Community

Mental

Health Act

Education of All

Handicapped

Children Act

Medicaid

Medicaid

Waivers start

EAHC extended to

Infants and toddlers

Individuals with

Disabilities Education

Act includes autism

Mental Health

Parity Act Olmstead Act

First autism

insurance

mandate (IN)

First autism Medicaid

waiver (MD)

Medicaid

covers

autism

treatment

1960 65 70 75 80 85 90 95 00 05 10 15

Affordable

Care Act Fair Housing Act

extended to people

With disabilities

Americans with

Disabilities Act

10.4%

17.1% 18.0%

$0

$50

$100

$150

$200

$250

$300

$350

Non MandateStates

1 Yr PostMandate

2 Yrs PostMandate

3+ Yrs PostMandate

Eligible Children Ineligible Children

Month

ly S

pendin

g

Wang et al. (2013)

1.2

Respite care

-8%

1% 3%

Therapeutic

care Other services

Effect sizes of .8 – 1.1

Weitlauf et al. Comparative

Effectiveness Review No. 137. AHRQ.

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

ESDM Community ESDM Community

ESDM EIBI OT/PT social skills special education speech therapy other

.26 .15

1 1 -1 -1 0 0

Effects of Community Treatment

.23 .21 1 1 -1 -1 0 0

Subject

Clinician

System

Restrictive inclusion and exclusion criteria

Whoever shows up

Highly trained and supervised in tx

Variable training, supervision, motivation and caseload

Grant funding insures tx delivery at desired intensity and duration

tx subject to programmatic and funding priorities

Traditional RCT Community Practice

Efficacy Effectiveness

Subject

Clinician

System

Restrictive inclusion and exclusion criteria

Whoever shows up

Highly trained and supervised in tx

Variable training, supervision, motivation and caseload

Grant funding insures tx delivery at desired intensity and duration

tx subject to programmatic and funding priorities

Traditional RCT Community Practice

Efficacy Effectiveness

An array of interventions and instructional strategies are utilized to support

teachers and staff who teach children with autism. Some of these include:

• ABA ( Applied Behavioral Analysis): task analysis, discrete trial

• VBA (Verbal Behavior Analysis)

• TEACCH

• Visual Supports (communication/instruction/schedules)

• Positive Behavior Supports (i.e. Jed Baker books, Tony Attwood)

• The Incredible 5-Point Scale

• Integrated technology for social stories/instruction (i.e. Smart Board)

• RDI (Relationship Development Intervention)

• Assistive Technology (i.e. communication boards, electronic communication)

• Floor time

• Pivotal Response

• Research-based reading and mathematics interventions

These strategies are used across all settings, ages and grades based on the

individual needs of students.

-10

-8

-6

-4

-2

0

2

4

6

8

10

0 1 2 3 4 5

Ch

an

ge in

IQ

How well teachers implemented the program (fidelity)

Adapted from Azjen (1986, 1991) and Williams and Glisson (2013)

Intentions

Self-Efficacy

Norms

Attitudes

Skill

Belie

fs

Behavior

Knowledge

School

District

State

Federal Policy/

Organizational

Environment

Intentions

Self-Efficacy

Norms

Attitudes

Skill

Belie

fs

Behavior

Knowledge

School

District

State

Federal Organizational

characteristics

What

Behavior?

Positive reinforcement

Data collection

One-to-one(?) intervention each day

Visual schedules

Pedagogy

Resources

Staffing Attitudes

Policy Outcome

Policy Practice Outcome