A Mixed Methods Investigation of the Kansas Autism Waiver's Implementation: The First Three Years

Abstract

This mixed methods study employed quantitative and qualitative methods as means of evaluating the Kansas Autism Waiver's first three years of implementation. The study was guided by the components of a quality assurance analysis and, to the extent possible, considered the fidelity of implementation of the waiver procedures. Data sources included child demographic variables, KAW service use variables, Vineland Adaptive Behavior Scale II (VABS II) standard scores, and the shared perceptions of parents, KAW service providers and management professionals Findings included the existence of long waiting periods for children to be assessed for eligibility and to begin services once eligibility has been determined and a general underuse of all but one KAW service (i.e. Autism Specialist services). However, participants were primarily concerned with the intensive individual support service (IIS) and the need for more hours of intensive individual service providers. Numerous barriers to this service were identified, but the qualitative participants voiced no concerns about the sufficiency of the other services. Participants saw the coordination role of the Autism Specialist as very valuable and saw the required training offered by the waiver as useful and the function of the steering committee and support provided by the KAW program manager as important. The complexity of navigating the system and the need to better coordinate with other Developmental Disability waivers were also noted. The analyses of the VABS II standard scores as a measure of child outcomes were inconclusive and difficult to interpret and revealed scoring errors. The qualitative analysis also indicated concern with the present eligibility assessment and reevaluation system that relies on the VABS II Adaptive Behavior Composite standard scores. Despite the concerns raised, participants in the qualitative component of the study reported a number of positive child outcomes and expressed a high degree of satisfaction with the waiver. The implications of the results and recommendations for KAW procedures and policies are also offered.