Who should (or should not) have the right to claim Jean Ayres' legacy

By E.J. Brown

This is the conclusion of a 3-part series on Jean Ayres' legacy in sensory integration dysfunction theory, and who should be its inheritors.

Brian Erwin remembers his "Aunt Jeanie" Ayres, founder of sensory integration theory, with great affection. "My parents would bring carloads of kids to [the University of Southern California] so that Jean could expand her pool of resource subjects," he wrote in an April 15, 2003, letter to occupational therapist Peg Bledsoe, then on the board of Sensory Integration International (SII).

"My two older brothers, sister and I spent countless hours of our childhood seated by Jean's side as she tried different diagnostic tests on us, making us one of her early control groups. I, myself, was instrumental in getting Jean to write and publish her classic book for parents, Sensory Integration and the Child [in 1979]."

The Family's Concerns

But Erwin was not just having a chat with Bledsoe. As successor trustee of the Franklin B. Baker/A. Jean Ayres Baker Trust, he is responsible for overseeing the monies that his aunt's work still brings in in royalties. Erwin demanded of Bledsoe that SII, which had bought the Ayres Clinic in 1984, along with permission to use Ayres' name to promote it, stop using his aunt's name.

"I have no interest in receiving any information about SII's forward-looking plans," Erwin told Bledsoe. "Given the severity of SII's violation of the sales agreement, there is nothing SII can do to lessen my resolve to force SII to cease and desist from using the Ayres name in any capacity."

He has besieged SII with legal correspondence about the issue ever since he discovered, sometime in 2002, that Sensory Integration International, plagued by overwhelming debt, was in trouble with the Better Business Bureau of the Southland, in Colton, CA. In fact, the BBB had given the non-profit fundraising organization an "unsatisfactory" rating for its failure to promptly refund customers' money for cancelled courses, or to be readily available to them. That rating still stands today.

Since the Ayres Clinic was the only entity entitled by law to trade on Jean's name, with its reputation went the Ayres legacy.

Erwin had been overseeing the family trust fund since his aunt died on Dec. 16, 1988, but he had had little communication with the SI community, at that point, for more than 10 years.

Falling revenues to the fund had propelled Erwin, a book publisher, to look into the matter in the first place. Ayres had published two major books on SI as well as the SIPT in the 1970s. Though he won't reveal how much is in the trust, he says that fund receipts were off by about 10 percent in the winter of 2002, indicating that Ayres materials weren't selling as well as they once had. "I thought maybe some of her materials needed to be updated."

SII's Story

SII executive director Anthony Wells says that no matter what its financial status, SII isn't violating anything by using Jean Ayres' name.

"We will never give it up," Wells told ADVANCE recently. "It is the organization. Without Jean Ayres, you have neither organization [SII or the Ayres Clinic]. She founded and developed them both."

Wells says he has been working for six years with SII's creditors to obliterate the debt and keep the organization out of bankruptcy.

When Ayres sold her practice to Sensory Integration International on Dec. 31, 1984, the contract tried to address name rights and use: "Seller hereby grants buyer a full and unrestricted perpetual license to use the names 'Ayres,' 'A. Jean Ayres,' 'Jean Ayres,' and 'Ayres Clinic' in connection with the promotion and operation of the clinic; provided, however, that the license hereby granted may be transferred to parties other than buyer only with the prior written consent of seller, which consent cannot be unreasonably withheld."

Erwin says those words specifically exclude using the Ayres name on SII's products and certification courses in administration and interpretation of the Sensory Integration Praxis Tests (SIPT). The courses are offered all over the country but are not literally connected with the operation of the clinic.

Wells says that Erwin is misreading the statement; to Ayres, the clinic and SII were essentially the same organization, and he points to covenants of the agreement which state that one of the purposes of the clinic is to "disseminate information about sensory integrative disorders and their treatment throughout the nation and the world." SII, Wells says, fulfills that obligation.

Jean Ayres originally established her clinic at 1518 Cabrillo, in Torrance, CA. It moved in November 2001 to 2340 Plaza del Amo, still under the ownership of SII, and continues to offer sensory integrative assessment and treatment through occupational therapist Patricia Oetter, a prominent therapist and a fellow of AOTA. She is an SII board member.

According to Wells, the clinic accepts patients from all over the world for intensive weeklong therapy in two-hour sessions. "We do about 80 a year," he said. "There's a waiting list." It has become, essentially, Oetter's practice, though she offers much to the clinic and SII on a volunteer basis, Wells said. She also works for Pediatric Development Programs, PDP Products of Stillwater, MN, a company founded by former SII board member Eileen Richter. PDP also offers educational courses in sensory processing.

However, the Ayres Clinic seems to run on so few wheels that if one of them stops working, there is no way to continue. A worst-case scenario follows.

In the spring of 2003, Patty Oetter had a serious health emergency that literally closed the clinic. It happened just as a mother and her young son were due to travel from Mexico to the United States for a five-day treatment session with Oetter. A short time before their departure, the mother called to confirm the appointment. She had spent $600 for the sessions in advance, and had already bought the plane tickets. But a spokesperson in the SII office told her that the session had had to be cancelled.

Two weeks later, the mother called back asking if there would be someone available to treat her child. The answer was no. The mother said she needed her refund to apply to treatment elsewhere if she could find any, and she emailed a notice to this effect. She received no answer.

She finally found the Pediatric Therapy Network, run by former staff of the Ayres Clinic, made arrangements and came to California.

"As soon as I got to Torrance, I headed for the Ayres Clinic," the mother wrote in a memo to Erwin. "Through the windows I could see it had no equipment. It only had a sign, 'The Ayres Clinic.' I then really started to be worried. I called them to ask their address, and they gave me the same Cabrillo one. I told them I was no longer in Mexico, but in a public phone booth two blocks away from the empty clinic."

After three months in the U.S., this mother still had not received her refund. She then threatened to take SII to small claims court.

Wells readily admits that this incident happened, but said SII is too strapped financially to deal with crises like this one.

Wells says that his organization has paid down debt steadily since he became executive director in 1998. Tax records show that in 1999, SII, a 501c3 non-profit corporation, did pay about $340,000 to its creditors. But Erwin is angry because, he says, by that year, the year in which complaints began to surface about lack of refunds for cancelled courses, the organization posted net gains of $142,000 after two years of net losses. Fueled by stories like the one above, he openly accuses SII of stealing the money it really owes to customers, simply by not paying them back.

Wells, of course, denies this, and in fact blames much of the problem on the sudden departure of the 40-member clinic staff in August 1996. Led by former director Zoe Mailloux, they opened their own business close by, Pediatric Therapy Network (see ADVANCE Nov. 1, 2004).

He is determined to get SII back on track. It's his mission.

SII is in the second phase, he says, of a three-phase debt reduction plan that prioritized creditors according to their import in the financial stability of the organization. Current debt, he says, "is in the $130,000-$140,000 range. I think the stage we're in is the 'plane on the tarmac getting its pieces back together so it can fly.'"

Memberships in SII bring in about $100,000 a year, he added. "I think by next December we will have moved into phase three. We will have been able to reduce what we put out in debt every month." Some supporters of SII are actually donating their time, he said. Phase three is to secure the organization "so no one can do this to us again," he said.

Wells said that most refund problems arise out of changes in course venues, when people cannot reschedule for whatever reason.

"We're not canceling courses and just leaving people there," he said. SII does intend to fully refund every cent that is owed to its customers, he said, but it is being done on a seniority basis—those with the longest outstanding claims go into the monthly cycle first. Though he gives them confirmation numbers, he cannot tell them exactly when they will be repaid. He sends out notices 30-60 days before the billing cycle in which that bill will be paid. He believes that there are about 15 people still waiting for refunds.

Wells admits the Better Business Bureau told him that "it's important that we do this in a more timely manner."

What About Quality?

Up until fairly recently, Sensory Integration International was the only entity that offered instruction and certification in using the SIPT, owned and published by Western Psychological Services. It is still the only credential that SI therapists can put behind their names. But what it means today may depend on where you get it.

The University of Southern California, where Ayres taught for so many years and actually did most of her work on SI theory, has partnered with WPS to offer more in-depth courses in sensory integration treatment and a certification in SI.

The USC/WPS Comprehensive Program in Sensory Integration is a four-course program that covers SI theory, assessment and intervention besides administration and interpretation of the Sensory Integration Praxis Tests (SIPT).

The intervention component became mandatory in 2003.

"[It] sets our courses apart in terms of the additional content and focus on planning and implementing treatment programs for children with identified sensory integration deficits," wrote Susanne Smith Roley, project director, to ADVANCE. "The goal of the management and instructors of the USC/WPS program is to provide an avenue that will increase the competencies of practicing therapists." But she added, "We do not feel that certification courses alone ensure competency, and therefore we strongly encourage therapists to continue learning through various methods."

Roley calls the USC program "the most comprehensive training program in SI in the U.S." Those who complete it are "certified in sensory integration," rather than just in the SIPT. Still, there is no separate designation for that, and no test to back it.

Part of the issue here is that sensory integration theory itself has always been, and still is, under the gun to prove itself. How it translates to treatment outcomes is still a matter of debate. Proponents like Roley want to stick as closely as possible to Jean Ayres' original theory and let research back its expansion.

Last May, in accordance with the clinic sales agreement, Brian Erwin granted the USC/WPS program the right to use her name to promote its courses. In his written statement, he noted, "Those practitioners seeking to become SIPT-certified are guaranteed that what they learn emanates directly from A. Jean Ayres' theory—philosophy and intention for its application in practice." He added a warning to SII: "Other SIPT certification providers who use the Ayres name to promote their courses do so without our endorsement and are in violation of A. Jean Ayres' trademark."

Actually, the Ayres name is not a trademark, which is a logo and title registered with the U.S. Patent Office, but Erwin said the name is part of the family's "intellectual property."

The Sensory Integration International Web site, too, offers courses in SI theory, assessment and treatment. But there have been complaints about the quality and depth of those courses for several years.

An East Coast OT who took SII's intervention course in 1997 noted in an email that the announced speaker had cancelled, and the class was taken over by a substitute who was not a good speaker and who "spent a lot of time talking about alternative treatments and too little on SI intervention. It was extremely disappointing."

But perhaps more importantly, this same writer had taken SII's theory course in 1996, and had found it "great." But when she decided to try for her SIPT, she went with the WPS program through an online provider; she discovered that the materials she was sent for the theory course were of a much higher caliber than what SII had offered, "more polished/professional," she said.

Some people who have talked to ADVANCE believe Sensory Integration International should not continue to offer its courses at all, particularly considering its unreliable record in handling customers. Others say there is still a place for SII if it can get its act together.

Here's what Wells believes: "We've certified 1,500 therapists since Sept. 6, 2001. We've held 30 courses a year since then. We've moved five courses in that particular time. We want our teachers to be the best; we've solidified our staff. We've developed a more consistent approach to our courses, and that's important when you're sitting for a test.

"We're positioning ourselves to become a national charity for SI. We don't want to have any complaints in the next fiscal year, and I don't think we will have any."

E.J. Brown is editor of ADVANCE. She can be reached at ebrown@merion.com.