COMMENT: Virginia does "poor job" providing autism services, and what that has to do with Oregon.

A couple of hours ago, a news alert from the Richmond Times-Dispatch (VA) came across my desk and definitely got my attention. Why is Virginia of so much interest? During the Oregon House Health Care Committee public hearing on HB 3000, this point was brought up by a consultant to one of the insurance companies,

"...but we will point out that in places like VA, where one of our leading developmental pediatricians comes from, the schools do much more on this [autism], and they feel that they have not even begun to reach the level of what their side of the bargain should do in this...".

And my reaction at the time was,

[Blog author note: Without the particular significance or special insight involved, the description of what was said by the colleague, "leading", or not is what is known as "anecdotal" or "testimonial". It may well be that VA schools are better, or not. If such was sufficient as evidence, the matter at hand, then we could dispense with experimental design altogether. The point is moot and irrelevant of the merits of this legislation. And if retaining it to the question of schools, if the anecdote that VA schools are doing much more but only scratching the surface, what does that say about the level of therapy in any venue available in Oregon?..."

So the headline from Virginia that caught my attention was,

VA. does poor job providing autism services, study says
by Tyler Whitley
Richmond Times-Dispatch

Published: June 8, 2009

"The state [VA] does a poor job of providing services to people with autism, the legislature's watchdog group said today...Parents seeking benefits for autistic children, and insurance lobbyists gearing up to oppose the possibility of mandated insurance benefits that might include autism treatments, filled a room at the General Assembly Building to hear the report...JLARC [Joint Legislative Audit and Review Commission] began the study last year. Its first report recommended that health insurance require that autism treatment be covered. Under heavy pressure from insurance interests and small-business owners, the General Assembly rejected the proposal..."

[Blog author: So that was what was really going on with insurance proposals in Virginia, and what does the JLARC report say (keeping in mind that the conditions in Virginia were presented as superior to that in Oregon)?]

Report of the Joint Legislative Audit and Review Commission To the Governor and The General Assembly of Virginia
Commission Draft: Assessment of Services for Individuals with Autism Spectrum Disorders
June 8, 2009, 256pp.

CHAPTER 2: ASDS CAN OFTEN BE EFFECTIVELY TREATED, RESULTING IN COST SAVING
"...Several treatment approaches have been scientifically shown to meaningfully improve the outcomes of individuals with ASDs, including the commonly referenced applied behavioral analysis (ABA) method. In particular, most young children with ASDs who participate in intensive early intervention programs based on ABA principles experience improvements, with almost half achieving normal levels of functioning and another 40 percent realizing moderate gains. According to cost-benefit analyses, providing intensive treatment to young children can significantly reduce public costs by decreasing the need for special education and other forms of public assistance, with savings likely to accrue over the lifetime of individuals with ASDs. While many approaches have been categorized as effective for treating ASDs, research indicates that packaged programs with a pre-determined curriculum, such as ABA, appear to have more promising results than programs that rely on a more informal mix of interventions..."

Chapter 2: Autism Spectrum Disorders Can Be Effectively Treated, Producing Cost Savings
p.11, "... The largest body of research exists for interventions based on applied behavior analysis (ABA). ABA-based interventions are supported by approximately 30 years of research pointing to their effectiveness and have been accepted by much of the medical community as effective techniques for treating ASDs, along with several other interventions. Further, research indicates that treatment is beneficial for many and could result in long-term savings of public resources over these individuals’ lifetimes...

See Figure 2: Interventions Have Been Categorized Based on Category: Scientifically Based Practices

"Significant and convincing empirical efficacy and support:
Applied Behavior Analysis, Discrete Trial Training. Pivotal Response Training, LEAP"

p.16, "...By applying the methodology used in the Pennsylvania and Texas studies to Virginia-related data, JLARC staff estimate that the Commonwealth could save approximately $137,400 in special education costs per student with an ASD if EIBI was consistently provided. In fact, the analysis indicates that Virginia could realize savings as long as at least 42 percent of students with ASDs who received EIBI make moderate improvements (require less intensive services and fewer supports), which is a substantially more conservative outcome than the outcomes reported in the research literature..."

p.33 -34, Table 8: Common Arguments Concerning Health Insurance Coverage for ASD-Related Therapies

[yin:] Many treatments are experimental, investigational, or unproven for ASDs. No treatment is known to be effective for all individuals.
[yang] Many in the medical community (including the U.S. Surgeon General, the Institute of Medicine’s National Research Council, and the American Academy of Pediatrics (AAP)), recognize certain therapies as research-based, including speech, occupational, physical, and behavioral therapies such as those based on the principles of applied behavioral analysis (ABA). Medical treatments are generally not effective for everyone who suffers from a given medical condition

Chapter 7: Improving the Delivery of Services to School-Age Virginians With ASDs
p.114, Specific “Packaged” Interventions Appear More Promising, but Many Schools Use the Mixed-Methods Approach

"...Because individualized educational programming often necessitates the use of multiple instructional strategies, Virginia schools commonly rely on a variety of approaches to serve students with ASDs. However, only a minority of schools report using comprehensive packages such as applied behavior analysis (ABA). Further, fewer than ten percent of schools use these packages as their preferred intervention, relying instead on a “mixed methods” approach to meeting the needs of students with ASDs, despite evidence that packages tend to yield better results (Chapter 2). The literature does note that a mixed methods approach could be just as effective as a package, in theory, but that it requires a degree of expertise, planning, and coordination that is often not present in Virginia schools..."

Read the report.