Colorado Autism Services Finding Ways To Address Challenges

Colorado ranks high among U.S. states for the level of services available to children on the autism spectrum and while there are still many barriers to access, some of those barriers are beginning to be addressed through telemedicine, digital databases and dedicated providers.

In some ways, Colorado is an interesting case study on how to address unmet needs for families.

Pain Point #1: Programs Typically Require Families to Commit To ~20 Hour Minimum

Many ABA providers require a minimum of 20 hours per week for a child to receive services, says Lea Anne Paskvalich, Executive Director at the Autism Society of Colorado.

“For a family that’s [very difficult], there are just not enough hours in the day,” she says. “And for a child that goes to school full time, that’s an automatic excluder for an ABA company, leaving families with fewer options. I see that across providers in Colorado whether they’re large or small,” says Paskvalich.

But not all ABA providers follow this rule. An ABA provider in Colorado says their minimum is only 4 hours a week.

Breann Gonzalez, MA, BCBA, Clinical Director at Colorado ABA Therapy, says their 4 hour minimum requirement helps to control cancellations and helps with staffing. If therapy is cancelled then the RBT does not get paid, which can affect how they keep staff.

“At the end of the day it is better to find a balance of what the parent can handle and still be effective because the goal is to keep the kid in services to make progress,” says Gonzalez.

Pain Point #2: Staffing Shortages

Like many areas in healthcare facing shortages right now, ABA providers are also experiencing shortages, particularly for RBT’s. The process is BCBA’s will write the behavioral treatment plan, share the plan with the family and then the RBT takes over. RBT’s are the direct provider of the services and often are underpaid, which can lead to burnout with the level of demand.

“There’s a high turn around in RBT’s and it’s hard on families,” Paskvalich says. “I spoke with a family that had 3 different RBT’s in 6 months. Change is hard for a person on the spectrum. [The RBTs] need to be paid more and it’s a hard job.”

Solution

None reported as this remains a significant problem for families and providers.

Pain Point #3: Billing-EVB Process Change

Medicaid implemented a requirement for service providers to “clock in and clock out,” taking the service providers GPS location and timestamp to reduce Medicaid billing fraud. Gonzalez says they are having challenges adjusting to it.

“It has been a process to transition billing systems into this process because they’re denying claims if you don’t have all this information about your appointment,” says Gonzalez.

Pain Point #4: Supply and Demand

In Colorado, there are still significant wait lists for ABA since due to the COVID pandemic like in many parts of the U.S. The early evening time slot when children get out of school is the most desirable time slot.

“But a majority of places, even for us, – mornings and mid-day are more available than after school as far as openings. The late afternoon time slot can be a hefty wait list,” says Gonzalez.

Solution

One way the demands are being met is to make connections with other families, and Wayfinder was designed to do just that, says creator Anthony Verducci.

Wayfinder is a digital health startup connecting people with intellectual and developmental disabilities to health and social services. Thousands of Coloradans use Wayfinder's care directory to discover in-network providers across 58 specialties in healthcare, education, employment, adaptive recreation, and more.

The online platform and app is for both autism service providers and consumers. It is constantly being updated and Colorado providers say it cuts down the time to find care for the patient from hours to minutes. Verducci’s ultimate goal is to expand the system to other states.

“I’ve spoken with many large providers in Colorado that have many clinics in other states and they have expressed interest in using it in their other locations,” says Verducci.

Paskvalich says that it’s a “gamechanger” and is very provider-driven, which will help thousands of families in Colorado.

Pain Point #5: Relocation To Rural or Urban Area?

Some families decide to relocate to Colorado due to their excellent autism ABA providers and resources compared to other states. Most typically migrate from Colorado Springs to Fort Collins, the eastern part of the mountains where services for children are well resourced compared to other rural areas.

“We have parents who call saying they live in Florida who want to move to the mountains, and I explain that they need to live where the services are – not Colorado as a whole but you need to choose very carefully. You need the resources to support your child or yourself as an adult,” Paskvalich says.

Solution-Telemedicine

Telemedicine opens doors to improve access but it’s effectiveness depends largely on what the child’s individual needs and goals are. Telemedicine is great for one-on-one social skill development or other visual aids but it isn’t effective for teaching everything.

“Learning how to shop for food in the grocery store or similar tasks doesn’t always work well for telehealth,’ says Paskvalich.

Pain Point #6: ABA in Schools - House Bill 22-60

This bill is about medical necessity. It would allow schools to be coded as an appropriate setting for ABA to be conducted, which advocates say would be better for the providers and children receiving those services.

“Currently there are schools billing Medicaid through occupational therapy and speech therapy – they can bill Medicaid but if some provider comes in they can’t bill Medicaid currently,” says Paskvalich.

The bill is “irrelevant” if the insurance company does not allow in-service codes for medically necessary locations for billing, says Gonzalez. Some schools have BCBA’s but those are very few and far between.

“Providers could service more kids this way - the bill is a huge win because schools are a large barrier to them,” says Paskvalich.

Pain Point #7: Adults with Autism

More people are being diagnosed with autism now than ever before and some say it’s largely due to social factors rather than biological ones. We now have better testing, knowledge of autism and services available to the public. CDC researchers reported in their MMWR that autism rates in the United States increased from 1 in 150 children in 2000, to 1 in 54 in 2016, and the rate now stands at 1 in 44 children and growing.

With these increases in diagnoses, adults are now realizing what they mistook for anxiety or ADHD their entire lives is actually undiagnosed autism. This is especially true for women. Typically, autism presents differently in women than it does for men and this is often one of the reasons it can go undiagnosed.

“You have adults that are living ¾ of their life not knowing they’re autistic,” says Paskvalich. “Anxiety is one of the most prevalent co-conditions to autism and people who are undiagnosed or misdiagnosed can end up dealing with anxiety and depression. That diagnosis can be a game charger for some people.”

Gonzalez just hopes barriers diminish. “I wish there were easier ways to reduce those barriers to get helpful services because at the end of the day providers are doing the best they can to get the services needed.”