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Wednesday, October 21, 2020

Autism in a Virginia Congressional Race

In The Politics of Autism, I discuss the issue's role in campaigns.

Republican Nick Freitas is running against incumbent House Democrat Abigail Spanberger

 

House Majority PAC released a new ad in Virginia’s 7th District connecting the dots between Nick Freitas’ pattern of taking thousands of dollars in campaign contributions from special interests, then voting for their benefit–even if it meant being the lone vote against expanding insurance for kids with autism. Twice. Fretias also stood with the special interests against a bill requiring background checks for daycare workers, showing even the safety of Virginia’s kids is up for sale.

“Expanding insurance for kids with autism and making sure our children are safe at daycare centers are really not controversial ideas, but Nick Freitas found reasons to vote against both of them,” said Abby Curran Horrell, executive director of House Majority PAC. “After taking thousands of dollars from special interests, Nick Freitas voted against bipartisan bills more than a hundred times, showing he’s not interested in protecting even the most vulnerable children if it comes at the expense of his special interest donors.”

The ad is available here and the script is below. The ad will run in Richmond and is supported by a budget of $360,000. House Majority PAC will also be running the ad, “Just One,” in the Washington, DC market with a budget of $840,000.

“Pattern”

TV :30

It’s a troubling pattern.

Nick Freitas took thousands from corporate special interests … and voted with them. Against bipartisan bills … a hundred times.

Nick Freitas was the only legislator — in either party — to vote ‘no’ on health insurance coverage for children with autism. Twice.

He even voted ‘no’ on background checks for daycare employees.

Nick Freitas. A pattern of defending special interests … to the extreme.

House Majority PAC is responsible for the content of this advertising.

Tuesday, October 20, 2020

Texas, Social Workers, Discrimination

In The Politics of Autism, I discuss  the civil rights of people with autism and other disabilities

Edgar Walters at The Texas Tribune:
Texas social workers are criticizing a state regulatory board’s decision this week to remove protections for LGBTQ clients and clients with disabilities who seek social work services.

The Texas State Board of Social Work Examiners voted unanimously Monday to change a section of its code of conduct that establishes when a social worker may refuse to serve someone. The code will no longer prohibit social workers from turning away clients on the basis of disability, sexual orientation or gender identity.

Gov. Greg Abbott’s office recommended the change, board members said, because the code’s nondiscrimination protections went beyond protections laid out in the state law that governs how and when the state may discipline social workers.

From NASW:

And while removing this language does not allow a social worker to discriminate based on other state and federal statutes, especially in the area of disability, it could send the erroneous message that this is allowed. This might deter a client from coming in for services, or cause a social worker to withhold a service they are ethically obligated to provide.  

From AP:

The National Association of Social Workers criticized the board’s decision to follow the governor’s recommendation rather than seek public comment.

Will Francis, director of the association’s Texas chapter, told the board during public comments that their decision was “incredibly disheartening.”

...

Francis said the board's decision creates the impression that people with disabilities can be discriminated against despite federal rules that are in place to protect them.

“It’s disturbing, even if it’s unintentional,” Francis said. “They created space for people to get the impression that this is allowed now. What the governor has done is put people with disabilities at risk for discrimination for no reason.”

 

Overall, Texas is a bad place for people with autism and other disabilities.  In 2017, the latest year for which comprehensive data are available, ANCOR and United Cerebral Palsy found that Texas had the largest HCBS waiting list and also saw the most growth; 21,538 more Texans with disabilities in 2017 were awaiting support than in 2016.

Monday, October 19, 2020

NCD Urges Replacement of AbilityOne

In The Politics of Autism, I discuss the employment of adults with autism and other developmental disabilities. Many posts have discussed programs to provide them with training and experience.

From the National Council on Disability:
NCD conducted a comprehensive analysis of the AbilityOne Program to determine whether it promotes Congress’ goal of improving employment opportunities for people who are blind or have significant disabilities. Today, the program is made of a government-appointed Commission and staff, three central nonprofit agencies (CNAs) that facilitate the program, and over 500 participating nonprofit agencies that hire people who are blind or have significant disabilities to sell goods and services to federal agencies.

NCD’s report raises the following concerns about the AbilityOne Program:
  • Despite increased program revenue earned through sales to the Federal Government, employment for people who are blind or have significant disabilities has steadily declined since 2011 – While overall program sales have increased, the number of employees and total direct labor hours from the employment of people who are blind or have significant disabilities have declined since FY 2011. The percentage of overall program revenue paying wages to people are blind or have with significant disabilities has also declined each year since FY 2011.
  • The program undermines current national disability policy goals to create competitive integrated employment opportunities for people with disabilities – The program is a federally sanctioned segregated jobs system from 1938 that reinforces distinct employment paths for people who are blind or have significant disabilities that may result in subminimum wages. The program relies on an outdated societal landscape that existed prior to a public right to education and other core civil rights for people with disabilities. For this reason, only approximately four percent of employees hired under the program exit the program to enter competitive, integrated employment each year.
  • Repeated concerns about transparency and conflicts of interest remain unaddressed and undermine confidence in the program – While the CNAs continue to seek opportunities to increase program revenue, past scrutiny and criticism from Congress, the Government Accountability Office, its own Inspector General, and the Advisory Committee on Increasing Competitive Integrated Employment for Individuals with Disabilities remain unresolved. The CNA program fee remains exempt from federal restrictions on its use allowing it to fund executive salaries and lobbying expenses. In addition, NPAs have the discretion to decide which employees have significant disabilities, however NCD’s interviews and site visits with NPAs raised concern that they lack the capacity, skill, and knowledge to objectively evaluate the skills of their workers with disabilities.
NCD concludes the report by advising Congress to transition the outdated AbilityOne Program into a new requirement under Section 503 of the Rehabilitation Act that will incentivize federal contractors to hire a percentage of people who are blind or have significant disabilities at competitive wages and provides recommendations to successfully transition the current 45,000 AbilityOne employees into competitive, integrated employment.
From the report:
The increased  prevalence and availability of the customized employment approach allow  people who were previously considered “unemployable”to successfully maintain employment in a competitive, integrated environment. The key to this approach is the use of flexible strategies. Rather than relying on open job postings, a job developer will work to determine the specific skills, assets, and interests of a person with a significant disability and how these skills can address an unmet need of an employer. For example, Sean, who is autistic, enjoyed organizing books and dusting. He was hired by Barnes & Noble bookstore to clean and organize the shelves prior to the opening of the store each morning. He loved his job, and the store was equally pleased because their other employees did not have the time to focus on such meticulous tasks. he advent  of customized employment negates the need for people with significant disabilities to rely on AbilityOne for employment.

Sunday, October 18, 2020

How to Overcome Antivax Sentiment


Foremost among the strategies researchers have devised to break through misgivings about vaccination is, essentially, scaring people into doing it. In 2015, Zachary Horne, a psychology professor at Arizona State University, divided 315 participants into three groups. The first group read a story about a child who contracted measles; looked at a picture of a child with measles, mumps, or rubella; and read warnings about the importance of vaccination. The second simply read statistics showing there is no link between vaccination and autism. The third read about an unrelated topic. The group exposed to the vivid anecdotes were more likely to change their attitude toward vaccines than the other two. Vaccine skeptics often tell frightening personal stories of injury; Horne did the same thing, but for diseases.
...

But other experts say adjusting attitudes is a fruitless exercise. Some evidence shows that giving people —including the vaccine-hesitant—correct information actually causes them to double down on their resistance, in a psychological concept known as the “backfire effect.” In a study similar to Horne’s, another group of researchers found that images of sick children only worsened parents’ misperceptions about the vaccine-autism link, and did not boost their intent to vaccinate their children.

Instead, this camp endorses a strategy called “direct behavior change.” Pediatricians might, for example, simply tell parents which vaccinations they’ll be performing during their child’s appointment, rather than ask them whether they’d like to vaccinate. According to research, parents are much more likely to avoid vaccinating if the pediatrician says something like, “What do you want to do about shots?” as opposed to, “Well, we have to do some shots.”

Saturday, October 17, 2020

NIH Research Funding

In The Politics of Autism, I discuss the incentive structure facing academic researchers:
This diversity of research agendas is partially a result of uncertainty. Amid the darkness, it might make sense to shine searchlights in all directions. Some of it may also stem from the availability of autism research money at a time of tight science budgets. To put it bluntly, publication-hungry scientists may have an incentive to rebrand marginally-relevant work as autism-related. Describing her study of how experts on sex differences have landed on the “biomedical platform” of autism, science historian Sarah Richardson says they “have begun to link their very basic research -- even if it’s on nematodes [roundworms] -- to frame it as a contribution to autism.”

 Paige E. Cervantes and colleagues have an article at the Journal of Autism and Developmental Disorders titled "Trends Over a Decade in NIH Funding for Autism Spectrum Disorder Services Research."  The abstract:

Investments in autism spectrum disorder (ASD) research, guided by the Interagency Autism Coordinating Committee (IACC), have focused disproportionately on etiology over a well-established stakeholder priority area: research to improve accessibility and quality of community-based services. This study analyzed National Institutes of Health ASD services research funding from 2008 to 2018 to examine funding patterns, evaluate the impact of IACC objectives, and identify future directions. Approximately 9% of total funds were allocated to services research. This investment remained relatively stable across time and lacked diversity across domains (e.g., area of focus, ages sampled, implementation strategies used). While advancements were observed, including increased prevalence of projects focused on adult samples and on dissemination/implementation and prevention areas, greater investment in service research is critically needed.

Friday, October 16, 2020

Increasing Number of Autistic Adults on Medicaid

The Politics of Autism includes an extensive discussion of insurance and  Medicaid services for adults with intellectual and developmental disabilitiesHome and Community-Based Services (HCBS) are particularly important.

In my 2020 APSA paper, I note that "studies that mention autistic adults typically contain phrases such as “little is known.” 

A release from Drexel University:

While much attention has been paid to the increasing prevalence of autism spectrum disorder (ASD) among U.S. children and adolescents, less is known about the population of adults with ASD. Medicaid is an important health care coverage provider for individuals with autism, including adults. Using administrative data from the Medicaid Analytic eXtract (MAX), researchers from Drexel University’s A.J. Drexel Autism Institute found a substantial increase in the percent of adults receiving services for autism in the Medicaid population from 2008-2012.

“An increasing number of adults will be relying on Medicaid, often through home and community-based services waiver programs, for key services, such as support for community integration and for maintaining employment, into the future,” said Whitney Schott, PhD, an assistant researcher professor in the Autism Institute and lead author on the study.

There was higher prevalence of ASD among younger adults (ages 18-24) over the 2008-2012 time period than other adults. Prevalence was lowest among older adults (ages 41-64).

“These results underline the importance of identifying effective and efficient service delivery models within Medicaid to serve the growing number of adults with ASD,” said Schott.

Researchers examined Medicaid administrative claims data from 2008-2012, including the population of adults with autism as well as a random sample of adults without autism, in order to identify the administrative prevalence of autism by age category. They looked at individuals that were enrolled in Medicaid for at least nine out of 12 months per year, in order to get a better sense of true administrative prevalence.

“Little is known about the age composition of the adult population with autism,” said Schott. “Our research provides key information about the distribution of autism across adult ages over the period 2008-2012, showing that prevalence is higher and growing more quickly among younger adults (ages 18-24) compared to older adults.”

She added as more and more youth with autism age into adulthood, many will rely on Medicaid for continued services to integrate into the community, workplace and economy. State Medicaid programs and other insurance providers would be interested in learning more about the age distribution of the adult population with autism enrolled in Medicaid to better serve them.

The study, “Autism Grows Up: Medicaid’s Role in Serving Adults on the Spectrum,” was published in Psychiatric Services and was supported by a grant from National Institutes of Health – National Institute of Aging. Co-authors include Kate Verstreate, Sha Tao and Lindsay Shea, PhD, of Drexel University.


Thursday, October 15, 2020

The NC Handcuff Story Is Going National

In The Politics of Autism, I discuss interactions between police and autistic people.  Police officers need training to respond appropriately.  When they do not, things get out of hand.


One such case, in North Carolina, is starting to get national attention.

 Teo Armus at WP:

The school resource officer was not in the room when a 7-year-old boy with autism, whose mother said he was overwhelmed by the comings and goings in his classroom, began spitting inside his special-needs school in Statesville, N.C.

But when the officer, Michael Fattaleh, arrived on the scene, he put the boy in handcuffs, taunted him and pinned him to the ground, according to body-cam footage of the September 2018 incident that was recently published by WSOC.

“You ever been charged with a crime before?” Fattaleh asked, pressing the boy’s head against a pillow on the floor. “Well, you’re fixing to be.”

So began an interaction that lasted nearly 40 minutes, as the child began crying and yelling that he was in pain and two special-needs teachers looked on without intervening.

More than two years later, after the body-cam footage was released, his mother is suing the school board, the Statesville city government and Fattaleh, who resigned days after the incident from his job as a police officer. The woman, identified only as “A.G.” in the suit, alleges the parties in question violated the constitution, participated in negligence and inflicted emotional distress on her and her son.

Rebecca Riess at CNN:

During other moments of the incident, while the 7-year-old is lying face down on the floor, with his hands cuffed behind him, Fattaleh appears to check on the boy's well-being, asking "Can you breathe?" and "Are you hot? Are you warm?"
When the boy's mother arrives, the officer tells her that her son "is going to be charged with one count of assault, maybe two," the video shows.
Among other things, the lawsuit seeks to hold Fattaleh liable for inflicting "unnecessary and wanton pain and suffering" on the boy, saying he suffered "severe and permanent psychological injuries and was forced to endure extreme pain, suffering, and emotional distress and mental anguish together with a total deprivation of his rights guaranteed him by the Constitution."
Interim Statesville Police Chief David Onley initiated an internal affairs investigation of the incident, the Statesville Police Department said in a statement.