An Examination of Disparities in Patterns of Use of State-Funded Disability Services

Background: Access to effective, evidence-based services for youth with developmental disabilities in the community is limited, especially for ethnic minorities populations where significant disparities in identification, service entry and utilization are documented (Mandell et al., 2002, 2005, 2007). There are a growing number of large-scale, system-driven efforts to address service disparities but little is known about the specific patterns and influences of service usage disparities among minorities, which are key to informing efforts to address service disparities. In 2016, the State of California Department of Developmental Services launched a large-scale initiative to address disparities in care for Latino clients statewide. To best inform this effort, the San Diego Regional Center (SDRC) prioritized the identification and tracking of disparities in current service expenditures and authorizations by ethnicity and race.

Objectives: The aim of the current study is to examine patterns of service use and expenditures for individuals with developmental disabilities receiving state-funded disability services to identify service disparities by ethnicity and specific disability. Service use patterns from birth to adulthood were also examined to identify age groups in which such disparities emerge.

Methods: SDRC administrative claims data from fiscal years 2014-2015 were extracted. Purchase of service (POS) data for 27,343 SDRC clients were used to characterize service utilization patterns, including differences in service use by ethnicity as well as disability group from birth to adulthood. Specific disability categories include intellectual disability (ID), autism spectrum disorder (ASD), and comorbid medical issues.

Results: Analyses indicate significant differences in POS for Latino and Non-Latino/White clients (F(3,27,332)=107.47, p<.01), with smaller POS for Latino clients. Follow-up analyses aimed to understand patterns to these disparities revealed a significant 3-way interaction between ethnicity, age, and disability types. Post-hoc analyses revealed significant differences in POS between Non-Latino/White clients and Latino clients with ID that emerge between the ages of 14-18:11 and for clients with ASD that emerge between 16-18:11 years of age, with lower POS for Latino individuals. A similar pattern was observed for individuals with comorbid ASD and ID, ID and medical issues and ASD and medical issues beginning at ages 19-21:11. Further analyses examining these disparities by service type will be discussed.

Conclusions: These results provide relevant information for targeted disparity reduction efforts, including identification of strategies targeting these age ranges.