Week Fourteen: Strategies for Increasing Consumer Participation in the Policy Process

In a democratic society, it is expected that policies be consistent with public preferences in meeting constituent needs (Kraft & Furlong, 2015). However, policymakers are often more engaged with organizational interests, such as health insurance companies or local school districts (Kraft & Furlong, 2015). In fact, public participation in voting has actually decreased in recent decades (Kraft & Furlong, 2015). As such, it is important to consider consumer participation in the policymaking process.

One theory regarding decreased consumer participation in policymaking relates to the general public’s perception of disconnection, as most people do not understand how the government’s decisions impact their daily lives (Kraft & Furlong, 2015). With the availability of Internet technology, social media, and website propaganda, public involvement could increase, especially if policymakers and government officials make a concerted effort in increasing public awareness. In fact, policy blogs, such as this one, have become more popular, and the potential for citizen involvement in policy continues to grow (Kraft & Furlong, 2015). The drawback to this method of increasing citizen involvement is that information from the Internet most frequently does not come from reputable sources and constituents may be exposed to manipulative and misleading material.

In regards to healthcare policy, healthcare leaders are responsible for participating in the policymaking process in order to encourage changes that would support the best interest of the patients they serve. A local representative reported, “If you are aware of an issue regarding healthcare that needs to be changed at the state level, contact your State Rep., State Senator, and/or the Chair of the Health Committee to explain it and try to change it” (Mach, 2015). She also advised healthcare professionals to utilize the media when they don’t receive an appropriate response.

Additionally, healthcare professionals can encourage patients to participate in the policymaking process in the form of advocacy, education, and interest groups. For example, when a new patient is seen for a developmental disability in practice, developmental providers in Arizona consistently refer families to Raising Special Kids, which is focused on increasing parents’ education. One of the most important resources that this program offers is educating parents on the Individualized Education Plan, specifically regarding the federally mandated responsibilities of the school to ensure that children have the best opportunity to succeed in the least restrictive environment (Raising Special Kids, 2015). As a result, parents are more knowledgeable regarding the services their child may be entitled. It’s important to note that individuals are much more likely to participate in policymaking and advocacy when they have a direct connection to the issue at hand. A major issue in Arizona right now is related to public education funding. It can be incredibly difficult to hire and retain qualified teachers passionate about educating children with disabilities. Knowledgeable parents have a greater understanding of the consequences of decreased funding and how this may impact their child, resulting in a sense of urgency and a desire to take action. Nurse practitioners prepared at the doctorate level are uniquely equipped to engage in healthcare policy and inform patients about legislation that could impact or improve their daily lives.

References

Kraft, M. E., & Furlong, S. R. (2015). Public policy: Politics, analysis, and alternatives (5th Ed.). Thousand Oaks, CA: CQ Press.

Mach, S. (2015, April 5). Interview by S. Ellis [Email]. Copy in possession of interviewer.

Raising Special Kids. (2015). About us. Retrieved from http://www.raisingspecialkids.org/about-us/

Week Thirteen: Sustaining Innovative Environments – Considerations of Time and Scope

We recently discussed characteristics of change agents. Kotter’s model outlined the importance of creating a climate for change and instilling a sense of urgency (Kotter & Cohen, 2002). Additionally, there are certain organizational attributes that might assist institutions in adopting a change culture in which innovation is valued. For instance, an adhocracy culture is characterized by visionary leaders who embrace change as an opportunity for growth (Cameron & Quinn, 2006). Such a culture would support the development of innovative leaders and thinkers moving for proactive improvements in healthcare quality.

The vast majority of healthcare policies are developed from modifications on existing policies (Longest, 2010). The consequences of a policy both on the stakeholders and the affected individuals may cause people to seek modifications (Longest, 2010). It is important to remember that virtually every policy has a history:

“An initial version is formulated which then evolves as it is implemented, either through amendments to the original legislation or through new or revised rules and changes in operation” (Longest, 2010).

These modifications contribute to sustaining innovative environments and account for societal changes and new applications for healthcare policies. Modification processes have significantly impacted the care of children with developmental disabilities such as autism. In Week Four, we looked at the progression of The Education for All Handicapped Children Act of 1975 to the Individuals with Disabilities Education Act, which has also been amended several times in efforts to solidify parents’ rights and increase the scope of services provided (U.S. Department of Education, 2007).

The cost of caring for a child with autism garnered attention in the media when Indiana enacted the first autism insurance reform bill in 2001 to increase services and therapies covered (Autism Speaks Inc., 2015). This was an innovative policy change at the time that motivated parents, providers, and other advocates to call for a nationwide policy change to improve the quality of life for families affected by autism. However, it was not until 2007 when another state, South Carolina, took that innovative step forward and enacted insurance reform. In 2015, we now have 39 states, including Arizona, with active autism insurance reform laws allowing for increased coverage for specialized therapies (Autism Speaks Inc., 2015).

Screen Shot 2015-04-12 at 8.35.56 PM

We have seen recently how policy decisions left to the states result in varying degrees of change and application. Consider same-sex marriage laws. Although recognized by the federal government, state policies vary from legal same-sex marriage, to recognized same-sex marriage, to banned same-sex marriage. Unfortunately, it can take time for an innovative change environment to spread considering the 50 different legislatures making state’s decisions across our country. Arizona has the opportunity to be a leader and join developmental screening initiatives in their early stages. Arizona’s Medicaid program, Arizona Health Care Cost Containment System (AHCCCS), should reimburse for dual developmental screening using both a general developmental tool and an autism specific tool. This will increase provider motivation in screening specifically for autism in early childhood, which will improve the developmental trajectory for affected children.

References

Autism Speaks Inc. (2015). State initiatives. Retrieved from https://www.autismspeaks.org/state-initiatives

Cameron, K. S. & Quinn, R. E. (2006). Diagnosing and changing organizational culture: Based on the competing values framework (Rev. Ed.). San Francisco, CA: Jossey-Bass.

Kotter, J. & Cohen, D. (2002). The heart of change: Real life stories of how people change their organization. Boston, MA: Harvard Business School Press.

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

U.S. Department of Education. (2007). History: Twenty-five years of progress in education children with disabilities through IDEA. Retrieved from http://www2.ed.gov/policy/speced/leg/idea/history.html

Week Twelve: Healthcare Financing

The financing of federal healthcare policies is complex. Additionally, for healthcare consumers, financial consequences may be a factor influencing the decision to seek care. The Congressional Budget Office is a nonpartisan agency tasked with making analyses, projections, and fiscal recommendations regarding policymaking (Longest, 2010). In the United States, rising healthcare costs are a major fiscal challenge, specifically in regards to spending on Medicare and Medicaid (Longest, 2010). In fact, in the past 30 years, total spending on healthcare has more than doubled and the current path of spending progression is unsustainable (Longest, 2010).

In a previous post, the Children’s Health Insurance Program (CHIP) was discussed, specifically in regards to Arizona’s program (KidsCare), which has been in a perpetual freeze. The CHIP Reauthorization Act of 2015 was introduced as H.R. 2 in March. In addition to reauthorizing CHIP, H.R. 2 would also repeal the Medicare sustainable growth rate and improve physician payments (Dayandante, 2015). The Congressional Budget Office revealed that enacting H.R. 2 would increase direct spending and revenues resulting in a $141 billion increase in federal budget deficits (Congressional Budget Office, 2015). Even with extensive funding, budget allotment, and federal reauthorization, it is uncertain if Arizona would lift the freeze on KidsCare. In a personal interview with an Arizona state representative, she revealed, “We have a lot of children living in poverty in AZ and most of them are not getting quality healthcare. How [CHIP reauthorization] affects our state system will depend on how much money they give each state and what are the restrictions for that money” (Mach, 2015).

The lifetime costs of caring for a child with autism in the United States are reported to be between $1.43 million and $2.44 million (Kaplan, 2014). Money spent may be on early intervention therapies (which we know can improve the developmental trajectory for affected children and improve independence in adulthood), special-education services, and the decreased productivity of parents who must quit their jobs to care for their children (Kaplan, 2014). As adults, costs are also tied to living expenses associated with specialty facilities (Kaplan, 2014). These sums are astronomical and can have drastic socioeconomic consequences for families. It has been suggested that we need to assume an investment perspective on the life course of someone with autism instead of focusing on the costs of caring for needy people (Kaplan, 2014). This should include allocating more funding for screening and early intervention methods so that all affected individuals have the best opportunities for improved quality of life. When asked about bills advocating for increased funding for children with autism, S. Mach (2015) revealed, “People with disabilities are incredibly under supported by the state – children and adults.” Therefore, the role of the nurse practitioner and other engaged healthcare professionals is to convince our representatives of the importance of prevention and early intervention in reducing the long-term costs associated with living with a disability.

References

Congressional Budget Office. (2015, March 25). H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015. Retrieved from https://www.cbo.gov/publication/50053

Dayandante, A. (2015, April 7). Rep. Burgess introduces Medicare Access and CHIP Reauthorization Act of 2015. Retrieved from http://insurancenewsnet.com/oarticle/2015/04/07/rep-burgess-introduces-medicare-access-and-chip-reauthorization-act-of-2015-a-611011.html#.VSSFLFzii2w

Kaplan, K. (2014, June 9). Study: Price tag of autism in the U.S> exceeds $236 billion per year. Los Angeles Times. Retrieved from http://www.latimes.com/science/sciencenow/la-sci-sn-autism-price-tag-20140609-story.html

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Mach, S. (2015, April 5). Interview by S. Ellis [Email]. Copy in possession of interviewer.

Week Eleven: Characteristics of Innovators and Change Agents in the Healthcare Sector

When characterizing change agents and policy innovators in regards to healthcare, it is first important to define innovation. Innovation is the applicability of something new, whether it is technological, a care delivery approach, or a new treatment modality, to daily life. An innovation has the power to change how we work, function, or process (Weberg, 2009). An innovator, therefore, is a proactive individual with a desire to improve healthcare. Unfortunately, policy decisions may not always be proactive, but instead reactive, as legislation is often drafted as a solution to a recognized problem (Kingdon, 2011).

Innovators in the clinical setting are focused on progress. Although not necessarily in management positions, innovators are tasked with leading and influencing others to accept and implement new ideas or processes. Strategic leadership is a process that includes communicating a shared vision, developing supportive organizational processes, and managing change. Additionally, a successful leader must be able to navigate the social, political, and economic institutions to understand and meet the needs of the patients and peers with whom they work (Wooten et al., 2006).

In order to influence policy at a state or even a national level, healthcare professionals and innovators may act as consultants to policy makers in regards to facilitating evidence-informed decisions (Jewell & Bero, 2008). To effectively influence policy development, research must incite, persuade, and be understandable by the average legislator (Jewell & Bero, 2008). Policymakers were more likely to utilize evidence when consultants conveyed research in a way that outlines the specific outcomes on individuals or groups (Jewell & Bero, 2008). Steven’s Law, passed in 2009, required private insurers to begin covering the costs of autism diagnostic visits and specialized service visits for children under the age of 16 years (Autism Speaks, 2009). Prior to the enactment of this legislation, professional consultants provided research highlighting the lifetime costs of caring for a child with autism and the recognized benefits associated with specific therapies. Similarly, state legislators could be presented with today’s statistics regarding autism screening and delayed diagnosis to influence a decision regarding mandated screening and increased insurance reimbursement.

Policymakers also appreciate when innovative research is linked with cost containment due to budgetary constraints (Jewell & Bero, 2008). A policy brief on screening for developmental delays prepared for legislators in the state of Washington specifically included information regarding healthcare cost savings associated with autism screening and early intervention: “Investing $33,000 per child with autism for intensive early intervention for 3 years before school entry saves society $200,000 per child by age 22” (Washington State Department of Health, 2009).

Lastly, as previously mentioned, policy decisions are often reactive instead of proactive. Thus, to affect long-term, innovative change, a healthcare consultant may attempt to reframe policy issues to resonate with the best evidence (Jewell & Bero, 2008). Consider Kotter’s model, discussed last week. Healthcare change agents may attempt to re-focus the issues to inspire a sense of urgency and call for action in order to create the climate for change and proactive decision-making (Kotter & Cohen, 2002).

There are multiple opportunities for innovative healthcare leaders to affect evidence-based change in the policymaking process. Legislators often use professional consultants to highlight research that informs practice. Although innovative clinical leaders may be frustrated by politicians’ typical reactive response, the presentation of the evidence may help healthcare leaders to draft sustainable solutions while also creating a culture for progress.

References

Autism Speaks. (2009). FAQs on Arizona’s autism insurance reform law. Retrieved from https://www.autismspeaks.org/advocacy/advocacy-news/faqs-arizonas-autism-insurance-reform-law

Jewell, C. J. & Bero, L. A. (2008). Developing good taste in evidence: Facilitators of and hindrances to evidence-informed health policymaking in state government. The Milbank Quarterly, 86(2), 177-208.

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (2nd ed.). Glenview, IL: Pearson.

Kotter, J. & Cohen, D. (2002). The heart of change: Real life stories of how people change their organization. Boston, MA: Harvard Business School Press.

Washington State Department of Health. (2009). Issue brief: Screening for developmental delay. Retrieved from http://www.doh.wa.gov/Portals/1/Documents/Pubs/970-128_DDScreeningIssueBrief.pdf

Weberg, D. (2009). Innovation in healthcare: A concept analysis. Nursing Administration Quarterly, 33(3), 227-237.

Wooten, L. P., Anderson, L., Pinkerton, J., Noll, T., Lori, J., & Ransom, S. (2006). Strategic leadership in healthcare: The role of collective change agents in closing the gap of healthcare disparities. Retrieved from http://deepblue.lib.umich.edu/bitstream/handle/2027.42/49241/1060-Wooten.pdf

Week Ten: Change Theory

Several nursing theorists have focused on innovative changes in healthcare. William Kotter (2002) developed a change management model that is characterized by three distinct phases including:

  1. Creating a climate for change
  2. Engaging and enabling the organization
  3. Implementing and sustaining the change

In Kotter’s model, he describes emotions regarding change as either pessimistic or optimistic and advocates for instilling a sense of urgency and feeling of action to inspire support. Perhaps most important in change theory is sustainability. According to Kotter (2002), culture change is the output of successful behavioral change, and as such, culture change occurs after a new process has been proven to succeed.

When considering changes in healthcare policy, timing and the “climate for change” are vitally important. According to Kingdon (2011), a “policy window,” is when an opportunity occurs for advocates to push their proposal forward. Advocates and lobbyists will wait for advantageous problems in which they can propose their solutions (Kingdon, 2011). The “policy window” opens infrequently typically related to a change in administration, shift in the partisan distribution of Congress, or as a result of a new problem that captures the attention of government and media officials (Kingdon, 2011). Consider the measles outbreak at Disneyland. The media attention surrounding the problem of unvaccinated or under-vaccinated children served as the “policy window” for advocates supporting more stringent vaccination requirements. A more predictable instance in which the “policy window” might open is related to the scheduled renewal of a specific government program (Kingdon, 2011). For instance, the Children’s Health Insurance Program (CHIP) is up for reauthorization this year. As a result, advocates supporting subsidized healthcare options for children may use this opportunity to propose increases in funding and coverage.

autism graph

With an estimated prevalence of 1 in 68 children, the increasing number of children affected by autism spectrum disorder is certainly a healthcare problem that needs further attention (Centers for Disease Control and Prevention, 2014). Advocacy organizations are using this “policy window” to actively engage government to support legislation benefiting children and families affected by autism. Autism Speaks, a private advocacy and research organization, is currently focused on insurance reform and encouraging states to cover comprehensive services for children with autism (Autism Speaks Inc., 2015). Additionally, the organization successfully advocated for the enactment of the Achieving a Better Life Experience (ABLE) Act, in which families can contribute to tax-free savings accounts to aid individuals with disabilities (Autism Speaks Inc., 2015). It is clear that current policy attention is focused on financially supporting families affected by autism spectrum disorders, which is certainly a noble cause.

Specialty providers, early intervention therapists, and primary care providers could also use this “policy window” to their advantage. Providers could support the expansion of legislation supporting Medicaid reimbursement for routine autism and general developmental screenings in primary care. This would likely improve universal screening rates and positively impact the age at diagnosis with autism spectrum disorder. Therapists could advocate for increased federal funding and Medicaid coverage for early intervention services. Additionally, considering the problem of the limited number of specialty providers and therapists, healthcare professionals could also use this window as an opportunity to advocate for education reform supporting those professionals choosing careers in developmental and behavioral pediatrics.

References

Autism Speaks Inc. (2015). Advocacy news. Retrieved from https://www.autismspeaks.org/advocacy/advocacy-news

Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years – Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR, 63(2), 1-21.

Kingdon, J. W. (2011). Agendas, alternatives, and public policies (2nd ed.). Glenview, IL: Pearson.

Kotter, J. & Cohen, D. (2002). The heart of change: Real life stories of how people change their organization. Boston, MA: Harvard Business School Press.

Week Nine: Policy Governing Access to Data and Privacy Protection in an Electronic and Genomic Age

Privacy protection has played an important role in healthcare policy since the 1970s when states began passing legislation to facilitate trust between patients and providers, thus promoting full disclosure (Pritts, 2007). Specifically, healthcare policy was intended to protect information related to diagnoses that are associated with discrimination including mental health disorders, genetic disorders, and HIV/AIDS (Pritts, 2007). In 1996, the federal government enacted the Health Insurance Portability and Accountability Act (HIPAA) to provide a national standard of care. The primary goals of the HIPAA legislation included enhancing patients’ access to their own records, controlling access to patient records, improving the efficiency of healthcare data exchange, and reducing healthcare costs (Beaver & Herold, 2004). Many individuals involved in healthcare have often heard the phrase “sharing information on a ‘need to know’ basis,” indicating that healthcare information should only be shared to those individuals that need access in order to provide adequate care.

Ultimately, the ability to enact health privacy standards shifted to the U.S. Department of Health and Human Services (Pritts, 2007). Under our current privacy regulations, all healthcare information, excluding psychotherapy notes, can be disclosed for treatment, payment, and operation purposes without obtaining individual consent (Pritts, 2007). The HIPAA Privacy Rule is the “minimal floor of protection,” and as such, states are still able to pass legislation offering increased privacy protection (Pritts, 2007).

Electronic healthcare systems (EHRs) offer users greater flexibility and broad access to patient records (Schweitzer, 2011). As a result of today’s electronic model of care, the HIPAA Privacy Rule specifically includes policies to guard electronic protected health information (ePHI), such as user identity management; encryption; limited access to servers; workstations; activity audits; data integrity verification; and transmission security (Schweitzer, 2011). However, there is a legitimate concern for data breach considering increased access to ePHI.

Recall that state legislation required increased protection for genetic and mental health conditions. Although the exact cause of autism is unknown, there does seem to be a genetic component with increased risk among siblings (Centers for Disease Control and Prevention, 2015). Additionally, several genetic disorders are associated with autism including Fragile X Syndrome and Angelman Syndrome (Centers for Disease Control and Prevention, 2015). Parents have the right to request genetic testing. However, it’s important to note that direct to consumer genetic testing agencies may not be subject to HIPAA privacy regulations resulting in the potential uninformed use and disclosure of healthcare information (Caulfield & McGuire, 2012). Genetic testing may also result in unexplained variances leading to further emotional distress (Caulfield & McGuire, 2012). Additionally, as adults, those children tested by their parents may not have chosen to receive genetic tests for autism or other syndromes due to their lifetime connotation.

For children with autism, the associated stigma can impact emotional health, psychosocial health, and development. Since the Affordable Care Act, most insurance plans are not allowed to limit coverage due to a pre-existing condition, including autism (U.S. Department of Health and Human Services, n.d.). Additionally, health insurance plants are prohibited from putting a lifetime dollar benefit on most benefits, allowing more children with autism access to expensive but effective therapies (U.S. Department of Health and Human Services, n.d.). These provisions prevent unintended health consequences related to sharing a child’s autism diagnosis. Furthermore, for adults with autism, the Americans with Disabilities Act prevents discrimination in employment (United States Department of Labor, n.d.). However, as a society, there are perceived limitations for children with autism including the stereotype that these children are universally intellectually disabled. As healthcare providers, we have the responsibility to promote societal acceptance to break stereotypes. Additionally, parents and patients transitioning to adulthood need increased education regarding autism privacy protection and who has the right to know specific diagnoses and treatment details.

 References

 Beaver, K. & Herold, R. (2004). The practical guide to HIPAA privacy and security compliance. Boca Raton, FL: Auerbach Publications.

Caulfield, T. & McGuire, A. L. (2012). Direct-to-consumer genetic testing: Perceptions, problems, and policy responses. Annual Review of Medicine. doi: 10.1146/annurev-med-062110-123753

Centers for Disease Control and Prevention. (2015). Facts about ASD. Retrieved from http://www.cdc.gov/ncbddd/autism/facts.html

Pritts, J. L. (2007). Federal efforts to impose uniformity on state health information privacy laws. Health Law & Policy, 1(1), Article 7.

Schweitzer, E. L. (2011). Reconciliation of the cloud computing model with US federal electronic health record regulations. Journal of the American Medical Informatics Association, 19, 161-165. doi: 10.1136/amiajnl-2011-000162

U.S. Department of Health and Human Services. (n.d.). The Affordable Care Act and autism and related conditions. Retrieved from http://www.hhs.gov/autism/factsheet-aca-autism.html

United States Department of Labor. (n.d.). Disability resources: Americans with Disabilities Act. Retrieved from http://www.dol.gov/dol/topic/disability/ada.htm

Week Eight: Private Sector Innovation and Policy Advancement

Private organizations have the ability to influence healthcare policy through advocacy, endorsement, lobbying, and agenda setting. In addition, private organizations are often involved in the implementation of healthcare policy (Longest, 2010). In Week 4, several private policy “actors” were outlined including Easter Seals and Southwest Human Development. These organizations’ advocacy efforts supporting autism research and developmentally appropriate services have strongly influenced legislative decisions in recent history including the 2009 reauthorization of the Children’s Health Insurance Program (CHIP) and the 2004 reauthorization and amendment of the Individuals with Disabilities Education Act (IDEA) (Easter Seals Inc., 2015b).

Private organizations choose to advocate for those policies that fulfill their mission and vision. For example, Easter Seals strives to provide services to help individuals with disabilities and special needs as well as offers support to their families, hence, this organization’s support of IDEA expansion (Easter Seals Inc., 2015a). Similarly, a policy implementing organization should have a good “fit” with policy objectives (Longest, 2010). Fit is determined by whether the implementing organization is sensitive to the policy’s primary goals (Longest, 2010). In addition, fit is influenced by whether the organization has the required resources, such as money, personnel, technology, facilities, and equipment to successfully implement the policy (Longest, 2010).

In considering Part C of IDEA, there are numerous private organizations in Arizona tasked with providing early intervention services to children and their families. Recall, early intervention is available to children from birth to age 3 years with at least a 50% deficit in one area of development (Arizona Department of Economic Security, 2014). Available services can include physical therapy, occupational therapy, and speech therapy as well as other family-based educational interventions. Services are provided free of charge to families and primarily funded through private and public insurance corporations as well as federal funding through IDEA.

The state of Arizona has been divided into regions by county and zip code with each region assigned certain private service agencies. When enrolled in the Arizona Early Intervention Program (AzEIP), families are assigned to a service provider based on their geographic location. Most early intervention services are provided by the agency in the home in order to foster family enrichment. Several of Arizona’s rural counties may have only one agency serving 30 or more zip codes. Other counties, such as Maricopa, have several different private agencies available allowing for a more equitable distribution of workflow among providers.

A to Z Therapies, LLC is one of AzEIP’s partner organizations entrusted with providing services to qualifying children and their families in Mohave and LaPaz counties (Arizona Department of Economic Security, 2013). Specifically, this organization provides Developmental Special Instruction (DSI), physical therapy, occupational therapy, and speech therapy (A to Z Therapies, LLC, 2015). In addition to providing services through Part C of IDEA, this organization provides private therapy services for children from infancy to adolescence, accepting not only early intervention referrals, but also private referrals from physicians, psychologists, and schools (A to Z Therapies, LLC, 2015). A to Z Therapies, LLC is committed to helping children reach their greatest potential and best quality of life through developmental services (A to Z Therapies, LLC, 2015). It’s clear that the mission of this organization is consistent with the objectives of Part C of IDEA, allowing for a good “fit” and enhancing policy implementation.

The private sector is influential in advocating for families with developmentally disabled children, and numerous agencies are also involved in policy implementation. However, A to Z Therapies, LLC is the only private agency providing early intervention services to Mohave and LaPaz counties in Arizona (Arizona Department of Economic Security, 2013). Obviously, our state is in need of more AzEIP contracted agencies with expanded resources in order to provide the services children need and maintain a good “fit” with IDEA’s objectives.

References

A to Z Therapies, LLC. (2015). About us. Retrieved from http://www.atoztherapies.com/about

Arizona Department of Economic Security. (2013). AzEIP referral contact list. Retrieved from https://www.azdes.gov/uploadedFiles/Arizona_Early_Intervention_Program/azeip_referral_contact_list.pdf

Arizona Department of Economic Security. (2014). Welcome to Arizona Early Intervention Program. Retrieved from https://www.azdes.gov/azeip/

Easter Seals Inc. (2015a). Frequently asked questions. Retrieved from http://www.easterseals.com/who-we-are/faqs/

Easter Seals Inc. (2015b). Legislative landmarks. Retrieved from http://www.easterseals.com/get-involved/advocacy/legislative-landmarks.html

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.