Wisconsin Evaluates Sensory Integration Effectiveness—Not Just an Isolated State Issue


By Stephanie Yamkovenko

Autism coverage continues to be a hot state policy issue. More than 30 states have laws that mandate coverage of treatment for children with autism, and AOTA has monitored and worked with state associations to ensure that occupational therapy is recognized as an important provider of services for children with autism.

Recently the Wisconsin Occupational Therapy Association (WOTA) alerted AOTA about a request from a state agency asking for the latest research on the efficacy of sensory integration for children with autism. “Both WOTA and AOTA realized that this was an opportunity and a challenge,” says Chuck Willmarth, AOTA’s director of state affairs. “AOTA staff assembled state and national leaders to develop a plan of action.”

AOTA staff had worked with immediate past AOTA President Florence Clark, PhD, OTR/L, FAOTA, and her team at USC to respond to questions about sensory integration in the past. “It was natural to invite her team to join the discussion,” says Willmarth.

For nearly 2 years during her AOTA presidency, Clark had studied the efficacy of sensory integration and reviewed reports and research about the topic (read about Clark’s work on the California Autism Advisory Task Force). Drawing on that experience, Clark and her team offered to develop the testimony for the Wisconsin Division of Long Term Care.

“I knew that we had a strong case that sensory integration therapy was not an experimental intervention and there was accumulating evidence that demonstrates positive outcomes,” says Clark. “I wanted to advocate on the basis of evidence.”

Clark’s team volunteered to collect the latest research and write a letter to the agency’s Treatment Intervention Advisory Committee (TIAC). AOTA and WOTA submitted the letter in early summer and provided testimony at a public hearing in July. The consensus was that Clark would be the best spokesperson, and she traveled to Wisconsin with Christina Metzler, AOTA’s chief public affairs officer, to deliver the testimony in person.

“What we are trying to do is to ensure that children get the services that meet their individualized needs, including occupational therapy,” says Metzler. “We want to make sure that the full spectrum of occupational therapy, including, but not limited to, those addressing sensory issues and approaches that use sensory integration procedures, are available to children with autism and their families.”

WOTA leadership provided support during the collaboration by inviting a consumer family to testify about the effect sensory integration has had on their lives and helping AOTA understand the payment system in Wisconsin and the problems that practitioners face when billing for sensory integration.

“There is definitely accumulating evidence of the effectiveness of sensory integration,” says Clark. “With 94% of children with autism having sensory abnormalities, it is very important that they be afforded the opportunity to access our services.”

Clark’s testimony made it clear that sensory integration therapy must be differentiated from other intervention approaches used in occupational therapy. “It’s one intervention among many that occupational therapy practitioners use,” says Clark. “I wanted to make sure that TIAC understands that occupational therapy practitioners use many interventions.” These can be grouped into broad categories such as those which are sensorimotor-based (e.g., sensory integration therapy) or performance-based (e.g., Cognition Orientation to (Daily) Occupational Performance or CO-OP). 

AOTA devoted the time and effort with this issue because of the possible implications it could have. “This could be viewed as an isolated state issue, but we know that it is important and can be an example to other states for addressing services for children with autism,” says Metzler.

Clark wants all members to know that occupational therapy interventions are being evaluated for the strength of their evidence by policymakers, and that there is accumulating evidence of the effectiveness of sensory integration therapy. “AOTA is joining state associations in advocacy efforts to ensure that our interventions are appropriately assessed,” she says.

“This could be a model case for what’s covered in the new health care reform exchange programs and the Medicaid expansion,” says Metzler. “This effort in Wisconsin is really benefitting the whole profession.”

Stephanie Yamkovenko is AOTA’s Web editor.