Despite increased public awareness, research advances, and wider insurance coverage for autism therapies, children often wait months — in some cases more than a year — to get an autism diagnosis and begin intervention services.
www.cnn.com
Yep- I'm currently booking assessments in Feb. 2023. I struggle to see why there is such a lack of psychologists who do this. As a sustainable business, purely doing ASD evals only became viable less than a decade ago, so there's that. I recognize my biases, butbi find it to be a really fun job which includes blowing bubbles, flipping rubber duckies in the air, and playing with play doh as a regular part of the empirically validated assessment. Pay and benefits are very good. No administrative responsibilities! The clients are universally adorable, and their families are very appreciative. I get to regularly work with a multidisciplinary team of EI providers who have done the hard work of preparing the families for what to expect. Yeah- there's still reports to write and that's always a bit tedious, but they're not overly complicated. I suppose it's a bit repetitive, but I like the lack of surprises and potential for chaos. You do occasionally make a parent cry, but you learn to address this kindly and supportively ( and it happens way less than you'd think). The clients do regularly poop in their pants and stink up your office, but the effects of this have been greatly reduced by our ongoing mask mandate. I can see where it may not be what comes to mind when people think "psychologist," so maybe people with an interest in working with toddlers are more likely to go a different direction. There's some gender stuff too, as there are very few cis males who do this.
I'm curious as to what you all see as reasons for this lack of access to ASD diagnosticians.
reasons for lack of access that I see in our clinic (have not read article or many of the previous comments but we have been doing some digging in our area to consider this and the increase in disparity/inequity related to various factors):
1) most significantly, the severe absence of diagnosticians that take Medicaid. FFS, why is it so damn hard to get approved with Medicaid for someone in private practice (legit question- I'm not in PP. Would love insight. is it a combo of red tape plus some combo of insurance / reimbursement / ethics rules? Would it be within scope of ethics to say I can take x# Medicaid pts a month but the rest need to be otherwise ensured or private pay?) Anyway related to this- there is a good several-county area in our state that is mostly rural where there is only ONE facility that takes Medicaid and does a full ASD eval (as opposed to diagnosis by pediatrician etc where they do not administer cog/devo testing + ADOS/CARS/observational measure and thus local MCOs / insurances won't accept)
2) families often come to us after they get a school IEP categorization. The schools were basically deferring / not doing evals during most of COVID leading to delay downstream (on an adjacent note- I really wish schools would make it clear to families that a school IEP categorization does NOT fly for insurance and they need a medical diagnosis to get on the waitlist for transition age / adult services well before high school).
3a) overall delay during COVID in ppl getting routine care etc., or delaying / discontinuing speech etc which is where many of our referrals come from;
3b) and related lack of contact with people who would have maybe sat down with them to help problem solve things like transportation (many ppl with MEdicad are not aware of how to access Medicaid transport for such things) and childcare for that time
4) people lost jobs and therefore insurance
5) some clinics that were doing in person evals were not allowing a gaggle of siblings / extra people to accompany, and with kids out of school, lack of childcare was a barrier for many families
6) many clinicians working at reduced capacity for various reasons (cycling through peopel being out with COVID / family illness / childcare / being deployed within the hospital system to help with COVID / triaging and assisting with other emergent or crisis situations) thus slowing down rate of working through waitlist
7) increase in deferred diagnoses / provisional or rule outs because harder to get info from school, lack of socialization and exposure to life outside the home in general leading to crazy anxiety (or just..... not great things in general if home life / parenting fit not great) but Medicaid won't provide ASD specific services in our area in most cases for provisional dx after age 3
8) families going out of state to live with other family members for various reasons during covid while schools were closed / jobs lost etc, or movign and not updating their address with the clinics where they are on the waitlist - we got a lot of returned letters
9) decreased outreach especially to communities where english is second language; office staff working from home more but not allowed to use personal phone to make return calls and thus were using *69 which shows up as unlisted number and many people just straight up ignore, block/screen out such calls and don't have voice mail set up or VM is full
10) schools contracting with ****ty eval-mill type folks in our area that give a CBCL to parents and diagnose anything that is elevated with no explanation, feedback, utility to the process or the report which due to paucity of information is insufficient for insurance coverage of therapy adn the diagnoses are wrong 60% or more of the time (specific to 2 folks in our area that after noticing the pattern, actions have been taken)
11) initially in COVID a really huge delay in systems getting up to speed in getting telelehtalth systems in place, training on it, making sure woudl be covered by the various insurances for doing telehealth for interviews and (where suitable) telehealth evals (and getting trained on those protocols etc)
