Do Diagnoses Smell as Sweet Under a Different Name?


Pardon the bad Shakespeare.  The American Psychiatric Association appproved the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, referred to as the DSM-5.  A number of articles have appeared on disagreements in its development, most notably about changes to the definition of autism.  The intention of revisions is sensible and practical:  to create consistency in approaches in order to identify best practices and make sure people get the most effective treatment possible.  The fear is that a change in definition might lead to insurance no longer covering a particular treatment or diagnosis, or a child no longer qualifies for special education services.

Here in Illinois, our fears came true over the last 15 years or so.  Our state grant to fund our workshop services was eliminated a couple of years ago.  That wasn’t just a funding cut–it was also the state completing a long process of re-defining developmental disability and ending eligibility for funding for people who once qualified for services.  The majority of people with IQs over 70, though they may need services and supports, can no longer receive them funded by the state.  The main reason for this change was financial–the state needed to utilize the definition under their Medicaid Waiver in order to get federal match money.  Since the state needs every resource it can get, this makes sense.  Also, it’s hard to talk about serving people who no longer meet eligibility requirements when there are 20,000 people who do meet them and cannot get them because there isn’t enough funding available for everyone.

Still, it’s important to recognize these people.  We don’t meet them as often as we used to here at SU, but we see them.  They still meet the qualifications for community employment services through the Division of Rehabilitation Services.  When we see them it is usually in their early 20s.  They left high school and didn’t go on to much…maybe a few jobs that just didn’t work out.  They have lost their good habits from school and also lost a lot of confidence.  The community employment services are pretty limited support–help the person get a job, support them to stay in that job successfully for at least 90 days, get paid.  That’s not always enough, so we give some of these young people work experience in our workshop.  It’s nothing funded by the state anymore, but it’s what they need.  The support we receive from our community makes this possible since the state eliminated the funding.

What would become of these folk without the additional support we find a way to give them?  Some might luck into a good job situation eventually and be just fine; some might continue from job to job and never build any measurable success and confidence; some might follow the wrong crowd and end up in jail or prison.

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