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Using the Race Model Inequality to Quantify Behavioral Multisensory Integration Effects
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Occupational Therapy, Physical Therapy, and Home Health Use Among People With Intellectual and Developmental

Khalilah R Johnson1, Izabela E Annis2, Kathleen C Thomas3

  • 1Khalilah R. Johnson, PhD, OTR/L, FAOTA, is Assistant Professor, Department of Health Sciences, Division of Occupational Science and Occupational Therapy, University of North Carolina at Chapel Hill, Chapel Hill; khalilah_johnson@med.unc.edu.

The American Journal of Occupational Therapy : Official Publication of the American Occupational Therapy Association
|May 28, 2026
PubMed
Summary

Structural racism and neighborhood segregation did not significantly impact service use for individuals with intellectual and developmental disabilities (IDD). However, age and Medicaid coverage were key factors influencing access to occupational therapy, physical therapy, and home health services.

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Area of Science:

  • Health Services Research
  • Health Equity
  • Occupational Therapy

Background:

  • Black individuals with intellectual and developmental disabilities (IDD) experience poorer health outcomes and reduced service utilization compared to White individuals.
  • Structural racism, particularly neighborhood segregation, is a suspected barrier to equitable healthcare access for this population, yet empirical evidence is limited.

Purpose of the Study:

  • To investigate the relationship between race/ethnicity and neighborhood segregation on the utilization of outpatient occupational therapy, physical therapy, and home health services among individuals with IDD.

Main Methods:

  • Secondary data analysis of the Medical Expenditure Panel Survey (2013-2020) combined with American Community Survey census tract data.
  • Weighted two-level logistic regression models were employed to examine associations.

Main Results:

  • Overall service use: 16% for outpatient OT/PT, 23% for home health.
  • Race and neighborhood segregation were not significantly associated with service use.
  • Age (younger individuals more likely to receive services) and Medicaid coverage were significantly associated with both OT/PT and home health service use, indicating age-related disparities.

Conclusions:

  • While direct racial disparities in service use were not evident in this dataset, structural and age-related factors significantly influence healthcare access for people with IDD.
  • Larger, more detailed datasets are needed to fully understand the complex interplay of race, segregation, and service utilization in the healthcare pipeline for individuals with IDD.
  • Findings highlight the need for occupational therapy practitioners and researchers to develop equity-driven methodologies and advocacy strategies to ensure equitable access to essential home and community-based supports for all individuals with IDD.