I am writing as the mother of a young man with autism and significant communication needs, and as someone who has worked in special education and studied behavior analysis. Our experience with the current autism crisis system was horrible, and I believe families need to talk openly about what happens when autistic individuals experience a serious behavioral crisis. My son, Aiden, has limited communication, approximately at an early elementary level. When he is overwhelmed, he cannot simply explain what is wrong, what hurts, what he needs, or why he is behaving a certain way. During one crisis, Aiden injured his hand and ended up in the emergency room for **three days**. Police monitored him. He was unable to use the bathroom normally, and a condom catheter and urine collection bag were used. Imagine experiencing this when you have autism, limited communication, sensory sensitivities, and difficulty understanding why you cannot leave. After the ER, he was transferred in handcuffs toCCCA, where he remained for about a month. This was not an appropriate environment for what he needed, but there were very few alternatives. We were repeatedly told about REACH. Unfortunately, REACH was not able to provide the level of support Aiden needed. He was eventually discharged from a REACH step-down home because they could not safely manage his needs. **So where is an autistic person like Aiden supposed to go?** I strongly believe we need to recognize that an **autism behavioral crisis is not always the same as a traditional mental health crisis.** When someone has limited communication, behavior may be communication. Instead of only asking, “How do we stop this behavior?” we need to ask: What is he communicating? What triggered this? Is he overwhelmed, in pain, trying to escape something, or experiencing sensory overload? Autism-specific crisis intervention should include **BCBAs, behavioral assessment and positive supports, communication supports, sensory areas, low-stimulation and clean environments, medical and psychiatric support when appropriate, and staff specifically trained in autism and developmental disabilities.** We also need more proactive approaches—regulation, movement, mindfulness, sensory support, and early intervention before the situation reaches police involvement, restraint, or hospitalization. What concerns me most is what happened afterward. Aiden’s world became smaller and smaller.... Our family became more cautious about community activities and seeking crisis help because we were afraid of what another crisis could lead to. Crisis intervention should help a person return safely to their community—not make the community feel even more dangerous to the individual and family. I am not blaming individual police officers, nurses, doctors, or crisis workers. Many are doing the best they can within the system available to them. The system itself needs another option! Families need autism-specific crisis services that understand behavior, communication, sensory regulation, medical needs, and dignity. A family should be able to ask for help without wondering whether asking for help will create another trauma. Our autistic community deserves better.

I am glad the Council is discussing crisis support for individuals with autism. But the subject also exposes a continuing gap in Virginia’s system. People with intellectual and developmental disabilities do not necessarily fit neatly into an autism-specific system. Some have intellectual disability, significant behavioral needs, psychiatric diagnoses, or require residential and waiver services, but are not autistic. Their families still face the same crisis questions - who responds, what services are available, and which part of state government is responsible for making sure the person does not fall between systems? Virginia has an Autism Advisory Council. It also has a Disability Commission. Yet people with I/DD whose needs cross developmental disability, behavioral health, Medicaid waiver services, residential care and crisis response can still be left without an obvious public body looking at the whole system. I would therefore like to ask Deputy Commissioner Heather Norton a specific question: **When an individual with an intellectual or developmental disability experiences a behavioral or psychiatric crisis but does not have an autism diagnosis, what Virginia crisis system is responsible for that individual, and are the services, eligibility standards, response capacity and safeguards equivalent to those available to an autistic individual with comparable needs?** If responsibility is divided among several programs or agencies, I would also ask that those programs be identified specifically. The distinction matters. Government can organize itself around diagnoses and departments. Families cannot. We have one person in front of us, and when that person is in crisis, somebody needs to be responsible for the whole person.