32366
What Services Do Preschoolers with ASD Utilize? Comparing Services in Two US Cities
Although 48 states in the United States have enacted laws requiring health plans cover autism-specific therapies, there is high variability in the legal requirements across states (Baller et al, 2015; Autism Speaks, 2018). Additionally, there are large disparities in access to services for children with ASD in minority groups (Mandell et al, 2002). Although the education system plays a critical role in providing services for preschoolers with ASD (Brookman-Frazee et al., 2009), increasingly, families are accessing additional services through insurance-funded programs. Recent research examining the effect of autism insurance mandates indicates an increase in insurance-based services, but also significant ongoing barriers to expanding access to services to meet need (Baller et al., 2015; Candon, 2018). More information is needed to understand how demographic factors and state and local policies affect children’s service utilization. Due to ongoing challenges with service access (Thomas et al, 2007), it may be useful to examine and compare regional service utilization in a diverse sample in order to understand where to intervene to improve access for underserved youth.
Objectives:
Explore differences in service use based on sociodemographic and geographic factors by comparing parent report of non-school based ASD services from preschoolers in Pennsylvania and California.
Methods: Data from two longitudinal studies of preschool children (3 – 5 years old) with ASD receiving publicly funded educational services in Philadelphia, Pennsylvania (N = 71; 83% male; 55% Black/African American; 18% Hispanic/Latino) and San Diego, California (N = 144; 80% male; 36% Hispanic/Latino; 2.8% Black/African American) were analyzed. Parents reported their children’s current non-school based services (e.g., speech therapy, occupational therapy) via interview (Philadelphia) or questionnaire (San Diego). Chi-square tests of independence were run to examine differences.
Results: Table 1 summarizes the percent of preschoolers with ASD whose parents reported receiving specific services outside of school programs in both locations. When compared to children in CA, children in PA received significantly less behavioral therapy, but significantly more mental health services (ps <.001). In addition, more children in CA received medication than in PA (p <.02). Further analyses will explore child and family characteristics (e.g. race/ethnicity, socioeconomic status) and state policy differences as predictors of service use.
Conclusions: Preliminary results suggest that there are differences in service utilization for preschoolers with ASD in CA and PA. These utilization differences may be related to sociodemographic characteristics of the families or differences in service availability due to state policies.