By Gabrielle Waclawik (PHS 795 student):
As Durkin points out in her study, we have seen an increase in prevalence of Autism Spectrum Disorder (ASD) over the years. Many reasons likely exist for this including advances in screening techniques, changes in medical training and education, and even increase in coverage in the popular mainstream media. Moreover, the DSM-V criteria switched in 2013, although after Durkin’s study period, to recognize Autism Spectrum disorder (with varying severity) to include what was previously diagnosed separately as Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder (Not Otherwise Specified). Despite all of these changes, Durkin states that the “findings collectively support the idea that children living in poorer or less well-educated areas are being diagnosed with ASD at lower rates because they have less access to health care providers who could make the diagnosis and provide needed support.”
While the Durkin calls for better access to screening and health care providers in lower SES areas, the most interesting and timely point for me comes towards the end of the article. Durkin states “if we are under-identifying ASD in certain socioeconomic groups — as seems likely — we need to be prepared to provide services at a higher level to more people. We need to find cost-effective interventions and supports and make sure they are distributed equitably and in a way that reaches everybody who needs them.” While this is likely only referring to childhood and early intervention programs and services, we must not forget that as many of these children age, they too likely continue to require services as adults. I say this is timely, because Dane County is currently undergoing a drastic long-term care reform as it transitions from a regionally structured individualized approach to a more standardized statewide insurance model, which includes medical care, that will take effect in 2018.
I recently attended an informational meeting on the Dane County long-term care transformation, since the change will directly affect my older brother who has severe Autism and medical needs that require 24/7 supervision and care. Throughout the meeting, it was difficult to ignore many of the current caregiver’s and advocate’s echoes of frustrations and complaints about the current transition, as they are fearful the new structure could jeopardize supportive services by combining them with medical care in contracts run by insurance companies. And trust me, I can tell you firsthand how any change or interruption of routine can be devastating for a someone with severe autism. However, the Dane County waitlist currently holds about 600 people unable to receive any covered support services. Under the new “family care” model, all of those people will gain coverage.
As 2018 is quickly approaching, we will see how the changes unfold. I have no doubt it will be an extremely unsteady transition, as every change is for my brother. We will see how the state budget and coverage for such long-term care services upholds over the coming years, and if waitlists will continue to be a part of the past. As Durkin points out, as we increase access to screening and health care, we will continue to see a rise in prevalence of ASD. And we will need to be ready to meet the increasing demand for these support services.