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Sunday, June 30, 2024

RFK Jr. Has Been Lying for a Long time

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrongA leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.

He is now running for president as an independent

In 2017, Seth Mnookin wrote at Scientific American:

For more than a decade, Kennedy has promoted anti-vaccine propaganda completely unconnected to reality. If Kennedy’s panel leads to even a small decline in vaccine rates across the country, it will result in the waste of untold amounts of money and, in all likelihood, the preventable deaths of infants too young to be vaccinated.

That wasted money will largely affect public health departments, whose budgets are already strained. A 2010 study in Pediatrics calculated the public sector expenses of containing a measles outbreak in which 11 children were infected at $124,517, an average of more than $10,000 per infection. That’s not to say that families won’t be affected as well: During that outbreak, 48 children too young to be vaccinated had to be quarantined at an average cost of $775 per family; medical costs for one infant who was infected were close to $15,000.

But those costs pale into comparison to the loss that will be felt by families who lose children to vaccine-preventable diseases, which typically strike when children are infected while still too young to be vaccinated.

Saturday, June 29, 2024

Disabilities and the End of Chevron Deference

Uncertainty and complexity are major themes of The Politics of Autism.


The Autistic Self Advocacy Network (ASAN) condemns the United States Supreme Court ruling on two combined cases, Loper Bright Enterprises v. Raimondo and Relentless v. Department of Commerce. The decision overturns a decades-old legal principle known as the Chevron Doctrine, which gives federal agencies the authority to reasonably interpret ambiguous laws when they create federal regulations. These regulations are made legally binding through a rulemaking process that is shaped by the public servants within federal agencies, the input of subject area experts across fields, and anyone who chooses to share their opinion. Instead, federal courts will now have the final say in circumstances where knowledge of highly specialized, complex, and technical issues is required. This ruling will weaken the regulatory authority of all federal agencies, including the Departments of Labor (DOL), Education (ED), Health and Human Services (HHS), the Social Security Administration (SSA), the Environmental Protection Agency (EPA), and the Food and Drug Administration (FDA).


This decision invites challenges to the forty years of legal precedents relying on Chevron. While these cases and the existing Code of Federal Regulations are not automatically overturned by Loper and Relentless, many will be challenged in the months and years to come. Future regulations are also under threat. Agencies may be less ambitious in fulfilling their mandates, protecting the public, and using taxpayers’ resources well in the face of increased risk that courts will undo their work. The endangered regulations include the Home and Community Based Services (HCBS) Settings Rule, the final rule implementing Section 504 of the Rehabilitation Act, the final rule implementing Title IX of the Education Amendments, and the final rule regarding section 1557 of the Affordable Care Act (ACA).

Friday, June 28, 2024

Implementing IDEA: California Does Poorly

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

 From the US Department of Education:

Following is a list of each State’s performance in meeting the requirements of IDEA Part B, which serves students with disabilities, ages 3 through 21: 

MEETS REQUIREMENTS Alabama Connecticut Florida Georgia Illinois Indiana Kansas Kentucky Maryland Massachusetts Minnesota Missouri Nebraska New Jersey Pennsylvania Republic of the Marshall Islands Texas Virginia Washington Wisconsin Wyoming 

NEEDS ASSISTANCE (one year) Arkansas Federated States of Micronesia Idaho Ohio Rhode Island South Dakota West Virginia 

NEEDS ASSISTANCE (two or more consecutive years) Alaska American Samoa Arizona California Colorado Commonwealth of the Northern Mariana Islands Delaware District Of Columbia Guam Hawaii Iowa Louisiana Maine Michigan Mississippi Montana Nevada New Hampshire New Mexico New York North Carolina North Dakota Oklahoma Oregon Puerto Rico Republic of Palau South Carolina Tennessee Utah Vermont Virgin Islands 

NEEDS INTERVENTION Bureau of Indian Education 

PART C DETERMINATIONS Following is a list of each State’s performance in meeting the requirements of IDEA Part C, which serves infants and toddlers birth through age 2: 

MEETS REQUIREMENTS Alabama Arizona Connecticut Georgia Iowa Kansas Kentucky Louisiana Maine Maryland Michigan New Hampshire New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 

NEEDS ASSISTANCE (one year) Arkansas Indiana Mississippi Nebraska New Jersey New Mexico Puerto Rico South Carolina 

NEEDS ASSISTANCE (two or more consecutive years) Alaska American Samoa Colorado Commonwealth of the Northern Mariana Islands Delaware District of Columbia Florida Guam Hawaii Idaho Illinois Massachusetts Minnesota Missouri Montana Nevada Virgin Islands 

NEEDS INTERVENTION California Rhode Island

Thursday, June 27, 2024

Special Education After COVID

  In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act. II also discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus proved to be the biggest disaster of all. 

Sara Randazzo  and  Matt Barnum at WSJ:

More American children than ever are qualifying for special education, but schools are struggling to find enough teachers to meet their needs.

A record 7.5 million students accessed special-education services in U.S. schools as of 2022-2023, including children with autism, speech impairments and attention-deficit hyperactivity disorder. That is 15.2% of the public-school student population, up from less than 13% a decade earlier, the most recent federal data shows.

Several factors are driving the increase. Pandemic disruptions left kids with lingering learning and behavioral challenges. Parents have become more assertive about asking for services, as the stigma around special education has lessened. Autism diagnoses have also risen in recent decades, and the state of Texas has seen a boom in special education after changing an approach that had limited access.


Since students returned to school, special-education teachers say they are seeing more mental-health issues and extreme behaviors, including students hitting staff, making lewd remarks and throwing furniture. Having the right support, like an aide to help a student calm down when they get stressed, can alleviate the behaviors.
“Traditionally there have been a lot of kids who were able to skate by and maintain at a level where they didn’t get flagged,” said Katy Chaffin, a special-education teacher in San Diego. “When you take years of school closure, for those kids, they’ve fallen so much farther behind.”


The 1970s-era federal law that created the special education system authorizes federal funding for up to 40% of the costs to provide the services, but the federal contribution has always fallen far short of that. Adjusted for inflation, regular federal funding for the law has fallen since 2010, according to figures compiled by the U.S. Department of Education.

A separate legal avenue for children with disabilities is a 504 plan, which guarantees school accommodations like extra time on tests. The share of students receiving a 504 has risen from 1% in school year 2009-2010 to 3.3% in 2020-2021, according to an analysis of federal data by Perry Zirkel, an education law researcher.

Wednesday, June 26, 2024

Early Intervention: More Is Not Necessarily Better

When a child is diagnosed with autism, health care professionals often recommend intensive interventions, which can amount to 20-40 hours per week, to support their development.

However, a new study led by Micheal Sandbank, Ph.D., assistant professor in the Department of Health Sciences at the UNC School of Medicine, and other researchers across the United States has found that more does not necessarily mean better.

Using data from 144 early childhood intervention studies, which involved 9,038 children between the ages of 0 and 8, researchers conducted a meta-analysis to determine whether higher intensity interventions provided increased benefits for young autistic children compared to less intensive interventions. They found that intervention outcomes did not improve as intervention intensity increased. Their results were published in JAMA Pediatrics.

"We concluded that there was not rigorous evidence supporting the notion that increasing the amount of intervention produces better intervention outcomes," said Sandbank, who was first author on the study. "Instead, we recommend that practitioners consider what amount of intervention would be developmentally appropriate for the child and supportive to the family."

The most commonly recommended approach for autistic children in the United States is called Early Intensive Behavioral Intervention, or EIBI. The current clinical guidelines regarding intensive intervention arose from a 1987 study, which found that autistic children who received 40 hours of behavioral intervention per week had more cognitive improvement than those who received only 10 hours per week. But many subsequent studies about behavioral intervention methods have provided mixed results and are lacking in quality. Of note, many studies have confused intervention amount with intervention approach, provided null results, or required retractions.

In November 2023, Sandbank found that many low-quality studies are dominating the field and that few studies have adequately examined whether interventions can have adverse effects or harms. Notably, interventions requiring young children to be away from home for long durations of time can deprive them of critical rest, socialization with family members, and more.

"In order to determine what amount of intervention is most effective, while also being minimally interruptive, we need more high-quality primary studies," said Sandbank. "Few high-quality studies systematically compare the same intervention offered at different amounts."

Many different types of intervention may be offered to young children on the autism spectrum. Behavioral interventions systematically teach functional and cognitive skills through direct one-on-one teaching and tend to be very intensive. Developmental interventions focus on improving children's engagement and social interaction through play with their caregivers and are frequently provided for only a few hours per week. Naturalistic developmental behavioral interventions blend behavioral and developmental approaches. All of these interventions can look very similar or very different in their implementation, depending on the provider.

In order to thoroughly investigate the impact of intervention amount, researchers measured it in three ways. They defined "intensity" as the amount of intervention provided within a given time frame (such as hours a day), "duration" as the total amount of time (in days) that intervention is provided, and "cumulative intensity" as an overall metric that describes the total intervention provided over the total duration.

Using these three metrics, researchers explored whether intensity, duration, or cumulative intensity were associated with developmental benefit in young autistic children. At the same time, researchers wanted to determine if the strength of the relationship between the metrics and developmental improvement differed depending on the type of intervention provided.

Their final sample for their meta-analysis included 144 separate studies involving a total of 9,038 participants. Knowing that neuroplasticity, or the brain's ability to adapt, is at its height during this developmental period and may affect the success of intervention, researchers controlled for participant age. They also accounted for the quality of included studies and intervention type with the help of meta-regression models.

Taking all of these factors into account, researchers found no evidence that higher intensity interventions provided increased benefits for young autistic children. The evidence contrasts the results of quasi-experimental studies and some meta-analyses suggesting that high-intensity behavioral interventions are associated with more cognitive gains in young children on the autism spectrum.

"There's probably a minimum amount of intervention needed to provide any benefit at all, and an optimal amount that is dependent on the child," said Sandbank. "Unfortunately, right now, we don't have clear evidence as to what that amount should be," said Sandbank.

This research suggests clinicians should avoid providing any specific amount of intervention as a default recommendation. Instead, clinicians should inform families that no single intervention amount is right for every child, and that a careful balance must be struck to meet the demands of intervention with other needs of the child to ensure that they thrive.

More information: Micheal Sandbank et al, Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children, JAMA Pediatrics (2024). DOI: 10.1001/jamapediatrics.2024.1832

Tuesday, June 25, 2024

IDEA Data 2022-23

From the National Center for Education Statistics:
Children 3 to 21 years old with an autism designation served under the Individuals with Disabilities Education Act (IDEA), Part B

..........................................................2012-13        2022-23

Number served in thousands................498..............980

Percent of children served................... 7.8..............13.0

Percent of total enrollment...................1.0................2.0

Monday, June 24, 2024

Identification Cards in Pennsylvania

 In The Politics of Autism, I discuss interactions between first responders and autistic peopleSome jurisdictions allow autistic drivers to ask for a blue envelope to disclose the driver's diagnosis in case of an accident or traffic stop Others have ID cards.

From Pennsylvania State Police:

The Pennsylvania State Police (PSP) today encouraged individuals with autism to take advantage of a free safety resource designed to enhance their interactions with law enforcement officers. The PSP has officially started to distribute an informational card that should be carried by people with autism and presented during any encounter with police.

“Behaviors associated with autism can cause barriers to effective communication. This card can be presented to reduce those barriers," said Colonel Christopher Paris, Commissioner of the Pennsylvania State Police. “When an officer is made aware a person has autism, they can respond accordingly, resulting in a safer interaction for everyone involved."

The informational cards alert law enforcement officers that the individual has autism and therefore may be nonverbal, bothered by loud noises, hyper-sensitive to touch, and unresponsive to commands or questions. The officers are directed to be patient, use a calm and direct voice, and keep their questions and commands simple.

Colonel Paris and Governor Shapiro met with advocatesOpens In A New Window to talk about how law enforcement can better serve individuals with autism. PSP's Office of Community Engagement developed the informational card, which is available on the Safety Resources page of PSP's website. Individuals may print the card from the website and carry it in a wallet, or they can choose to save it on their phone. Troopers will distribute the cards at public community events.

The PSP encourages individuals with autism to present the informational card during interactions with any police officer. The officer does not need to be a Pennsylvania state trooper.
The Shapiro Administration is working across agencies to provide resources to Pennsylvanians in the intellectual disabilities and autism (ID/A) community, strengthen mental health parity, and improve access to care in Pennsylvania. Governor Shapiro's 2024-25 budget proposal, which has received bipartisan support, includes a major investment in the ID/A community and would invest $483 million in federal and state funding to increase wages for home and community-based service providers. Governor Shapiro announced late last year that the Pennsylvania Department of Human Services (DHS) would re-examine rates earlier than required to better support home and community-based service providers and the direct support professionals who dedicate their careers to helping Pennsylvanians with ID/A. In addition, service providers also received a one-time supplemental payment in June to assist with workforce recruitment and retention. Earlier this year, Governor Shapiro directed DHS to immediately release additional program capacity to counties, which will allow an additional 1,650 Pennsylvanians to receive services this year. The 2024-25 proposed budget seeks to build on this by investing $78 million in federal and state funds to serve an additional 1,500 Pennsylvanians in the next fiscal year. Governor Shapiro and the Pennsylvania Insurance Department (PID) also announced last November that the Shapiro Administration will require all commercial insurers to meet their obligations under Pennsylvania law to provide coverage for autism benefits.

For more information on the Pennsylvania State Police, visit

Sunday, June 23, 2024

RFK Jr. Lies Again

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrongA leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.

Madison Czopek at PolitiFact:

After an appeals court ruled in favor of Los Angeles school employees who opposed COVID-19 vaccination mandates, independent presidential candidate Robert F. Kennedy Jr., celebrated on social media.

"The ranks of the conspiracy theorists now include the Ninth Circuit Court of Appeals, which just ruled Covid vax mandates unconstitutional because the vaccine does not stop transmission," Kennedy wrote in a June 12 Facebook post. "I dunno, maybe it’s the brain worm, but I seem to remember the experts and authorities telling us otherwise."

But Kennedy’s characterization distorts the court’s ruling. Kennedy has made misleading anti-vaccine claims a hallmark of his work and campaign. Kennedy’s campaign of conspiracy theories was PolitiFact's 2023 Lie of the Year.

The 9th Circuit Court of Appeals on June 7 ruled only that the lawsuit filed against the Los Angeles Unified School District could move forward. It overturned a lower court decision to dismiss the lawsuit, which was brought by the nonprofit Health Freedom Defense Fund, which advocates against vaccine mandates, and employees who opposed the district’s COVID-19 vaccination mandate.

Saturday, June 22, 2024

Olmstead at 25

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

At STAT, Timmy Broderick writes about the 25th anniversary of the Olmstead decision.
Prolonged, involuntary stays in institutions used to be the norm for people with disabilities, as books like “One Flew Over The Cuckoo’s Nest” have portrayed. But after two Georgia women with mental illness and developmental disabilities sued to leave a state hospital, the Supreme Court decreed in 1999 that siloing people with disabilities in hospitals was discriminatory and a violation of the Americans with Disabilities Act.

This landmark ruling, known as the Olmstead decision, augured a shift away from institutional care for long-term services and towards the most integrated setting possible — treating people with disabilities not as outcasts but as community members who can make choices and decide their own futures. The name refers to the main defendant, Tommy Olmstead, the commissioner of the Georgia Department of Human Resources at the time. Some experts refer to it as the Brown v. Board of Education for people with disabilities because of its dramatic expansion of civil rights in the face of forced segregation and a rejection of “separate but equal” institutions.


Twenty-five years after the Olmstead decision, home and community-based services (HCBS) is the norm rather than the exception for Medicaid recipients. National Medicaid spending on HCBS routinely exceeds spending on institutional services, and nearly 10 million people received some form of HCBS in 2019. Most states now have “Olmstead plans” that sketch out how to further grow community care, too.

But those gains are unevenly distributed, and disability advocates have had to sue several states to ensure their compliance.


Twenty-five years after the Olmstead decision, home and community-based services (HCBS) is the norm rather than the exception for Medicaid recipients. National Medicaid spending on HCBS routinely exceeds spending on institutional services, and nearly 10 million people received some form of HCBS in 2019. Most states now have “Olmstead plans” that sketch out how to further grow community care, too.

But those gains are unevenly distributed, and disability advocates have had to sue several states to ensure their compliance.

Immigration and the Direct Support Workforce

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families.  One is a shortage of caregivers and direct support professionals, which is likely to get worse.  

Tara Watson at Brookings:

It is estimated that more direct care workers will be needed in the next decade and beyond. The Bureau of Labor Statistics projects 3% employment growth in the average occupation 2023-2032, but 22% for home health and personal care aides, with about 700,000 openings projected annually. One 2017 estimate from MIT researcher Paul Osterman predicted a shortfall of 151,000 paid direct care workers by 2030 and 355,000 workers by 2040. Chronic shortages have been exacerbated by the pandemic. More than half of nursing homes surveyed in 2022 reported that they limited new patient admissions due to nursing shortages. Even if U.S.-born participation in this occupation can be stabilized, there will still be a severe need for direct care workers as the population ages.

Economic research supports the critical importance of immigrants in the care workforce. Immigrants are important to nursing home staffing and quality of care. They also reduce flows into nursing homes by facilitating aging in place of U.S.-born older adults through their employment as home health aides. (Immigrants are also disproportionately represented among doctors, and could continue to help address chronic shortages in nursing.)

Friday, June 21, 2024

Student Debt

In Defying the Odds, we talk about the social and economic divides that enabled Trump to enter the White House. In Divided We Stand, we discuss how these divides played out in 2020.  The Democratic Party is a coalition of minorities and college-educated whites.  They have problems with rural and white working-class voters.  The latter do not always favor student debt forgiveness.

Ayelet Sheffey at Business Insider:
Former President Donald Trump is making sure voters know how he feels about student-loan forgiveness.

During a Tuesday campaign rally in Wisconsin, Trump delivered a more than an hourlong speech on topics including immigration, national security, and the economy.

He also used that time to criticize President Joe Biden's efforts to enact student-loan forgiveness for millions of Americans.

"He's throwing money out the window," Trump said.

"This student-loan program, which is not even legal, I mean it's not even legal, and the students aren't buying it, by the way," he added. "His polls are down. I'm leading in young people by numbers that nobody's ever seen before."

A Harvard Youth Poll conducted in March found that among people 18 to 29, Biden was leading Trump at 45% compared with 37%. That was still a reduction from Biden's youth support in the poll in 2020.

Colin Binkley and Linley Sanders at AP:
As he campaigns for reelection, President Joe Biden frequently touts his work on student debt, pointing to the millions of people who received cancellation under his watch. Yet relatively few Americans say they’re fans of his work on the issue, even among those who have student loans.

Three in 10 U.S. adults say they approve of how Biden has handled the issue of student loan debt, while 4 in 10 disapprove, according to a new poll from the University of Chicago Harris School of Public Policy and The Associated Press-NORC Center for Public Affairs Research. The others are neutral or don’t know enough to say.

The outlook wasn’t much better for the Democratic president among those responsible for unpaid student loan debt, either for themselves or for a family member.

States Warn About Shrub Oak

Jennifer Smith Richards and Jodi S. Cohen at Pro Publica
Two more states are now scrutinizing a New York boarding school for autistic students and have warned school districts about troubling conditions there.

In Connecticut, education officials visited Shrub Oak International School and alerted districts that a state watchdog group determined there were ongoing “serious safety concerns” at the unregulated for-profit private school. Separately, the state’s Department of Developmental Services, which serves residents with intellectual disabilities and autism, has decided to stop sending more students there, an agency spokesperson told ProPublica. That agency described the facility as looking “more akin to a penal institution than an educational campus.

Washington education authorities, meanwhile, visited Shrub Oak this month and warned school districts to contact the state before considering enrolling students there. Officials are reviewing the state’s relationship with the school, officials told ProPublica.

The scrutiny of Shrub Oak comes as a ProPublica investigation published in May documented how parents and workers repeatedly asked New York authorities to investigate their concerns at the school to no avail.

Thursday, June 20, 2024

Trump and Vaccine Mandates

A polio ward

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread   Examples include measlesCOVID, flu, and polio.

number of posts discussed Trump's support for the discredited notion.

Steve Benen at MSNBC:

For those who keep an eye on the former president’s rhetoric, the line was familiar. After all, the Republican recently peddled the identical line in Michigan. And Florida. And Washington, D.C. And Texas, Minnesota, and New Jersey. And Pennsylvania, Ohio, Georgia, and Virginia.

And that's just recently. Trump has made the same declaration, word for word, for over a year.

Every time, his base applauds, offering timely reminders that Trump often takes his cues from his followers, as opposed to the other way around. Far-right voters oppose lifesaving vaccines, so the Republican candidate is only too pleased to tell them what they want to hear.

When Trump first started peddling this vow, there was some discussion about whether he was referring specifically to Covid vaccine mandates or all vaccine mandates, but the presumptive GOP nominee, at least publicly, has ignored the distinction. What’s more, in some instances, Trump has said his policy would apply to all public education, “from kindergarten through college.”

Or put another way, a second Trump administration — if the candidate’s promises are to be believed — would be prepared to cut federal support from every public school district in the United States, as well as most institutions of higher learning. (Remember, all 50 states require vaccinations for students.)

Wednesday, June 19, 2024

An Injunction in Connecticut

 In The Politics of Autism, I write:  "Support from the general public will be an important political asset for autistic people. Another will be their sheer numbers, since a larger population of identified autistic adults will mean more autistic voters and activists."  Previous posts have discussed autistic officeholders and political candidates in California,  New YorkGeorgiaTexas, and Wisconsin.

Chris Dehnel at Enfield Patch:

A Connecticut judge has ordered an injunction against the Enfield Board of Education as part of a lawsuit brought forth by a former board member who is both autistic and deaf.

Sarah Hernandez, regarded as one of the first openly autistic people to run for, and be elected to, public office in Connecticut, filed a lawsuit against the school board, the town of Enfield and then-board chairman Walter Kruzel in late 2019. The suit claims she was discriminated against in violation of the federal Americans With Disabilities Act.

On June 14, United States District Judge Stefan R. Underhill announced the injunction in Bridgeport.



The injunction was the next step in the lawsuit after a federal jury in U.S. District Court in Bridgeport sided with Hernandez in January, finding the board and the town discriminated against her in violation of Title II of the ADA and Section 504 of the Rehabilitation Act for failing to provide her with basic accommodations needed to equally participate as a member of the board.

Hernandez was elected to the school board in 2017, running for a seat because she wanted to "show up and be a voice for people with autism in the decision-making process," she said upon filing the suit.

She has difficulty hearing and understanding telephone conversations and in-person conversations unless she gets written materials, can see the speakers and can take notes. She asked the board to communicate with her between meetings in writing, such as by email and text, and to provide written materials and an erasable white board for note-taking, according to the lawsuit.

Although the board agreed to the accommodations, Kruzel and other board officials refused to follow through, repeatedly insisting on communicating by telephone between meetings and refusing to provide written information or a white board for executive sessions. Her requests were often met with open hostility and anger, according to the lawsuit.

Tuesday, June 18, 2024

Measles 2024

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea persists and can hurt people by allowing diseases to spread   Examples include measlesCOVID, flu, and polio.

Beth Mole at Ars Technica:
Since the start of 2024, the US has seen a steady march of measles infections nationwide. As of May 31, the CDC has recorded 146 cases across 21 states. Of those cases, 64 were part of a large outbreak in Chicago, which was declared over on May 30.

Among the national cases, 45 percent were in children under the age of 5. Fifty-five percent of all cases required hospitalization, including 65 percent of the cases in children under the age of 5. The highly infectious virus mostly struck the unvaccinated—85 percent were unvaccinated or had no documented status, while 12 percent had only received one of two recommended doses.

The 146 cases in the first five months of this year have easily surpassed the 58 cases in all of 2023 and the 121 cases in 2022. CDC experts have cautioned that the US is at risk of losing its measles elimination status, attained in 2000 after a decades-long fight against the airborne virus. The US will lose its status if the virus circulates continuously over a 12-month period. In 2019, the US was close to losing its status amid two prolonged outbreaks in New York, which helped the year's case count hit 1,274. Now, in the wake of the pandemic, measles is having a global resurgence, and vaccinations in the US have fallen below target rates that would protect against continued spread.

Monday, June 17, 2024

Residential Treatment Facilities

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

The Senate Finance Committee has issued a staff report titled Warehouses Of Neglect: How Taxpayers Are Funding Systemic Abuse In Youth Residential Treatment Facilities

 In July 2022, the Senate Committee on Finance (the Committee) and Senate Committee on Health, Education, Labor, and Pensions launched an investigation into allegations of abuse and neglect at Residential Treatment Facilities (RTFs) operated by four providers – Universal Health Services (UHS), Acadia Healthcare (Acadia), Devereux Advanced Behavioral Health (Devereux), and Vivant Behavioral Healthcare (Vivant). Since then, the Committee has engaged in a sweeping inquiry, reviewing over 25,000 pages of company productions, holding dozens of conversations with behavioral health stakeholders, and visiting RTFs on the ground.
Children should receive high-quality mental health services in the least-restrictive environment that meets their needs. Children are sent to RTFs by private and public actors, including parents and guardians, psychiatrists, child welfare agencies, the juvenile justice systems, and educational systems. The Committee has jurisdiction over many RTF placements funded through the Medicaid program and the Social Security Act’s child welfare provisions, through which RTF providers are paid per diems for the children in their care.
The RTF providers optimize per diems by filling large facilities to capacity and maximize profit by concurrently reducing the number and quality of staff in facilities. The Committee’s investigation found that children at RTFs suffer harms such as the risk of physical, sexual, and emotional abuse at the hands of staff and peers, improperly executed and overused restraint and seclusion, inadequate treatment and supervision, and non-homelike environments. These harms amount to acute safety concerns and have long-term effects, including suffering, trauma and even death. Taken together, the Committee finds that these harms are endemic to the RTF operating model.


 At its core, the RTF model typically optimizes profit over the wellbeing and safety of children. The rampant civil rights violations that children experience in RTFs are a direct consequence of the industry’s model. RTFs employ substandard labor practices and avoid investments in physical maintenance. So long as providers are allowed to proceed with business as usual, children will continue to suffer.

Last week, the committee held a hearing on the subject.