When parents become concerned about their child’s development, the journey that they embark on is often long and wrought with roadblocks. The first stop that they typically make is their pediatrician – as she or he is often viewed as the trusted advisor for their child’s well-being. But often, pediatricians feel powerless in the face of institutional and regulatory barriers. Securing the diagnostic and ongoing services that patients with special needs require, both inside and outside of the classroom, is not easy.
THE INITIAL DOCTOR VISIT
As a pediatrician, parents of children ranging from toddlers to teenagers would voice concerns of developmental, learning or behavioral issues in their child. The initial step was to determine if the underlying condition is medical. Some medical conditions can be more quickly diagnosed and treated by pediatricians – such as attention deficit hyperactivity disorder (ADHD). But, once a medical condition is ruled out, pediatricians shift to serving as an advocate for the patient as they seek adequate care and services. Variables like a child’s age, location, school district, and healthcare insurance are all factored into an action plan with the family.
WHAT ARE THE OPTIONS?
While much progress has been made since I last saw patients, it is still not easy to access adequate educational services, and it is nearly impossible to obtain services through health insurance or find affordable private-pay options.
Although there are more services available today for certain children, such as those on the autism spectrum or those whose condition is deemed to be a “covered” diagnosis by their insurer, there is still a black hole in access to care for behavioral, social, processing, and learning disabilities. To make matters more challenging, most pediatricians are not trained on the government programs that define school-based special education.
WITHIN THE SCHOOL: FEDERAL PROGRAMS 101
More often than not, pediatricians and parents must “learn as they go” when advocating for their child. A crash course in federal programs is often needed.
1) Individuals with Disabilities Education Act (IDEA): Education-based assessment and services provided by their school district. An Individualized Education Program (IEP) assessment will determine if a child qualifies for physical, occupational, speech, and behavioral therapy as needed specifically to succeed in educational environments.
2) 504A: As a part of the Rehabilitation Act of 1973, Section 504A can help secure services and accommodate changes to the learning environment so that a child can learn as adequately as others.
OUTSIDE OF THE SCHOOL: INSURANCE 101
Parents often express concern that their child is not achieving their therapy goals with just education-based services, and they wanted to explore their options for outside assessments and services. Unfortunately, thirty percent of patients seeking developmental services are denied coverage by their insurance carrier. Some of the major insurers will cover acute services for certain non-chronic, non-development conditions, such as short-term rehabilitation therapy, but ongoing therapy for special needs is typically not covered.
THE ONGOING ROLE OF THE PEDIATRICIAN
The pediatrician’s role does not end after a diagnosis and care plan is developed. We often get on the metaphorical bus with families and alternate roles as bus driver and passenger. Today, pediatricians are increasingly busy as patient panel sizes continue to grow while the number of pediatricians decreases. Helping care for kids with special needs may be as simple as diagnosing and treating ADHD or as complex as advocating for a patient more than once through educational and insurance-based systems. Yet, busy or not, pediatricians continue to be an active member of the child’s advocacy team.
INNOVATION TO THE RESCUE
Innovation is increasingly making its way into the EdTech space – much as it has in the last decade in the healthcare space. The path for innovative and affordable therapy options has been paved by telemedicine. So much like other industries, entrepreneurs are solving issues that the education and healthcare systems have failed to fix. Now, parents are slowly being armed with more options for affordable and convenient services for their child with special needs. For not much more than the cost of a copay, families can now access online, face-to-face speech, occupational, and behavioral therapy with a click of a mouse – in the comfort of their own home.