EBD Blog

In the Virginia (US) legislature (which I sometimes call the “House of Burgess” for fun), efforts to mandate coverage of intensive behavioral therapy (AKA “ABA,” “discrete-trial training,” etc.) by insurance policies gained a little momentum 16 February when Senate Bill 464 passed by a nearly 2-to-1, bi-partisan margin. Earlier this legislative session, one similar bill (HB 303) was rejected by a narrow vote (4-to-4) in the committee on Commerce and Labor of the Virginia House but another (HB 34) may still be alive (I’m too uniformed about legislative processes to know).

The summary of the just-passed Senate bill, whose chief patron is Senator Janet D. Howell of Reston (VA, US), is as follows:

Requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage for the diagnosis of autism spectrum disorder (ASD) and for treatment of ASD in individuals from age two to six, subject to an annual maximum benefit of $35,000. This requirement does not apply to individual or small group policies, contracts, or plans, and will not apply to the state employees’ health insurance plan until July 1, 2015. This measure will not apply to an insurer, corporation, or health maintenance organization if the costs associated with coverage exceed one percent of premiums charged over the experience period.

Virginians who are concerned about helping young children with Autism to succeed should contant their representatives to urge passage of this legislation. It is not a perfect solution (for example, the coverage is limited to young children only), but this is a situation in which the perfect should not be the enemy of the good.

Senator Howell’s bill has co-patrons, including R. Creigh Deeds, Mark R. Herring, David W. Marsden, J. Chapman Petersen, Richard H. Stuart, Patricia S. Ticer, Jill Holtzman Vogel, and Mary Margaret Whipple. Way to go to them and to every Virginia Senator who voted for the bill: Blevins, Colgan, Deeds, Edwards, Herring, Houck, Howell, Locke, Lucas, Marsden, Marsh, McEachin, Miller (Y.B.), Norment, Northam, Petersen, Puckett, Puller, Quayle, Reynolds, Saslaw, Stosch, Stuart, Ticer, Vogel, Wampler, and Whipple. Thanks.

• HB 34 Health insurance; mandated coverage for autism spectrum disorder.
• SB 464 Health insurance; mandated coverage for autism spectrum disorder.
• HB 303 Health insurance; mandated coverage for autism spectrum

The state legislature voted nearly 2:1 to reject similar legislation in 2009 (HB 1588 Autism spectrum disorder; mandated health insurance coverage).

As the US House of Representatives prepares to make statements about and amend HR 4247, Representative Joe Courtney (CN, US) posted a statement on the blog maintained by the House committee that will debate the legislation. The post, “Rep. Joe Courtney: Congress Must Make Schools Safe Havens for Children,” touts Representative Courtney’s perspective on the legislation. There’s lots more about the proposed legislation via that blog and related resources. Take a look.

Also, read the actual proposed legislation, “Preventing Harmful Restraint and Seclusion in Schools Act” and the position statements by the Council for Children with Behavior Disorders about seclusion and restraint and “Position Summary on Restraint and Seclusion.”

The US Congress is considering legislation to prevent abusive restraint and seclusion of students in schools. This is a welcome consequence of the highly visible reports about terrible abuses of students’ right to be free from harm. However, as much as I support this initiative, it is important to make clear that the laws (and regulations resulting from them) must be crafted carefully.

Here’s some text from the press efforts by the US House of Representatives about this important legislation. I follow it with a cautious support of the law.
Continue reading ‘US legislators consider law for preventing abusive restraint and seclusion’

Lord Jones of Cheltenham, a member of the the UK Parliament, has formally asked “what measures are planned to improve services for (a) children with serious emotional disturbance, and (b) adults with mental health illnesses.” The request is in response to recent UK report, Keeping Children and Young People in Mind – Full Government Response to the CAMHS Review that, in turn (and as the title shows), was a response to the government-sponsored review of child and adolescent mental health services (CAMHS).

Keeping Children and Young People in Mind calls for a system of universal services, targeted services, and specialist services accompanied by support for them from local and national government agencies. Get a copy of Keeping children and young people in mind: the Government’s full response to the independent review of CAMHS and visit the Web site of the UK Department of Children, Schools, and Families for more about “services supporting the emotional wellbeing and mental health of children and young people.”

See the Parliamentary records for a written version of the request by Lord Jones.

Right here in my home commonwealth of Virginia last week, Mira Signe, Vicki Hardy-Murrell, John Morgan, and Margaret Nimmo Crowe explained why it is important that government and private organizations attend to and address issues in children’s mental health. By explaining that Virginia has inadequate services and that one in every five children or youths experience mental health problems at some time during their lives, they made the point that that there is a tremendous need for public focus on these issues. This was the kick-off event for the Campaign for Children’s Mental Health.

The Campaign for Children’s Mental Health is a 3-year sustained effort to make mental health services more available and accessible to Virginia children in need. It will strongly endorse Governor-elect McDonnell’s call for system improvements; urge the General Assembly and state and local government to work collaboratively with the administration to address system deficiencies; and conduct a high-profile three-year advocacy and education drive to build public and political support for improved mental health services for children.

Only about one in 20 of Virginia’s children have access to the key services listed in the accompanying box. So, four out of five children who need these services do not have access to them.

No, Virginia, this is not an acceptable way to treat our children. Let’s do better.

• Down load the press release (source of the excerpt quoted here).
• Read coverage in these newspapers:
  • Lynchburg News and Advance—Coalition pushes mental-health care for children
  • Washington Examiner&mdash:Advocates start bid to expand children’s mental health services under bleak budget;
  • Richmond Times Dispatch— Coalition advocate mental-health care for children
  • Washington Post (blog)—New coalition has AG’s support for mental health reforms
• Visit (and support) the Web site of the Campaign for Children’s Mental Health.
• Download pdfs of “Survey of Community Services Board Child and Adolescent Services” and “Review of Community Services Board Child and Adolescent Services“; these are report by James W. Stewart, Inspector General for Virginia’s Mental Health, Mental Retardation & Substance Abuse Services (now called Behavioral Health and Development Services). The list of key services comes from these reports;
• Visit the < href="http://www.facebook.com/pages/The-Campaign-for-Childrens-Mental-Health/183467424796?v=wall" target="_blank">Facebook page;
• Listen to a brief (3+ min) interview with Ms. Crowe from WMRA: Pushing for Children’s Mental Health Reform.

In the November 2009 issue of Pediatrics, Tanya Froehlich and colleagues reported that maternal smoking during pregnancy and children’s exposure to lead were associated with diagnoses of attention-deficit hyperactivity disorder (ADHD). Each factor alone was linked to ADHD, and the two in combination had an even greater association ADHD.

OBJECTIVE: The study objective was to determine the independent and joint associations of prenatal tobacco and childhood lead exposures with attention-deficit/hyperactivity disorder (ADHD), as defined by current diagnostic criteria, in a national sample of US children.
Continue reading ‘ADHD and smoking and lead’

While we’re on the subject of ineffective interventions, I want to revisit facilitated communication (FC). The US commonwealth of Massacheusetts apparently is considering a bill that will require teachers to learn to use FC. In “An Act To Improve Augmentative And Alternative Communication Opportunities For Children With Disabilities,” the legislative houses of Massachusetts are proposing to revise regulations for licensing educators to ensure that special and general education teachers have received training in using augmentative and alternative communication procedures, including FC.

The legislation, introduced into the senate by Senator Cynthia Stone Creem of the First Middlesex and Norfolk district and into the house by Representative Garrett J. Bradley of Plymouth, provides this definition of alternative and augmentative communication:

The term “alternative and augmentative communication” shall be defined as methods of 26 communication other than oral speech that enhance or replace conventional forms of expressive 27 and receptive communication to facilitate interaction by and with persons with disabilities who 28 are nonverbal or have limited speech, including, but not limited to: specialized gestures and 29 signs; communication aids such as charts, symbol systems and language boards; mouth sticks; 30 facilitated communication; and electronic communication devices such as switches, head 31 pointers, eye tracking, dynamic displays, auditory scanning and speech synthesizers.

Although the bill was introduced in January 2009 (and apparently has been introduced in previous sessions), I can find no record of whether it has been passed. It was referred to a joint committee on education and there was a “Public Hearing date 10/20,” the legislative record shows nothing more as of the date I’m writing this. When originally introduced, it was Senate Bill 00223, but it may now be listed as Senate Bill S02692. Anyone know the status?

Flash of the electrons to Gina Green for her post APBA Sponsor, Affiliate Oppose MA Legislation Promoting Bogus Technique alerting me to this questionable legislative activity. She pointed me to an article about a hearing on the legislation; fortunately, some folks objected to including FC in the law.

An individual who goes by the screen name C0nc0rdance posted a pair of videos to YouTube on 1 October 2009 that make a clear and compelling case for ignoring ill-reasoned arguments recommending that parents avoid vaccinating their children.

When we make risky decisions about our health, it’s always good to be in possession of all the facts, to let our brains, and not our hearts, make the decision. Your child is thousands of times more likely to die from a preventable disease you didn’t vaccinate them against than to develop autism from a vaccine you did give them. The case for autism and vaccines is solely based on weak correlations and emotional responses.

Continue reading ‘C0nc0rdance’s anti-vax takedown’

Arne Duncan, US Secretary of Education, wrote to the chief officers of education for each of the states in the US on 31 July 2009 regarding the use of seclusion and restraint in schools. He expressed concern about the testimony heard recently by the Education and Labor Committee of the US House of Representatives, and recommended that states adopt Positive Behavioral Interventions and Support.

My home State of Illinois has what I believe to be one good approach, including both a strong focus upon Positive Behavior Intervention and Supports (PBIS) as well as State regulations that limit the use of seclusion and restraint under most circumstances….

Several other States have also adopted effective seclusion and/or restraint policies, but there are many jurisdictions that have not, leaving students and teachers vulnerable.
Continue reading ‘A. Duncan promotes PBIS’

The parents of Daniel Watt, a youth who had multiple problems, told the story of their son’s life and suicide. Tom Jackman of the Washington Post reported the story of Danny and his parents, helping explain some of the problems of addressing the needs of children with multiple diagnoses—co-morbid schizoaffective disorder and substance abuse, in Danny’s case.

Danny Watt once leapt from a moving train. He hurtled through the windshield of a rolling car. Got pummeled by drug dealers. Overdosed. Swallowed rat poison. Tried to hang himself.

In his tumultuous 21 years, Danny Watt danced with death in the most amazing, horrible ways. In the end, two college students spotted him facedown in the cold, murky water of the C&O Canal one afternoon in April 2008. The medical examiner said Danny had drowned.

Continue reading ‘Danny Watt’s story’

Parade Magazine, the insert into millions of Sunday newspapers in the US, carried a brief piece about seclusion and restraint in the versions to be delivered 26 July 2009 (available on line 25 Jul 2009). The piece doesn’t present anything new, but we can hope that it helps to sustain concern about providing appropriate treatment for individuals with disabilities.

Link to the story. Flash of the electrons to Mike Kruger of the US House of Representatives Committee on Education and Labor News of the Day: Should Schools Use Restraints on Students?. On the House Ed & Labor blog one can also see a video of Chair George Miller talking about seclusion and restraint.

For previous coverage of seclusion and restraint on EBD Blog, please use the items with that label in the “tags” section of the side rail.

On behalf of the families of two children with Autism, a consumer advocacy groups claims that regulators in California (US) are allowing insurers to deny access to needed therapy. Consumer Watchdog seeks to require the Department of Managed Health Care to mandate that insurers pay for treatment based on applied behavior analysis for children with Autism.

KABC LA coverage

On the heels of the recent agreement in Michigan (US), I have to wonder whether advocates for children with Autism are seeing the beginning of a wave of changes in insurance support for early and intensive behavioral treatment of Autism.

Consumer Watchdog, which was previously known as “Foundation for Taxpayer and Consumer Rights,” has a pretty broad agenda. In addition to insurance issues, it addresses patients’ rights, political corruption, corporate excesses, and other topics. Consumer Watchdog’s site has links to multiple items regarding Autism.

Also see coverage by Lisa Girion of the Los Angeles Times: “Autism patients’ treatment is denied illegally, group says“; Ms. Girion covered this topic previously (see 10 Mar 2009). For other earlier posts on EBD Blog about insurance coverage for children with Autism, see 25 Jun 2009 and 20 Sep 2008.