calls her up and says, I have this family that's coming from California. Um, can you help them with some housing while they're here for intensive? And that's just removes a burden on the parent financially, and also it creates community where Abby Burl, the founder of Love Your Story, she makes sure that that parent is well supported while they're staying in in the their house, the the Love Your Story house and doing intensive. So um it it just becomes more resources for our parents that are coming to us when we have those relationships with all those organizations.

SPEAKER_05 22:00

That's so beautiful. And I hear just your heart for people. Where does that come from, Noreen? What it what drives you to care so deeply for people?

SPEAKER_00 22:09

I guess, you know, growing up, I come from a healthcare family. Yeah. Lots of doctors, nurses, therapists. And so we have a, I think my parents instilled a giving heart in all of us and to help. And that for me, when I can that that's where my drive is. When I can help somebody, if I can help a parent, if I can help them just make progress with their child in therapy, I that that gives so much meaning to me to life. And as I have grown the company, I really feel like when I can support my therapists, that they then can do the same and give the same support to their families. So with our company, it's extremely vital and important to us that we fully support our therapists in whatever programs they want to learn. If they want to instill a new program, we say, bring it to us, let us help you reach your goals. Because I can't treat every patient. And when we can support these therapists to then know that they're well supported, that they they can learn new techniques, they can support their parents, they can instill new programs. It's it's just multifold. No, right, it's and it evolves.

SPEAKER_05 23:42

Yeah, I love that. I don't think our listeners know. I I know because your sweet sister treated my son. How many family members do you have working at Totstill?

SPEAKER_00 23:51

Yes. So I'm one of five siblings, and two of my sisters, Teresa and Patricia, are both speech therapists. Yep. And fortunately for me, I was able to convince them to relocate to Georgia over the last 10 years. And they both have moved here. They live in Brazilton, very close to me, and they work with me at Tender Ones. And they are a big support in the administration system of Tender Ones and the support system to the therapists. And then they're also awesome speech therapists.

SPEAKER_05 24:27

They are. I I love Patricia. She has a piece of my heart because she treated my son. And I just think that you guys have a wonderful working relationship, and the support that you give each other is just wonderful. My mom is actually from New York, so that's another big factor of loving being with Patricia. She reminded me of my mother's sisters and my mom in a lot of ways because my mom grew up in Long Island and was born in Queens. And we would go to New York every summer and winter. And it just is a beautiful thing to share that fun, loving New York City accent, New Long Island accent. And uh I always remarked about Patricia's perfume. It reminded me of my mom. So when I was going in for care for my son, and it felt like home. Oh I've always felt that. And so we've gone to a bunch of offices, and of course, we work alongside each other. You have this unique gift to make it feel like home. What is that?

SPEAKER_00 25:23

Yes. Well, that was really important to me when I, as I've grown the company, I want every patient that walks in that door to feel like this is their family. And we call it it's the TOTS family. So from every staff member that works there to every patient that walks in the door, we want everybody to feel like this is our is your your second home. Because first of all, the staff are there the majority of their time through the week, right? And then the patients, many of them come from multiple therapies, and they're coming for years of therapy. And it it you you have to we know how their life is that that coming to therapy is such a commitment, and we want to know that we're so happy that they're there. So we make a and I I try to do it, and I I know all my staff does it, that as a patient walks in, or if I'm walking through the gyms, and I'll stop a therapist and say, tell me his his name, or I'll ask the child, what is your name, so that I can get to know them and and know their face with their name. And then we all do it. We're like, Hi, Christopher, hey, hey, you know, John, it's so great to see you. And that makes it so much more special for that patient, too, and that child, because if everyone is motivating them around them, like, hey, you're walking down the aisle, the the hall, you're doing awesome. And if I'm able to say them by their name, then they know that that means a lot to them. Like, this is home, this is a place for you to know that you're well loved and taken care of. And and I I think a lot of that comes from I had an experience with a parent walk into the office, and he was very it w he was a new patient to our office, and he was, I could tell he was on the defense, yeah, that he was ready to uh just fight for what his child needed. And and I think it really stuck to me, and I said to other people in the front office, I said, we don't know what his day has been like. He may have just picked up his child from school and they have told this parent, this is all the terrible things that your child did today. Yeah. Okay, and he knows that his child has special needs, and he knows his child has challenges and behaviors, and uh now he's coming to us and he's just waiting for us to say, No, I can't see this child, or this is what your child did, and and that is not how we approach it. We we say, No, this is their safe space, and this is your safe space, and we can we are going to help and try to help this child as best we can, and we know that your daily life is very challenging, so we always look at it that way, that you know, this might be a difficult session with this child, but let's think about what that parent is going through daily. So, how can we support that parent when we're working with this child for an hour? And many patient parents, and even this one, will say, I'm so sorry if he's screaming or if he's doing this or he's doing that, and we're like, No need to apologize. This is the safe space. We get it, we totally get it. You know, and especially new parents coming, they're they know when they take their child out to dinner and it's so difficult because their child is screaming or has bad behaviors or something like that, yeah. And now they're going to a new therapy place and they're like, oh no, now they're gonna see these behaviors. We want them to feel like this is your safe space. But we we get it, um, and the kids we don't mind the screaming, you know. We it's just like, okay, you're fine, you're fine.

SPEAKER_05 29:48

Yeah, it's part of your job, it's part of our job. We're your design for it. I think um I've noticed that um because some of our patients that are similar and just how they speak about your therapists and the hospitality that you guys give your parents and the patients, so much so uh I love telling this story. When you opened your new space in Dekula, one of your pride and joys is the changing table.

SPEAKER_03 30:12

Yes.

SPEAKER_05 30:13

And I love that and how much it mattered to you to make sure parents had a safe place to change their adult children. Right. And that it really was an effort to make sure parents had what they needed to be able to do therapy and you prepare for parents. I would love for you to brag. I know you don't get to brag enough, but our listeners need to know to the degree that you've prepared for them.

SPEAKER_00 30:38

Well, when we were building our our our big beautiful building that we have that's 10,000 square feet, um, we really surveyed our staff and our parents, and we we asked the staff, you know, what do you think we need in this building? How does this need to be set up? And it w we asked from the front office to every therapist in the building. And because they're gonna hear the feedback from the parents of what they want. And one of the the um requests from parents was I would love to have a safe changing space for my child who is 15 who needs to still be changed and toileted. And so we we did some research and we said, okay, well, we're going to get that high-low changing table, and we have it in our our we're gonna put the bathroom in the waiting room, and we're gonna put this high-low table there for those parents so that they are able to safely change their their full-size child, their child that's maybe a teenager, and that they need to change. So that's just one of the little things that we listen to. And I I think it it gives back to us when we see that we've just made this parent's life that much easier.

SPEAKER_05 32:01

Yeah.

SPEAKER_00 32:02

And all those little things that we do.

SPEAKER_05 32:05

I I think it goes to your belief system though, because you really love the children that you all get to serve, and I see that. And you and I sit in rooms where people wonder, does their life matter? I know I've had parents say this to me, and that they were told in multiple appointments how this is going to be inconvenient. Oh my goodness. And we get to sit on the other side and say, their life has so much purpose, right? And we're so grateful that you trust us with their care. I I wondered if you have a parent or a patient with being HIPAA compliant that really impacted you, that reminds you kind of your why when you go into work.

SPEAKER_00 32:44

Yes, uh every patient I've treated, of course. I've learned so much from parents and patients, but I do have there's a little boy that I started treating when he was seven years old. His name is Jacob. And his parents brought him to me. He he was he's significantly delayed and physically impaired. And I just there this family has inspired me so much, and I have been working with Jacob. I still work with him, he's 30 years old, and um, mom, dad, and Jacob come every week for therapy, and I've learned so much from Jacob and his family. And Jacob is nonverbal, and he cannot um he cannot sit alone, he cannot stand alone. And what they taught me was patience. And I learned this 20 20 years ago when I first started working with him, and I was always a patient person, but they really taught me patience because they they knew his their child so well that if you just allowed him enough time, he will make a vocalization in response to your question. He will move as how you want him to move. And I'm a very busy person. I'm a very okay, let's get this done, let's go over here, let's move, let's go to the next thing. And they taught me to slow down and wait. And with the beauty of that is then you you see these little what could be surprises of he's gonna sing happy birthday to me. He's gonna say hi if I took the time to just wait and see. And that's where it just you learn the meaning of how every person is so special and how they do have meaning, and that their relationship of coming into my life has changed my life so much.

SPEAKER_05 34:54

I know. I uh that's such a beautiful story. I love that you carry that with you. And I I experienced you only as patient. So thank you, Jacob, because I I've always appreciated that about you is you take your time to make a decision, you take your time to think through. Uh, and I I think it brings forth the the freedom, even for other people around you, not to feel hurried because you're not frenzied trying to get to the next thing that we all can okay, we can take some time and think about it. We don't have to make a decision right now. Right, right. That kind of brings me to my next thought is you know, you counsel so many parents and you see a variety of patients. I wondered if you could encourage a parent who potentially got a really hard diagnosis and they don't know where to start and they don't know anybody who has special needs. And I know you have had this experience, we've had this experience. They don't know about the services that are available and where do you start? And would you give some encouragement and some practical tips?

SPEAKER_00 35:57

Um, well, of course, they can go to our website, tenderones therapy.com, and there is a lot of resources on that, and it it shows the services that we have, but we also have a blog on there and it gives information about what milestone are they achieving? Um will they maybe need therapy? Are they reaching these goals? This goes back to why we collaborate with so many of our partnerships with other organizations, is because when a parent comes to us and we can see the struggle that they're having, we want to be able to tell them, hey, contact this organization. I recently was talking to a parent, and I could see financially the burden of the copay on them, and they had a newly diagnosis of autism for their child who's only two. And the the burden of getting that diagnosis and saying how is his future going to be, and financially, how can I pay for therapy? And so what we do, and I was speaking with him fortunately, and I said, let me get you information about Katie Beckett, the waiver, let me put you in contact with this group of people and find out, just start doing your research and and reaching out. So we really want to be resources for parents so that they know that they can come to us, ask us what their what their challenge is, and we want to be able to give them the resources.

SPEAKER_05 37:34

No, that's so important. And it was a perfect segue into the insurance reimbursement area, which I think most parents, even if you have typical kids, insurance re reimbursement is challenging, let alone uh having to navigate how to fill out a waiver like Katie Beckett. And we had um a mutual patient's mom, Kristen Winsler, on and she talked about in your office actually a mom helped her navigate and figure out how to fill out the form, and that other moms, and you've created this community of moms at Tender Ones that help each other. So when new, newly diagnosed kiddos come into your clinic, they find more I call it veteran moms. Yes, who know the ropes. Yes. What would you say is kind of the most important thing a parent needs to do with insurance reimbursement first and foremost?

SPEAKER_00 38:25

Well, one thing we do for our parents is we try to take the burden off of them of worrying about financially what their cost participation is going to be. I we make sure that we verify their benefits and we talk to the parents up front before receiving receiving services, this is what your cost participation is going to be. We tell the parents, we are going to take care of the authorizations. We you come to therapy, unless we call you to say there's no authorization from insurance, you don't worry about it. We've got it covered. And when there is a difficulty with insurance and they are saying no more insurance, no more benefits, then we encourage the parent to reach out to their insurance company and get documentation from their physician. And also, they can also reach out to their employer because sometimes employers can have a relationship with the insurance company to let them know I want you to provide more benefits to this parent. This child has this diagnosis, you should not be denying services for them. And it it is uh when you have a medical diagnosis and insurance is saying you only get 20 visits of PT, well, then you are denying my child services. So parents should complain to the insurance company and demand that therapy is a medically prescribed service. And if you're not going to pay for my child to get these services, then you're denying their care.

SPEAKER_05 40:09

It's so important that you know your rights and that you're able to advocate for your child. One of the things that we've done recently is a piece of legislation for parents to be able to fight for their children to have secondary devices with state-regulated insurance. It goes into effect in 2026. And because of some of the political advocacy I've been able to do, I sat in a room where a lot of legislators dreamed that Georgia would be a state where kids with special needs would be the best place for them to grow up. With that big dream, if you could wave a wand, Naureen, what would have to be in place in Georgia for kids with special needs to have the best outcomes here in Georgia?

SPEAKER_00 40:52

Well, one of it is um the authorization process. Yeah. Twenty years ago, with Medicaid, you did not have to get authorization to provide PTOT and speech. And over the years, the authorization challenge has gotten harder and harder for therapists. And currently we have to hire people in the front just to do authorizations for Medicaid, for CMOs, for private insurance. And it's a huge burden on the company to do that. So one thing, if the authorization process was removed, and children can just get the care that they need, because a doctor is going to re recommend what the child needs, the therapist is going to recommend what the child needs, and is not going to take advantage of over-prescribing. They're going to prescribe what the child needs. And removing all these authorization processes and these hoop hoops that we have to jump through is would be fabulous. Gosh, it would be fabulous. It'd be life-changing. But it's just, yeah, provide them the services they need.

SPEAKER_05 42:07

Yeah. And if a physician is prescribing it and it's within the normal means of right medical practice in our scope, why wouldn't we? Uh it just uh we experience the same thing. And so that's great to hear. So, lawmakers, if you're listening, we need authorization to be removed or to less hoops for sure. For sure. I wanted to switch because we really haven't talked about orthotics, and that's really what we do. Yes. I didn't know what was your introduction to orthotics and when would you recommend orthotics for a patient and kind of help parents know how that process works?

SPEAKER_00 42:43

So I've always tried to work really close with the orthodists, and what I have appreciated with Alliance of us having our partnership together is Jason was so willing to come into our office and discuss what a child needs for in terms of orthotics. So even years ago, when I would um when I would be thinking, okay, I think this child needs assistance with orthotics. Let me uh reach out to this orthodist, have a discussion with him. This is what I see going on. What are your recommendations? Will you come into the office? Will you come see the child in therapy so you can see what they're doing? And so we really love having Jason to and all your staff that is willing to come to our offices, whether our Gainesville office or our Dekula. And when we built our new building in Dekula, we wanted to have a lease space. And to me, it was really important to have who was going to occupy that space needed to complement our services. So we reached out to you and Jason. And said, Would you want to partner with us and lease this office that is attached to our building? Because as we talked about before, about how many appointments parents have to go to, if we can reduce another trip to an appointment for them, and we can partner with an orthodist that we we value and appreciate his his knowledge and the way that Alliance, your whole company, we feel like you align with our mission to be patient-centered and family supported. And um so we were thrilled when you guys said yes, we'd love to have that space. And by doing that, we can have your staff come into our office during therapy and discuss the orthotics with the therapist and the patients. So to me, I'm gonna go a little sidebar here. So when I went to work there, these they were not children anymore, they were adults 40, 50 years old. And what I experienced is what happens to a child who becomes an adult who did not have the benefit of having orthotics embracing, and what happens to the the significant deformities that occur. And when I was working there, it was really important. I felt how can I make the biggest impact on these adults? And it would be supporting them with wheelchair prescription so that they had custom molded wheelchairs and also bracing to help protect them from further deformity. So I think that's where my buy-in to orthotics was because uh it's when you have a child who's an infant, it's very difficult to foresee and understand what can happen to this skeletal system if they're not properly braced. So having that experience, it gives me background and I try to educate therapists on the importance of prescribing orthotics for their patients. Because what I educate parents is that our role is to protect that skeletal system until they're full grown. And the way that bone matures and grows is based on the forces that are applied to it. So if you twist a bone over and over and over again, or you have high tone and you pull on a bone in a certain direction, that bone is going to deform in the way that the forces are directed upon it. So I explained to parents, it is so important to get those bones in a child's feet properly aligned so that as they grow, they will grow in the best alignment that we can hope for until they're fully grown. Now, that being said, it doesn't mean that every bone is not going to still deform if you wear orthotics, but you're going to minimize the complications and the potential for severe deformities. And I know presenting orthotics to parents when they're young children and parents, it's a, oh no, my child needs braces. But I try to say, you know, we wear glasses for vision difficulties. We wear braces on our teeth to straighten our teeth. And this, the braces are their help, their help to the children so that they can help reach their goals. And I say, What is your goal? And if your goal is for your child to stand and walk, then let's give your child the best support so that they can reach those goals. And I am truly a believer that it's so important to put your braces on as soon as your child wakes up, you put your braces on, it gives them a foundation for standing and walking. And I try to tell a parent, um, you know, if you think of a building, you have to have a good foundation, right? If you have a wobbly foundation, how is the building going to stand up? So it's the same thing. If your child's feet are collapsing, or they don't have full range of motion, or they don't have full strength, then they cannot support their the rest of their body to stand up straight. And and I know there is some discussion and parents get conflicting viewpoints about bracing or not bracing.

SPEAKER_05 49:01

They do.

SPEAKER_00 49:02

And what I try to explain to them is that if a child has a neurological condition, that is going to that impacts on their ability to move, right? We know the child has a delay. A typical child does not need therapy to learn how to move their foot up and down. A typical child just learns how to move, learns the skills, stands, walks, and runs. Okay, when there's a neurological um impact on a brain, a child has special needs, that foot cannot move up and down on their own without specifically learning it and moving it with the guidance of a therapist or the parent doing the home program. So some parents feel and they've been told, don't brace so that the child can learn how to move. Well, if the child could learn how to move on their own, they would have done it already. Okay, so when they come to learn that skill, the therapist would work with them very specifically on okay, this is how you move your ankle up and down. But what you also have to remember, and parents need to be educated, is that movement develops proximally to distally. And when we say that, proximally is core and shoulders and hips, and distal movement is fine motor movement, and that relates to the foot as to moving your foot up and down. So if your child does not have good core strength and cannot sit up on their own and cannot support themselves, and they don't have good hip and shoulder strength, they're not going to be able to move their foot up and down independently on their own. And when you're tasking them to learn that skill, your demand is too high for them. They're not going to be able to do it because they're trying to learn how to sit up. So give them the assistance of let's take the demand of learning how to move your foot up and down by giving you stability of your foot. So now we give you this strong foundation with the brace. So now you can sit upright and you can come to standing and learn how to control your core and your hips without being having the demand of what's going down on in your foot.

SPEAKER_05 51:33

That's such good advice. And also just the education of why orthotics are so important in that intervention. It's not for every patient, and we understand that. But when it is necessary, it's important that you get it early and that you're able to work with your orthodist. We've seen patients actually exit orthotics, which is the best news when they don't need us anymore. Um, but we also have patients who for their lifetime they will use orthotics and they have all the variety of sizes and it's like shoes and growing out of it. I wondered if you could encourage parents who are trying to find a therapy clinic or trying to find an orthotic clinic, helping them know where when they found the right one, they might not be right here. If they're in our area, we think they should come to us, of course. But what would be the key indicators that you have found a place that you know it's gonna treat your child and your family really well?

SPEAKER_00 52:30

So for therapy, it's communication, definitely. It's communication from the front office, communicating to the parents, and it's also the therapist communicating with the parent on what are your goals for your child. And you may have goals of I want my child to walk independently. And the therapist should always have that goal in the in their mind, but they probably and they should be talking to you and saying, okay, that's going to be our focus. But right now, in order to get to that goal, he needs to learn how to roll over. So first, we're our goal is going to be learn how to roll over. And then before that, our next goal is going to be he's going to learn how to sit up. So we're always going to have that long-term goal in our mind that we know that's what you want us to work towards. But let's break it down and let's work on the the goal, the goals in steps and always looking forward. So a therapist should be in good communication with a parent, and and the parent should be saying, This is what I want for my child. And the therapist should be asking, What do you want for your child? And how, what are your difficulties at home? Tell us how we can support you. And then ask your therapist, this is what's going on with my child. Is there something that they could be doing that we're not doing? Is there a is there a specialist? Is there a program that they can be doing in conjunction? Asking those questions and making sure that the therapist is communicating and bringing new things to the parent, and making sure that the therapist is is having discussions with you about orthotics, and the parent saying, Do you think my child could benefit from orthotics? And it might be a cranial molding helmet, or it could be a spinal brace, or it could be something for their feet. And how long do I need to wear my their orthotic? And who who should I go to talk to? And what should we be asking? Because I I think having the partnership with you all with Alliance, we know we can discuss what the patient needs. It would be it used to be very frustrating to me before I had a relationship with all of you and other orthodists, is that a parent would just get a prescription from a doctor, go to an orthodist, and they would make an orthotic based on what the orthodist saw that day, what the child was doing. But they had no information from the therapist or from me. They didn't know what the daily activities are of the child. And when a family just walks into an orthodist, and that's just a little snippet of what the child is doing for that moment. So it's really important that the orthotist is really open to having relationship and discussion with therapists so that we can find out what are the difficulties that the parents are having with the braces. Are they being consistent and why not? And let's let's try to help that parent.

SPEAKER_05 55:44

No, I think that's such great advice. And I think we believe in collaboration as well because really we're an extension of every referral. When they trust us to share a patient with us, we really are there to make y'all look good and whatever it is that you need us to do. And so that collaboration is key. So of parents who are looking for a team, you you want people who work well together and they listen to each other. And I believe there's enough sun for everybody. And I know that's your same belief system. We get to chat at different events and say, you know, there's too many patients to be competitive. So honestly, there's a great need in our state right now for companies to work together to serve patients really well. I think the cool thing that we get to continue to do is work alongside one another. I rarely get a microphone in my real life. And I thought maybe you don't really get a microphone every day. But to conclude our podcast, I wondered if there's any people you would like to thank or thinking about your future with TOTs that you just want to say thank you to, knowing that you have 20 plus years, over 100 employees now, started in your basement. Maybe there's some things that you want to just share with parents and our audience of gratitude.

SPEAKER_00 56:58

Well, definitely gratitude from every staff member that works for TOTS. A lot of gratitude towards Melanie, who I mentioned earlier, because she was the one who uh really encouraged me to do the intensive and continue to grow the company. And I didn't mention before, but she's she started working for me in the front office 20 years ago, and she is our intensive coordinator. And when you know, it was really important for me when I first hired her. She was my first office staff member, and I knew she could support the families because she has gone through all of this, you know, with her child, Brandon, and she so she knows exactly what the parents are facing from Katie Beckett to authorizations to doing intensive programs to going to multiple appointments all the time. And it's just been it shows testament about her dedication to the company and it really helping to grow that family atmosphere that you were talking about before because she welcomes every intensive patient and and she knows the challenges of them traveling from out of state. And um Melanie and the other staff, they all have that family approach. So I'm grateful that that they all want to welcome all of the patients, just like every therapist. I'm grateful for every therapist who has been dedicated to the company, and many of them have longevity with us, which also is a testament to what they believe in the company and that that that they are being supported. Um, Dr. Alyssa Wals, who is one of our PTs, has created an amazing paddle boarding program that it was the first one in the country, and um she's she's spreading her her love for paddleboarding and encouraging other companies to start these programs. And we do paddleboarding therapy with the children at the lake every summer, and they get speech therapy, OT and PT while on the paddleboarding at the lake, and the kids love it, it gives them a chance to be in a new experience, and we also do paddleboarding camp, and it's therapists like Alyssa who just want to keep giving and growing and giving to these families and these children and starting these programs, and I'm grateful for every therapist that is not just um content with doing the regular therapy day and after day, and they are the ones who are reaching out and finding new programs to help their patients. And one of them was um actually Alyssa and and David helped to put together a continuing ed course this spring and brought in a specialist in NIST STEM, which is a spinal spinal stimulation where it's not anything internal, but it's a way to use electrical stem over the spinal cord for children with spina bifida, cerebral palsy. And we hosted this continuing ed program, and we probably have at least 10 of our PTs that are all trained in offering this spinal stimulation now. So it when when you have a staff who is who says, yes, let's go, let's go learn more and give back to our patients. And I'm just grateful for all our families and our patients who just give back to us every day.

SPEAKER_05 1:00:48

That's beautiful, Noreen. I just thank you so much for what you're doing in our state, in our area, and our audience if you're listening. Tender Ones is an excellent place to receive care. And if you need any help connecting, you can go to their website and Lane, our amazing producer, she's going to link all the good stuff, social media, any way to connect with Noreen and her team. And if you're looking for a job, I know Noreen is always hiring some people. Always hiring, always hiring good and qualified people. So please reach out to them. And again, Noreen, thank you so much for your time. Thank you, Rachel. I appreciate you having me on today. It's been great. Were you inspired or challenged today? If so, connect with us. Follow the links in the description box below. We want to hear from you. Until next time, thanks for listening to the Alliance Goldigger podcast.