Dr Rebecca Mathews MAPS, Manager, Practice Standards, National Office
In 2007, the Australian Government introduced the Helping Children with Autism (Autism) package which included assessment and early intervention services for children diagnosed with an autism spectrum disorder. The Government has recently expanded this package with the introduction of the Better Start for Children with Disability (Better Start) initiative which was launched on the 1 July 2011. An expansion of funded services to children with a disability is a positive move and acknowledges the need for more allied health services for these children.
The Better Start initiative provides assessment and early intervention services to children diagnosed with the following disabilities:
- Vision impairment
- Hearing impairment
- Cerebral palsy
- Down syndrome
- Fragile X syndrome.
Psychologists are one of seven allied health professions approved to provide services under this package. Early intervention services are designated through early intervention panels to eligible children under the age of six. Assessment and early intervention services can also be provided through the expansion of the Medicare items in the Autism package. Medicare rebates are available for up to four allied health assessment services for eligible children up to the age of 13 years. A maximum of 20 allied health treatment services can be provided to eligible children up to the age of 15 years who are being managed under a treatment and management plan prepared by the referring medical practitioner (provided the treatment and management plan is in place before the child is aged 13 years).
Changes to the Autism initiative as a result of the introduction of Better Start
Many aspects of the Better Start initiative are identical to the Autism program. Medicare item numbers and descriptors are the same and application for membership of the early intervention panels is similar, although the administrators of the early intervention panels differ for the two initiatives. For the Autism program State-based administrators were appointed, whereas for the Better Start initiative Carers Australia will oversee the early intervention packages nationally. In addition, while for the Autism program referral must be through a paediatrician or child psychiatrist, for Better Start a general practitioner or any specialist or consultant physician can refer a child for services.
Provision of multiple services on the same day
There are some changes to the delivery of services under the Autism program as a result of the introduction of the Better Start initiative. A positive change is that for both initiatives clients will now be able to access up to four Medicare-rebated sessions on the same day if needed. These services can be made up of any combination of eligible allied health practitioners. This change will be of particular benefit to families from regional and rural locations that at times travel large distances to access assessment and intervention services for their children.
Expansion of eligibility to other allied health professions
A change to the Autism program of great concern has coincided with the introduction of Better Start. From 1 July this year the types of eligible allied health providers who can provide services under the Autism package has been expanded to include all the allied health professionals eligible to provide services under Better Start. The inclusion of these other health professionals has not been informed by best practice for the assessment and treatment of children with autism and to date, no clear explanation or rationale for this change has been provided. This change has the potential to reduce vulnerable families’ access to the limited funding that is available for effective evidence-based treatments provided by psychologists, speech pathologists and occupational therapists.
The APS has been represented on the Expert Reference Group which advises the Department of Families, Housing, Community Services and Indigenous Affairs on issues relating to the implementation of the Better Start initiative. While the APS views the introduction of more services to children with disability as a great benefit to the community, a number of concerns have been raised regarding the implementation of Better Start. These concerns include the lack of an evidence-based framework to support the implementation of the initiative, the need for funding to provide specific training for psychologists and other allied health professionals to work with children with disabilities given the unique set of skills such work requires, and the importance of allowing work at the family level rather than only interventions directly to the child. The APS has also written to the Minister to voice concerns about the inclusion of the additional health professionals as providers under the Autism package, given the lack of evidence for this and the fact that no consultation process with the health professions involved in the Autism package occurred prior to the formulation of these changes.
Further information about the Better Start for Children with Disability initiative and the Helping Children with Autism program can be found on the APS website at www.psychology.org.au/medicare/.
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