Therapists for a state service that helps infants and toddlers with special needs are worried that changes in the way the program operates could hurt the quality of care for the children in it.

The Indiana Family and Social Services Administration is in the early stages of rolling out several reforms to its First Steps program, which provides in-home speech, occupational, physical and developmental therapy to children up to age 3.

One of the key changes is requiring that all service providers be part of an agency that employs at least 12 therapists and operates out of a public location open during business hours five days per week. That would mean the roughly 1,000 therapists or very small businesses who now contract directly with the state would have to find jobs with those agencies.

And that’s raised myriad concerns. Among them is that some of the talented therapists will leave or be forced out of the field. Others worry that the agency structure will limit the time they can spend with their clients—and limit parents’ flexibility in choosing who works with their children.

“They’re adding a middle man,” said Rion Lahr, an Indianapolis speech therapist who works for the First Steps program. “With an agency it’s always the bottom line. With independent [therapists] and small companies, it’s what’s best for the child.”

But state officials, who decided on the changes last month, say a shift to an agency structure will enhance the service by improving communication between the various therapists serving a child.

They also say it will help fill a gap in the number of therapists serving children in rural and inner-city areas. Such a disparity has been created because therapists have been able to choose their own service territory. The agency also projects the changes would save $2 million a year—an important factor because the program faces a sizable deficit.

“We wanted to make sure we were living as much as we could within our means,” said Dawn Downer, First Steps’ director. “But we also wanted to make sure we had a program that provided quality services to the families we serve.”

This year, the First Steps program, which is funded by a combination of federal and state dollars, insurance and small payments from families, is aiming to cut $9 million of its $71 million budget to help head off a $15 million shortfall.

Part of the savings would come from cutting therapists’ pay rate by 5 percent.

Downer said the move to an agency model also would save money by helping the program better target its services.

Currently, parents with children in First Steps choose their therapists from a list on the program’s Web site. Some children require several types of therapy, while others may only require one.

Under the changes, families would be able to pick their initial therapist, but if their child required another type of service, the other therapist would have to work for the same agency as the first.

Having therapists from the same agency work with a child, Downer said, would allow the therapists to collaborate more. They then could better identify their clients’ needs and cut down on redundant or unnecessary treatment.

But some parents in the program say it would hamper their options.

When Becky Hufty’s now 3-year-old son, Jack, participated in First Steps, he was switched from his original occupational therapist to another who had more expertise in the type of service he needed. Jack has problems with his esophagus, brain and spine that accompanied a premature birth.

Hufty, of McCordsville, worries that parents in the program won’t have that same flexibility under the new system.

“You have so much trust in what the therapists are doing with your child,” Hufty said. “You need to have the option to choose who you’re going to work with.”

Lahr said she’s concerned that the agencies will not have enough room to absorb the 1,000 individual or small-business therapists—about 70 percent of the therapists in First Steps. Even if they do, she thinks top-notch therapists will leave the program out of frustration with the new system.

And she worries that the agency structure would limit the time she spends with her clients. Now, for instance, she’ll spend an additional 15 minutes to as much as an hour with the children if needed, but with a more structured agency system, she says she wouldn’t have that luxury.

“The children get would less service,” Lahr said.

Downer understands that therapists are concerned about the change, but she says their concerns should not take precedence over what she sees as best for children in the program.

“I hope most of these providers can also look at the greater good,” she said. “This program is very valuable to the children and families that they serve.”

Therapists’ transition to the agencies is expected to begin next month. The changes will go into effect next year.