Last month, we wrote a post in support of Dr. Bob Sears, a California pediatrician who was dropped by TRICARE. He saw more than 500 insurance military families in his practice, many of whom had a child on the spectrum. TRICARE is in the news again.
When you are a parent of a young child with an ASD diagnosis, you learn quickly that your pediatrician is likely, at best, a referral source for Early Intervention, school based services and specialists. My girls saw a terrific Physician Assistant whose own father was a pediatrician. She cares. She really wanted to help my girls. She admitted she had nothing in her toolbox - nothing. She helped me with everything I had researched and asked for - but relied on me, the parent, to guide her. Imagine if that were the case with cancer or broken bones? It's as ridiculous today as it was 22 years ago when I started this autism journey.
A recent article in The News Tribune (below) reports that Tricare is re-evaluating ABA therapy, once the "gold standard" of autism treatment, in demand and hard to come by, despite recommendations for up to 30 hours a week for young children by well known institutions like Ladders in Massachusetts. ABA is expensive. Wicked expensive as we say in Boston. $261,000,000 annually for Tricare expensive. You bet your Boston Baked Beans they are going to evaluate it. All insurance companies who have started paying for services for autism are waking up to the monumental expense. As are schools. But this review is not new.
In 2013, Sarah Stockwell wrote a post for us about Tricare's changes to ABA for military families.
Military families with a child with autism are used to fighting. The service members fight on the battlefield when deployed and the spouses, with constant military moves in and out of states and school districts fight for their childrens’ right to an appropriate education as well as the daily battle to raise a child in a world they are ill-equipped for and vice versa. One fight that military families with children with autism should not have to face however is the battle to ensure their children receive appropriate medical care. There are estimated to be over 20,000 military children with autism.
One such fight is gearing up in the military community right now. Tricare, the military healthcare provider has made drastic changes to the way it provides ABA therapy for military dependents with autism spectrum disorders and these changes are due to take effect on the 25th of July.
Military families have been campaigning for years to improve access to autism therapies for their children and until now, have been making progress. There was a semi-victory in this respect for coverage for retiree families and wounded warriors, when a ‘pilot program’ was included in the recent NDAA. Shortly after Tricare announced (later than was originally required) the details of this pilot program in June, advocates in the community noticed that Tricare had made unannounced, extensive changes to the eligibility criteria and method of access for ABA under Tricare, which would apply to the children of both active duty troops, retirees and wounded warriors.
Beyond the expense, let's talk about my personal experience long term efficacy. As a Mom to three adult daughters on the spectrum, I can tell you that discrete trial, prompt based training for a decade or more creates an adult who may have a hard time fitting into the adult services world. Now, for those children for whom ABA helps guide them to the highest end of the spectrum, or even OFF the spectrum, that's great. But for many families, the systems ingrained into our kids are not in place in the adult services world. My DDS behaviorist is a PhD and mother of 4 children on the spectrum herself. She has talked to my school district many times about fading prompts, stopping the "click" mentality by the high school years. To no avail. My girls' day program is one of the only programs in my area that has a behaviorist team. Most do not. They don't know from ABA. They are used to serving adults with Down Syndrome and other ID diagnoses. The autism epidemic is only just recently aging out into adult services.
Here's the article below. Share your thoughts on how ABA has worked for your child in the comments.
Nearly 15,000 military children with autism receive Applied Behavorial Analysis (ABA) services, usually 20 or more hours of therapy a week, to learn desired behaviors and douse undesirable behaviors under a demonstration program offered through TRICARE, the military’s health insurance benefit.
Though TRICARE launched the program in 2014, and has seen spending rise to $261 million annually, it’s still labeled a “demonstration” because the effectiveness of applied behavioral techniques for autism remains unproven, said Navy Capt. Edward Simmer, chief clinical officer of the TRICARE Health Plan.
“As of right now,” Simmer said, “Applied Behavioral Analysis does not meet TRICARE requirements for evidence-based coverage as part of the basic benefit. It still does not meet what we call the ‘hierarchy-of-evidence’ standard.” Read more here: