A

mazing and $850.

I swallowed hard when Perel dropped the price. But we needed an eval. And I didn’t want to waste money on someone who didn’t come highly recommended. Not for an initial evaluation and treatment plan. Not when I was suddenly noticing the little struggles everywhere. It seemed like now that I started picking up on it, I couldn’t unsee it.

Moishy knocking over the cereal box when he tried to get the milk. Putting both legs into one pant leg and getting stuck. Holding his crayon like a dagger. Taking forever to pull his pajama top over his head.

Once I got over the sticker shock, the evaluation itself was great, at least to my untrained eye. Kayla ran her own clinic — it was actually beautiful, like it could’ve come straight from an interior designer’s portfolio. Probably did.

Bright walls, therapy swings hanging from the ceiling, bins of textured toys, a climbing wall painted sky-blue. The faint hum of a white-noise machine somewhere behind the glass door. Reception area with small chairs and a receptionist and everything.

Kayla came out in sneakers and a calm smile. She had that air of brisk warmth that made you believe she’d seen everything.

She crouched to Moishy’s level. “Hi, Moishy. Wanna come play with me for a bit?”

He nodded, solemn, and followed her into a room full of colored mats and beanbags.

She had him do a whole assortment of things — standing on one foot, hopping squares on the floor tape, catching a soft ball, drawing a circle, cutting a line with kiddie scissors. Every few minutes she scribbled notes on a pad, sometimes pointing out small things like “right follows left with delay” or “cross-midline difficulty.”

When he colored, his elbow moved instead of his fingers; when he cut, his tongue stuck out and the scissors veered off. Kayla didn’t look alarmed, just observant. She asked me questions while he played: Was he an early or late walker? Any reflux, colic, torticollis? Does he switch hands when he eats? Does he tire easily with playground stuff — climbing, swings? I tried to answer, although for many of the questions, I really hadn’t noticed anything.

After about 40 minutes she sent him to the waiting area with a box of sensory beads and turned back to me, still jotting.

“Okay,” she said, putting her notes aside and just looking directly at me. “He’s not weak and there’s nothing wrong with his muscles. His brain just hasn’t finished linking both sides of the body. Think of it like fuzzy wiring between left and right — so he has to think through what should happen automatically.”

That actually made sense. I could picture it: Moishy’s body lagging behind his ideas.

“This is absolutely fixable,” she said, then smiled and softened it. “Meaning — it’s developmental. With some therapy we can teach his body to coordinate. It takes work, but you’ll see a big difference.”

Relief loosened something in my chest. Fixable sounded good. Manageable. Hopeful.

…Expensive.

Kayla scrolled through her tablet. “We do have a bit of a waitlist for OT here, but I should have a slot opening in six to twelve weeks with one of my therapists.”

I blinked. “Oh — okay.”

Was that a given? That we’d continue here? I thought this was just an evaluation.

Perel had said Kayla was the person to see, and she really did seem to understand him. Still, I hadn’t exactly signed on for months of therapy in this place.

Kayla seemed to misunderstand the reason for my hesitance. “I’m sorry, I simply don’t have any slots with me personally at all. Not for months. Maybe a year,” she said, apologetically. “But that’s why I have my own therapists here, trained and supervised by me. Once he starts, I’ll be supervising the sessions, making sure everything follows the plan.”

“Uh, okay. Sure,” I said. Kayla’s place did look great. Perel had said that Kayla was top, and we did want the best therapy for Moishy. And two months was plenty of time to think. Maybe research other options. Maybe not. For now, I just wanted to believe the part about fixable.

T

he reassurance and hope that the evaluation left me with fizzled fast, though. It seemed like now that I knew — now that I had a label for this — I was noticing it more and more. And Moishy was starting to grow frustrated about it, too.

I saw it in the park when we went one Sunday afternoon. He stood at the bottom of the jungle gym, watching the other kids swing across the bars. When he tried, his arms slipped halfway and he landed in a heap.

When I sat down at the table with him to do an art project, he refused. “I’m not good at it. I can’t do it,” he said, pushing the scissors away.

Even Morah Hadassah mentioned it. “He’s such a bright boy, but he’s starting to get discouraged. You said you had the evaluation, right? It would be wonderful if he could get the therapy soon.”

But how soon was soon?

One evening, I called Perel. “I’m thinking  maybe I should just go elsewhere for therapy,” I said. “Maybe another clinic or a home-based therapist? Kayla’s waitlist is just so long.”

“Sara Esther, I’m telling you, if you have a slot with Kayla, don’t give it up,” Perel said.

But I didn’t have a slot yet. And I was getting more and more frustrated.

After six weeks, I called the clinic to check in. The sweet receptionist assured me that Moishy was next on the waitlist as soon as an OT slot opened up, and they’d call me as soon as they had that slot.

Two weeks later, after a particularly disastrous morning with Moishy tripping in the kitchen, bumping his head and ending up in a puddle of juice and needing a full change before preschool, I decided to call again. Hadn’t Kayla said six to 12 weeks? Surely they should know something more by now?

This time, I asked to speak to Kayla herself, and — wonder of wonders — got put through to her. She sounded a little distracted, like I’d caught her in the middle of ten other tasks, but at least I had her on the line.

“Yes, of course, Moishy’s mother, I remember you,” she said. “He’s on our list. I’m sorry, things are a little delayed. One of our therapists went on maternity leave early, and some other children needed more sessions than anticipated. I’d say give it another two to three months. We’ll give you the first available slot.”

Two to three months?

I pictured another few months going by: Moishy struggling, Moishy falling behind, Moishy losing ground socially. I couldn’t wait so long.

Maybe it was time to just find another therapist. And if I was at it — I could look for someone more affordable, more flexible, maybe someone who could come to our house.

I’d done the hard part already: the evaluation. We had a clear diagnosis and Kayla seemed to know exactly what he needed. I should probably just take her recommendations and find a different provider to do the sessions. So it wouldn’t be the top expert; at this point, I just wanted him to start getting actual help.

A

fter several inquiries, I found Blimi. Warm, encouraging, and motherly, she told me she’d definitely worked with kids like Moishy before, and she’d be happy to give him OT in our home. She outlined some of her treatment protocol, and she sounded professional and experienced — working in the field for 15 years, with lots of happy references. Best of all, she had a slot opening up the following week, and she was half the price of therapy in Kayla’s clinic.

I felt like a stone had rolled off my chest.

When I mentioned that Kayla had done the original evaluation, she was impressed.

“Kayla evaluated him? She’s really tops. If you had her evaluate and make a treatment plan, you don’t need me to redo it — it would be a waste of time and money. And besides, I’d rather use Kayla’s recommendations, she’s a real expert. Just get me a copy of her eval and I can start right away with the treatment.”

“Okay, sure, I’ll get it for you,” I said.

But it wasn’t so simple.

When I finally got Kayla on the phone, her tone was polite but brisk. “I’m sorry,” she said, “I don’t give out written evaluations or treatment plans.”

I blinked, certain I’d misheard. “I just need the report so the new therapist can start working with him. You already told me what he needs.”

“Yes, I did,” she said. “But my notes are for internal use only. They’re written for my team, not for outside clinicians. The treatment plan needs supervision — it’s not meant to be implemented elsewhere.”

“But it’s my child,” I said, trying to keep my voice steady. “I paid for the evaluation. I’m not asking for extra work, just a copy of what you already have.”

“I understand,” she said, sounding genuinely regretful, but also like she was scanning her emails while we spoke. “I really wish I could, but this is my policy. I have to go now — I have a client coming in. I’ll have the office call when a slot opens up.”

The line clicked.

So that was that?

I stared at the silent phone.

I was literally locked out of the system, waiting months on end for therapy — and not able to even go elsewhere so my son could get the help that he needed?

I paid for this evaluation. I paid $850, for what? A treatment plan that could never leave Kayla’s desk?

If I could tell Kayla one thing it would be: Your policies are making it impossible for me to get my child the help he needs.

Kayla

IT was 9 a.m., and the clinic was already alive. Sessions starting, phone ringing, coffee machine working overtime. I hadn’t finished my own morning dose of caffeine yet, hadn’t even opened my notes, and already three people needed me.

“Kayla, I had a question for you about the Gerber kid, you said you wanted to try something new in today’s session?”

“Kayla, I’m stuck with that insurance form, do you have a minute?”

“Kayla, a parent’s asking if we can add a second session next week.”

The questions blurred together. I smiled, answered, redirected, then slipped into my office to catch my breath.

The desk was its usual chaos — charts, sticky notes, a protein bar I’d brought in for lunch yesterday and forgotten to eat. My inbox, emptied at the end of yesterday in some superhuman feat, was overflowing with unread emails again. Three new voicemails, two billing issues, one message from the lawyer about updated compliance forms.

This was the part no one thought about when they heard I ran my own clinic. They saw pastel walls and success stories, not the endless supervision logs, not the late-night report writing, not the weight of dozens of families expecting transformation.

I wouldn’t trade it for anything. I’d worked so hard to get here. But it was still… a lot.

I scrolled through messages, dictated a note, signed a progress summary. The printer jammed. I fixed it. Another therapist poked her head in with a question. I leaned over her tablet, explained, smiled again.

By noon I was almost caught up, with half an hour to go before my own scheduled sessions for the day. I rubbed my temples, sipped cold coffee, and opened the next intake.

M

uch as I loved the clinic, there was nothing like the satisfaction of simply doing it myself: working with a child, figuring out what the challenges were, how I could help, watching the slow progress as they met goals.

I did very few actual therapy sessions these days — mostly I trained and supervised the OTs I’d hired in the clinic — but evaluations, I did like to do myself, because that’s where everything begins. Years of postgraduate training, hundreds of hours of mentorship, and more certifications than I cared to count had taught me how easily an evaluation could go wrong. One missed reflex pattern, one misread observation, and the entire treatment plan would be built on sand. A therapist could follow a map, but someone had to draw it right first.

In my clinic? With my reputation on the line, and more importantly, with the level of care my clients deserved? I wasn’t going to outsource this crucial step.

Today I was doing an extra eval during what should’ve been lunch break, but let’s be real, usually turned into an emergency meeting or an extra session or evaluation that someone was absolutely desperate for. Three-year-old boy, mother had hesitantly described some coordination and motor concerns.

He was a sweet kid — bright eyes, chatty, cooperative. But I could see exactly what the mother and teacher had been concerned about. When he hopped, one foot lagged behind. His hands switched mid-task. On the balance beam, his eyes fixed on his toes instead of scanning ahead. When he colored, his shoulder did all the work while his fingers barely moved.

I jotted quick notes on my tablet as brief reminders for the treatment plan I’d create with the therapist later: weak core stability, immature bilateral integration, visual-motor delay. Devorah would be perfect for him. She had a gentle touch and a knack for complex motor-integration cases. I checked her schedule — one slot opening up in a few weeks. Good.

The mother seemed a little taken aback when I told her about the spot. Most parents did — I was used to them asking why I couldn’t see their child myself.

But I barely took on any clients myself anymore. And honestly, my team was great. Handpicked. Rigorously trained. And I supervised them too, we had high standards, great protocol.

I assured the mother that her son would be in good hands, and we wrapped up the meeting. It was a little overtime, which meant I had to run straight into the next meeting, forget about lunch, but it felt great to know that I’d been able to help, squeeze them in, and set Moishy up for getting the help he needed.

“Looking forward to working with you!” I said warmly, meaning it.

She smiled back.

T

he call came late afternoon. I was halfway through signing off progress notes when Miriam, the receptionist, buzzed me.

“Kayla? It’s Mrs. Moller, Shira’s mother.”

Shira, right, I’d done an evaluation for her last week.

“She… she wants the treatment plan,” Miriam said, lowering her voice a notch. “I told her it’s against our policy, that we never give out the written evaluation and plan, but she insisted on speaking to you about it. I tried to explain, but –”

“It’s okay. Put her through,” I said wearily.

I got these calls so often, but they never got easier. Having to refuse, and explain, and hear them out, and still refuse was hard. Frustrating. And maybe they thought I was just being stubborn or upholding policies for my own gain. But it was really so much more than that.

It was hard, turning people down — especially people who were desperate, and who couldn’t understand. But this was my name, my clinic, my responsibility. My treatment plan? If it was misunderstood, implemented wrongly, or needed adjusting, the parent could end up pouring hours of time and thousands of dollars into wasted efforts. Which was why I used my evals internally only  — where I could supervise, update, and track progress myself, with therapists I’ve trained and mentored.

People want a “top evaluation” — but what they don’t realize is that that has to go hand in hand with “top implementation” in order for the therapy to work.

Besides, creating a written evaluation and treatment plan was a whole separate job. It could take two hours of my time — time that I needed, for supervision, for clinic management, for paying clients. Internally, I could use my drafted notes, shorthand, have the therapist write it up after we discussed it. To create the plan for any therapist out there to use would take hours of my time, with zero returns for me.

And I wasn’t the only one with this policy. Far from it.

A

nd then there were the logistical parts of the job — things that no one could foresee, part and parcel of managing a team instead of working solo.

Michal, one of our therapists, had a baby two months early. She was on maternity leave, but more than that — with a baby in the NICU, she wouldn’t be coming back anytime soon, and all her clients were at loose ends, suddenly left without their sessions filled.

I pulled an all-nighter re-shifting schedules, asking my team to each take on just one more client somehow, trying to make things work. It took days of calls and lots of coordination to figure it out  — and it also meant that our availability was even more limited than it had been until now. The waiting list was growing. I knew we’d have slots free up eventually. But… it wouldn’t be as soon as I’d thought.

When Moishy’s mother called again about her son’s therapy, I explained that we’d had some delays, but we hoped to have a slot in a few weeks.

“Oh,” she said, sounding deeply disappointed. “I just — he really needs the help. I’m noticing it getting worse… and his teacher says he’s struggling. I thought you said maximum twelve weeks….”

“I know,” I told her. “I’m really sorry about this. I hope it won’t be much longer. I have a great therapist lined up for him.”

A

round a week later, she called again. I was about to repeat the same thing — sorry, nothing’s changed, hopefully in a few weeks we’ll have that opening for you — when she said, “I’ve actually found someone else who’s available right away. Could I just have the evaluation you did so she can use it to start?”

Oh. That. Again.

“I’m sorry,” I said, trying to inject some regret into my tone. “I don’t offer written evals or treatment plans.”

Sara Esther sounded stymied. “But… I just need the report for the new therapist. She asked for it. And you told me what he needed, the motor thing, the coordination. I just want her to have those notes also.”

I had so much to do, so much work, I couldn’t just sit and defend my policies over and over.

“I know, but those notes are for internal use only, that’s the only way I do it,” I said. “They’re written for my team, and for me to supervise. I don’t give them out elsewhere.”

The mother sounded upset. Betrayed, even. I got that — she obviously hadn’t known the policy, and she had invested a lot in the evaluation.

But this was what coming to a clinic meant. I did the evals, sure, but that was in order for my team to give the treatment. And we offered top quality treatment — using those evaluations.

Why couldn’t parents understand that the evaluations and plans weren’t just products they could pay for and take home? They were the product of hours of work, time, effort — and more than that, they were a framework for treatment that I could only take responsibility for if it was under my supervision.

If I could tell Sara Esther one thing it would be: I wish I could help — but I have professional policies for a reason.

(Originally featured in Mishpacha, Issue 1085)