The disability service sector finds itself at a crossroads. The current federal administration is working with Congress to reduce the size of government and overall spending levels. It is likely that this will affect Medicaid Long Term Service and Supports in many states, creating concern within the intellectual and developmental disability (I/DD) community about the future of the service systems on which they depend. Medicaid remains the most significant funding mechanism for autism and I/DD services in the United States.
This environment has prompted provider agencies to re-evaluate the sustainability of their service models. As aSuggestion, an innovative digital health ecosystem designed to support individuals with developmental disabilities, their families, and caregivers, interacts with its provider network across the country, a consistent theme is emerging: the savviest organizations are deciding that they need to put a digital health strategy in place to meet the challenges in the current funding environment. Those that do are likely better positioned to weather future uncertainties than those that do not.
This is especially important as many providers are still struggling to return to pre-pandemic staffing levels, as reflected in recent national surveys, like ANCOR’s 2023 survey. The impact of inflation on wages has also exacerbated staffing issues, as the meager wages paid to Direct Support Professionals have led to a loss in their buying power, prompting them to search for better pay elsewhere. Even before the pandemic, staffing ratios were often strained. Today, many agencies face even greater challenges in maintaining adequate staff-to-client coverage.
At the same time, long-standing concerns about waitlists continue to plague the system. Even before recent budget conversations began, many families were waiting months or even years for access to services. Now, with potential budget contractions and limited human capital, these waitlists are likely to grow. In a scenario where agencies are forced to serve fewer people, those currently receiving support may be at risk of losing it. If a provider that once served 1,000 individuals can now only support 700 due to resource limitations, then 300 individuals could suddenly find themselves without services.
One potential solution to the uncertainty that currently exists in the funding system is the partnerships that several agencies have formed with aSuggestion to deploy digital health ecosystems designed to expand access, reduce strain on in-person services, and offer meaningful support to individuals, families, and caregivers alike.
These ecosystems are not merely extensions of traditional online content libraries. They represent interactive, personalized, and dynamic platforms that engage individuals through social experiences while promoting education, wellness, and self-determination. Each digital environment is responsive to the specific interests of the users, providing them with a safe and supportive social media-style experience where they can connect with others, explore new interests, and build new skills in a fun and friendly space.
Through these platforms, the users with I/DD can access curated educational content, contribute to community discussions, and search for real-time answers to everyday questions like how to do laundry, how to prepare a meal, or how to navigate a job interview. A wide variety of videos, interactive modules, and learning resources are available. AI-driven supports also help guide users in productive directions, gently redirecting content or behavior that may be unhelpful, inappropriate, or confusing.
To ensure a safe user experience, advanced moderation tools are built into the system, supported by live human moderators and automated systems that flag concerning behavior or language. The platform is designed to be predator-free, prioritizing both the safety and privacy of its users. This infrastructure allows users to engage anonymously with real-time monitoring by AI systems that provide notifications to their families and caregivers based on certain red flags built into the system.
In addition to supporting individuals and professionals, these digital ecosystems are also being developed as supportive spaces for families. In the same safe, secure, and constructive space that supports individuals, families can connect with one another through various forums that they can join, which enables them to share ideas and encouragement. This environment fosters a community of learning and empathy, where families no longer feel isolated in their day-to-day caregiving efforts, helping to address the burden of care.
Likewise, education of paid caregivers (who we call Direct Support Professionals or DSPs) is a critical component of this evolving model. The aim is not simply to assign tasks to DSPs but to equip them with the skills and strategies necessary to promote the independence of those they support. For example, it’s long been understood that the role of DSPs should not be merely to do laundry or cook meals for someone they support, but rather, teach that person how to sort, wash, and care for their own clothing or to learn how to cook for themselves. However, the DSPs need to be guided in teaching techniques to help individuals in skill acquisition. Content and supports tailored for their efforts are no less important than any of the other constituents served across the platform.
The platform offers powerful backend features. Activity summaries, user trend reports, and behavior flags can be automatically compiled and securely shared with family members. These summaries can be formatted for integration into Electronic Health Records (EHRs), reducing documentation burdens on agencies while improving care coordination. When specific behavioral triggers are identified, alerts and notifications can be sent directly to support teams, helping them respond quickly and appropriately.
Thanks to their digital nature, these ecosystems also eliminate geographic limitations. Whether a family is located ten minutes or five hours from the nearest service agency, they can now access high-quality digital support at any time. This approach provides much-needed relief for families in rural or underserved communities.
A prime example of this collaboration is taking shape at The Roland Center in California. Their team, led by Dr. Thomas Buckley and Thomas Cook, S.Psy.S., is actively contributing clinical content and staff training information that informs the AI and content moderation layers behind the scenes. By embedding clinical intelligence into the system architecture, the platform is able to offer better structure, support, and guidance to all users, helping them grow in confidence and independence.
“Families are looking for support from service providers, but with funding shortfalls and a shortage of Direct Support Professionals to do the work, even in a state like California, which has an entitlement to I/DD services, it’s hard for them to get some relief,” Thomas Cook said. “With aSuggestion, The Roland Center can literally provide a portal for the loved ones of families who would like additional support options to access all the features of the platform. We’re excited to be partnering with aSuggestion on this innovative option for families to find a meaningful alternative to social media sites like Facebook that offer nothing of value to their loved ones. It’s the difference between what Sesame Street has offered to children vs. Looney Tune cartoons.”
Other key partners contributing to this national initiative include:
- Kevin Salera at Charles River Center in Massachusetts,
- Katie Svihlik at GoldStar Learning Options in Colorado,
- Adam Tyus at Arc of Central Alabama in Alabama,
- Bill Myhre at Eden II in New York,
- Brandt Emory at Ability Focused in Delaware.
Each of these leaders is playing a role in shaping the future of digital support through their insight, leadership, and commitment to innovation.
This creates a synergy on the platform because each participating agency contributes resources and expertise to the broader ecosystem. For instance, one partner agency might contribute content on emotional intelligence and communication strategies for direct support professionals. Another might build a video curriculum for individuals learning daily living skills. These contributions enrich the platform and improve the user experience for everyone involved.
Perhaps most importantly, the business model underpinning this work ensures that partner agencies, content contributors, and platform providers benefit as enrollment increases. A revenue-sharing structure rewards those who invest their time, talent, and resources into building the ecosystem. This helps sustain innovation and ensures that this digital health movement continues to grow.
While the field of autism and I/DD services faces significant challenges ahead, there is also an opportunity to innovate to supplement what the current service delivery system does for individuals and families. Digital health ecosystems offer a path forward that is scalable, sustainable, and person-centered. By embracing technology, collaboration, and shared learning, agencies can extend their reach, improve their impact, and empower the communities they serve.
Greg Wilson is CEO of aSuggestion for Wellness & Care.
