You asked whether Connecticut has enough people trained to teach children with autism and work with their families and what approaches the state might adopt to develop a system for training such people.

SUMMARY

Connecticut, like most states, has too few professionals and paraprofessionals available to work with children with autism spectrum disorders (ASD). And many people working in the field do not have specific training in ASD. The causes for these shortages include:

1. an increasing number of children diagnosed with ASD,

2. the lack of ASD-specific training requirements or opportunities,

3. the need to train people in new methods of educating children with ASD, and

4. staff turnover.

Different training approaches may be needed to address these different causes.

Other states have established organizations and networks to provide professional development for people who work with children with ASD. Dr. Brenda Myles, an education professor at the University of Kansas and a national authority on preparing professionals in this field, cited four exemplary programs: Division TEACCH in North Carolina, the Indiana Autism Research Center, the Pennsylvania Training and Technical Assistance Network, and the Minnesota Autism Project.

These states rely on different institutions to run their programs. The North Carolina and Indiana models are centered in the state's flagship university. The Pennsylvania and Minnesota systems were initiated and funded by their state education agencies and are operated by independent entities.

The programs' scope also varies. Pennsylvania provides training in all areas of exceptionality, Minnesota's autism project is part of a larger program that provides training in other special education areas, and North Carolina and Indiana focus only on ASD.

All four states provide continuing education through workshops, conferences, and on-line and written materials that focus on teachers, paraprofessionals, other school personnel, and people working in early intervention programs. Typically, this training counts toward their states' continuing education requirements for most professions. Pennsylvania offers a graduate-level program specific to ASD, and staff in the Indiana center teaches autism-related courses at Indiana University. Division TEACCH specializes in a specific approach to working with children with ASD; the other three provide training in a variety of methodologies.

WORKFORCE SHORTAGE AREAS AND THEIR CAUSES

Shortage Areas

Connecticut, like most states, has too few professionals and paraprofessionals available to work with children with ASD. In addition, many of those working in the field do not have specific training in ASD. Shortages, both in terms of numbers and specialized skills, exist among

1. certified special education teachers from early childhood through secondary school,

2. speech and language pathologists,

3. behavior analysts,

4. paraprofessionals,

5. occupational therapists trained in sensory integration, and

6. faculty to teach these various specialists about ASD.

Shortage Causes

These shortages are attributable to several causes; each of which suggests different workforce development approaches.

Increasing Autism Diagnosis and Prevalence. More children are being diagnosed with ASD. The federal Centers for Disease Control (CDC) estimates that currently about 500,000 individuals between birth and age 21 have ASD. Between 1994 and 2003, it says, the number of children receiving special education who were classified with ASD increased six-fold, from 22,664 to 141,022; another recent analysis of national data found the prevalence of ASD among children requiring special education has increased annually over the past 15 years (“National Autism Prevalence Trends From United States Special Education Data,” Pediatrics, Vol. 115, No. 3 March 2005). In 1994, the CDC says, ASD was the 10th most common disability among children ages six to 21 receiving special education; today it is the sixth most common.

The causes of this increase are not known, but some attribute it to (1) the relatively recent (1992) classification of ASD as a disability requiring special education and a concomitant shifting of diagnoses from other disabilities, (2) better tools for diagnosing ASD, and (3) changes in classification patterns. Some people have also suggested environmental causes.

Regardless of the causes, the increased number of children with ASD suggests that more people in all shortage fields must be recruited and trained to work with them. This might be accomplished by (1) publicizing job opportunities in shortage areas; (2) expanding existing training programs to accommodate more people; (3) identifying areas in which training programs do not exist and creating new programs to address these; and (4) providing incentives to enter the field such as tuition reimbursement or stipends.

General Rather than Specialized Training. Most people in or entering a field in which they may work with children with ASD are trained as generalists and lack specialized training in ASD. This is particularly true of teachers and others who work in school settings. Special education teachers in Connecticut, like many states, are certified by the age of the children they teach (e. g. , birth to K, K-12).

The required course work for Connecticut's prospective special education teachers covers the growth and development of the gamut of exceptionalities (including gifted) and methods of identifying and teaching them. The same is true of the special education courses regular classroom teachers must take. Likewise, speech and language pathologists and school psychologists need not take any courses specifically in ASD to work in Connecticut public schools.

Teacher training programs in Connecticut's public colleges appear to offer few, if any, courses that specifically deal with children with ASD. (Southern Connecticut State University is in the planning stages of a master's level concentration in ASD). But Cathy Scutta, an educational consultant with Pennsylvania's Training and Technical Assistance Network (see below), notes that “the 'meat' of [ASD] therapy and instruction requires focused, in-depth training on various evidence-based strategies followed by practical application with a learner and coaching or guided practice from an experience educator or clinician. ”

Such specialized training is expensive in both time and resources. It may be most appropriate for active special educators who wish to concentrate on teaching children with ASD. It could be provided as part of graduate programs or through continuing education courses. Another alternative might be to create an autism certificate or endorsement for special educators (Delaware, Florida, Michigan, Nevada, and West Virginia offer specialized endorsements in autism).

New Methods of Serving Children with ASD. Increasing prevalence, new diagnostic tools, and more research have led to new, evidence-based methods and strategies to serve children with ASD. These include applied behavior analysis (ABA), facilitated communication, sensory integration, and relationship development intervention. In addition, earlier diagnosis means more children with ASD are being served at home in birth-to-three programs and in early childhood education settings.

Continued research and development of new teaching methods means that college faculty will need to keep up with these changes and get hands-on field experience with them across a variety of ages and levels of autism in order to train their students. It also means that people currently working with children with ASD need continuing education in the new research, methods, and strategies.

New methods and strategies may create new types of professionals to deliver services, for example various levels of behavior analysts to plan, implement, and monitor therapies. Traditional training programs, geared toward classroom teachers or school-age students, may need to be revised to train people working in new environments (e. g. homes and day care) and with new methods (e. g. , applied behavior analysis (ABA)).

Burnout. Working with children with ASD is physically, mentally, and emotionally exhausting, according to Scutta. Their parents are often very well informed about autism and sometimes know more than the professionals working with their children, who may have had only general training. Parental expectations add an additional layer of stress. These factors can lead to staff turnover and shortages.

EXEMPLARY STATEWIDE PROGRAMS

Division TEACCH (North Carolina)

The North Carolina legislature created the Division for the Treatment and Education of Autistic and Related Communication Handicapped Children (Division TEACCH) in 1972. It is housed in the University of North Carolina School of Medicine's psychiatry department. Division TEACHH claims to be the nation's largest statewide education and treatment program for children and adults with ASD.

The TEACCH approach focuses on the person with ASD and the development of an intervention program based on his or her skills, interests, and needs. TEACCH promotes structured teaching methods that include organizing the physical environment, developing schedules and work systems, making expectations clear and explicit, and using visual materials.

Operating through nine regional centers, Division TEACCH provides both services (diagnostic evaluation, individualized curriculum development, social skills, and vocational training) and training.

Training subjects range from characteristics of ASD to diagnosis and assessment, structured teaching methods, behavior management, and communications. Programs targeted to parents, special and general educators, specialists, and administrators are offered throughout the year.

Each summer TEACCH offers one-week intensive training sessions for new teachers and assistant teachers of classes for children with ASD. Training is open to North Carolina teachers and a limited number from other states and countries. The training combines presentations and opportunities to work directly with students under the direction of TEACCH staff. It emphasizes basic TEACCH model topics, like the characteristics and nature of autism, structured teaching, working with families, assessment, language and communication, independence and vocational skills, social and leisure skills, and behavior management. Summer training is also offered for people who work in preschool, early elementary, and adolescent and adult residential settings.

TEACCH also operates the Carolina Living and Learning Center, a residential and vocational program for adults. In addition to providing services for this population, the center offers training for professionals working in these settings. A weeklong training program in TEACCH methods is offered each fall and a two-day program in the winter.

Indiana Resource Center for Autism (IRCA)

IRCA is one of seven centers that compose the Indiana Institute on Disability and Community. It is housed at Indiana University. IRCA's goal is to conduct research, training, and consultations and develop and disseminate information on behalf of people with ASD. It focuses on providing organizations, professionals, and families with the knowledge and skills to support children and adults in early intervention, school, community, work, and home settings.

IRCA uses several training approaches. It conducts regional workshops for teachers and paraprofessionals on topics such as early intervention, education, adult services, and positive behavior supports. It holds one to three day intensive training sessions, often involving national experts. Because it is part of Indiana University, its staff teaches undergraduate and graduate courses in autism, positive behavior supports, and other ASD-related topics and lecture in other classes.

IRCA also employs a team training approach. Each year, special education planning districts are invited to send teams for an intensive, six-day training program. (Indiana organizes its 297 school districts into 66 planning districts that provide joint services for their members; they are similar to Connecticut's regional education service centers. ) In some instances, team members returning to their districts act as mentors or coaches for local staff. Over the past 10 years, IRCA has trained 224 teams.

PENNSYLVANIA TRAINING AND TECHNICAL ASSISTANCE NETWORK (PaTTAN)

PaTTAN is an initiative of the Pennsylvania Department of Education's Bureau of Special Education. It is an element of Pennsylvania's comprehensive system of personnel development (CSPD), which coordinates and facilitates efforts among state agencies, school districts, intermediate units (the equivalent of Indiana's special education planning districts), colleges, and early intervention service providers to recruit, train, and retain qualified personnel. (The federal Individuals with Disabilities Education Act (IDEA) requires every state to have a CSPD. Information on Connecticut's CSPD is available at http: //www. ctserc. org/cspd/. )

PaTTAN offers professional development and parent training, primarily in special education. Its scope is not limited to ASD, although this is one of its priorities. It delivers services through three regional offices whose staff helps assess local needs and broker or provide training based on those needs. Many of its programs are conducted on-line or via videoconference.

PaTTAN and Penn State University jointly offer a 12-credit, graduate-level certificate in autism targeted to special education teachers. The certificate does not affect a teacher's state certification or any other professional license. The program uses distance-learning media—the five certificate courses are offered via videotape or DVD, and interaction with instructors is through e-mail and Internet message boards.

But an Autism Task Force convened by the Department of Public Welfare (which administers the state's birth-to-three program) noted several program shortcomings in its 2004 report: (1) teachers of children with ASD are not required to take or complete the program, (2) too much instruction is provided via videotaped lectures, and (3) the program is available only through Penn State.

Penn State also offers (1) a 15-credit ABA certificate program designed to prepare participants for the national certification examination sponsored by the Behavior Analyst Certification Board, Inc. and (2) a 30-credit, two-year autism specialist master's program. The ABA certificate program consists of four graduate-level courses that students can complete in one academic year. The first three courses are offered via videotaped or DVD lecture, customized course materials, and supplemental online activities. For the final course of the series, participants attend the National Autism Conference at Penn State. (Students in Connecticut can access this program through UConn. )

The autism specialist program is targeted to special education teachers and speech and language pathologists. It focuses on medical, legal, ethical, and treatment issues; family and cultural factors; augmentative and alternative communication; and ABA. Participants receive tuition remission and a $ 700 monthly stipend. Educators completing the program are qualified for state teacher certification and the national ABA certification test; speech pathologists are eligible for professional certification and state licensure.

MINNESOTA AUTISM PROJECT

The Minnesota Department of Education's Special Education Division funds this statewide training and technical assistance project. The project's goal is to build the capacity of staff, districts, and regions to provide a full array of educational services for all students with ASD. Among its activities, the project:

1. provides advanced training throughout the state;

2. collaborates with higher education institutions to develop training curricula, on-line training materials, and an annual symposium for teachers; and

3. operates a teacher-mentoring project to help beginning teachers acquire the highly specialized knowledge and skills needed to teach this population, locate the resources they need, and overcome the isolation of working in this field, particularly in rural areas.

Project programs are delivered through an 11-region network. The autism project is one component of the Minnesota Regional Low Incidence Project, which provides professional development to teachers and others working with students with several other disabilities such as deaf-blind, visually impaired, and physically impaired.

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