American Academyof Pediatrics

l!rc 20,2012

Vem F. Tait MD, FAI"P

On behalf oftheAmerler Acsdctly of Pcdlatrics

Before theSubcomnitr.. o! P.rtorlel,S.Drt. r{n.d S.Bic6 CoDrlft .

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Chairh.nWebbard Rlnkjne MehberGEhan.tlankyoulorholdilgtoda/s hearin8onsuch an lnponabt toplc-the pro8rzns and pollcles that the Depa.tnent of Defente ha3 l.place to support milltary ramilles with chlldED with sp.cial needs, My nane ls v.F FdTait, MD, FMP, and I ah r.presentiq th. Anerlcan AddeDy of P.diatri6 (MP), a ron-prc6t professional org.niatio. of nore than 60,000 pnnary @r€ pedbtndatu, pedlrtrich ed iel sub-sp*i.l lsti, .nd p.diatric s urgical speclaltsts d.di.ated to th e h e.lth, sat !,,,and w€ll-belnE of intanri, children, adolescenLs, and youhC.dults,

I an. pediatric neu.olosistand ana.Associat. Ere@tlve Dlrecto. at AAL as rell a th.Di.ectorofMP! D.pann.nt of Connunity.nd Spe.l.lty Pediatncs.ln addltionto hyrol€ with th€ Ahencar Acadeny of P€djadcs I .d also a nenber oi the Child N.urologrSoci.tyand the A$ocletjon ofMarernal.ndChUd Bealth P.oghns, Prlo. to jolnlngtheA'A?, I {as in practice fo. hore than 25 years and my najo. areas or expenis. ilchdechildren a.d youth with speclalhealthcare needs, tFunatl. bnin injury,neuro de vel op nenial di sab'lit{€s, a.d neurolosical rehabnltatio tr h was Dy pnviFge tocare aor fanilies with .hildren with autirm spectruh dlsordeB and otherreumdeveloph€ntal djebiltres,

I have D eBonalD exp erien.ed !h e strusle th at hany pediatri clanr race sery day {hert ryi ng to ac. es s need ed n.d ical, educati on al ar d otbe r serices for chl ld.€n $th sp.cialheahhcareneed! FindinS n€eded se ic6 c.n be difiidlt.ven when tiey are adequltely.over€d by h.a& insuEn.e. It is only moa difficult when a prlmary care pedi.trjctan orsubsplciallsr.an lo@te 6re only !o lind itis not covered by a hnllyr iiluEne,

Ca.ligfor o!; nadont nilltarylanillesandthel.childrenhasalE's bcn ofpaRnountinporrance for the Acadehy, I am preud to say that on. of th. oldsi settioN e. h.v€ :tthe Acadehy rs the section on unifom.d seMes. crcat€d h 1959, the tAP r section onUnifomed SelMe! has help.d dlr.a rhe acadlmy's l.ade.shlponthe h.althandwell'beinsolourn.uon'r mrhury(hlldan and adolescents.The Secdon rs compnsed;fov.r900 nembers who a.e active durt or Edred mllit rv as well as clvlllaD pedla$lcians whosene h ilir.ry benen d a n.r, Th e se.tion worlc cld ely wiih the pediatric @nsultan ts to tb.su.Seon seneEl of e.ch banch oftb. nilitary.

An eE nple of o n. ot the secrron r nos$ecent ..co nplishbe hts h the d ev.lop nent of th.Militl.y Youth Deplofm.nt SuoponVid.o Pro8hn, wnich is dslgned to h.lp childrenandadolescents cope wth th. deployment ofone, or soE.tines eren both, of their parcn$ orguardians to other.ou!$ies aroud tb. world. Th. vid@ ms inltjally dsilred bt tlesedron on unlromed S.ryi.es .nd B subeqt€ndy udllad by th. Ullted St2tes ArhyM.didl Conn.nd. So fd DoE tnan 20,000 @pl4 of the p.ogFh have been dinributed

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worldidde !o nrlrrary fanrlr.s, vs.Ious nrlitary yourh s€.ur8 p@fcsrional aSeicl€r an.l

The health and w.ll-bein8 olchildren lh Anenca's m'litaryfahrli4 nnks aone ofth. toPpnortties ofthe Acaden, and that 6 ehy I am hoDored to Eprcsent AA? herc today. fhelnpacls oflons or duldpl. d.ployn.nts on all nilitary lamilles 6r b. signiica.t aad fortahihes wjth ch d.eh wlih .utir h spectrud dls orders, n eurodevelo p ne ntal dlsordeB orother dlsablllties, these lhp.cts are often signlficantly exace.b.ted.

The am.non Ac.d€my of PediatrjB bell.v4 th.t th€ optlEl health dd wellb€lhg of allIhfants, children, adole5c€nts a.dyolhg.dultsthrough 26yeaE olag€-lncludingthose inhilitaryfantlt*-isbestachl.v.d blth acc.is to apprcp.i.t.and conpeh.m'v. neathcare lBlance b.n.nts, Thde b.nenE nst b. aE abb tnreug! public l$urznce pldlik€ Medrerd,the chrldr€n 3 Heahh ltuuEnceProg..m (CHIP) and TtucARE, as well dDrivare health insuranc. pkns,

AA? pollc, recohh€nds that nhinlm health b.aefiti fo. all infants, cntdr€n and yolthshould prevlde aU n€dically necessary c.re. add hcludesuch seMc.s as:

. anbulatory D.ti.ht s€Mces

. .ner3enc, nedkal sed,ces

. har.mity and nebom.arc,.nd

. ncnblh.ahl2ndsrhsbherb!..dlsorde.setutces,

akd i..luded in the set ofb€nelits should b.:

rehabilltative and babilirative se ic.s and devlces

.hrcnic dls€.se nana8.nent, andonl, b€arin8 ad vklon .are,

rn shori, al! chlldren nun haE a bediol bon., ,{AP b€ll{6 ti.t n€dlc2l and od.rreftjc should be d.llv.r€d dd coordirat d in a .ompr€h.B'v€, Pad.nt and f.njly_.enter.d, physlcian.led mediel hohe-tle quallty settln8 for pnhary caE dellve..d ordireded by well-tElned ph'ric'ans who are loom to th€ child and hnll, eho hav.develop.d. prrt e6hlp of nutual responslbjlity ad rust with th.h,.nd who pdtldeae.sslbl€,continuoB!.@rdinated,andempr.hensive c.re,

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The health lnsurdcc plan that nost mllitary tanllies us. t TRICARE. Seflnces cov.ed byTtuCiRE ar. provid€d by p.dradcians {ho are act'v€ duly milita.y but also connunitypedi.bcians and p.diat.ic subsp.cialists who previde 6re Ear nilit2ry bd€s and otherhtl :ry faciljti.s. AAP n.nbeB provjdins care ro .hlldEn ,nd t n0ies @ver.d btTRICARE lae unique chall.nss conpaed to otner public and private pro8atr aDd plans.

For.Enple,oneofthechauensesthatnllit.yfanllleswlthchlldrenfacersthattheTRICARE prcgFn ls largely based oD Medicare, a health systen deslSn.d to prclidecov.rag.forsehior adults, Because ofthtr prcCnn.liSnment, military fahilis oft€n faechalleng$ nav,lgatlns the TRICARE progni, bany tine5 stru8glir8 to frnd appropriatepedladcprovid€B orbav€cenairpedi.b'csedl.es cover€d Thh is especiallylrue forpar€n6of chjldren v'th rp€clalhealth care reeds- A.4Ihas workedcloselywlthTRICAREprc8Fm ro e$ure neededs.ruices arearailableLom routineinnunlzarions to h'8hbspeclalized and acute pedlatnc care.

one.rea oa panicula. @ncem aoorgDilitarypa.entsofchilden v'ttl speclal needs js the.ov€rage of s.M.es ror chlldFnwidrautlso spectrundiso.ders oroihe!neuroloslcaldisord.rs. Recendy released data tron the CentcE for Disease Conn ol and Preventionco.fims tbattheDEvalence ofchildren with AsDs h 3rowi4,:s ls th€ n.ed for efi€.tiv.s"rui,es ro help chrldren Mth ASD maxrnize.h.tr porential.

AuUsn spectrun dltord.a, s lnl l.r to other rcu rodevelop men tal dis. bil lil€s, are 3e ne.allynot icuhblei".nd conpler care 15 Equtred for the child alo4lr'lth s.ry,ces for the fanlly,untortu.ately, tbere h often no shple solutlon fo. families and .fiealv€, tanily-center€d6r€will include nun.rouspbtlde6, A.oordi.atedapprca.h tolnt.d.ndon and

trearb€nt anong rhc hedic.lhohe, eduGtional iDstitutions ahd fi.fanllyls (ltical for

OpttnlzingFedicalcareand lherapy can b.ve a positive impa.t on the habilltatlv€rprosxessahd qlall9oflifeforthechlld, M.dielly n€etsary trcatD.nt5 am.lioFt€ o.naha8e synptons, ihprov€ tu.ctoni.8; andlo. prev.nt d€te.loration. Th6, in addliion tooutine prcventive @re and tr€bn.nt of..ute lllne$8, childr€n with AsDs also requireh.na8enentof sle€pprobleE.obsesslveb€hrvjors, hyglen. and selt6re skilh,eatin8 a

healthy diet, and llnttlbSsellinlunous behavioE,

Efiectlve nedlcal @c and treatnenr d.y atso allow a chlld ryith tSD to benent horeoptim.lly ftlmtleFDeuticinleNentions, Theapeltlc tnteru€ntlont includt4behav,obl

stnteSi es aDd habil it tlv€ ther.p ies, ae lhe comeBtones of ca E for AS Ds. Th eseInterue.tionsaddresscoDmunicatton,socialshlk,daily'UviDgrhlls,playa lelsuerlolls, a6deD ic ach

'.vem enl a nd behavioi

An €xanple of a denonstBted, .ffective treatneni for ASD is Appli.d s.havlor A.al'sb, orABA AaA ures b€havloEl health prlncipl* to irc@s€ md d.lnt in po3itiv. adaptiv.beh.vior and reduce regadre behallos ornarrowtieconditrons underwhlcntheyoc.urABA @n teach newsklls,and aenenliz. then to neentrcnnents or situations. ABAfocs$ on th€ n.aurem.nt and objectlre evalu.tion ot obseru€d behavjo. ln the hone,

ASD is a m€dlcal/neuredevelopne.ial ondition witb beh.vioral symptoms that aretlj.ectly.ddressedbyapplled bebavior.nalysis nethods.ABAhas provedetf€ctive inaddesthsth. core sydptoms olautisnas well asdevelopinsskills and imprcvihgandenhancl4 tunctlooirg in nuD€rous aus that atr ct tne h.alth a.d well-beiig or people

The eflectiv.ness otABA'bs€d int.dertions in AsDs hasbeen weu documented $roughalonshisloryoi.esear.b in univeBity and coBmuity settings , children who rccelve earlyint.nsive behavioal trdtnenl nave ban shoM to make substartial g.ins in cognltlol!languaSe,academicp€.fomanceardadaptlve b€havioraswell as someneasures of soctalbehaviorand theiroutcomes hav.been si8nifio.tlybettertbantboseofchildr.n in

Lat.lastyeari TRICARE proposed to ext€nd coverag€ und.rthe kt€nded C.re HeahhOption for Applied Eehavior Anal'sis irtedentjons for Active Duty S€nice M€sbe6 whohave fanily menbe.s with autlsh spedrum disord€B, A.AP connented on tne proposedrul€ and conhended rhe Departne.tof Defens.forurd.rsklnstheimponanttaskorprcposlng heasures to nake it .ale. for adive Duty serice henbeB with children witlASD to bett.r aee$ needed healtl care s.dices lor their children,

ln shon, thouslt hor. resarch it n.ed.4 ABA h.s both long'term e6pln.al and res.archdata to denonstrate lt! efiectlveress r! h.lpln8 child@n who are dtagrosed with AsD, andMP has eldocedti. use ofAlAaeatoenlswh.n d.t.mi.€d apprcprlate by physlci.nsreithin a Eediol hone ln cl4e consulBnon elth ranlli$. ABA remai$ an active 3ublect ofrd earch and se enco u raSe ih. 0e pann enr of o.fe lse to na lntain flerlbility in theprcvislon ofABA *dic$ as n.w dzta hay .n.rxe.

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Berrhd just ABA seMces, ole way to hake it easler fo. nilltary parents with speclal needs

children wodd be to €xab lne how TRI CARE cune.tlv wo rk5 for tts ben€dciaries lh e

A@demy supporc leerslalion i.o oduced in the House-the TRICARE to. K.ls Act3' Phich

odd begin the proess of bakin g TRTCARE wo rk better ior all parents but especi.llv those

with children with ASD or otler 5pecial healti care needs

TRICARE for Ktb would requie TRICARE to estabush a worldnS group of relevant

stakeholders to review TRICARE policies and pcctices and develoP a plan to ensure th.tTRICARE meets dre pediatrk-spe.lfic heeds of hllltarv families, includins those childEn

wltn chronic and special health care needs. We believe this is a! excelle.t .ollaboEtivenodel to ensure that TRICARE tollces work lor all children tn military Iamtlles

Th,nk you for allowins ne to tesdry before the subconnlttee todav. As I said earlier,

canng for our nation's military fanilies and th€ir children bas almvs been ofla@nountlEporta.ce to. tleAherican Acad€ny of Pedlatris We nust do all ilat we @n to suppo't

ou; milhry families, especially tnose who h3ve the add€d challense of ra'sing cnid'e'wtth special health care needs.

I look foMrd to your questions.

I T!. TroCAi! for Xid! Ad *s $k.quouy indudd s 6 mddfd b rh.