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Nelson BB, Dudovitz RN, Thompson LR, Vangala S, Zevallos-Roberts E, Gulsrud A, Porras-Javier L, Romley JA, Herrera P, Aceves I, Chung PJ. Early Childhood Care Coordination Through 211: A Randomized Clinical Trial. Pediatrics 2024:e2023065232. [PMID: 39054946 DOI: 10.1542/peds.2023-065232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Early intervention services can improve outcomes for children with developmental delays. Health care providers, however, often struggle to ensure timely referrals and services. We tested the effectiveness of telephone-based early childhood developmental care coordination through 211 LA, a health and human services call center serving Los Angeles County, in increasing referral and enrollment in services. METHODS In partnership with 4 clinic systems, we recruited and randomly assigned children aged 12 to 42 months with upcoming well-child visits and without a known developmental delay, to intervention versus usual care. All children received developmental screening and usual clinic care. Intervention children also received telephone connection to a 211 LA early childhood care coordinator who made referrals and conducted follow-up. Primary outcomes at a 6-month follow-up included parent-reported referral and enrollment in developmental services. Secondary outcomes included referral and enrollment in early care and education (ECE). Logistic regression models were used to estimate the odds of outcomes, adjusted for key covariates. RESULTS Of 565 families (282 intervention, 283 control), 512 (90.6%) provided follow-up data. Among all participants, more intervention than control children were referred to (25% vs 16%, adjusted odds ratio [AOR] 2.25, P = .003) and enrolled in (15% vs 9%, AOR 2.35, P = .008) ≥1 service, and more intervention than control children were referred to (58% vs 15%, AOR 9.06, P < .001) and enrolled in (26% vs 10%, AOR 3.75, P < .001) ECE. CONCLUSIONS Telephone-based care coordination through 211 LA is effective in connecting young children to developmental services and ECE, offering a potentially scalable solution for gaps and disparities.
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Affiliation(s)
- Bergen B Nelson
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca N Dudovitz
- Departments of Pediatrics and Children's Development and Innovation Institute
| | | | - Sitaram Vangala
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Amanda Gulsrud
- Psychiatry, Semel Institute for Neuroscience and Human Behavior
| | | | - John A Romley
- Price School of Public Policy and School of Pharmacy, University of Southern California, Los Angeles, California
| | - Patricia Herrera
- California State Council on Developmental Disabilities, Sacramento, California; and
| | | | - Paul J Chung
- Medicine Statistics Core
- Pediatrics and Health Policy & Management
- Department of Health Systems Science
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Gerdts J, Casagrande KA, Bateman KJ, Hudac CM, Bravo A, Mancini J, Mannheim J, Ogata B, Orville K, Stobbe GA. ECHO Autism Washington: Autism Diagnostic Evaluations in Primary Care. Clin Pediatr (Phila) 2024:99228241255866. [PMID: 38828759 DOI: 10.1177/00099228241255866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
ECHO (Extensions for Community Healthcare Outcomes) Autism is a telementoring learning model to increase community capacity for autism-related health care. Seventy-seven pediatric providers (mostly primary care, seeing exclusively Medicaid patient populations) enrolled in 1 year of ECHO Autism Washington. Analysis of self-report surveys showed a significant increase in autism diagnoses made by ECHO providers after 1 year, F(1, 65) = 7.52, P = .008. Providers who attended more sessions reported making more diagnoses, F(2, 613.26), P = .045. Of note, autism diagnoses were not externally validated. The total number of reported barriers reduced, F(2, 61) = 13.5), P < .001, and confidence ratings increased F(2, 60) = 24.21, P < .001. The average number of diagnostic referrals from ECHO providers to the state's largest autism specialty clinic significantly reduced, t(43) = 4.23, P < .001, with significantly fewer diagnostic referrals made during and after ECHO training compared with a comparison group of 28 non-ECHO providers, t(58.77) = -3.36, P < .001. Overall, 1 year of ECHO Autism Washington participation led to significant changes in autism diagnostic practices.
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Affiliation(s)
- Jennifer Gerdts
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Karís A Casagrande
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Caitlin M Hudac
- Department of Psychology, Carolina Autism and Neurodevelopment Research Center, University of South Carolina, Columbia, SC, USA
| | - Alice Bravo
- College of Education, University of Washington, Seattle, WA, USA
| | - James Mancini
- Institute on Human Development and Disability, University of Washington, Seattle, WA, USA
| | | | - Beth Ogata
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kate Orville
- Institute on Human Development and Disability, University of Washington, Seattle, WA, USA
| | - Gary A Stobbe
- Department of Neurology, University of Washington, Seattle, WA, USA
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3
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Rizk S, Ngui EM, Salgado Z, Bosak DL, Khetani MA. Medical Home Care and Educational Services for Children and Youth on the Autism Spectrum: A Scoping Review. J Autism Dev Disord 2024:10.1007/s10803-024-06235-3. [PMID: 38416384 DOI: 10.1007/s10803-024-06235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/29/2024]
Abstract
This scoping review examined current evidence on medical home care and its association with educational services for children and youth on the autism spectrum. We searched five databases and grey literature resulting in 328 publications. Publications meeting inclusion criteria were mapped to medical home care component(s) addressed, type(s) of educational services and their strength and type of association. The Andersen Behavioral Model of Health Services Use was used to summarize predisposing, enabling, and need factors considered. Eighteen publications were reviewed, including eight practice/policy reports and ten original research publications. Medical home care components most addressed included family-centered care (n = 10), referrals (n = 16), and effective care coordination (n = 13). Seven publications also addressed multiple educational service types. Two of the five publications that established a significant association between medical home care components and educational services had mixed results, with one publication reporting a negative association and the other publication reporting a positive association. Challenges to medical home care and educational services were most categorized as enabling factors. Results suggest three areas for further investigation: (1) limited evidence on the strength and type of association between medical home care components and educational services; (2) limited use of population data sources; and (3) the need to consider a broader range of factors when examining their association.
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Affiliation(s)
- Sabrin Rizk
- School of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA
| | - Emmanuel M Ngui
- Community and Behavioral Health Promotion, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Zurisadai Salgado
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA
| | - Dianna L Bosak
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA
| | - Mary A Khetani
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA.
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4
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Koob C, Stuenkel M, Gagnon RJ, Griffin SF, Sease K. Identifying Risk Factors Associated with Repeated Referrals Within a Pediatric Navigation Program. J Community Health 2023; 48:1044-1051. [PMID: 37658945 DOI: 10.1007/s10900-023-01274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/05/2023]
Abstract
Approximately 1-in-5 children have a diagnosed mental, behavioral, and/or developmental disorder or delay by age 8 in the United States. Children with such conditions often require complex, complicated diagnostic and specialty care, making them susceptible to repeated referrals and ongoing unmet healthcare needs. Patient navigation programs (PNPs) are designed to integrate care from primary care providers to community-based services, using trained navigators to help patients and their families manage referrals and connect with referred services. This study examines factors associated with repeated referrals to an active PNP to inform ongoing referral patterns and adaptations to standard navigation support within a large healthcare system in South Carolina (SC). Data is sourced from the inception of the PNP in 2017 through 2022, including 15,702 referrals. Overall, 71.07% had no repeated referrals. Children who are older, diagnosed with attention deficit disorder(s), behavioral concerns, depression, multiple referral needs, and insured by Medicaid were found to be most susceptible to repeated referrals. Conversely, children who are non-Hispanic Black, were referred at a well-child visit, and are primarily insured by private insurance or Tricare were least likely to have repeated referrals. Children who are insured by Medicaid are more likely to be younger, identify as non-Hispanic Black, Hispanic, or another race/ethnicity, and have multiple needs at time of initial referral, identifying a potentially compounded risk for those who hold multiple risk factors to experiencing repeated referrals. Findings may inform adaptations to this PNP model to adjust navigator protocol for at-risk populations and equitably optimize referral-to-service connection.
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Affiliation(s)
- Caitlin Koob
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, USA.
- Prisma Health Children's Hospital-Upstate, Greenville, SC, USA.
| | | | - Ryan J Gagnon
- Department of Parks, Recreation, Tourism, and Management, Clemson University, Clemson, SC, USA
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, USA
| | - Kerry Sease
- Prisma Health Children's Hospital-Upstate, Greenville, SC, USA
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
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Barger B, Salmon A, Moore Q. Medical Home, Developmental Monitoring/Screening, and Early Autism Identification. J Autism Dev Disord 2023:10.1007/s10803-023-06044-0. [PMID: 37477840 DOI: 10.1007/s10803-023-06044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
Developmental monitoring/screening predict early identified autism spectrum disorders (ASD), but studies have not yet robustly controlled for a key health care service impacting early identification: medical home. National Surveys of Children's Health (NSCH; 2016-2020) were used to determine the relationship between medical home, developmental monitoring/screening, and identified ASD. NSCH overall medical home variable had a minimal relationship with ASD (under 5 years of age, under 5 identified in last year, under 5 identified over a year prior). Usual source of care was positively, and care coordination negatively, associated with ASD identified in last year, suggesting the overall medical home variable may mask variance from subscales. Research is needed to determine how medical home relates to identification in applied settings.
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Affiliation(s)
- Brian Barger
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA.
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA.
| | - Ashley Salmon
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
| | - Quentin Moore
- Center for Leadership in Disability, School of Public Health, Georgia State University, 75 Piedmont Rd., Atlanta, GA, 30303, USA
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta, USA
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Hu JC, Cummings JR, Ji X, Wilk AS. Evaluating Medicaid Managed Care Network Adequacy Standards And Associations With Specialty Care Access For Children. Health Aff (Millwood) 2023; 42:759-769. [PMID: 37276470 PMCID: PMC10706697 DOI: 10.1377/hlthaff.2022.01439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medicaid managed care plans cover more than 80 percent of Medicaid-enrolled children, including many children with special health care needs (CSHCN). Federal rules require states to set network adequacy standards to improve specialty care access for Medicaid managed care enrollees. Using a quasi-experimental design and 2016-19 National Survey of Children's Health data, we examined the association between quantitative network adequacy standards and access to specialty care among 8,614 Medicaid-enrolled children, including 3,157 with special health care needs, in eighteen states. Outcomes included whether the child had any visit to non-mental health specialists, any visit to mental health professionals, or any unmet health care needs and whether the caregiver ever felt frustrated in getting services for the child in the past year. We observed no association between the adoption of any quantitative network adequacy standard and the above outcomes among Medicaid-enrolled children. Among CSHCN, however, adopting any quantitative standard was positively associated with caregivers feeling frustrated in getting services for the child, especially among CSHCN who visited non-mental health specialists. Without additional interventions, adopting new network adequacy standards may have unintended consequences for CSHCN.
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Affiliation(s)
- Ju-Chen Hu
- Ju-Chen Hu , Emory University, Atlanta, Georgia
| | | | - Xu Ji
- Xu Ji, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
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Horan MR, Latendresse SJ, Limbers CA. Mental Health in Mothers of Autistic Children with a Medical Home: The Potentially Mechanistic Roles of Coping and Social Support. J Autism Dev Disord 2023:10.1007/s10803-023-05997-6. [PMID: 37142909 DOI: 10.1007/s10803-023-05997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
Mothers of autistic children often report poor mental health outcomes. One established risk factor for these outcomes is the child having a medical home. This study examined possible mediating variables (coping, social support) in this relationship in 988 mothers of autistic children from the 2017/2018 National Survey of Children's Health (NSCH). The results of the multiple mediation model suggest the relationship between having a medical home and maternal mental health is largely explained by indirect associations with coping and social support. These findings suggest that clinical interventions for coping and social support provided by the medical home for mothers of autistic children may improve maternal mental health outcomes over and above implementation of a medical home.
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Affiliation(s)
- Madeline R Horan
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS735, 38105, Memphis, TN, USA.
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8
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The Medical Home and Use of Mental and Non-mental Specialty Services Among Children with Autism Spectrum Disorder (ASD). J Autism Dev Disord 2023; 53:1202-1212. [PMID: 35653008 DOI: 10.1007/s10803-022-05596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
This study assessed the relationship between the medical home and use of health services among children with autism spectrum disorder (ASD). Data from 2016 to 2018 National Survey of Children's Health was analyzed. Outcome measures were receipt of mental and non-mental specialty care, difficulty receiving needed mental and non-mental specialty care and unmet need for mental care. Having a medical home was associated with significantly lower odds of having unmet mental health need for children with ASD ages 11-17 (OR 0.14, 95% CI 0.07-0.30) but not for those ages 3-10 (OR 0.54, 95% CI 0.21-1.43). Having a medical home was also associated with lower odds of difficulty getting needed mental health care (OR 0.38, 95% CI 0.22-0.66) as well as non-mental specialty care (OR 0.24, 95% CI 0.13-0.44).
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9
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Rizk S, Ngui E, Benevides TW, Moerchen VA, Khetani M, Barnekow K. Is medical home care adequacy associated with educational service use in children and youth with autism spectrum disorder (ASD)? BMC Pediatr 2023; 23:12. [PMID: 36617543 PMCID: PMC9827663 DOI: 10.1186/s12887-022-03776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/24/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The American Academy of Pediatrics (AAP) recommends medical home care for children and youth with autism spectrum disorder (ASD) for health needs. Children and youth with ASD also receive educational services for cognitive, social, and behavioral needs. We measured whether inadequate medical home care was significantly associated with current educational service use, controlling for sociodemographic factors. METHODS We analyzed the 2016/2017 National Survey of Children's Health (NSCH) on 1,248 children and youth with ASD ages 1-17. Inadequate medical home care was operationalized as negative or missing responses to at least one medical home component. Educational service use was defined as current service use under individualized family service plans (IFSP) and individualized education programs (IEP). RESULTS Inadequate medical home care was significantly associated with higher likelihood of current educational service use (aOR = 1.95, 95% CI [1.10, 3.44], p = 0.03). After adjustment, older children (aOR = 0.91, 95% CI [0.84, 0.99], p = 0.03), lower maternal health (aOR = 0.52, 95% CI [0.29, 0.94], p = 0.03), and children without other special health care factors (aOR = 0.38, 95% CI [0.17-0.85], p = 0.02) had significantly lower odds of current educational service use. CONCLUSIONS Inadequate medical home care yielded higher odds of current educational service use. Child's age, maternal health, and lack of other special health care factors were associated with lower odds of current educational service use. Future research should examine medical home care defined in the NSCH and improving educational service use via medical home care.
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Affiliation(s)
- Sabrin Rizk
- grid.185648.60000 0001 2175 0319Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1919 West Taylor Street, AHSB 744, Chicago, IL 60612 USA
| | - Emmanuel Ngui
- grid.267468.90000 0001 0695 7223Community & Behavioral Health Promotion, University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, 1240 North 10th Street, Rm 417, Milwaukee, WI 53205 USA
| | - Teal W. Benevides
- grid.410427.40000 0001 2284 9329Department of Occupational Therapy, College of Allied Health Sciences, Augusta University, 987 St. Sebastian Way, EC-2324, Augusta, GE 30912 USA
| | - Victoria A. Moerchen
- grid.267468.90000 0001 0695 7223Department of Rehabilitation Sciences & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, 3409 North Downer, Pavilion, PT Suite, Rm 366, PO Box 413, Milwaukee, WI 53201 USA
| | - Mary Khetani
- grid.185648.60000 0001 2175 0319Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1919 West Taylor Street, 316A, Chicago, IL 60612 USA
| | - Kris Barnekow
- grid.267468.90000 0001 0695 7223Department of Rehabilitation Sciences & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, 2400 East Hartford Avenue, Enderis Hall, 979, PO Box 413, Milwaukee, WI 53201 USA
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Parent-Reported Problems Accessing Mental Health Services Among a National Sample of Youth with Autism Spectrum Disorder and Anxiety. J Dev Behav Pediatr 2022; 43:320-326. [PMID: 35075046 DOI: 10.1097/dbp.0000000000001062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/30/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to identify factors associated with parent-reported problems accessing needed mental health services (MHS) in youth with autism spectrum disorder and anxiety. METHODS This study is a secondary analysis using the National Survey of Children's Health 2016 to 2017 data sets with multivariable logistic regression. Subjects are 6 to 17 year olds with parent-reported autism spectrum disorder (ASD) and anxiety. Outcome is parent-reported challenge accessing needed mental health treatment, dichotomized to not a problem versus problem. Covariates included race/ethnicity, intellectual disability, insurance, medical home, poverty level, and parent education level. RESULTS The sample included 568 youth with ASD and anxiety-78% male subjects, mean age 12.5 years, and 63% White, non-Hispanic. Fifty-three percent of youth with ASD and anxiety had parent-reported problems accessing needed MHS. Lack of medical home (adjusted odds ratio [aOR] 5.97, 95% confidence interval [CI] [2.72-13.09]) and coexisting intellectual disability (aOR 2.23, 95% CI [1.08-4.60]) were significantly associated with problems accessing MHS. Reported family incomes at 0% to 99% and 100% to 199% of the federal poverty level as compared with family income at 400% federal poverty level or above (aOR 0.32, 95% CI [0.11-0.94] and aOR 0.35, 95% CI [0.13-0.95], respectively) was associated with decreased problems accessing MHS. CONCLUSION In this nationally representative study, more than half of youth with ASD and anxiety had parent-reported problems accessing needed MHS. Lack of a medical home, co-occurring intellectual disability, and higher socioeconomic status (SES) are associated with problems accessing MHS. Therefore, policies to support the medical home; increase mental health supports available for those with ASD, anxiety, and coexisting intellectual disability; and support access for all SES levels may increase mental health access.
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Swann-Thomsen HE, Lindsay R, Rourk S, Hofacer R, Nguyen E. National Survey Data to Evaluate Case Management Services: A Systematic Review on Care Coordination Using the National Survey of Children With Special Health Care Needs. Prof Case Manag 2022; 27:124-140. [PMID: 35363658 DOI: 10.1097/ncm.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hillary E Swann-Thomsen
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Ryan Lindsay
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Seth Rourk
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Rylon Hofacer
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Elaine Nguyen
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
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Cheak-Zamora N, Betz C, Mandy T. Measuring health care transition: Across time and into the future. J Pediatr Nurs 2022; 64:91-101. [PMID: 35248956 DOI: 10.1016/j.pedn.2022.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 01/19/2023]
Abstract
PROBLEM Youth with special health care needs often experience significant difficulty transitioning into adult health care services and adult life. Services supporting youths' transition from pediatric to adult health care (Health Care Transition (HCT)) have been a priority for nearly 30 years to improve this transition process. The Health Resources and Service Administration, Maternal and Child Health Bureau have measured HCT service provision since 2001 but the longitudinal use of this measure has never been examined (Blumberg, 2003; Maternal and Child Health Bureau, n.d.). ELIGIBILITY CRITERIA This manuscript highlights the consistent and inconsistent uses of HCT constructs in two prominent national surveys (the National Survey of Children with Special Health Care Needs (NS-CSHCN) and the National Survey of Children's Health (NSCH)) between 2001 and 2019. All studies utilizing an HCT measure within a national survey between the 18 years were included in this examination. RESULTS Significant changes have been made to the measurement of HCT service provision resulting in inconsistencies over the last 18 years. Measurement criteria and survey questions have changed substantially from the NS-CSHCN and NSCH limiting one's ability to examine trends in HCT since 2001. Since 2016, few changes have been made, allowing for analysis of trends over time. Importantly, the NSCH includes added questions pertaining to HCT that are not included in the composite HCT outcome measure. CONCLUSION Future work should include a validation study of the HCT outcome in the National Survey of Children's Health and inclusion of additional HCT questions to promote continued and extensive use of a measure that more fully represents the needs of youth and their families.
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Affiliation(s)
- Nancy Cheak-Zamora
- Department of Health Professions, School of Health Professions, University of Missouri- Columbia, 510 Clark Hall, Columbia, MO 65211, United States of America.
| | - Cecily Betz
- University Center for Excellence in Developmental Disabilities, University of Southern California, 4650 Sunset Blvd. Mailstop 53, Los Angeles, CA 90027, United States of America.
| | - Trevor Mandy
- Department of Health Management and Informatics, School of Medicine, University of Missouri- Columbia, 510 Clark Hall, Columbia, MO 65211, United States of America.
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13
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Badgett NM, Sadikova E, Menezes M, Mazurek MO. Emergency Department Utilization Among Youth with Autism Spectrum Disorder: Exploring the Role of Preventive Care, Medical Home, and Mental Health Access. J Autism Dev Disord 2022; 53:2274-2282. [DOI: 10.1007/s10803-022-05503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
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14
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Robinson LA, Gaugh L, Yapo S, Al-Sumairi R, Lorenzo A, Weiss M. Defragmenting the path to diagnosis for underserved youth with Autism Spectrum Disorder in a community-based health system. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2022; 10:100597. [PMID: 35144168 DOI: 10.1016/j.hjdsi.2021.100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/15/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder that affects about 1 out of every 54 youth and is characterized by impairments in social communication and functioning. ASD is a treatable condition though, and early initiation of interventions in the home and community can lead to improved long-term outcomes. Despite the clear benefits of early diagnosis and intervention, many youth, particularly from impoverished and minoritized populations, face tremendous barriers to accessing a timely formal diagnosis and critical early supports. Many of these barriers are inherent features of a fragmented health care system that even the most resourced of families struggle to navigate. Informed by the principles of coproduction of health care, value-based care design, and health equity, we present a quality improvement initiative to defragment the experience of care for underserved families seeking a timely formal diagnosis of ASD in a safety-net community-based health system. Over the course of 2.5 years, we were able to partner with families to create clinical workflows that cut in half the duration of time from first developmental concern to ASD diagnosis, and lowered the median age of ASD diagnosis in our health system by more than 3 years. We share our process and lessons learned in the hopes of helping other health systems pursuing similar goals for patient- and family-centered care design.
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Affiliation(s)
- Lee A Robinson
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA.
| | - Laura Gaugh
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Scott Yapo
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Rami Al-Sumairi
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Aileen Lorenzo
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Margaret Weiss
- Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
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15
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Dick CC, Ibañez LV, DesChamps TD, Attar SM, Stone WL. Brief Report: Perceptions of Family-Centered Care Across Service Delivery Systems and Types of Caregiver Concerns About Their Toddlers' Development. J Autism Dev Disord 2021; 52:4181-4190. [PMID: 34510314 DOI: 10.1007/s10803-021-05248-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
Family-centered care represents a collaborative partnership between caregivers and service providers, and is associated with positive caregiver and child outcomes. This approach may be especially important for caregivers with early concerns about autism, as service providers are often the gateway to appropriately-specialized intervention. Perceptions of family-centered care received from primary care providers (PCPs) and Part C Early Intervention (EI) providers were rated by two groups of caregivers: those concerned about autism (n = 37) and those concerned about another developmental problem (n = 22), using the Measure of Processes of Care (MPOC-20). Ratings did not differ across caregiver groups, but both groups rated EI providers significantly higher than PCPs, which may reflect systems-level differences between primary care and EI.
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Affiliation(s)
- Catherine C Dick
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA.
| | - Lisa V Ibañez
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Trent D DesChamps
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Shana M Attar
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA
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16
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Wagner S, Rubin IL, Singh JS. Underserved and Undermeasured: a Mixed-Method Analysis of Family-Centered Care and Care Coordination for Low-Income Minority Families of Children with Autism Spectrum Disorder. J Racial Ethn Health Disparities 2021; 9:1474-1487. [PMID: 34231160 DOI: 10.1007/s40615-021-01086-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
This study examined how a racially and socioeconomically diverse group of caregivers of children with autism spectrum disorder (ASD) responds to national standard measures of family-centered care (FCC) and care coordination (CC) and what aspects of quality care are missing from these measures. Based on survey and interview data collected from 70 caregivers who have a child with ASD that receive services at a community-based autism clinic located in Atlanta, GA, we compared proportions of answers to FCC and CC questions to national and state representative data using chi-square analyses and contextualized our findings through a thematic analysis of qualitative interviews. Compared to national- and state-level data, the Atlanta autism clinic data had a higher percentage of participants who identified as Black, relied on public health insurance, and lived below 200% of the federal poverty line. The Atlanta autism clinic responses were significantly more positive in four measures of FCC but significantly less effective in two CC measures, including a lower reported percentage who received CC and greater reported percentage who needed extra help. Qualitative data revealed a range of positive meanings and challenges associated with FCC and identified areas of help needed beyond CC, including physical and mental health care and emotional connection, especially for low-income single Black female caregivers. Our mixed-method approach identified strengths in FCC, barriers to CC, and suggestions for developing more pragmatic questions in national surveys that address experiences of quality-of-care among low-income, racial minority families of children with ASD.
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Affiliation(s)
- Stephanie Wagner
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.,Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - I Leslie Rubin
- Department of Pediatrics, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.,The Rubin Center for Autism and Developmental Pediatrics, 750 Hammond Drive, Bldg. 1, Suite 100, Atlanta, GA, 30328, USA
| | - Jennifer S Singh
- School of History and Sociology, Georgia Institute of Technology, 221 Bobby Dodd Way, Atlanta, GA, 30332-225, USA.
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17
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Wong V, Pham M, Godfrey K, Milstein A. Distilling innovative US autism care programs that address widely perceived unmet patient and family needs. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:281-286. [PMID: 34210189 DOI: 10.1177/13623613211027999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Currently, the quality of care for autistic individuals is not good. Many care services for autistic individuals are not well coordinated, nor are they tailored. We wanted to find out a better model for autism care and believed that the autism community knows where these programs are. So, we had conversations with and surveyed 55 autistic adults, family members, clinicians, and researchers. They shared 90 innovative autism care programs that had been collaboratively designed with patients and families and that are likely to improve the quality of life of autistic individuals and their families. We then narrowed down the 90 nominated programs to 15 programs across the United States by applying researcher-selected criteria, such as providing services actively and having data on program effectiveness. We compiled a list of these innovative, quality autism care programs.
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Affiliation(s)
| | - Mai Pham
- Institute for Exceptional Care, USA
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18
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Long M, Register-Brown K. Autism Spectrum Disorder. Pediatr Rev 2021; 42:360-374. [PMID: 34210755 DOI: 10.1542/pir.2020-000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Kelly Register-Brown
- Division of Psychiatry and Behavioral Health Sciences, Children's National Hospital, Washington, DC
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19
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Cantor J, McBain RK, Kofner A, Stein BD, Yu H. Where are US outpatient mental health facilities that serve children with autism spectrum disorder? A national snapshot of geographic disparities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:169-177. [PMID: 34120484 DOI: 10.1177/13623613211024046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT There has been a rise in the observed prevalence of autism spectrum disorder among children. Existing studies show the share of counties with a treatment facility that offers care for children with autism spectrum disorder. However, no estimates exist of the share of US outpatient mental health treatment facilities that provide services for children with autism spectrum disorder. We identified key facility-level characteristics in offering mental health care for children with autism spectrum disorder. We used a telephone survey to contact almost all outpatient mental health treatment facilities in the contiguous United States. We asked the facilities if they provided mental health care for children with autism spectrum disorder. We took the results of this survey and estimated multivariable regressions to examine county- and facility-level predictors of offering services. We found that over half (50.3%) of the 6156 outpatient facilities reported offering care for children with autism spectrum disorder. Non-metro counties, counties with a lower percentage of non-White residents, counties with a higher percentage of uninsured residents, and counties with a higher poverty rate had fewer outpatient mental health treatment facilities providing care for children with autism spectrum disorder. Facilities accepting Medicaid as a form of payment, offering telehealth, and private for-profit facilities were more likely to provide services for children with autism spectrum disorder. Because only half of outpatient mental health treatment facilities offer care for children with autism spectrum disorder, public health officials and policymakers should do more to ensure that this vulnerable population has access to mental health services.
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Affiliation(s)
| | | | | | | | - Hao Yu
- Harvard Medical School, USA
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20
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Health Service and Functional Measures of Benefit of a Medical Home in Children with Autism. Matern Child Health J 2021; 25:1156-1163. [PMID: 33914226 DOI: 10.1007/s10995-021-03150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES A medical home is a model of patient-centered, comprehensive care recommended by the American Academy of Pediatrics for all children. The aims of this study were (1) to determine if the presence of a medical home is associated with improved health service outcomes of children with autism, and (2) to determine if the presence of a medical home is associated with improved key functional outcomes in children with autism. METHODS This study used data from the 2016-2017 National Survey of Children's Health. We used a medical home construct of 14 survey questions as the main independent variable in logistic regression models estimating cross-sectional association, and also evaluated the interaction between medical home and demographic and household characteristics, including race, income, household composition, and autism severity in regression for outcomes. RESULTS Overall, the presence of a medical home was associated with increased parent reporting of shared health care decision-making, receipt of preventive pediatric care, and reduced frustration in accessing services. Some functional outcomes were also positively associated with the presences of a medical home in children with parent-reported mild autism symptoms; children who had a medical home visited the ED less often than children without a medical home. This did not persist for children with moderate or severe parent-rated autism. CONCLUSIONS FOR PRACTICE: Based on parent-reported, cross-sectional data from a large, nationally representative sample of families with a child with autism, the presence of a medical home was positively associated with some improved health services and functional outcomes.
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21
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Srinivasan S, Ekbladh A, Freedman B, Bhat A. Needs assessment in unmet healthcare and family support services: A survey of caregivers of children and youth with autism spectrum disorder in Delaware. Autism Res 2021; 14:1736-1758. [PMID: 33876563 DOI: 10.1002/aur.2514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022]
Abstract
The study aimed to collect data from families of children and youth with Autism Spectrum Disorder (ASD) in the state of Delaware, USA to understand their ongoing needs and challenges in accessing child healthcare and family support services. We analyzed responses from 263 caregivers of children and youth with ASD from 3 to 24 years using a statewide needs assessment survey. Over 50% caregivers indicated having unmet needs relative to both child/youth healthcare services and family support services. Between 24 and 38% caregivers expressed unmet needs for healthcare services such as social skills training, speech-language therapy, behavioral intervention, and occupational therapy for their child and 20-24% expressed needs for family support services such as respite care, parent/sibling support groups, counseling, and babysitting support. Additionally, number of prior early interventions received, limitations in accessing healthcare services, and unmet needs for family support services significantly predicted child/youth unmet healthcare needs. Greater ASD severity and difficulties accessing child/youth healthcare services predicted participant's functional dependence on caregivers for activities of daily living. Together, these findings call for designing holistic, family-centered interventions that address needs of both children and youth with ASD and their families. LAY SUMMARY: A statewide needs assessment survey of caregivers of children and youth with ASD revealed that 50% responders had unmet needs relative to both child/youth healthcare services and family support services. Number of prior services received, limitations in accessing healthcare, and unmet needs for family support are linked to child/youth unmet healthcare needs. Severity of autism and difficulties accessing child/youth healthcare are associated with participant's functional dependence. Together, these findings call for placing the family at the heart of the service system in ASD.
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Affiliation(s)
- Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.,Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA.,The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Annalisa Ekbladh
- Center for Disabilities Studies, University of Delaware, Newark, Delaware, USA
| | - Brian Freedman
- Center for Disabilities Studies, University of Delaware, Newark, Delaware, USA
| | - Anjana Bhat
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.,Biomechanics & Movement Sciences Program, University of Delaware, Newark, Delaware, USA.,Behavioral Neuroscience Division, Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
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22
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Suen CG, Campbell K, Stoddard G, Carbone PS. Patient-Centered Outcomes in an Interdisciplinary Clinic for Complex Children with Autism. J Dev Behav Pediatr 2021; 42:182-190. [PMID: 33086336 PMCID: PMC7990680 DOI: 10.1097/dbp.0000000000000877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the perspectives of caregivers of children with autism receiving care at the Neurobehavior Healthy Outcomes Medical Excellence (HOME) Program, an interdisciplinary clinic that provides primary care and behavioral/mental health services for patients with autism and other developmental disabilities, with those responding to the 2016 National Survey of Children's Health (NSCH). We focused on ratings related to shared decision-making, care coordination, family-centered care, and care within a medical home. METHODS We administered a subset of items from the 2016 NSCH to caregivers of children with autism enrolled in HOME and compared responses with the same items from a nationally representative group of caregivers of children with autism who completed the 2016 NSCH. We compared the proportions that reported receiving shared decision-making, care coordination, family-centered care, care within a medical home, and unmet needs among the 2 study groups using Poisson regression, controlling for age, sex, race/ethnicity, payor, autism severity, and intellectual disability (ID). RESULTS Compared with the NSCH cohort (n = 1151), children enrolled in HOME (n = 129) were older, more often female, had severe autism, and had co-occurring ID. Caregivers perceived that children receiving care within HOME more often received family-centered, coordinated care within a medical home compared with a national sample of children with autism. HOME enrollees also reported increased access to behavioral treatments and adult transition services with less financial burden compared with the national sample. CONCLUSION An interdisciplinary clinic model may best serve children with autism, especially those with higher severity symptoms and co-occurring conditions.
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Affiliation(s)
- Catherine G. Suen
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Kathleen Campbell
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Gregory Stoddard
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Paul S. Carbone
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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23
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McClain MB, Shahidullah JD, Mezher KR, Haverkamp CR, Benallie KJ, Schwartz SE. School-Clinic Care Coordination for Youth with ASD: A National Survey of School Psychologists. J Autism Dev Disord 2020; 50:3081-3091. [PMID: 30877418 DOI: 10.1007/s10803-019-03985-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Many youth with autism spectrum disorder (ASD) may benefit from interdisciplinary care coordination. Communication and collaboration between the school and clinic settings is particularly important when youth with ASD are receiving both special education and clinic-based services. The responsibility of initiating coordinated care has historically been with the medical home (e.g., primary care clinicians), however, educational professionals (e.g., school psychologists) are also well positioned to assume a leadership role in care coordination. Little is known about the current state, feasibility, or effectiveness of school psychologists leading care coordination efforts. The current study utilizes a mixed-method approach to understand school psychologists' engagement in interdisciplinary collaboration across settings, a central tenet to coordinated care, in providing services to youth with ASD.
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Affiliation(s)
| | - Jeffrey D Shahidullah
- University of Texas at Austin Dell Medical School, Austin, USA.,School of Psychology at Rutgers University-New Brunswick, New Brunswick, USA
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24
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Family-Centered Care: How Close Do We Get When Talking to Parents of Children Undergoing Diagnosis for Autism Spectrum Disorders? J Autism Dev Disord 2020; 51:3073-3084. [PMID: 33140145 PMCID: PMC8349341 DOI: 10.1007/s10803-020-04765-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 12/16/2022]
Abstract
Autism spectrum disorder (ASD) affects 1:59 children, yet little is known about parents’ perceptions of family-centered care (FCC) during the diagnostic process leading up to diagnosis. This mixed-methods study explored key elements of FCC from 31 parents of children recently diagnosed with ASD using parallel qualitative and quantitative measures. Parents rated highly their receipt of FCC and discussed ways providers demonstrated FCC. However, the majority of parents indicated that the period when their child was undergoing diagnosis was stressful and reported symptoms of depression and anxiety. The study points to ways in which health care providers can enhance FCC provided to families when a child is undergoing ASD diagnosis.
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25
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P. Nowell K, Christopher K, Sohl K. Equipping Community Based Psychologists to Deliver Best Practice ASD Diagnoses Using The ECHO Autism Model. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1771564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Kerri P. Nowell
- Department of Health Psychology, Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Kourtney Christopher
- Department of Health Psychology, Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Kristin Sohl
- Department of Child Health, University of Missouri, Columbia, MO, USA
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26
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Robinson LA, Menezes M, Mullin B, Cook BL. A Comparison of Health Care Expenditures for Medicaid-Insured Children with Autism Spectrum Disorder and Asthma in an Expanding Accountable Care Organization. J Autism Dev Disord 2020; 50:1031-1044. [PMID: 31836944 DOI: 10.1007/s10803-019-04327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As value-based care continues to expand, more children with autism spectrum disorder (ASD) will be treated by accountable care organizations (ACOs), provider organizations seeking to improve population health while reducing costs. To inform ACO strategies for children with ASD, this study compared health care expenditures of children insured by a Medicaid managed care organization, empaneled to a safety net ACO, with ASD, asthma, and neither diagnosis. Compared to other study groups, children with ASD were more costly, had lower rates of acute care, and had higher rates of "leaked" care provided by home- and community-based mental health agencies outside of the ACO. These findings highlight the need for unique value-based strategies for children with ASD in a public sector ACO.
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Affiliation(s)
- Lee A Robinson
- Cambridge Health Alliance, Cambridge, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | | | | | - Benjamin Lê Cook
- Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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27
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McBain RK, Kareddy V, Cantor JH, Stein BD, Yu H. Systematic Review: United States Workforce for Autism-Related Child Healthcare Services. J Am Acad Child Adolesc Psychiatry 2020; 59:113-139. [PMID: 31150751 PMCID: PMC6883168 DOI: 10.1016/j.jaac.2019.04.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/11/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A diversity of health professional disciplines provide services for children with autism spectrum disorder (ASD) in the United States. We conducted a systematic review examining the availability, distribution, and competencies of the US workforce for autism-related child health care services, and assess studies' strength of evidence. METHOD We searched PubMed, PsychINFO, Embase, and Google Scholar from 2008 to 2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of prespecified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research. RESULTS Of 754 records identified, 33 studies (24 quantitative, 6 qualitative, and 3 mixed-methods) were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably. The most common specialties studied were pediatricians (n = 13), occupational therapists (n = 12), speech therapists (n = 11), physical therapists (n = 10), and child psychiatrists (n = 8). Topical areas included the following: provider availability by service area and care delivery model; qualitative assessments of provider availability and competency; role of insurance mandates in increasing access to providers: and disparities in access. Across provider categories, we found that workforce availability for autism-related services was limited in terms of overall numbers, time available, and knowledgeability. The greatest unmet need was observed among minorities and in rural settings. Most studies were short term, were limited in scope, and used convenience samples. CONCLUSION There is limited evidence to characterize the availability and distribution of the US workforce for autism-related child health care services. Existing evidence to date indicates significantly restricted availability.
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Affiliation(s)
| | | | | | | | - Hao Yu
- RAND Corporation, Pittsburgh, PA
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28
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 474] [Impact Index Per Article: 118.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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Singh V, Pinkett-Davis M, Kalb LG, Azad G, Neely J, Landa R. A preliminary study of care coordination services within a specialized outpatient setting for youth with autism spectrum disorder. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519893659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IntroductionParents of children with autism spectrum disorder often experience high levels of stress and challenges when organizing medical and behavioral services for their child. Care coordination could alleviate these challenges, however little is known about the effectiveness of this service. This study examined the need, feasibility, and acceptability of a care coordination program.MethodsFamilies of 176 children with autism, seen at a multidisciplinary autism clinic in the United States, participated in a prospective observational study. Families received a three-month structured care coordination program and completed pre- and post-program questionnaires that probed parents’ beliefs about the need and acceptability of the program through structured and open-ended questions.ResultsMost (≥90%) parents reported both a need for care coordination and satisfaction with the program. Qualitative themes identified valuable aspects and ways to improve the program.DiscussionParents raising a child with autism spectrum disorder experience an unmet need for care coordination. When provided, parents’ demonstrated high uptake of service and high levels of satisfaction with the program.
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Affiliation(s)
| | | | - Luther G. Kalb
- Kennedy Krieger Institute, USA
- Johns Hopkins Bloomberg School of Public Health, USA
| | - Gazi Azad
- Kennedy Krieger Institute, USA
- Johns Hopkins Bloomberg School of Public Health, USA
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Cheak-Zamora NC, Maurer-Batjer A, Malow BA, Coleman A. Self-determination in young adults with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:605-616. [PMID: 31561711 DOI: 10.1177/1362361319877329] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This study examined rates of and contributing factors to self-determination among young adults with autism spectrum disorder. Caregivers of young adults with autism spectrum disorder, 16-25 years, from five Autism Treatment Network sites completed surveys about their young adults' transition experiences including the American Institutes for Research Self-Determination measure. Data were analyzed using univariate and multivariate analysis. Caregivers (n = 479) reported their young adults with autism spectrum disorder as having moderate overall self-determination (x = 38; standard deviation = 9.04) with low capacity (x = 15.3; standard deviation = 5.67) and high opportunities at home (x = 23.1; standard deviation = 4.59). Young adults with autism spectrum disorder with intellectual disability or severe autism spectrum disorder symptomology experience significant disparities in overall self-determination compared to those without intellectual disability and less frequent symptom expression and severity. Barring severity indicators, there were few significant predictors of self-determination. Findings show a breakdown in self-determination skill-building. Young adults with autism spectrum disorder with intellectual disability or severe symptomology experienced significant disparities in self-determination. These findings show that current promotion of self-determination is not meeting the needs of young adults with autism spectrum disorder. Future interventions must identify what supports young adults with autism spectrum disorder need to capitalize on these opportunities to be independent and exert autonomy in their daily lives.
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Martinez M, Thomas KC, Williams CS, Christian R, Crais E, Pretzel R, Hooper SR. Family Experiences with the Diagnosis of Autism Spectrum Disorder: System Barriers and Facilitators of Efficient Diagnosis. J Autism Dev Disord 2019; 48:2368-2378. [PMID: 29453706 DOI: 10.1007/s10803-018-3493-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper examines family experiences with the efficiency of ASD diagnosis. Children were age 8 or younger with ASD (n = 450). Outcomes were delay from first parent concern to diagnosis, shifting diagnoses, and being told child did not have ASD. Predictors were screening, travel distance, and problems finding providers. Logit models were used to examine associations. Screening was associated with reduced delay in diagnosis; problems finding providers were associated with greater delay. Screening, travel distance, and delay in diagnosis were associated with shifting diagnoses and being told child did not have ASD. Physician and parent training in communication and addressing mental health professional shortages and maldistribution may improve the diagnosis experiences of families of children with ASD.
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Affiliation(s)
- M Martinez
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 MLK Blvd, Chapel Hill, NC, 27599-7590, USA
| | - K C Thomas
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 MLK Blvd, Chapel Hill, NC, 27599-7590, USA.
| | - C S Williams
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 MLK Blvd, Chapel Hill, NC, 27599-7590, USA
| | - R Christian
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, 101 Renee Lynne Ct, Carrboro, NC, 27510, USA
| | - E Crais
- Department of Allied Health Sciences, 321 S. Columbia Street, Bondurant Hall, CB#7190, Chapel Hill, NC, 27599-7190, USA
| | - R Pretzel
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, 101 Renee Lynne Ct, Carrboro, NC, 27510, USA
| | - S R Hooper
- Department of Allied Health Sciences, 321 S. Columbia Street, Bondurant Hall, CB#7190, Chapel Hill, NC, 27599-7190, USA
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Health Disparities among Children with Autism Spectrum Disorders: Analysis of the National Survey of Children’s Health 2016. J Autism Dev Disord 2018; 49:1652-1664. [DOI: 10.1007/s10803-018-3862-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Berg KL, Shiu CS, Feinstein RT, Msall ME, Acharya K. Adverse Childhood Experiences Are Associated with Unmet Healthcare Needs among Children with Autism Spectrum Disorder. J Pediatr 2018; 202:258-264.e1. [PMID: 30220443 DOI: 10.1016/j.jpeds.2018.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/24/2018] [Accepted: 07/05/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To explore associations between level of adverse childhood experiences (ACEs) and unmet healthcare needs among children with autism spectrum disorder (ASD) using a population-based sample. STUDY DESIGN Cross-sectional data from the 2011-2012 National Survey of Child Health were analyzed to estimate prevalence of unmet healthcare needs among children with ASD, aged 2-17 years (ASD = 1624; estimated population = 1 174 871). Multivariate Poisson and logistic regression models were used to estimate the relationship between reported ACEs and unmet healthcare needs among children with ASD. RESULTS After we adjusted for all other variables, children with ASD who experienced 1-2 ACEs and 3+ ACEs were associated with 1.78 (P < .05) and 2.53 (P < .01) times the incidence rate of unmet healthcare needs in comparison with children without ACEs. Compared with children who experienced 0 ACEs, the adjusted odds of any unmet healthcare need were 2.34 (P < .01) and 2.66 (P < .01) for children with 1-2 ACEs and 3 + ACEs, respectively. CONCLUSION Although limited to cross-sectional data, our study provides compelling evidence on the link between ACEs and unmet healthcare needs among children with ASD. It advances understanding of risk factors in the child and community context that contribute to health disparities and negatively impact healthcare access and use in this population.
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Affiliation(s)
- Kristin L Berg
- Department of Social Work, University of South Dakota, Sioux Falls, SD.
| | - Cheng-Shi Shiu
- School of Nursing, University of California-Los Angeles, Los Angeles, CA
| | - Rebecca T Feinstein
- Department of Health Services Management, College of Health Sciences, Rush University, Chicago, IL
| | - Michael E Msall
- Comer Children's Hospital, and Kennedy Research Center on Intellectual and Developmental Disabilities, University of Chicago Medicine, Chicago, IL
| | - Kruti Acharya
- Department of Disability & Human Development & Pediatrics, University of Illinois-Chicago, Chicago, IL
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Wilson SA, Peterson CC. Medical care experiences of children with autism and their parents: A scoping review. Child Care Health Dev 2018; 44:807-817. [PMID: 30136407 DOI: 10.1111/cch.12611] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 07/08/2018] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Abstract
Children with autism spectrum disorder (ASD) and their families may benefit from the provision of additional supports in health care settings, particularly when preparing for and attending medical appointments. This review examined literature that describes experiences in medical care settings from the perspective of patients under age 18 with ASD and their caregivers. A scoping review was conducted to examine the experiences of children with ASD and their families in medical care settings. Twenty-nine studies meeting inclusion criteria were identified and reviewed. The review indicated a number of challenges (e.g., parent-reported problems in parent-provider communication and overwhelming environments) as well as factors that facilitate positive experiences (e.g., providing positive reinforcement and explaining exam steps) during medical appointments. Children with ASD and their families are faced with many challenges while receiving care in medical settings. The present review identified many challenges families face, as well as facilitators of positive experiences. Understanding the unique experiences of patients with ASD and their parents will help to improve experiences in medical care settings for children, caregivers, and health care providers.
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Affiliation(s)
- Shelby A Wilson
- Department of Applied Behavior Analysis Services, The Children Center of Wayne County, Detroit, Michigan
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Yonek JC, Jordan N, Dunlop D, Ballard R, Holl J. Patient-Centered Medical Home Care for Adolescents in Need of Mental Health Treatment. J Adolesc Health 2018; 63:172-180. [PMID: 29887487 PMCID: PMC6113081 DOI: 10.1016/j.jadohealth.2018.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/03/2017] [Accepted: 02/08/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE The patient-centered medical home (PCMH) has emerged as an optimal primary care model for all youth; however, little is known about the extent to which adolescents in need of mental health (MH) treatment receive care consistent with the PCMH. This study assessed (1) 10-year trends in PCMH care among U.S. adolescents according to MH need and (2) variations in PCMH care and its subcomponents among adolescents with MH need, by individual and family characteristics. METHODS This was a secondary analysis of Medical Expenditure Panel Survey data (2004-2013). The sample included adolescents aged 12-17 years with ≥1 office-based visits in the past year (N = 18,717). Questions assessing a usual source of care and care that is accessible, comprehensive, family-centered, and compassionate were used to define PCMH care. For adolescents with MH needs, multivariable logistic regression was used to describe the association between PCMH care and sample characteristics. RESULTS Fifty percent of adolescents experienced PCMH care, with little change between 2004 and 2013. Adolescents with MH need (N = 3,794) had significantly lower odds of experiencing PCMH care compared with those without MH need (odds ratio, .78; 95% confidence interval, .69-.87). Among adolescents with MH needs, being uninsured and living with a parent who did not graduate high school were negatively associated with PCMH care, whereas parental usual source of care was positively associated (odds ratio, 1.69; 95% confidence interval, 1.28-2.22). CONCLUSIONS Increasing care accessibility, integrating MH services into primary care settings, and targeting socioeconomically disadvantaged subgroups could improve rates of PCMH care among adolescents with MH needs.
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Affiliation(s)
- Juliet C Yonek
- Department of Psychiatry, Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California.
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Department of Preventive Medicine, Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dorothy Dunlop
- Departments of Medicine and Preventive Medicine, Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel Ballard
- Department of Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jane Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Expanding the Capacity of Primary Care to Treat Co-morbidities in Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 48:4222-4230. [DOI: 10.1007/s10803-018-3630-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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The medical home for children with autism spectrum disorder: an essential element whose time has come. Curr Opin Pediatr 2018; 30:311-317. [PMID: 29389684 DOI: 10.1097/mop.0000000000000605] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the role of the medical home in children with autism spectrum disorder (ASD). A high-quality medical home is essential, given the increase in prevalence of ASD and the array of services, community partners, specialists, therapists, and healthcare team members needed to care for this population. RECENT FINDINGS Providing care through the medical home model results in fewer unmet needs. Care coordination and integration are the aspects of the medical home currently most lacking. Navigating the healthcare landscape for children with ASD may be enhanced with patient navigators, integration of physical and behavioral health, and telehealth services. SUMMARY Children with ASD have an increased number of medical and mental health needs. Obtaining care via a medical home has been shown to decrease unmet healthcare needs. However, they are less likely to receive care through the medical home model compared with other children with special healthcare needs. Barriers identified by families include a lack of early identification, limited knowledge on educational plans, and unknown community resources. Barriers identified by providers include lack of time, training, and resources. Providing care coordination and family-centered care in a medical home model are essential for children with ASD.
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Magallón-Neri E, Vila D, Santiago K, García P, Canino G. The Prevalence of Psychiatric Disorders and Mental Health Services Utilization by Parents and Relatives Living With Individuals With Autism Spectrum Disorders in Puerto Rico. J Nerv Ment Dis 2018; 206:226-230. [PMID: 29112530 DOI: 10.1097/nmd.0000000000000760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Knowledge about prevalence rates of psychiatric disorders and mental health services use among parents and relatives of persons with autism spectrum disorder (ASD) is limited, particularly when referring to epidemiologic samples. The current study is based on an island-wide probabilistic multistage cluster sample of adult individuals (N = 3062) living in Puerto Rico. Results showed a significantly higher rate of attention deficit hyperactivity disorder and serious mental illness in parents (n = 34) or relatives (n = 34) of ASD individuals, as compared with the Puerto Rico adult population as a whole. Although not definitive because of the small sample size, the fact that the rates of mental health utilization were similar to the population sample suggests a need for greater attention by health professionals attending children with ASD to the needs for mental health services of both parents and relatives of individuals with ASD.
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Goldrich Eskow K, Ann Summers J, Chasson GS, Mitchell R. The Association Between Family-Teacher Partnership Satisfaction and Outcomes of Academic Progress and Quality of Life for Children/Youth With Autism. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jppi.12221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Wilfley DE, Staiano AE, Altman M, Lindros J, Lima A, Hassink SG, Dietz WH, Cook S. Improving access and systems of care for evidence-based childhood obesity treatment: Conference key findings and next steps. Obesity (Silver Spring) 2017; 25:16-29. [PMID: 27925451 PMCID: PMC5373656 DOI: 10.1002/oby.21712] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e., clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 h over 6 to 12 months to improve weight status) and to expand payment for these services. METHODS In July 2015, 43 cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. RESULTS Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g., >25 h) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. CONCLUSIONS Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale up training to ensure quality of care.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Myra Altman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Chicago, Illinois, USA
| | - Angela Lima
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sandra G Hassink
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Chicago, Illinois, USA
| | - William H Dietz
- Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, Washington, DC, USA
| | - Stephen Cook
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA
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Parent-Reported Shared Decision Making: Autism Spectrum Disorder and Other Neurodevelopmental Disorders. J Dev Behav Pediatr 2016; 37:20-32. [PMID: 26703325 DOI: 10.1097/dbp.0000000000000242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Assess differences in parent-reported shared decision making (SDM) based on diagnostic group in a national sample of children with neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], or Down syndrome [DS]). Assess contribution of medical home and child functional impairment. METHODS Secondary analysis of 2009 to 2010 National Survey of Children with Special Health Care Needs explored reports of 3966 children with ASD, CP, or DS. SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Regression models were adjusted for child/family characteristics, medical home, functional impairment, and diagnostic group. RESULTS SDMcat and SDMcont were significantly lower in the ASD group (56.7% [95% confidence interval = CI, 53.4-59.9] and mean 8.7 [95% CI, 8.5-9.0]), compared with the CP group (70.5% [95% CI, 63.4-76.7] and mean 9.7 [95% CI, 9.3-10.1]), or the DS group (70.8% [95% CI, 61.2-78.8] and mean 10.0 [95% CI, 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio 6.6, p < .001, mean = 11.9, and p < .001), and less likely for children with greatest functional impairment (adjusted odds ratio 0.4, p = .002, mean = 10.1, and p = .001). Adjusted analysis of SDMcont also showed differences based on diagnostic group with lower SDMcont scores in the ASD group (mean = 10.1 and p = .005) compared with the DS group. CONCLUSION A medical home was associated with higher SDM, whereas greater functional impairment and ASD diagnosis were associated with lower SDM.
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Carbone PS, Young PC, Stoddard GJ, Wilkes J, Trasande L. A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder. Acad Pediatr 2015; 15:626-35. [PMID: 26547543 DOI: 10.1016/j.acap.2015.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 07/15/2015] [Accepted: 07/19/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD. METHODS The 2009 Kids' Inpatient Database was used to examine hospitalizations for ACSC in children within 3 cohorts: those with ASD, those with chronic conditions (CC) without ASD, and those with no CC. RESULTS The proportion of hospitalizations for ACSC in the ASD cohort was 55.9%, compared with 28.2% in the CC cohort and 22.9% in the no-CC cohort (P < .001). Hospitalized children with ASD were more likely to be admitted for a mental health condition, epilepsy, constipation, pneumonia, dehydration, vaccine-preventable diseases, underweight, and nutritional deficiencies compared with the no-CC cohort. Compared with the CC cohort, the ASD cohort was more likely to be admitted for mental health conditions, epilepsy, constipation, dehydration, and underweight. Hospitalized children with ASD admitted for mental health conditions had significantly higher total charges and longer LOS compared with the other 2 cohorts. CONCLUSIONS The proportion of potentially preventable hospitalizations is higher in hospitalized children with ASD compared with children without ASD. These data underscore the need to improve outpatient care of children with ASD, especially in the areas of mental health care and seizure management. Future research should focus on understanding the reasons for increased inpatient health care utilization in children with ASD admitted for mental health conditions.
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Affiliation(s)
- Paul S Carbone
- Department of Pediatrics, University of Utah, Salt Lake City, Utah.
| | - Paul C Young
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | - Jacob Wilkes
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; Intermountain Healthcare, Salt Lake City, Utah
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Do Children with Autism Overutilize the Emergency Department? Examining Visit Urgency and Subsequent Hospital Admissions. Matern Child Health J 2015; 20:306-14. [DOI: 10.1007/s10995-015-1830-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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