Our Point of View
July 6, 2008
Kaiser Permanente Comments on Los Angeles Times Article About Autism
At Kaiser Permanente, our top priority is to provide our patients with the most appropriate care to manage their medical needs. However, many conditions also require work with experts in areas other than medicine, such as education.
Such is the case with autism, featured in a Los Angeles Times article on July 6.
When examining a child, Kaiser Permanente pediatricians in Southern California, for example, look for a constellation of symptoms and behaviors that might lead to a diagnosis of autism along a wide spectrum. The course of medical treatment is based on the individual and unique needs of each child and may require referral to our own specialists or to professionals in the community. Kaiser Permanente Southern California has teams of autism experts that include developmental pediatricians, child psychiatrists, child neurologists, and speech therapists, that work together to provide and coordinate the care for the children and their families.
In California, the many services needed to support those diagnosed with autism are provided by a combination of government-sponsored Regional Centers, our public schools, health care providers, social service agencies, and other public and private programs. As a health care provider, our goal at Kaiser Permanente always has been to treat the medical needs of people diagnosed with autism.
There are more questions than answers for this very complex condition. As a result, parents often find themselves questioning what is being done for their children, and whether or not it is the best path for their situation.
As part of our leadership in the field of autism, researchers from Kaiser Permanente and the California Department of Public Health, as well as researchers from five other sites nationwide, are enrolling families in the largest ever study to date investigating the genetic and environmental factors that may cause autism and other developmental disabilities.
This five-year research study, called the Study to Explore Early Development, will involve 2,700 children and their parents from six areas around the nation, including Santa Clara and Alameda counties in the San Francisco Bay Area. Factors that will be studied include family medical history, genetics, socio-demographic, lifestyle and environmental factors. All of these illustrate the complex constellation of impacts and services required to treat this disease.
A California Legislative Blue Ribbon report on autism in September 2007 cautioned the need for further study to determine best practice guidelines for the medical evaluation and treatment of autism.
Kaiser Permanente thinks the best approach is for all providers of autism-related services (family members, educators, social services, and medical professionals) to work together to help children with autism. Purchasers of private health insurance cannot bear the full costs of addressing all the emotional, developmental and social needs of children with Autism Spectrum Disorder.
Much of the current debate surrounding autism centers upon Applied Behavioral Analysis or ABA therapy. Our view is that ABA therapy is primarily used to change behavior to achieve educational objectives, rather than to address clinical problems. It is not required to be provided by people with clinical training or a clinical license and is best provided in a home or school setting rather than a medical setting. This view has been upheld in a number of cases which have been reviewed by the California Department of Managed Health Care and the DMHC’s independent medical review process.
However, in this one case, which was featured in the Los Angeles Times, a DMHC independent medical reviewer provided a different answer. Despite the open questions about ABA, this reviewer's opinion and this family's questions have prompted us to look more closely at our overall system of care for autistic children. Clearly, this case illustrates the significant differences of opinion in the community regarding the medical and non-medical interventions to help children with Autism Spectrum Disorder.
- For example, a clinical report in November 2007 from the American Academy of Pediatrics listed ABA therapy under Educational Interventions along with speech and occupational therapy. They were not listed in the section on Medical Management. *Management of Children with Autism Spectrum Disorders, Pediatrics Vol. 120 No.5 November 2007.
We are reviewing our current practices to look for potential opportunities for improvement. In addition, we are interested in soliciting feedback from parents of autistic children as to how we might improve the coordination of services and care that children with autism receive. It's important to understand this will not happen overnight. It’s also important to remember that we all share a common goal – to gather the best minds and ideas together to work toward providing more help to the children who need it.
This will take efforts from lawmakers, parents, health plans, physicians, advocacy groups, educators and therapists—again, all working towards a common goal of providing greater hope for autistic children and their parents.