By James G Baker MD MBA
Child Psychiatrist and Chief Executive Office
Metrocare Services, Dallas, Texas
In my clinic a few weeks ago I saw a teenage boy with autism who is struggling with his behavior both at home and at school. The family pediatrician had tried all sorts of medications to help but to no avail. His parents were exhausted from managing him, as he is a big youngster, and quite strong when he gets agitated.
His parents came to our community center seeking respite services. Respite is a service that pays for a professional who can give parents a break for a few hours from the 24-hour caretaking that many children with developmental disabilities require. It is a “safety net” service that we, as taxpayers, have traditionally funded through laws passed by our legislature.
Although generally savvy politically, my new patient’s parents were totally unaware of the recent cutbacks in state funding that left their son — and many other children and families — on a waitlist for respite services. Fortunately there is no wait for behavior therapy, and so one of our dedicated young clinicians started working with the boy both at home and at school.
He is doing better now, but I was struck by how this family’s timing in seeking services left them caught up in the ever-changing currents of public-sector funding streams for health care. After all, if they had come to my clinic just a few months earlier, they would have received the respite they sought.
Cuts in funding now and the unknowns about the costs of future health system reform offer huge challenges for public-sector physicians who want to provide high-quality care to all of our patients yet sometimes lack the funding to offer a patient any service, at all. It seems to me that taxpayer and legislator education is critical if physicians and patients are to successfully navigate the choppy waters ahead in health system reform.