First autism Medicaid Education of All waiver (MD) Individuals - PowerPoint PPT Presentation

First autism Medicaid Education of All waiver (MD) Individuals with Handicapped Disabilities Education Children Act Community Act includes autism Mental Mental Health Medicaid Health Act Olmstead Act Parity Act Waivers start 1960 65 70 75 80 85 90 95 00 05 10 15 Americans with Medicaid Disabilities Act Medicaid First autism covers insurance autism EAHC extended to mandate (IN) treatment Infants and toddlers Affordable Fair Housing Act Care Act extended to people With disabilities

18.0% 17.1% 10.4%

$350 $300 Monthly Spending $250 $200 $150 $100 $50 $0 Non Mandate 1 Yr Post 2 Yrs Post 3+ Yrs Post States Mandate Mandate Mandate Eligible Children Ineligible Children

Wang et al. (2013)

1.2 3% 1% Therapeutic Other services -8% care Respite care

Effect sizes of .8 – 1.1 Weitlauf et al. Comparative Effectiveness Review No. 137. AHRQ.

$70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $0 ESDM Community ESDM Community ESDM EIBI OT/PT social skills special education speech therapy other

.15 .26 1 -1 1 0 0 -1 Effects of Community Treatment

-1 .23 -1 0 1 0 1 .21

Efficacy Effectiveness Community Practice Traditional RCT Grant funding insures tx subject to programmatic System tx delivery at desired and funding priorities intensity and duration Highly trained and Variable training, supervision, Clinician supervised in tx motivation and caseload Restrictive inclusion and Whoever shows up Subject exclusion criteria

Efficacy Effectiveness Community Practice Traditional RCT Grant funding insures tx subject to programmatic System tx delivery at desired and funding priorities intensity and duration Highly trained and Variable training, supervision, Clinician supervised in tx motivation and caseload Restrictive inclusion and Whoever shows up Subject exclusion criteria

An array of interventions and instructional strategies are utilized to support teachers and staff who teach children with autism. Some of these include: • ABA ( Applied Behavioral Analysis): task analysis, discrete trial • VBA (Verbal Behavior Analysis) • TEACCH • Visual Supports (communication/instruction/schedules) • Positive Behavior Supports (i.e. Jed Baker books, Tony Attwood) • The Incredible 5-Point Scale • Integrated technology for social stories/instruction (i.e. Smart Board) • RDI (Relationship Development Intervention) • Assistive Technology (i.e. communication boards, electronic communication) • Floor time • Pivotal Response • Research-based reading and mathematics interventions These strategies are used across all settings, ages and grades based on the individual needs of students.

10 8 6 4 Change in IQ 2 0 0 1 2 3 4 5 -2 -4 -6 How well teachers implemented the program (fidelity) -8 -10

Policy/ Federal Organizational State Environment District Attitudes School Beliefs Norms Intentions Behavior Knowledge Self-Efficacy Skill Adapted from Azjen (1986, 1991) and Williams and Glisson (2013)

Federal Organizational State characteristics District Attitudes School Beliefs What Norms Intentions Behavior Behavior? Knowledge Self-Efficacy Skill

Visual schedules Positive reinforcement Data collection One-to-one(?) intervention each day

Pedagogy Resources Staffing Attitudes

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Policy Outcome

Policy Practice Outcome