Therapy use for U.S. school-aged children with developmental disabilities: State variation and determinants

Area of Science:

• Pediatric Health Services Research
• Developmental Disabilities Care
• Health Equity Studies

Background:

• Therapy services are crucial for addressing developmental needs and social-emotional outcomes in children with developmental disabilities (DD).
• Timely therapy access is vital for school-aged children with DD, yet geographic variations and determinants of service use remain understudied.
• Understanding these disparities is key to reducing persistent health inequities.

Purpose of the Study:

• To investigate state-level variations in therapy service utilization among U.S. school-aged children with DD.
• To identify key health determinants associated with therapy access in this population.

Main Methods:

• Secondary analysis of 2016-2017 National Survey of Children's Health data.
• Inclusion of 9984 school-aged children (6-17 years) with DD.
• Multilevel logistic regression models used to analyze therapy use variations and determinants.

Main Results:

• Overall, 34.6% of children with DD received therapy services.
• Significant geographic variation in therapy use was observed across states.
• Factors associated with higher therapy access included younger age, public insurance, functional limitations, individualized education programs, service access frustration, and care coordination needs.
• Higher Medicaid Home and Community-Based Services waiver costs correlated with lower therapy use.

Conclusions:

• Significant geographic disparities in therapy service use exist for school-aged children with DD.
• Multilevel strategies are needed to enhance therapy access and address these disparities.
• Findings underscore the importance of state-level analysis in understanding and improving care for children with developmental disabilities.