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Published on: July 31, 2017
Community-based service use in preschool children with autism spectrum disorder and associations with insurance
Eric Rubenstein1, Lisa Croen2, Li-Ching Lee3
1University of Wisconsin Madison, Waisman Center, 1500 Highland Ave, Madison WI, 53705.
Insights
Many preschool children with autism spectrum disorder (ASD) lack community services. Public insurance is linked to less behavioral therapy and more medication, highlighting access disparities.
Area of Science:
- Neurodevelopmental Disorders
- Pediatric Health Services Research
- Public Health
Background:
- Early intervention services are crucial for children with autism spectrum disorder (ASD), yet community-based service utilization during the preschool years remains understudied.
- Understanding service patterns outside of school settings is vital for optimizing developmental trajectories in young children with ASD.
Purpose of the Study:
- To characterize the amount and types of community-based services used by 3-5-year-old children diagnosed with ASD.
- To investigate how health insurance status influences the utilization of these services.
Main Methods:
- Cross-sectional analysis of 792 children with ASD diagnoses from the Study to Explore Early Development (2012-2016).
- Maternal reports of current child service use and insurance status at enrollment.
- Log-Poisson and logistic regression models were employed to compare service use across different insurance groups.
Main Results:
- Approximately 40% of children with ASD were not receiving any community-based services.
- Children with public insurance utilized fewer total community services compared to those with private or dual insurance coverage.
- While insurance type did not affect the variety of service categories accessed, children with public insurance exclusively were less likely to receive behavioral therapy and more likely to be prescribed psychotropic medications.
Conclusions:
- A significant proportion of preschool-aged children with ASD do not access community-based services, with utilization patterns varying by insurance type.
- Disparities in service access, particularly for public insurance beneficiaries, necessitate efforts to enhance the availability and accessibility of evidence-based interventions.
- Improving access to community-based services for young children with ASD, especially those on public insurance, holds potential for better outcomes.
Background:
ASD-related services can improve outcomes for children, but less is known about service outside of school settings during preschool age. We aimed to describe amount and category of community-based service use among 3-5-year-old children with ASD and examine differences by health insurance.
Methods:
We used cross-sectional data on 792 children with ASD diagnoses in the Study to Explore Early Development, a community-based study of neurodevelopment with enrollment between 2012-2016. Mothers reported current child service use and insurance status at study entry. We used log-Poisson and logistic regression to compare service use by insurance group.
Results:
Nearly 40% of children were not receiving community-based services at study entry. Children with public insurance had fewer total services than children with private or both insurances. After adjustment for sociodemographic confounders, insurance status was not associated with types of different categories of community-based services. However, children with public insurance alone were least likely to receive community-based behavioral therapy and most likely to receive psychotropic medication compared to other insurances.
Conclusion:
Many preschool-aged children do not receive community-based services, with receipt associated with insurance type. Increasing access and availability for evidence-based service, especially for beneficiaries of public insurance, may improve service use and outcomes.
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