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Tuesday, November 12, 2013

Oregon and ABA

According to The Lund Report, an evidence subpanel of Oregon's Health Evidence Review Commission seems likely recommend ABA for younger children on the Oregon Health Plan, butcontinue denying treatment for children over 12.  The Commission and its panels rely on the evidence reviews of the Center for Evidence Based Policy at Oregon Health and Science University.
The commission has already rejected the autism treatment once, in 2008, but the new law compelled the health evidence board to reconsider the evidence and come to a new decision about providing treatment, beginning next fall.

“If you don’t have good evidence, it could suck up resources,” Dr. Alison Little, a physician at the policy center, told The Lund Report. “If this doesn’t work, we really need to be putting resources into what does.”
Another rejection would disproportionately affect racial minorities, particularly blacks and Latinos, whose representation on the Oregon Health Plan is roughly twice what it is in the statewide population.

Dr. Katharine Zuckerman, a pediatrician at OHSU, testified that denying treatment to older kids would further disproportionately affect children from these minority groups.

The average autistic child is diagnosed at 5, but the age is 7 for black and Latino children.
Dr. John Sattenspiel, who sits on the evidence subcommittee, pointed out that the new coordinated care organizations are being monitored on the percentage of behavioral health exams they conduct for children, eliminating much of the racial and class disparity in diagnosis and catching these kids at the crucial younger ages.

The mention of CCOs brought up an ironic twist — the organizations have been championed for their flexibility to use cost-effective, common-sense solutions like employing community health workers and buying air conditioners to improve overall health.

But without the ability to provide proper psychological treatment for autism, the CCOs as well as the Department of Human Services will be on the hook for millions of dollars more to provide for their needs of disabled kids and adults in more intensive settings, such as special education, group homes, and 24-hour nursing care.

“If you intervene early, you won’t have to pay as much later,” said Dr. Keith Cheng, the medical director at Trillium Family Services, Oregon’s largest provider of juvenile mental health treatment.