Get SMART-School and Medical Collaboration to Evaluate Children for Autism

1. Get SMART-School and Medical Collaboration to Evaluate Children for Autism An Introduction for the SW Washington Autism Conference Amy Carlsen, RN Jennifer Polley, MD Oct 27, 2018

2. Purpose of Workshop • Increase awareness and use of School Medical Autism Review Team (SMART) option among families and providers in Lewis County and surrounding communities • Support new communities starting a SMART process and those interested in joining existing SMART teams • Increase Medical-School-Family collaboration to better serve our shared children

3. Lewis County SMART – it all started here How and Why: • Lewis County Autism Coalition • Workgroup to address challenges families faced to get timely ASD diagnoses: • Long wait lists at Mary Bridge and Seattle Children’s, UW • Travel issues for families to go out of county – cost, time • Support and encouragement from MB, Seattle Children’s, UW, and the WA State Dept. of Health • Workgroup with help from Amy Carlsen, RN and UW graduate fellows created forms, processes

4. The Picture Statewide PendOreille Whatcom San Juan Okanogan Skagit Ferry Stevens Island Clallam Snohomish Chelan Spokane Jefferson Douglas Lincoln Kitsap King GraysHarbor Mason Grant S.Sound ASD Coalition Kittitas Adams Whitman Thurston Pierce Pacific Franklin Lewis Garfield Yakima Columbia Cowlitz fall 2018 Asotin Benton Skamania Wahkiakum Walla Walla Klickitat Community Asset Mapping (CAM) Child Health Coalitions Established SMART Team Exploring/developing SMART Team Clark 10/26/2017medicalhome.org

5. Who’s SMART? • Pediatrician • Special Education Director • School Psychologists • Speech Therapists • Birth to Three • ABA Therapist • Coordinator, can be a RN, Community Health Worker, or Family Resource Coordinator • Others at times: OT, other school/medical, parent representative

6. Why SMART Works • Local people with passion • Know many of the children and families • Variety of agencies with broad knowledge – child development, medical, educator, IEP/evaluations etc. • Coordinator keeps us organized and connects with families and agencies. • Open discussion – all input welcome and valued • BENEFITS wider than autism- • sharing info, knowledge, resources between schools, pediatricians and community services

8. Variation - Community Resources and Need Criteria for children seen • Age, specific to practice or insurance, ASD concerns or broader Coordinator • Role and funding Diagnosis/eligibility for what systems/services – depends on who diagnoses • For Developmental Disability Administration (DDA)? For Medicaid? For other insurance? For Special Education Services under the Autism category? Outcome from evaluation • Final Diagnosis or clear pathway to further evaluation

9. What is a Center of Excellence? • A Center of Excellence (COE) is any medical practice, psychology practice, or multidisciplinary assessment team that has received the COE training from the Health Care Authority or has been judged by the HCA to be qualified to write a prescript ion for ABA services. There are many different ways for children and youth to get a diagnosis of autism. In order for a child or youth to be eligible for ABA therapy through Apple Health/Medicaid, a recognized Center of Excellence (COE) must conduct a comprehensive evaluation, and write an order for Applied Behavior Analysis therapy, within the last two years.

10. What COE Training Qualifies a Pediatrician to do in Washington State • Pediatricians or other primary care providers including family medicine physicians and ARNPs who complete a 1 day COE training AND REQUEST to be listed by the HCA as a COE will be able prescribe ABA therapy for Medicaid eligible children.  COE status may help other insurance plans to authorize ABA services for their covered children but each insurance plan may have different diagnostic requirements.  COE status and training is focused entirely on making ASD diagnoses.

11. Centers of Excellence and the Health Care Authority More Information: https://www.hca.wa.gov/billers-providers/programs-and-services/autism-and-applied-behavior-analysis-aba-therapy Contact: Rebecca (Becky)Peters ABA Clinical Program Manager CQCT HCA ABA@hca.wa.gov Tel: 360-725-1194

12. How to Qualify for DDA services • DDA will accept an ASD diagnosis only from certain specialties including: • ARNPs associated with an autism or developmental center • Board certified Neurologist • Board certified Psychiatrist • Developmental Pediatrician • Licensed Clinical Psychologist Note other medical providers are not able to make ASD diagnoses for DDA eligibility • Evidence of substantial limitations of adaptive functioning requiring a qualifying score completed in the past 36 months of one of the tests below: • Vineland (VABS)- an adaptive behavior composite score of 69 or less • SIB-R- a broad independence standard score of 69 or less • ABAD-II-an adaptive behavior composite score of 69 or less • ICAP- a broad independence standard score of 69 or less

13. Future Opportunities • Providers who are interested in being part of the SMART process, but want more training can visit Seattle Children’s Hospital for more training • Talks are underway to bring an Autism ECHO project to Washington State to support COE trained providers to increase their knowledge and comfort with diagnosing and providing ongoing care of children with autism locally • There is a partnership with the WA State Health Care Authority to support a change in the WAAC code to make an autism diagnosis by a COE provider valid for DDA services • There is work being done with the HCA to increase Medicaid reimbursement for ABA therapy to attract more ABA providers

14. Further Information UW Medical Home Partnerships Project • Amy Carlsen carlsa@uw.edu • Kate Orville orville@uw.edu