Barriers to Healthcare in an Insured Latino Population with ASD

Background:

In the United States, ethnic minorities are more likely to receive inferior mental health care than Whites. The disparity extends to autism spectrum disorders (ASD) where Latino children experience critical delays in diagnosis and treatment. These health care disparities are partially explained by structural barriers, such as lack of insurance, or limited availability of services. However, even when controlling for structural factors, ethnic minorities underutilize available health care services. This exploratory study will identify barriers to accessing resources and recommended assessment, diagnostic, and treatment services for ASD among Latino children receiving healthcare at Kaiser Permanente Northern California (KPNC).

Objectives:

To describe how socioeconomic and language factors affect access to healthcare resources and utilization of behavioral and mental health services among Latino children with ASD across target subgroups defined by insurance type (Commercial vs. Medicaid) and primary language (English vs. Spanish).

Methods:

We identified all Latino children with ASD among the membership of KPNC (N=3263). English and Spanish survey materials were mailed to 1164 parents in the 4 target subgroups with the goal of obtaining 100 completed surveys per subgroup. Three weeks after the initial mailing, we called non-responders to invite them to complete the survey by phone. The survey covered parental access to information about ASD services and resources, barriers to use of ASD services (e.g., cost, lack of awareness, logistics, language barriers), parent literacy and health literacy, and social determinants of health and healthcare access (e.g., food insecurity, trouble paying for different basic necessities, transportation difficulties, social support). Data collection began in 2018 and is ongoing. Differences by language and insurance type were examined for the first 50 completed surveys in each subgroup (total N=200).

Results:

Significant differences by language were seen regarding low educational attainment (76% of Spanish vs, 19% of English speakers had no education beyond high school and 36% vs. 3%, respectively, had not completed high school), health literacy (34% of Spanish vs. 3% of English speakers lacked confidence filling out health related forms by themselves), receiving unpaid help with their child from friends/family (71% of Spanish vs. 44% of English speakers), never or rarely getting enough social and emotional support (52% of Spanish vs. 38% of English speakers), and use of the patient portal to communicate with their child’s clinical care team (18% of Spanish vs. 75% of English speakers). Significant differences by insurance type were seen for household income < $35,000 (48% of Medicaid vs. 11% of Commercial), trouble paying for housing (18% of Medicaid vs. 8% of Commercial), and trouble paying for ASD services (7% of Medicaid vs. 35% of Commercial). Approximately 1/3 of the sample was food insecure, with notable differences in prevalence between English-speaking Commercial (16%) and English-speaking Medicaid (50%).

Conclusions:

Preliminary results indicate that in this population of insured Latino children with ASD, family social and economic risk factors such as low income, low health literacy, and lack of social support may limit parents’ ability to utilize developmental evaluations and specialty ASD care for their children.