The California Legislative Blue Ribbon Commission on Autism has released an extensive report on Autism Spectrum Disorders in California. The draft report is available at http://senweb03.senate.ca.gov/autism/index.HTML, under “What’s New.”

Following are key findings of the draft report from the executive summary.

Barriers and challenges
The commission identified specific issues that currently impose serious barriers and challenges to the health and optimization of potential, and to the well-being of individuals with ASD and the supports needed by their families. The findings and gaps are presented and described in detail within each of the subsequent chapters of the report. Each chapter also contains pertinent background information and proposed goals and objectives for state policy.

Many of the issues are evident for individuals with ASD and their families across the life span and involve multiple systems of care. Thus, the commission’s findings of major “overarching” gaps are summarized as follows:

• There are a significant number of children with ASD who are not screened, assessed or referred to receive early intervention services in an appropriate and timely manner. These delays are longer and occur with more frequency in underserved communities.
• In many communities, public awareness, education and outreach efforts on ASD programs and services must be intensified and expanded.
• Many existing systems of care are very complex, and a significant number of families confront major barriers in accessing and navigating programs and services.
• There are many services and programs for ASD that require greater coordination and integration to comprehensively and effectively serve individuals with ASD throughout the life span.
• Many programs for ASD are often categorical in nature; therefore, eligibility criteria and the types of services offered may vary across the state.
• Many programs and services for ASD would be improved by the availability of additional resources, infrastructure and supports to meet the needs of all individuals with ASD and their families.
• There are many services and programs for ASD that would benefit from the availability of additional professional and paraprofessional development and training.
• Some programs for ASD that involve the public and private sectors require clarification as to the roles and responsibilities of each group in providing services for ASD.
• In many regions of the state, some programs, services and persons who are involved with and respond to specific emergencies, such as medical and public safety responders, require additional information and training on ASD.
• Many programs that provide services to individuals with ASD and their families could benefit from additional resources and assistance to promote effective strategic planning, communication and collaboration between service agencies and consumers and their families, and thereby also avoid contentious disputes.
• There are highly effective programs and services for ASD that should be identified, analyzed, evaluated and replicated throughout the state.
• Throughout the state, there is an intense need to plan for and address the impending housing, transportation, employment and educational needs of the “tsunami” of young people with ASD who will soon transition into a community setting.

Policy recommendations
The commission was charged with analyzing the existing gaps and providing policy recommendations that would begin to address these issues. The recommendations are related to the three key areas identified in Senate Concurrent Resolution 51: the early identification of ASD; the education and treatment of children, adolescents, transitional youth and adults with ASD; and the comprehensive and integrated continuum of programs, services and funding that will be required to address the “aging out” of children who comprise the current autism epidemic. The policy recommendations are summarized as follows:

• Early identification and intervention. Establish a demonstration project at multiple sites that will serve as a template to expand early identification programs, with a focus on distressed communities; ensure the timely diagnosis of and intervention for children with ASD; improve collaboration among providers; provide supports to families and caregivers; establish a seamless system for service delivery between regional centers and local education agencies for children with ASD from birth to kindergarten.
• Health insurance coverage. Establish regulations to ensure appropriate and equitable coverage for ASD by private health plans and insurers.
• The ASD public health crisis. Implement a statewide public awareness campaign on ASD linked to innovative efforts by the California Department of Public Health to improve access to and navigation of programs and services for ASD.
• Education of children with ASD. Provide innovative approaches to increase the number of teachers and paraprofessionals, as well as improve the competencies of credentialed teachers and other school-based personnel, to educate children with ASD.
• Resolution of service disputes. Empower families and local education agencies to collaborate in establishing appropriate and effective individual education plans for children with ASD. Have the state of California conduct a comprehensive and independent review of the process for resolving service disputes at the state and local levels.
• Needs of youth and adults with ASD. Expand post-secondary educational opportunities and establish new and effective career technical education models, including intensive supports, for individuals with ASD. Expand innovative, community-based approaches to employment, transportation, social-recreational pro­grams and housing for the ASD population.
• Awareness of ASD in emergency situations. Provide training and information on ASD to peace officers, first responders, allied judicial public agencies and emergency response systems.

Conclusions and next steps
The California Legislative Blue Ribbon Commission on Autism urges the state Legislature and Gov. Schwarzenegger to adopt these recommendations by enacting legislation the commission will offer for the next legislative year.

The ensuing legislative discussion must include a comprehensive fiscal review and analysis of current state spending on programs and services for ASD and the impact of the commission’s recommendations. The commission also urges state policymakers to make ASD an important public policy priority during the next three to five years.

As part of an ASD public policy agenda, there should be greater coordination in planning and policy development across the state agencies that have key roles and responsibilities for helping Californians with ASD and their families.

Given the commission’s time frame, it was not feasible to address all issues identified by families and other ASD stakeholders. The following important issues warrant further analysis to identify appropriate solutions:

• There are an insufficient number of speech and language therapists, behavioral therapists and occupational and physical therapists to provide services to children with ASD.
• Low-income Californians who receive health and mental health care services through the Medi-Cal Program experience serious problems locating primary care and other health providers with expertise in ASD.
• A diagnosis of autism does not entitle children eligible for the Medi-Cal Program to receive medically necessary specialty mental health services through county mental health departments under the Early and Periodic Screening, Diagnostic and Treatment benefit.
• There is a need for long-term quality assurance and monitoring of the efficacy, or alternatively any specific risks, of the interventions and treatments provided to individuals with ASD.