Showing posts with label Healthcare. Show all posts
Showing posts with label Healthcare. Show all posts

 https://www.newsweek.com/dual-approach-autism-opinion-1818062

To drive true progress and improve the quality of life of all autistics we need BOTH Strengths_based_Opportunities AND Challenges_based_Solutions. 
It is not Either-Or.





#Autism #Research #Strengths_based_opportunities #Challenges_based_solutions.

 https://www.newsweek.com/dual-approach-autism-opinion-1818062

To drive true progress and improve the quality of life of all autistics we need BOTH Strengths_based_Opportunities AND Challenges_based_Solutions. 
It is not Either-Or.





#Autism #Research #Strengths_based_opportunities #Challenges_based_solutions.

 https://www.newsweek.com/dual-approach-autism-opinion-1818062

To drive true progress and improve the quality of life of all autistics we need BOTH Strengths_based_Opportunities AND Challenges_based_Solutions. 
It is not Either-Or.




#Autism #Research #Strengths_based_opportunities #Challenges_based_solutions.

Dispel notion that any medical intervention is inherently harmful


To drive true progress and improve the quality of life of all autistics we need BOTH Strengths_based_Opportunities AND Challenges_based_Solutions. 
It is not Either-Or.





#Autism #Research #Strengths_based_opportunities #Challenges_based_solutions.


 https://www.newsweek.com/dual-approach-autism-opinion-1818062

To drive true progress and improve the quality of life of all autistics we need BOTH Strengths_based_Opportunities AND Challenges_based_Solutions. 
It is not Either-Or.






#Autism #Research #Strengths_based_opportunities #Challenges_based_solutions.

Diagnostic Overshadowing Issue in Autism


To drive true progress and improve the quality of life of all autistics we need BOTH Strengths_based_Opportunities AND Challenges_based_Solutions. 
It is not Either-Or.





#Autism #Research #Strengths_based_opportunities #Challenges_based_solutions.


 

Dual Approach for Autism

My article in Newsweek 

https://www.newsweek.com/dual-approach-autism-opinion-1818062

To drive true progress and improve the quality of life of all autistics we need BOTH Strengths_based_Opportunities AND Challenges_based_Solutions. 
It is not Either-Or.





#Autism #Research #Strengths_based_opportunities #Challenges_based_solutions.

DSM vs ICD

The DSM (Diagnostic and Statistical Manual of Mental Disorders) and ICD (International Classification of Diseases) are two different systems used to classify mental disabilities. 
  • The DSM is used in the US and the ICD is used internationally. 
  • The latest version of the DSM is the DSM-5-TR, which was published in March 2022 (revision of the 2013 DSM-5). The latest version of the ICD is ICD-11. It was adopted by the World Health Assembly in 2019 and came into effect on January 1, 2022.
  • The DSM is more focused on clinical dx, while the ICD is more focused on public health.
  • Both systems use a multiaxial approach, which means that they assess mental disabilities on multiple dimensions, such as symptoms, severity, and functional impairment.
  • Both systems are updated periodically to reflect new research and understanding of mental disorders. The DSM is more detailed and specific and updated more frequently than ICD. 

The Autism - Parkinson's Connection

Research has found some evidence of a potential link between autism and Parkinson and that autistics are at higher risk for PD as they age. 

No surprise really as many autistics (like me) already have many movement-disorder-like movements, which really impacts our everyday functioning and which currently gets lost in the world of Autism dx overshadowing where everything is attributed to "autism" so nothing more need be done. 

Urgent need for research and translatable solutions

Apr 7 is World Health Day

Its the day the WHO was founded in 1948. 

Urgent need to step up to the healthcare needs of autistics. 

Biomedical research is a CRITICAL part of this solution. 


Health Care Considerations

April is Autism Solutions Month. 

Some Healthcare Considerations

Autistic and other high-support disabled people often need full sedation to access procedures like regular dental care, yet such procedures are rarely covered by insurance—which means people aren't getting the care they need, says @HariSri108.

Another medical care consideration from @HariSri108 is that often autistic people cannot tolerate the sight of medical implements like syringes. Providers can take simple steps like covering implements with towels until they are actually used.





Autism Solutions Month


We are way beyond talk of Awareness, way beyond talk of Acceptance, way beyond talk of Inclusion

We need TRANSLATABLE SOLUTIONS that actually assists us.

And we need it now. 

I'm calling April,  AUTISM SOLUTIONS MONTH





Research and the Testable Autistic

A fundamental issue in autism research is that again and again we are testing only a narrow band of "testable autistics." 

Essentially past and current research on Autism is oversampling the same ~30% of autistics, the testable autistics. Then we assume the results apply to all, when they do no. 

I was in a research stakeholder meeting last week where another autistic talked about the variety of different research studies she had participated in over the years. 

I was thinking of how many autism research studies where I've been a participant - it was ZERO, literally!! It was not that I did not want to, I was always in the exclusion criteria zone even in autism research. 

Growing up, I used to hear about what autistics are supposed to be thinking/doing, all based on the hundreds of studies that had already been done. And the thought was -  the results don't reflect me. Do I have the wrong dx?

We badly need to RETHINK RESEARCH METHODOLOGY along with new NEW TECHNOLOGY , so that we can expand this ZONE OF TESTABLE AUTISTICS so it's more representative of even those with high support needs like me. 

We can expand the range of testable autistics only if we use methods that don’t need fluent oral communication or fluent motor manipulation or expect a person to sit absolutely still. 

We need every neurodiverse/neurotypical mind thinking about this!!

So, what kind of methods can we use to extend the range of testable autistics.

We need to find answers and solutions for all autistics. THIS IS URGENT. 



Incoming Lambda

Not enough that we have a delta variant causing grief the world over. 

And now there a Lambda variant which is slowly creeping in. 

Image Source news-medical.net

A Thank you to Healthcare Workers around the world

From 6 Countries and 14 languages comes this tribute to healthcare workers around the world from the Sacramento based WeEmbrace and founder Meena Kalayanasundaram

Happy to have played tiny role in this compilation


My tiny bit

https://youtu.be/6gbMqJhSYi4


Crip Camp Conversations: Disability Leaders Respond to Coronavirus




The Best Audience Chat Comment undoubtedly was
"I feel like my life will now be measured as “pre this talk” versus “post this talk”. Thank you for this!" 

Amazing experience being on the panel for this webinar. Glad to be able to add value to this very important issue. 


I got several requests to share what I'd "talked" about in the webinar. 
Here are the slides and transcript of audio. 

Introduction 



Image Description. Young Indian American male sitting in front of a laptop. Black hair. Wearing a cap and T-shirt that say Berkeley.

Hi everyone. Thank you for having me here. My name is Hari Srinivasan. I’m a non speaking autistic. I type to communicate. I have a bunch of other challenges like oral-motor apraxia, ADHD, OCD, anxiety etc. 

I’m a student at UC Berkeley with a major in psychology  and minor in disability studies. 

This is my third semester as student instructor for a faculty sponsored semester long class on autism. I think of it as a way to change awareness in the way 30 students each semester will come to view disability and autism in their future lives. A majority of the students are non-autistic and able-bodied. We had a very interesting discussion on autism and covid-19 just two weeks ago. 

I’m also a student journalist for the Daily Californian. I get to write about many disability related issues which have included a column on autism. My two recent articles focused on social distancing and on healthcare issues surrounding the disability community during this pandemic. If you google my name and Daily Cal you should find links to these articles. 



I joined the board of ASAN, the Autistic Self Advocacy Network earlier this year. 

As the pandemic unfolded ASAN has really been working with other disability orgs to advocate for our civil rights. An early area was medical rationing, the combined advocacy has lead to non discrimination directives at various levels. But we have to continue to be vigilant that this is translated to in the field. 

ASAN is also branching out now to work on issues like making sure people who need a support person can bring their family member or communication partner with them if they are hospitalized, even if the hospital has a no visitors policy, as a reasonable accommodation under the americans with disabilities act. As a person with high support needs, this is an area close to home for me. 

In terms of home and community based services, ASAN is pushing very hard for the next covid bill to include emergency grants to service providers so that people can be supported in their homes, and to keep people from ending up in congregate settings. To make that possible, support people need personal protective equipment and higher pay, as well as emergency child care and paid leave. Some agencies need to hire more folks and rearrange how they provide services etc. ASAN is also tracking infections, hospitalizations, deaths from covid-19, of people with disabilities living in congregate settings, because we know those settings are so much deadlier than a person's own home. 

Several disability orgs, including ASAN, are partners on the #WeAreEssential social media campaign, which lays out a lot of these issues along with others.

Issues facing Students and Families during this time

Hari, we know covid19 has had a great impact on students and families. Can you tell us about student responses or your thoughts on this?



I’ve been informally polling other peer autistics and their families to find out their challenges. And, as an autistic with high support needs, I experience many of these issues myself as well. 

To start with, this pandemic is kind of like a waiting game filled with endless uncertainty and anxiety. If the abled bodied population themselves are having increasing mental health issues, it’s a multiplier effect on the disabled population. I’m hearing that even kids under 10 are getting prescribed antidepressants. 

In autistics this uncertainty and anxiety can also manifest in so many different ways. There has been a huge increase in all kinds of maladaptive behaviors, whether it's meltdowns, obsessive compulsive behaviors, aggression, self-injurious behavior, disturbances in sleep patterns and other things that add to the already stressful times. 

It's the disruption or even lack of access to support services, therapies and education itself. The remote education model or tele therapy does not work for many who need that physical one on one support and have other needs. I want to quote one parent who says that “only certain people with certain needs qualify for tele therapy.”  Students  who are transitioning between the school and adult programs, like one of my friends, are stuck in limbo with no help at all.  

Many autistics had been working on building independence in community based skills or social interaction skills. Many don’t have the same access to the outdoors or nature hikes as before even for physical exercise. 

Even prior to the pandemic, we as a community have experienced a great deal of social isolation and stigma; this lockdown has given it a frightening face.  Lack of these critical supports, therapies and social opportunities will mean a regression in skills for autistics. 

At the same time, many other skills and behaviors have to be un learned for the current time, such as shaking hands or holding the door open for others. Then there is other hygiene issues - autistics with impulse control issues find it hard to not touch surfaces or maintain a six feet distance. 

Even for those who are able to avail of some form of remote instruction, whether at school or college level, there are big time gaps between the classes, with basically nothing to do. While some have figured out ways to cope, others find this to be very isolating and suffocating. One of my peers says he is “super duper frustrated.”

A bright spot is that some autistics are enjoying remote instruction, where you are free from social interaction pressures. I can just mute my zoom to cut off my stemming noises. Keeping up with social expectations can be exhausting for autistics. 


Wearing a mask has presented another challenge as many autistics have sensory issues. 

Every autistic has a different set of challenges and things that calm or work for them.
 It takes time for families and other caregivers to figure these out. Those with higher support needs rely on caretaker familiar with their needs. During this pandemic the caregiver role defaults to the immediate family for many autistics.  What happens if those caregivers fall ill or if the individuals themselves fall ill. Will healthcare workers even know what to do, how to handle our “behaviors” and other unique needs?. 

Autism is wide spectrum which means that many have health co-morbidities, like seizures and gut conditions. Even during non-pandemic times, many of these go undiagnosed. How will doctors even begin to treat us. 

Many of us will need our support person with us if we need to be isolated or hospitalized. It is a scary thought to imagine being alone in a hospital. I am so happy ASAN, Communication First and other orgs are working on this issue,  That support people be not just be allowed to accompany us, but also be provided the PPE protective gear. 

Some of my peers have needed hospitalization for other issues during this time, which can be absolutely un nerving. 

 I can’t even begin to articulate the plight of autistics who are in group residential settings, especially the larger ones.They like nursing homes for the elderly, are sitting ducks. 



Now for another perspective.  I mentioned earlier that we had discussed autism and covid at the autism class at U C Berkeley for which I am a student instructor. A majority of the class are able-bodied students. What really struck me was the lack of awareness on the part of the non-disabled community. Some of the student responses in my class - from surprise to shock is so telling.  Here are a couple of sample reactions. 

“This entire pandemic is making me absolutely sick about how the disability community is being treated. Dehumanized and devalued. It’s not fair, it doesn’t make any sense”

“The disregard for people with autism, or any intellectual disability, by hospitals in the time of covid 19. It is saddening to see, especially when it is in direct noncompliance with the Americans with Disabilities act.”

“Something that surprised me was how people on the spectrum are being treated throughout covid 19. It actually makes me so upset that people need just as much medical attention as those that are being affected. Just because we are having a pandemic does not mean the normal life things just suddenly stop.”

The point I want to make by showing you these student reactions is that we need to work even more vigorously on awareness of these issues in the mainstream community to bring about change. We need even more allies in the non disabled community. Only then will change be easier and can happen. The current scorched earth scenario is laying bare all the inadequacies of the system. This is like a shocking wake up call of sorts.

What gives me hope

What is giving you hope or resiliency right now?



I am in awe, of the fierce advocacy efforts being done by organizations and individuals to keep our civil rights alive by making noise and lobbying and widely publicizing our issues. We need to make a lot more noise.

This time of need has also given way to so many random acts of generosity and kindness.
An example is the many different online free classes that have sprung up to help us through this hard time. I am able to try out new classes and am no longer limited by having to travel to a remote location amid traffic  to try these things.

Our new normal has meant that many of what we thought had to be social norms are no longer applicable. You don’t have to sit in a cubicle from nine to five to be able to hold down a job for instance. You can turn off the camera or the mic on your zoom if you want. You can choose to be heard and seen. 

I am also encouraged at how greener our earth is getting in just such a short span of time. Just cutting down traffic can have such a huge impact on our air quality. It gives me much hope that we can do something about climate change. And with people in lockdown, the animals are finally getting to enjoy the outdoors in peace which is again telling of their oppression. 

I am in deep admiration that many in the disabled community are not just helping out each other during this time but also participating in the greater community good, like making masks for healthcare workers.

Our strength of character and resilience is shining through. And that gives me so much hope for now, and the future.

A Call to Action

We have enough time for each panelist to make one call to action.



This has been a tremendous wake up call of sorts for all of us.

 I'll keep this call to action very short with ASAN’s big ask right now. 

We really really need people to call, to email, to tweet your congressperson, and demand funding for home and community based services. 
autisticadvocacy.org/2020/03/action-alert-covid19-relief/



Additional Audience Chat Comments
Fantastic insights indeed Hari. Thank you so much for sharing
Thank you Hari - great insights!
Thank you Hari for your positive words of hope.
Great insights Hari. 




A chilling waiting game: disability and healthcare during a pandemic


https://www.dailycal.org/2020/04/04/a-chilling-waiting-game-disability-and-health-care-during-a-pandemic/

A chilling waiting game: disability and healthcare during a pandemic


I have always taken pride in the tremendous progress (though far from perfect) that this country of mine has made in leading and furthering disability rights. Though I may be a minimally speaking autistic with comorbidities which significantly affect my daily functioning, and though the road has not been clear of bumps, such rights enable me to pursue higher education at UC Berkeley and aim for much more.


Now with the COVID-19 pandemic, people with disabilities like me all seem to be playing a chilling waiting game that is anxiety-filled. I wonder how long it will be before this virus impacts our family, caregivers and other supports we rely on for our wellbeing. If we are personally infected, how bad will it be? Death is an inevitability for all humankind, and I am not afraid of dying. However, what would be both macabre and tragic is if the death of a person is due to the fact of their life being thought of as not having value to society.


When I first came across the term medical rationing toward people with disabilities recently, my reaction was shock. It was even more disconcerting to learn that such practices are in play in this day and age and exacerbated by shortages in a developed country like the US, which is supposed to be a global leader in terms of resources, technology and medical research. 


Historically, our society has marked some lives, such as those with disabilities, as having less value and therefore as not entitled to all that the rest of society may take for granted. For instance, in my disability studies class at UC Berkeley we had learned of the eugenics movement and sterilization laws that targeted those with disabilities; they were termed “weak and feeble minded” and thus prevented from passing on their ‘defective genes.’ 


With respect to medical rationing, Samantha Crane, Legal Director and Director of Public Policy of the Washington D.C.-based disability rights organization, Autistic Self Advocacy Network, states that while some states may not have explicit written laws, they do have triage guidelines that deny healthcare to some people with disabilities. 


“For example, New York State Department of Health has guidelines saying that if there is a shortage of ventilators, doctors can consider ‘severe chronic conditions that adversely impact health functionality,’ like spinal muscular atrophy (SMA), when deciding who should have access to a ventilator. Even if someone was already on a ventilator before coming to the hospital, doctors can actually remove them from the ventilator if they don't meet the guidelines, said Crane.


From 2010 up until February this year, Alabama enabled healthcare discrimination against people with intellectual disabilities, with its now-unpublished, former ventilator triage  guidelines for mass-casualty emergencies stating that “children with severe neurological problems may not be appropriate candidates.” In my mind, this guideline impacts a significant percentage of autistic children alone, not to mention children with a wide range of other disabilities. It is concerning that these guidelines were in place until just this year. Tennessee and Washington are further examples of states with discriminatory guidelines.


According to Crane, many disability organizations across the nation at both the local and national level have been collaborating in the effort to file complaints with the Department of Health and Human Services, or HHS, in recent weeks in what has become almost a race against time. 


Lawrence Carter-Long, Communications Director and Director, Disability and Media Alliance Project, at the Berkeley-based Disability Rights Education and Defence Fund, also pointed to resources that the DREDF had compiled, “to give folks the resources necessary to fight back — do the homework basically — so other groups across the nation and in other states don't have to reinvent the wheel.”  


These resources include information on the Illegality of medical rationing on the basis of disability as well as a letter to Governor Gavin Newsom urging him to prohibit such healthcare rationing.


Carter-Long explained, Our intention with this material was/is to 1. make sure this is on the Governor's radar and to go on record, 2. compile the necessary resources for other groups across the nation and 3. create a template other advocacy organizations can use with minor changes.”


On March 28, the HHS Office for Civil Rights released a bulletin telling medical providers they could not discriminate against people with disabilities. Roger Severino, OCR Director is quoted in the bulletin as saying, “Our civil rights laws protect the equal dignity of every human life from ruthless utilitarianism. Persons with disabilities...should not be put at the end of the line for health care during emergencies.” 


In addition, on March 30, the California Departments of Health Care Services (DHCS), Public Health (CDPH), and Managed Health Care (DMHC) issued a joint bulletin stating, “The State of California understands that people with disabilities are concerned that medical providers might consider an individual’s disability status when determining which patients to treat if hospitals or other health care facilities experience a surge of patients needing life-saving care. This joint bulletin reminds health care providers and payers that rationing care based on a person’s disability status is impermissible and unlawful under both federal and state law.


But whether these directives will translate to reality in a field that is already absolutely overwhelmed and desperately short of resources during a pandemic remains to be seen. 


Clarissa Kripke, M.D is a Health Sciences Clinical Professor and Director of the Office of Developmental Primary Care at UCSF. Kripke is on the frontlines of this pandemic and felt that “one thing that confuses doctors is that function has been used as a proxy for life expectancy.” 


She explained by the time someone is having functional problems due to age or chronic disease  in their vital organs, those organs have very little capacity left and any little thing could be fatal. So loss of function is associated with a poor prognosis if the reason for the loss of function is severe damage to one or more vital organs from age or disease.


Kripke, who is also Vice-Chair on the board of Communication First, which advocates for communication-disability civil rights, added that people with neurological conditions often have severe functional or cognitive problems, but perfectly healthy vital organs. In that situation, poor function doesn't mean poor prognosis at all. According to Kripke, people with disabilities and healthy vital organs benefit greatly from aggressive medical care. 


“In the language of rationing schemes this distinction often gets muddy and people are assumed to be dying even when they are not. Function or diagnostic labels such as intellectual disability or autism should not be used to estimate likelihood of benefiting from medical treatment. Only signs of the health of vital organs should be used, Kripke said. 


Kripke wants to stress that the lives of people with disabilities are meaningful and valuable. She feels that healthcare rationing is not inevitable and that it instead will be determined by two things. First, the degree to which we collectively and individually do our part in stopping the spread of the virus, and second, how soon we do it. If we take action too late, then we face untenable rationing in which there is no justice any way you look at it.  


It would be helpful if we could predict who will benefit from treatment, and who will not, but we don’t have a way to do that accurately. Healthcare by lottery isn’t a better solution, Kripke said. 


Since there is no known cure for COVID-19, your immune system is the main thing that will fight the virus, explained Kripke. By the time someone is critically ill enough to need a ventilator, their prognosis is poor, with or without a ventilator, and there is little healthcare professionals can do to change the course of the illness at that point. So she would like everyone to really focus on optimization of compliance and prevention strategies. 


According to Victor Pineda, every field of ethics incorporates value judgments, and there are evolving conceptions of what justice is and what is ethical or unethical. Pineda is a world renowned human rights activist, UC Berkeley adjunct lecturer at the department of city and regional planning and Director of Inclusive Cities Lab at the Institute on Urban and Regional Development.


He explained in modern times, people with disabilities have been seen as deficient or as an expense or liability to society. At the same time, we have the universal declaration of human rights like the UNCRPD (United Nations conference on the rights of people with disabilities). The current situation is thus an opportunity to rethink medical ethics in ways that follow the principles of social justice.


“In these times we are really tested to show who we really are, what we really care about, what are the values worth fighting for, what are the values worth defending. Do we value human rights and human dignity, social justice and equality? It's exactly when we should be most challenged, that we should live up to those highest morals and aspirations,“ said Pineda.


Pineda has a neuromuscular condition that requires him to use a wheelchair and a machine to breathe so he can live with his current 9% lung capacity. His machine provides non-invasive pulmonary breathing support in that it goes over his nose. He took the decision to self-quarantine early on during this pandemic to reduce risk. 


Right now he feels that he lives in this existential level of threat that is assaulting not just entire systems and economies, politics, policies and institutions, but also his personal wellbeing. Pineda has had to engage in different risk assessments relative to his personal care.


 “Who will care for me? How responsible are they? How closely will they follow protocol, in terms of hygiene, in terms of cleanliness, in terms of washing their hands, in terms of washing my equipment, wiping down surfaces? What is the cost associated with that much higher level of care? ... So with that I think we are in a very difficult place, said Pineda. 


Pineda had been advised by his Stanford pulmonologist not to go to the hospital if infected with the virus and instead to maximize his settings at home and try to recover there. Should he reach a point that he simply can’t breathe, then he will need to go to the hospital to be attended to. 


The problem is that Pineda would not be able to go to the hospital by himself as he needs an attendant to even take him there, which puts him at tremendous threat and risk. It is akin to someone who is deaf and unable to go without a sign language interpreter. 


In addition, Pineda said his ventilator would be confiscated as it does not meet certain criteria and he would be intubated, wherein they put a tube down his throat and perform a surgery called a tracheostomy. So the thought of going to the hospital without the two things he most needs — his ventilator and his attendant — is very scary for Pineda. 


I have to echo Pineda's sentiment that this is all quite scary as the unfolding events feel out of control. An issue that has been on my mind is that those of us with more significant disabilities and limited spoken language ability are highly dependent on parents, family or known caregivers for much of our basic living skills support. I can just imagine my already limited communication skills absolutely shutting down when in trauma or when ill.  The thought of being quarantined or left alone without support is frightening. 


I also wonder what happens if both our parents or our primary caretakers during this time get infected. And what happens in the case of a single-caretaker home, for not everyone comes from a large circle of friends and support. Even in ‘normal’ times, public service agencies for the disabled community like the Regional Centers set up by the California Department of Developmental Disabilities take time in setting up or coordinating services; they would be utterly overwhelmed in a pandemic that requires almost immediate responses. 


But while the immediate future has a level of uncertainty, Kripke also offered advice for individuals with disabilities and their families during this time of the global coronavirus pandemic.


The first is that it is important to have access to food, medications and supplies that people with disabilities rely on to maintain good health and also access to consistent paid and unpaid support. 


She stressed that retaining your rights and being safe and wise are not the same thing. People who moved around before the shelter-in-place took effect unwittingly may have contributed to the public health crisis. She also points out that although you may be entitled to services in your home, providing those services could pose a risk to you and your family. Therefore each of us needs to make good choices about what risk is “essential.’ 


Kripke also felt that the complex support needs of individuals with disabilities may mean even stricter physical distancing requirements than for the general population to reduce the risk of exposure for individuals and their caregivers. It may mean postponing medical procedures or forgoing important but non-essential services. 


It may also mean getting telehealth advice rather than risk physically going to a clinic, she continued, as there is not only the danger of your getting infected or spreading infection, but also the risk of being separated from your advocates and communication support. While hospitals could make individual exceptions, there are reasons why a support person is not allowed as they risk being exposed to the coronavirus in addition to hospitals not being able to spare protective gear for the support person’s use. For some people with disabilities, it makes more sense to provide enhanced treatment at home rather than receive care in a hospital. 


If, however, you are having an emergency where minutes matter, she urges you to call 911. 


Kripke stressed putting together a circle of support, as you also need to think about who would provide care if your supporters or parents are sick. She pointed to a webinar by California-based Disability Voices United on Coronavirus Emergency Preparedness discussing tools that could help individuals with disabilities and their families think through such a plan. In the webinar one parent actually expressed the sentiment that what terrified parents was not dying as such, rather it was dying and leaving their disabled child (of any age) without support. 


Kripke also advised developing a plan for what you will do if one or more of you in a household develops a fever or cough. If you need personal assistance that requires close contact, then your household should try to secure protective equipment (masks, gloves, eye protection, gowns) to address the first 72 hours after someone in the household becomes ill to avoid spreading the virus in the home. You may be able to get more supplies from your department of public health if someone is sick. 


While it is not possible to provide care to a sick person without getting exposed to the virus, she advised trying to limit exposing all supporters. This may mean some family members moving to a separate room or out of the house for a period. And if possible, exposed and unexposed people should not share bathrooms. 

Other important issues according to Kripke are not allowing the more flexible regulation and oversight to lead to increased abuse and neglect; protecting service providers' health and economic interests; and access to safe quarantine centers if sick people with disabilities, housemates, family members or service providers need to be separated. Discrimination and social isolation are also important issues to be considered. 


Kripke is appreciative that the Bay Area’s early and aggressive spatial distancing and shelter in place directives are being taken seriously by residents and is proud of local, city and state leaders who are sending consistent and appropriate messages, taking action and calling upon all of us to do our part. She sees the community too is coming together, and she encourages everyone to keep it up. 


She feels that if we do our part to flatten the curve, public health departments and hospitals and regional centers will have more time, personnel and resources to help solve problems and accommodate. In the meantime, any solutions you come up with your friends, family and trusted community organizations will probably be safer and better than the ones they will be able to arrange. 


Kripke leaves us with some very encouraging words of advice: Let’s use this crisis as an opportunity for community organizing and sending a message that none of us are expendable. We won’t leave anyone behind. Our country has problems, and we are the solution. We can save ourselves, our families, our community, our country, and our world by sharing information, working together, acting in unison, and helping each other.”