The Autism Services Market

 The Politics of Autism includes an extensive discussion of autism service providers.

Ronit Molko at Forbes:

The autism services market is estimated to be worth around $5 billion to $7 billion annually and it’s growing, with a total addressable market estimated between $50 billion and $90 billion. The majority of the services provided to individuals with autism are behavioral services and are provided at home, in school, or in a clinic setting. Most of these services are based on the science of applied behavior analysis, or ABA, which is a scientific method that employs specific techniques and principles to impart skills and bring about meaningful changes in behavior. ABA is the most widely funded treatment option that private insurance companies, or state or federal programs, will cover.

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 While the current national players are acquiring smaller providers to grow their platforms, there are still many underserved communities and many opportunities for organic growth. As of 2016, it was reported that the top nine multi-site providers accounted for nearly $400 million in revenues – almost 40 percent of the market share, but the market, and these companies, have grown considerably in the past two years. Despite the efforts by investors to consolidate the market, there is still space for more providers on the national level.

A Death in El Dorado Hills

In The Politics of Autism, I discuss the use of restraint and seclusion.  Many posts have mentioned these techniques, both in schools and facilities for people with disabilities.

At a California school, an autistic student stopped breathing after nearly an hour under prone restraint. Sawsan Morrar and Phillip Reese at The Sacramento Bee:

The boy, identified by the Sacramento County Coroner’s Office as Max Benson, 13, became unresponsive while in the restraint hold and died a day later at UC Davis Medical Center.

The incident took place Nov. 28 at Guiding Hands School on Windplay Drive, according to the El Dorado County Sheriff’s Office. Benson became unresponsive while being held in a ‘prone restraint’ for nearly an hour, according to a source familiar with the investigation.

In a letter sent to the school’s site administrator, Cindy Keller, on Dec. 5 from the California Department of Education and released to The Sacramento Bee through a California Public Records Act request, state regulators found “sufficient evidence” that the facility had violated multiple state rules governing how and when physical restraints can be used on students.

Those violations included using an emergency intervention — the prone restraint — for “predictable behavior,” using an emergency intervention as a substitute for the student’s personally-designed behavior intervention plan and using the restraint for longer than necessary.

Social Media and Twice-Exceptional Students

 In The Politics of Autism, I examine the role of social media in the development of the issue.  Social media can spread vaccine disinformation, but they can also provide autistic people and their families with a way to connect with one another and to press for government action.

Twice-exceptional students are both gifted and disabled.  Many are autistic. At Education Week, Sasha Jones writes:

Twice-exceptional parents are not the first to take advantage of online connection, offering support and information to those hungry for it, and even driving state and national-level change. The advocacy group Decoding Dyslexia, for example, grew out of social media and now has branches in all 50 states, 42 of which have passed dyslexia-specific laws.

Robbi Cooper, a parent involved in policy and advocacy at Decoding Dyslexia Texas, says that social media connects advocates involved in various parts of the legislative process and builds support from lawmakers and administrators.

"Social media allows the door to open when the door's not locked. If the door is locked, then they won't let you in—but that doesn't mean there's nothing you can do," Cooper said, indicating that continued growth and research can serve as the key. "Once they start listening to you and start taking you seriously, then they unlock the door."

Unvaccinated in Oregon

 In The Politics of Autism, I look at the discredited notion that vaccines cause autism.

Blair Stenvick at Portland Mercury:

In Oregon, where both libertarians and natural lifestyle devotees abound, the anti-vaccination mindset is particularly strong. At 7.5 percent, Oregon currently has the highest percent of kindergartners in the country whose guardians claim exemptions for vaccinations on philosophical or religious grounds. That’s a full percentage point higher than what Oregon recorded in 2017—and the figure has risen steadily since the early 2000s.

“There’s an extraordinary amount of information, much of it wrong, some of it right, on the internet,” says State Representative Mitch Greenlick, who chairs the health committee in the Oregon House of Representatives. “This is part of a wave of anti-science attitudes in the country, and even the state.”

Oregon parents are generally required to have their kindergartners vaccinated against diphtheria, measles, mumps, rubella, polio, chickenpox, Hepatitis A and B, and tetanus. But there are exemptions for kids who have medical conditions that would make vaccines dangerous—and for kids whose parents cite religious or philosophical objections to vaccines.

In 2013, Oregon passed a law requiring that parents who claim non-medical vaccine exemptions must either watch an hour-long online video about vaccines produced by the Oregon Health Authority (OHA) or discuss vaccines with a medical professional. But the law has failed to make a meaningful impact on vaccination rates: While Oregon’s rate dropped in 2015 from 7 percent to 5.8 percent, it climbed steadily to 7.5 percent between 2015 and 2018, making the exemption rate higher than before the law went into effect.

Bad Data on Special Ed Teacher Employment

Uncertainty is a major theme of The Politics of Autism.  Much of the uncertainty stems from the state of the science.  Some stems from bad data.

Christina A. Samuels and Alex Harwin at Education Week:

For more than four decades, the U.S. Department of Education has asked states to submit information on special education teacher employment, along with a raft of other information that the Individuals with Disabilities Education Act requires to be collected.

But the employment numbers that are submitted to the federal government are sometimes wrong—wildly so. In some cases, state data managers say the mistake is theirs. In other cases, state officials say they aren't sure where the federal government got the numbers, even though states are the ones responsible for submitting them.
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Mississippi is another one of several states with implausible personnel numbers. Federal records show the special education teacher count at 3,770 for the 2005-06 school year. The number of teachers reported in federal records drops to 910 in the 2010-11 school year. It jumps again to 4,145 teachers in 2011-12. For 2015-16, the number of special education teachers reported in the state is 5,086.

Patrice Guilfoyle, the director of communications for the Mississippi education department, said that the state's records show that it has had around 4,000 to 5,000 special education teachers over the past decade. She could not explain the federal numbers.

IDEA Full Funding

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act

A release from Senator Chris Van Hollen (D-MD):

Today U.S. Senator Chris Van Hollen (D-Md.) introduced the Keep Our Promise to America’s Children and Teachers (PACT) Act, which would put Congress on a fiscally-responsible path to fully fund Title I and the Individuals with Disabilities Education Act (IDEA) on a mandatory basis.

“When our children have access to a first-rate, quality education not only do they succeed, but our economy and our entire country succeed. Congress had the right intentions when it passed Title I and IDEA, but we have fallen short on the promises in the law to fully fund these critical programs. It’s time we kept our promises to kids today and to future generations. The Keep Our PACT Act will make sure we do just that,” said Senator Van Hollen.

Title I, which gives assistance to America’s highest-need schools, is a critical tool to ensure that every child, no matter the zip code, has access to a quality education. However, it has been deeply underfunded, shortchanging our most vulnerable students living in poverty. According to the Alliance to Reclaim Our Schools, the Title I formula was underfunded by $347 billion from 2005-2017. Maryland alone was shortchanged by $4.7 billion.

Similarly, IDEA calls on the federal government to fund 40 percent of the cost of special education, but Congress has never fully funded the law. Currently, IDEA state grants are funded at just 14.7 percent. In the state of Maryland, IDEA was underfunded by $316 million in 2017 alone and by nearly $3.5 billion between 2005 and 2017.
The Keep Our PACT Act would create a 10-year mandatory glide path to fully fund both Title I and IDEA, ensuring that education is a priority in the federal budget. It is supported by the National Education Association, the American Federation of Teachers, the Alliance to Reclaim Our Schools, and AASA, the School Superintendents Association.

The Number of Special Ed Teachers Has Fallen

 In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.

Christina A. Samuels and Alex Harwin report at Education Week:

The number of special education teachers nationally has dropped by more than 17 percent over the past decade, a worrisome trend in a career path that has seen chronic shortages for years.

An analysis of federal data by the Education Week Research Center shows that while the number of special education teachers was dropping, the number of students with disabilities ages 6 to 21 declined by only about 1 percent over the same time period. And as a whole, the number of teachers in all fields has gone up slightly over the past decade, as has overall enrollment.

For the 2015-16 school year, which offers the most up-to-date data, there was one special education teacher for every 17 students with disabilities. That's more special education students per special educator than the overall teacher-student ratio, which has held steady at about 1 to 16 for the past decade.