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Rubenstein E, Tewolde S, Skotko BG, Michals A, Fortea J. Occurrence of mosaic Down syndrome and prevalence of co-occurring conditions in Medicaid enrolled adults, 2016-2019. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024:e32097. [PMID: 38925597 DOI: 10.1002/ajmg.c.32097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Mosaic Down syndrome is a triplication of chromosome 21 in some but not all cells. Little is known about the epidemiology of mosaic Down syndrome. We described prevalence of mosaic Down syndrome and the co-occurrence of common chronic conditions in 94,533 Medicaid enrolled adults with any Down syndrome enrolled from 2016 to 2019. METHODS We identified mosaic Down syndrome using the International Classification of Diseases and Related Health Problems, tenth edition code for mosaic Down syndrome and compared to those with nonmosaic Down syndrome codes. We identified chronic conditions using established algorithms and compared prevalence by mosaicism. RESULTS In total, 1966 (2.08%) had claims for mosaic Down syndrome. Mosaicism did not differ by sex or race/ethnicity with similar age distributions. Individuals with mosaicism were more likely to present with autism (13.9% vs. 9.6%) and attention deficit hyperactivity disorder (17.7% vs. 14.0%) compared to individuals without mosaicism. In total, 22.3% of those with mosaic Down syndrome and 21.5% of those without mosaicism had claims for Alzheimer's dementia (Prevalence difference: 0.8; 95% Confidence interval: -1.0, 2.8). The mosaic group had 1.19 times the hazard of Alzheimer's dementia compared to the nonmosaic group (95% CI: 1.0, 1.3). DISCUSSION Mosaicism may be associated with a higher susceptibility to certain neurodevelopmental and neurodegenerative conditions, including Alzheimer's dementia. Our findings challenge previous assumptions about its protective effects in Down syndrome. Further research is necessary to explore these associations in greater depth.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Salina Tewolde
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Michals
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
- Instituto de Investigación - Hospital de la Santa Cruz y San Pablo, Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Lindsay S, Li Y, Joneja S, Hsu S. Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review. Disabil Rehabil 2024:1-20. [PMID: 38864302 DOI: 10.1080/09638288.2024.2364823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers. METHODS We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes. RESULTS Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers. CONCLUSIONS This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Simran Joneja
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
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Mendez AI, McQueen E, Gillespie S, Klin A, Klaiman C, Pickard K. Access to Part C, Early Intervention for children younger than 4 years evaluated for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1431-1440. [PMID: 38360525 DOI: 10.1177/13623613241229150] [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] [Indexed: 02/17/2024]
Abstract
LAY ABSTRACT Health disparities are defined as preventable differences in the opportunities to achieve optimal health outcomes experienced by marginalized and underrepresented communities. For families with autistic children, health disparities limit accessing early intervention services-which have been found to improve quality of life and other outcomes. One specific early intervention service in the United States is Individuals with Disabilities Education Act, Part C Early Intervention programs, which are federally funded interventions for children birth-to-three with developmental delays. This study adds to this topic by examining which factors impact accessing Part C, Early Intervention services for children who were evaluated for autism. Results showed that only half of the sample received these services despite there being concerns about development for all children. In addition, results showed that those who identified as Black had decreased odds of having accessed Part C, Early Intervention compared to those who identified as White. These results suggest that there are disparities when it comes to accessing important early intervention services that may be negatively impacting the Black autistic community.
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Affiliation(s)
- Adriana I Mendez
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | | | - Scott Gillespie
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Cheryl Klaiman
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
| | - Katherine Pickard
- Emory University, USA
- Marcus Autism Center, USA
- Children's Healthcare of Atlanta, USA
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Fannin DK, Williams EDG, Fuller M, Pearson JN, Boyd BA, Drame E, Taylor J, Dickerson AS, Spinks-Franklin A, Coles-White D. Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth. Autism Res 2024; 17:1072-1082. [PMID: 38804591 PMCID: PMC11186720 DOI: 10.1002/aur.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629-1638; Smith et al., 2020. Pediatrics, 145, S35-S46.). Black 8-year-olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29-49.) where services may not be autism-specific or have Individual Education Plan goals only focused on "behavior problems" (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261-3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411-424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech-Language Pathology, 31, 2159-2174.). Additionally, ADMM researchers report consistent disparities in the identification of co-occurring intellectual disability where Black autistic children have significantly more co-occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, "…improved…access to services among historically underserved groups," (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). We will then recommend strategies to address the ongoing disparities.
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Affiliation(s)
- Danai Kasambira Fannin
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | | | - Marcus Fuller
- Department of Education, University of Maryland Eastern Shore, Princess Anne, MD
| | - Jamie N. Pearson
- Department of Teacher Education and Learning Sciences, North Carolina State University, Raleigh, NC
| | - Brian A. Boyd
- School of Education, University of North Carolina, Chapel Hill, NC
- Frank Porter Graham Child Development Institute, Chapel Hill, NC
| | - Elizabeth Drame
- Department of Teaching and Learning, University of Wisconsin, Milwaukee, WI
- Division of Diversity, Equity, and Inclusion, University of Wisconsin, Milwaukee, WI
| | - Jonte’ Taylor
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA
| | - Aisha S. Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - D’Jaris Coles-White
- Department of Speech, Language, Hearing Science, Western Michigan University, Kalamazoo, MI
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Larson SA, Caldwell J, Robinson G, Oteman Q. Housing and Long-Term Services and Supports for People With Intellectual or Developmental Disabilities From Racially and Culturally Minoritized Communities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 62:200-210. [PMID: 38802099 DOI: 10.1352/1934-9556-62.3.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 02/13/2024] [Indexed: 05/29/2024]
Abstract
This article describes research on the places people with intellectual and developmental disabilities (IDD) live and disparities in housing and long-term services and supports (LTSS) outcomes for people with IDD from racially and culturally minoritized groups. It also summarizes the conclusions and recommendations of the Housing and Long-Term Services and Supports strand of the 2022 State of the Science Conference on the Intersection of Diversity, Equity and Inclusion and Supports and Services for People with IDD, identifies limitations of the available research and recommends strategies to improve research, knowledge translation, and practices.
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Affiliation(s)
- Sheryl A Larson
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
| | - Joseph Caldwell
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
| | - Gregory Robinson
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
| | - Quinn Oteman
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
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Roux AM, Voltaire S, Steinberg H, Williams ED, Anderson KA, Hutson TM, Shea LL. More Than Just a Variable: The Need to Explicitly Focus on Black Youth Within Autism Transitions Research. AUTISM IN ADULTHOOD 2024; 6:119-127. [PMID: 39144071 PMCID: PMC11320561 DOI: 10.1089/aut.2023.0041] [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: 08/16/2024]
Abstract
Little evidence is available to provide context for understanding the experiences of parents and youth from historically marginalized groups as they age into adulthood, especially in regard to the transition experiences of Black autistic transition-age youth and their family members. This commentary builds upon recent publications that inform intersectional understandings of Black autistic experiences in America, and outlines research recommendations to better address the specific needs of Black autistic transition-age youth. Given the noted deficits in transition research and the transition process in regard to the experiences of Black autistic youth, we provide recommendations for improving autism transition research. We propose changes that are necessary to achieve equitable research processes, which could inform the design of targeted interventions to improve transition experiences for Black autistic youth.
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Affiliation(s)
- Anne M. Roux
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Samuelle Voltaire
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Hillary Steinberg
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ed-Dee Williams
- School of Social Work, Boston College, Boston, Massachusetts, USA
| | - Kristy A. Anderson
- College of Social Work, Florida State University, Tallahassee, Florida, USA
| | - Turea M. Hutson
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lindsay L. Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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Oosting DR, Howard MS, Carter AS. Reciprocal Associations Between Language Ability and Social Functioning Development in Pre-verbal Autistic Children. J Autism Dev Disord 2024; 54:1643-1655. [PMID: 36719605 DOI: 10.1007/s10803-023-05906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
Longitudinal research on language abilities and social functioning in young children suggests that gains in one domain affect gains in the other. However, few studies have examined inter-relations of language and social functioning jointly among young children diagnosed with autism spectrum disorder (ASD). Pre-verbal toddlers with ASD are a group of particular clinical relevance, given that greater language abilities at school entry have been associated with positive long-term adjustment in many areas, including adaptive and social functioning. Reduced attention to and engagement in social interactions among autistic toddlers who are not yet speaking may interfere with language development concurrently and over time. The present study examined reciprocal associations between language ability and social functioning over a 2-year period across three time points in a sample of 90 pre-verbal autistic toddlers using cross-lagged panel analyses conducted in MPlus. Cross-lagged panel analyses revealed significant within-timepoint synchronous correlations, within-domain autoregressive paths over time, and as hypothesized, reciprocal significance in all cross-lagged paths. For very young pre-verbal children with ASD, language ability and social functioning appear to exert concurrent and cascading developmental influences on one another. Targeting both language and social functioning simultaneously may enhance intervention efficacy for very young pre-verbal children with ASD.
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Affiliation(s)
- Devon R Oosting
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Mya S Howard
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA.
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Modirrousta A, Harris YR. Parental strategies to promote theory of mind development in autistic children of color. Front Psychol 2024; 15:1347504. [PMID: 38699568 PMCID: PMC11064013 DOI: 10.3389/fpsyg.2024.1347504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Autism Spectrum Disorder is characterized by an impaired ability to take other people's perspectives, which is known as theory of mind. However, little is known about how theory of mind exhibits itself in autistic children of color and how parents foster their child's developmental skills in communities of color. Methods Two interviews were created to assess how parents appraise their child's developmental skills and help their child grow: a perspective-teaching interview and a general developmental skills interview. Four families participated in the study; three children were African American or mixed, while one had an Asian mother. Parents were asked how their child exhibited various developmental skills and how they helped their child with those milestones. Results Parents pointed at similar delays in theory of mind and other developmental skills, such as turn-taking and reading faces. They also provided similar strategies to teach those abilities, such as modeling and reinforcements. Several insights and common themes were found regarding autistic behaviors their children expressed and how those affected their parenting experiences. Discussion These findings allow for a better understanding of parents' experiences raising autistic children of color; future research could expand on their stories and create interventions tailored to these underrepresented communities.
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Baum RA, Berman BD, Fussell JJ, Patel R, Roizen NJ, Voigt RG, Leslie LK. Child Health Needs and the Developmental-Behavioral Pediatrics Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678H. [PMID: 38300001 DOI: 10.1542/peds.2023-063678h] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Developmental-behavioral pediatrics (DBP) subspecialists care for children with complex neurodevelopmental and behavioral health conditions; additional roles include education and training, advocacy, and research. In 2023, there were 1.0 DBP subspecialists per 100 000 US children aged 0 to 17 years (range 0.0-3.8), with wide variability in DBP subspecialist distribution. Given the prevalence of DB conditions, the current workforce is markedly inadequate to meet the needs of patients and families. The American Board of Pediatrics Foundation led a modeling project to forecast the US pediatric subspecialty workforce from 2020 to 2040 using current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios and reports results in headcount (HC) and HC adjusted for percent time spent in clinical care, termed "clinical workforce equivalent." For DBP, the baseline model predicts HC growth nationally (+45%, from 669 to 958), but these extremely low numbers translate to minimal patient care impact. Adjusting for population growth over time, projected HC increases from 0.8 to 1.0 and clinical workforce equivalent from 0.5 to 0.6 DBP subspecialists per 100 000 children aged 0 to 18 years by 2040. Even in the best-case scenario (+12.5% in fellows by 2030 and +7% in time in clinical care), the overall numbers would be minimally affected. These current and forecasted trends should be used to shape much-needed solutions in education, training, practice, policy, and workforce research to increase the DBP workforce and improve overall child health.
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Affiliation(s)
- Rebecca A Baum
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Brad D Berman
- Division of Developmental-Behavioral Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, California
| | - Jill J Fussell
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas
| | - Rohan Patel
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill/North Carolina Children's Hospital, Chapel Hill, North Carolina
| | - Nancy J Roizen
- Division of Developmental and Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Robert G Voigt
- Michael R. Boh Centers for Child Development, Department of Pediatrics, Ochsner Health, and University of Queensland Medical School/Ochsner Clinical School, New Orleans, Louisiana
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Slopen N, Chang AR, Johnson TJ, Anderson AT, Bate AM, Clark S, Cohen A, Jindal M, Karbeah J, Pachter LM, Priest N, Suglia SF, Bryce N, Fawcett A, Heard-Garris N. Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:147-158. [PMID: 38242597 DOI: 10.1016/s2352-4642(23)00251-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 08/02/2023] [Accepted: 09/08/2023] [Indexed: 01/21/2024]
Abstract
Racial and ethnic inequities in paediatric care have received increased research attention over the past two decades, particularly in the past 5 years, alongside an increased societal focus on racism. In this Series paper, the first in a two-part Series focused on racism and child health in the USA, we summarise evidence on racial and ethnic inequities in the quality of paediatric care. We review studies published between Jan 1, 2017 and July 31, 2022, that are adjusted for or stratified by insurance status to account for group differences in access, and we exclude studies in which differences in access are probably driven by patient preferences or the appropriateness of intervention. Overall, the literature reveals widespread patterns of inequitable treatment across paediatric specialties, including neonatology, primary care, emergency medicine, inpatient and critical care, surgery, developmental disabilities, mental health care, endocrinology, and palliative care. The identified studies indicate that children from minoritised racial and ethnic groups received poorer health-care services relative to non-Hispanic White children, with most studies drawing on data from multiple sites, and accounting for indicators of family socioeconomic position and clinical characteristics (eg, comorbidities or condition severity). The studies discussed a range of potential causes for the observed disparities, including implicit biases and differences in site of care or clinician characteristics. We outline priorities for future research to better understand and address paediatric treatment inequities and implications for practice and policy. Policy changes within and beyond the health-care system, discussed further in the second paper of this Series, are essential to address the root causes of treatment inequities and to promote equitable and excellent health for all children.
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Affiliation(s)
- Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA.
| | - Andrew R Chang
- Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Ashaunta T Anderson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Aleha M Bate
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA
| | - Shawnese Clark
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Stanely Manne Children's Research Institute, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alyssa Cohen
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Monique Jindal
- Department of Clinical Medicine, University of Illinois, Chicago, IL, USA
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Lee M Pachter
- Institute for Research on Equity and Community Health, ChristianaCare, Wilmington, DE, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Naomi Priest
- Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia; Population Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nessa Bryce
- Department of Psychology, Harvard University, Boston, MA, USA
| | - Andrea Fawcett
- Department of Clinical and Organizational Development, Chicago, IL, USA
| | - Nia Heard-Garris
- Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Chicago, IL, USA; Department of Pediatrics, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Fisher AP, Lynch JD. Differences Between Black and White Caregivers in the Association Between Autism Diagnostic Process Satisfaction and Service Use. J Autism Dev Disord 2024:10.1007/s10803-023-06233-x. [PMID: 38231381 DOI: 10.1007/s10803-023-06233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Black families of children with autism spectrum disorder have less access to high quality, culturally responsive care for their children. METHOD We assessed satisfaction and service utilization among fifty (29%) Black caregivers and 124 (71%) White caregivers of children with autism spectrum disorder. We also examined whether race moderated the association between satisfaction and service utilization. RESULTS We did not identify racial differences in satisfaction or service utilization. Race moderated the association between satisfaction and total service use, F(170) = 5.29, p =.02, therapy service use, F(163) = 3.59, p =.046, and community service use, F(169) = 4.76, p =.046. For Black families, there was a positive association between satisfaction and service use. There was no association between satisfaction and service use among White families. DISCUSSION Satisfaction may be particularly important among Black families, who have been mistreated by the healthcare system and frequently face discrimination. Our results suggest the importance of culturally responsive care for Black families.
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Affiliation(s)
- Allison P Fisher
- Department of Psychology, University of Cincinnati, 45 W. Corry Blvd, Cincinnati, OH, USA.
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA.
| | - James D Lynch
- Department of Psychology, University of Cincinnati, 45 W. Corry Blvd, Cincinnati, OH, USA
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12
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Hardy RY, Chavez LJ, Grant VR, Chisolm DJ, Daniels CJ, Jackson JL. Healthcare Use Among Black and White Congenital Heart Disease Medicaid Enrollees. Pediatr Cardiol 2023; 44:1754-1762. [PMID: 37535077 DOI: 10.1007/s00246-023-03249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
Congenital heart disease (CHD) is the most common birth anomaly in the US. Research shows lost-to-follow-up trends and racial disparities in healthcare use. This study examines racial differences in healthcare use among Medicaid-covered children with CHD. Using 2010-2019 claims data from a pediatric Medicaid Accountable Care Organization, 960 Black and White children with complex CHD and ≥ 3 years of continuous Medicaid coverage were identified. Three cohorts were constructed (starting age: < 1-year-olds, 1-5-year-olds, 6-15-year-olds) and followed for 3 years. Multivariate analysis assessed annual healthcare use (cardiology, primary care, emergency department) by race, adjusting for patient and provider covariates. Overall, 51% of patients had an annual cardiology visit, and 54% had an annual primary care visit. Among the 1-5-year-old cohort, Black children were predicted to be 13% less likely to have an annual cardiology visit compared to their White counterparts (p = 0.001). Older Black children were predicted to be more likely to have a primary care visit compared to their White counterparts. Nearly half of Medicaid-enrolled children with complex CHD did not receive recommended cardiology care. Young Black children were less likely to receive an annual cardiac visit, while older Black children were more likely to receive primary care. While the percentage with an annual cardiac visit was low, the majority had seen a cardiologist within the 3-year window, suggesting these children are still receiving cardiology care, if less frequently than recommended. Opportunities exist for cardiology and primary care to collaborate to ensure patients receive timely recommended care.
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Affiliation(s)
- Rose Y Hardy
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA.
| | - Laura J Chavez
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Victoria R Grant
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Deena J Chisolm
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Curt J Daniels
- Division of Cardiovascular Medicine & Nationwide Children's Hospital, The Ohio State University Department of Internal Medicine, 473 W 12th Ave., Columbus, OH, 43210, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
- College of Medicine, Department of Pediatrics, The Ohio State University, 370 W 9th Ave., Columbus, OH, 43210, USA
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13
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Friedman C. Technology first: The impact on technology availability for people with intellectual and developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1251-1263. [PMID: 37482893 DOI: 10.1111/jar.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/02/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND In the United States, 16 states have adopted Technology First initiatives to improve people with intellectual and developmental disabilities' access to technology. METHOD Our aim was to examine if Technology First initiatives impact the allocation of technology in Home and Community-Based Services (HCBS) for people with intellectual and developmental disabilities. To do so, we analysed HCBS programs from across the United States in fiscal year 2021. RESULTS Technology First states were more likely to offer telehealth service delivery in their HCBS programs. However, we found few other significant differences in allocation of technology - the number of people receiving and projected spending - based on states' Technology First status. CONCLUSIONS While these findings do not mean that there is no value in Technology First initiatives, it appears these initiatives have yet to truly impact resource allocation when it comes to HCBS.
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Affiliation(s)
- Carli Friedman
- CQL | The Council on Quality and Leadership, Towson, Maryland, USA
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14
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Rubenstein E, Michals A, Wang N, Scott A, Tewolde S, Levine AA, Tripodis Y, Skotko BG. Medicaid Enrollment and Service Use Among Adults With Down Syndrome. JAMA HEALTH FORUM 2023; 4:e232320. [PMID: 37566429 PMCID: PMC10422190 DOI: 10.1001/jamahealthforum.2023.2320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
Importance Down syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid. Objective To describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid. Design, Setting, and Participants In this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023. Main Outcomes and Measures Data were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use. Results This cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome. Conclusion and Relevance This cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome.
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Affiliation(s)
- Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Amy Michals
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Ashley Scott
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Salina Tewolde
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - A. Alex Levine
- Department of Health Policy Law and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Brian G. Skotko
- Down Syndrome Program, Massachusetts General Hospital, Boston, Massachusetts
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15
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Wallisch A, Boyd BA, Hall JP, Kurth NK, Streed Jr CG, Mulcahy A, McMaughan DJ, Batza K. Health Care Disparities Among Autistic LGBTQ+ People. AUTISM IN ADULTHOOD 2023; 5:165-174. [PMID: 37346996 PMCID: PMC10280185 DOI: 10.1089/aut.2022.0006] [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: 03/07/2023]
Abstract
Background Lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people and disabled people experience disparities in access to health care compared with others. However, we have yet to understand how health care disparities may be further exacerbated at the intersection of disability and LGBTQ+ identity, particularly among autistic people. Objectives The primary goals of this study were to (1) examine differences in unmet health care needs and health status between LGBTQ+ autistic people and straight/cisgender autistic people and (2) explore how state policies and demographics predict the unmet health care needs of the autistic LGBTQ+ people. Methods We conducted a cross-sectional analysis using data from the 2019 National Survey on Health and Disability that included a subsample of autistic participants, with 62 LGBTQ+ adults and 58 straight/cisgender adults. To address our first study goal, we used an independent samples t-test, and to address our second study goal, we used Poisson regression. Results The LGBTQ+ group reported significantly more days of poor physical and mental health, more co-occurring diagnoses, and more unmet health care needs than the straight/cisgender group. For LGBTQ+ people, protective state health care laws and a lower income resulted in significantly more health care needs being met. Conclusions Findings from this study suggest that the intersection of an LGBTQ+ identity and autism is associated with greater disparities in physical and mental health as well as unmet health care needs; however, state policies prohibiting discrimination of LGBTQ+ people may act as a protective factor and result in fewer unmet health care needs. Future research should examine additional structural factors that may mitigate health inequities for autistic LGBTQ+ people.
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Affiliation(s)
- Anna Wallisch
- Juniper Gardens Children's Project, University of Kansas, Kansas City, Kansas, USA
| | - Brian A. Boyd
- School of Education, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean P. Hall
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Noelle K. Kurth
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Carl G. Streed Jr
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Abigail Mulcahy
- Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, Portland, Oregon, USA
| | - Darcy Jones McMaughan
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Katie Batza
- Women, Gender and Sexuality Studies, University of Kansas, Lawrence, Kansas, USA
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16
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Hynes DM, Thomas KC. Realigning theory with evidence to understand the role of care coordination in mental health services research. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023; 26:55-61. [PMID: 37333504 PMCID: PMC10273861 DOI: 10.1177/20534345231153801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy; Cecil G. Sheps Center for Health Services Research and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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ASD Diagnosis and Treatment Experiences Among Mexican Heritage Families. J Autism Dev Disord 2023; 53:1017-1033. [PMID: 35305543 PMCID: PMC9986214 DOI: 10.1007/s10803-022-05512-3] [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: 03/02/2022] [Indexed: 10/18/2022]
Abstract
To understand the ASD diagnosis and treatment pathways for US families, N = 38 Mexican-heritage mothers were interviewed about how and when they obtained an ASD diagnosis for their children. Most children (84%) were diagnosed between two and three years old. One-third of mothers reported receiving four to seven referrals before diagnosis. Mothers identified multiple diagnosis circumstances including two diagnoses and services offered before diagnosis. A multiple case study design documented the diagnosis and treatment experiences of four representative participants. As compared to previous studies that utilized a deficit lens to rationalize barriers to diagnosis and treatment (e.g., parents not knowledgeable about ASD), these findings revealed a complex understanding of how structural barriers (e.g., immigration status), initial diagnosis rejection among caregivers, and abrupt service cancellation complicated the diagnosis and treatment process. Implications identified suggestions to optimize and streamline ASD diagnosis and treatment pathways for Mexican heritage families.
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18
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Pham C, Bacon EC, Grzybowski A, Carter-Barnes C, Arias S, Xu R, Lopez L, Courchesne E, Pierce K. Examination of the impact of the Get SET Early program on equitable access to care within the screen-evaluate-treat chain in toddlers with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221147416. [PMID: 36629055 PMCID: PMC10333446 DOI: 10.1177/13623613221147416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
LAY ABSTRACT Delays in autism spectrum disorder identification and access to care could impact developmental outcomes. Although trends are encouraging, children from historically underrepresented minority backgrounds are often identified at later ages and have reduced engagement in services. It is unclear if disparities exist all along the screen-evaluation-treatment chain, or if early detection programs such as Get SET Early that standardize, these steps are effective at ameliorating disparities. As part of the Get SET Early model, primary care providers administered a parent-report screen at well-baby examinations, and parents designated race, ethnicity, and developmental concerns. Toddlers who scored in the range of concern, or whose primary care provider had concerns, were referred for an evaluation. Rates of screening and evaluation engagement within ethnic/racial groups were compared to US Census data. Age at screen, evaluation, and treatment engagement and quantity was compared across groups. Statistical models examined whether key factors such as parent concern were associated with ethnicity or race. No differences were found in the mean age at the first screen, evaluation, or initiation or quantity of behavioral therapy between participants. However, children from historically underrepresented minority backgrounds were more likely to fall into the range of concern on the parent-report screen, their parents expressed developmental concerns more often, and pediatricians were more likely to refer for an evaluation than their White/Not Hispanic counterparts. Overall results suggest that models that support transparent tracking of steps in the screen-evaluation-treatment chain and service referral pipelines may be an effective strategy for ensuring equitable access to care for all children.
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Affiliation(s)
| | | | | | | | | | - Ronghui Xu
- University of California, San Diego, USA
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19
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Ming DY, Jones KA, White MJ, Pritchard JE, Hammill BG, Bush C, Jackson GL, Raman SR. Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J 2022; 26:2407-2418. [PMID: 36198851 PMCID: PMC10026355 DOI: 10.1007/s10995-022-03543-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality. METHODS Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years old with 3 years continuous Medicaid coverage (10/1/2015-9/30/2018). Exposures were medical complexity, race/ethnicity, and rurality. Three medical complexity levels were: without chronic disease, non-complex chronic disease, and complex chronic disease; the latter were defined as CMC. Race/ethnicity was self-reported in claims; we defined rurality by home residence ZIP codes. Utilization and costs were summarized for 1 year (10/1/2018-9/30/2019) by complexity level classification and categorized as acute care (hospitalization, emergency [ED]), outpatient care (primary, specialty, allied health), and pharmacy. Per-complexity group utilization rates (per 1000 person-years) by race/ethnicity and rurality were compared using adjusted rate ratios (ARR). RESULTS Among 859,166 Medicaid-insured children, 118,210 (13.8%) were CMC. Among CMC, 36% were categorized as Black non-Hispanic, 42.7% White non-Hispanic, 14.3% Hispanic, and 35% rural. Compared to White non-Hispanic CMC, Black non-Hispanic CMC had higher hospitalization (ARR = 1.12; confidence interval, CI 1.08-1.17) and ED visit (ARR = 1.17; CI 1.16-1.19) rates; Hispanic CMC had lower ED visit (ARR = 0.77; CI 0.75-0.78) and hospitalization rates (ARR = 0.79; CI 0.73-0.84). Black non-Hispanic and Hispanic CMC had lower outpatient visit rates than White non-Hispanic CMC. Rural CMC had higher ED (ARR = 1.13; CI 1.11-1.15) and lower primary care utilization rates (ARR = 0.87; CI 0.86-0.88) than urban CMC. DISCUSSION Healthcare utilization varied by race/ethnicity and rurality for Medicaid-insured CMC. Further studies should investigate mechanisms for these variations and expand higher value, equitable care delivery for CMC.
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Affiliation(s)
- David Y Ming
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle J White
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA
| | - Jessica E Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - George L Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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20
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Ames JL, Morgan EH, Giwa Onaiwu M, Qian Y, Massolo ML, Croen LA. Racial/Ethnic Differences in Psychiatric and Medical Diagnoses Among Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:290-305. [PMID: 36601333 PMCID: PMC9807255 DOI: 10.1089/aut.2021.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Racial/ethnic disparities in access to diagnostic services are pervasive for autistic children. However, a few studies have examined racial/ethnic health disparities among autistic adults, who commonly experience higher rates of health conditions than non-autistic adults. We aimed at examining the intersection of autism and race/ethnicity in association with psychiatric and medical diagnoses. Methods The study population included adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. We ascertained 1507 adults who had an autism diagnosis documented in their electronic medical records. We sampled a matched control group of adults without an autism diagnosis (N = 15,070) at a 10:1 ratio. Our sample was 46% White, 17% Hispanic, 16% Asian, 7% Black, and 14% other race/ethnicity. We compared health diagnoses (a) between autistic and non-autistic adults within strata of race/ethnicity and (b) across race/ethnicity within strata of autistic and non-autistic adults. Lastly, we examined the interaction between autism and race/ethnicity on both multiplicative and additive scales. Results Autistic adults were more likely to be diagnosed with most medical and psychiatric conditions compared with their non-autistic counterparts of the same race/ethnicity. Among autistic adults, Black, Hispanic, and Asian adults were less likely to be diagnosed with psychiatric conditions and Black and Hispanic autistic adults were more likely to be diagnosed with obesity than their White counterparts. In interaction models, we found that adults who were Black and autistic were disproportionately less likely to be diagnosed with psychiatric conditions and autoimmune disease and more likely to be diagnosed with hypertension than expected. Conclusion Health vulnerabilities may be compounded at the intersection of autism and race/ethnicity. Future research should continue to apply an intersectional lens toward understanding and addressing these disparities. Our findings likely underestimate the health disparities that exist in uninsured autistic adults and those living in other parts of the United States.
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Affiliation(s)
- Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Address correspondence to: Jennifer L. Ames, PhD, MS, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612-5190, USA
| | - Elizabeth H. Morgan
- College of Education California State University Sacramento, Sacramento, California, USA
| | - Morénike Giwa Onaiwu
- Center for the Study of Women, Gender, and Sexuality, Rice University, Houston, Texas, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Maria L. Massolo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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21
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Holtman SJ, Winans KS, Hoch JD. Utility of Diagnostic Classification for Children 0-5 to Assess Features of Autism: Comparing In-person and COVID-19 Telehealth Evaluations. J Autism Dev Disord 2022; 52:5114-5125. [PMID: 35708824 PMCID: PMC9200933 DOI: 10.1007/s10803-022-05606-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Logistic regression was used to examine the use of Autism Spectrum diagnostic categories from pre-COVID-19 in-person evaluations and COVID-19 telehealth evaluations at a specialist community mental health clinic. The diagnostic classification for children 0-5 (DC: 0-5) affords a wider range of diagnoses that allowed for inferences of clinician certainty of diagnosis. Use of full criteria diagnoses was significantly lower from telehealth evaluations during the pandemic, and was less certain for younger children, some non-English speakers, and children reporting Native American/Alaska Native race. Higher Child Behavior Checklist (CBCL) ASD subscale scores, lower CBCL total scores, and global developmental delay diagnoses predicted greater use of full ASD diagnoses. Findings suggest factors that could identify children appropriate for telehealth evaluations.
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Affiliation(s)
- Sara Julsrud Holtman
- College of Social and Behavioral Sciences, Northwest University, 6710 108th Ave NE, Kirkland, WA 98033 USA
- Fraser, 3333 University Ave SE, Minneapolis, MN 55414 USA
| | | | - John D. Hoch
- Fraser, 3333 University Ave SE, Minneapolis, MN 55414 USA
- Department of Educational Psychology, University of Minnesota, Twin Cities, 3333 University Ave SE, Minneapolis, MN 55414 USA
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22
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Mathews TL, Daly E, Kunz GM, Lugo AM, McArdle P, Menousek K, Kupzyk K. Addressing the Need for Training More School Psychologists to Serve Toddlers and Preschoolers with Autism Spectrum Disorders. CONTEMPORARY SCHOOL PSYCHOLOGY 2022; 28:1-16. [PMID: 36311282 PMCID: PMC9590395 DOI: 10.1007/s40688-022-00434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
The prevalence of autism spectrum disorder (ASD) has risen significantly in the past two decades. Unfortunately, there is a shortage of mental health providers who have specialized training in delivering evidenced-based services to this population. Early intensive behavioral intervention (EIBI) is an evidenced-based treatment recommended for toddlers with ASD, and school psychologists are uniquely positioned to help children with ASD receive it. However, many school psychologists do not receive adequate training in this subspecialty. This paper makes recommendations to school psychology training programs about how to add or improve training in this subspecialty based on the results of an Office of Special Education Programs grant-funded ASD training program which involved collaboration between a NASP-approved and APA-accredited school psychology training program and a community-based early intensive behavioral intervention (EIBI) clinic. The grant supported development of an interdisciplinary didactic and clinical training program to increase the ASD knowledge, skills, and competencies of school psychology graduate students, with the broader goals of developing a replicable training model and increasing the workforce of trained providers for this underserved population. Fifteen graduate students completed the training program. Outcomes related to trainee knowledge, skills, and competencies, trainee satisfaction, and lessons learned over time analyzed within a logic model that guided the project's development and execution can be informative for other school psychology programs undertaking training in this subspecialty.
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Affiliation(s)
- Therese L. Mathews
- University of Nebraska Medical Center, College of Nursing, Nebraska Medical Center, Omaha, NE 985330 USA
| | - Ed Daly
- Department of Educational Psychology, University of Nebraska– Lincoln, NE Lincoln, USA
| | | | | | - Paige McArdle
- Children’s Mercy Hospital and Clinics, Kansas City, MO USA
| | | | - Kevin Kupzyk
- University of Nebraska Medical Center, College of Nursing, Nebraska Medical Center, Omaha, NE 985330 USA
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23
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Shenouda J, Barrett E, Davidow AL, Sidwell K, Halperin W, Silenzio VMB, Zahorodny W. Disparities in Early Intervention Program Participation by Children With Autism Spectrum Disorder in a US Metropolitan Area, 2006 to 2016. JAMA Pediatr 2022; 176:906-914. [PMID: 35849409 PMCID: PMC9295023 DOI: 10.1001/jamapediatrics.2022.2366] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Multiple studies have shown the value of early interventions for autism spectrum disorder (ASD). In the US, the Early Intervention Program (EIP) is mandated by law (Part C of the Individuals With Disabilities Education Act [IDEA]) to provide services to all young children with delays or disabilities. However, the extent to which children with ASD participate in this key service system is unknown. OBJECTIVES To evaluate EIP use by children with ASD from 2006 to 2016 and to describe the factors associated with EIP participation. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used repeated data collected from 2006 to 2016 by active ASD surveillance of the New York-New Jersey metropolitan area as reported in the New Jersey Autism Study. The New Jersey Autism Study identified 4050 children aged 8 years with ASD from 2006 to 2016. Demographic and clinical data were collected and participation in an EIP was assessed through active surveillance. Data were analyzed from June to December 2021. EXPOSURE Sociodemographic factors associated with the outcome of EIP participation. MAIN OUTCOMES AND MEASURES Participation in an EIP assessed at age 8 years. Demographic, ecological, and clinical factors, as well as temporal patterns, were examined by using standard and multilevel logistic regression models. RESULTS Among 4050 children aged 8 years with ASD by active surveillance, 1887 (46.6%) received EIP services. Of these children, 3303 (81.6%) were boys; 1105 (27.3%) were Hispanic, 801 (19.8%) were non-Hispanic Black, 1816 (44.8%) were non-Hispanic White, and 328 (8.1%) were non-Hispanic other (included Alaska Native or American Indian and Asian or Pacific Islander). In adjusted regression models, non-Hispanic Black children with ASD had lower odds of EIP participation (adjusted odds ratio [AOR], 0.67; 95% CI, 0.54-0.84) compared with their non-Hispanic White peers, and children residing in affluent areas had higher odds of receiving EIP services (AOR, 1.71; 95% CI, 1.36-2.15) compared with children residing in underserved areas. Children with ASD born in 2008 had higher odds of EIP participation than children born in 1998 (AOR, 2.64; 95% CI, 2.07-3.36). CONCLUSIONS AND RELEVANCE Early identification of ASD is an important public health priority and receipt of EIP services may improve ASD outcomes. Approximately half of the population of children aged 8 years with ASD received EIP services between 2006 and 2016, and EIP participation by children with ASD increased during the 10-year period. However, receipt of EIP services was marked by strong socioeconomic status- and race and ethnicity-based disparities. Universal ASD screening and additional strategies are needed to address disparities and to increase access to EIP services.
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Affiliation(s)
- Josephine Shenouda
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, Piscataway, New Jersey,Department of Pediatrics, Rutgers New Jersey Medical School, Newark
| | - Emily Barrett
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, Piscataway, New Jersey
| | - Amy L. Davidow
- Department of Biostatistics, New York University School of Global Public Health, New York
| | - Kate Sidwell
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark
| | - William Halperin
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, Piscataway, New Jersey
| | - Vincent M. B. Silenzio
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, Piscataway, New Jersey
| | - Walter Zahorodny
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark
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Brasher S, Stapel-Wax JL, Muirhead L. Racial and Ethnic Disparities in Autism Spectrum Disorder. Nurs Clin North Am 2022; 57:489-499. [DOI: 10.1016/j.cnur.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Angell AM, Varma DS, Deavenport-Saman A, Yin L, Solomon O, Bai C, Zou B. Effects of Sex, Race, and Ethnicity on Primary and Subspecialty Healthcare Use by Autistic Children in Florida: A Longitudinal Retrospective Cohort Study (2012-2018). RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 94:101951. [PMID: 35498508 PMCID: PMC9053730 DOI: 10.1016/j.rasd.2022.101951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Amber M. Angell
- Department of Occupational Therapy at University of Florida, PO Box 100165, Gainesville, FL 32610
| | - Deepthi S. Varma
- Department of Epidemiology at University of Florida, 2004 Mowry Road, Gainesville, FL, 32610
| | - Alexis Deavenport-Saman
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
| | - Larry Yin
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy at University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089
| | - Olga Solomon
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
| | - Chen Bai
- Department of Biostatistics at University of Florida, 2004 Mowry Road, Gainesville, FL, 32610
| | - Baiming Zou
- Department of Biostatistics at University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599
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Straiton D, Sridhar A. Short report: Call to action for autism clinicians in response to anti-Black racism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:988-994. [PMID: 34533064 PMCID: PMC9008552 DOI: 10.1177/13623613211043643] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Black autistic people experience anti-Black racism when interacting with service systems and the clinicians in those systems. In this article, we describe the various steps families take to get services and how anti-Black racism makes that process even harder. We discuss research that shows the negative effects of anti-Black racism in autism assessment, treatment, and quality of care. We then provide five recommendations that clinicians should follow to reduce anti-Black racism in the autism field: (1) find Black autistic people and listen to their opinions about your organization, (2) always keep learning about how your profession promotes anti-Black racism, (3) recognize that the process of a clinician learning to be culturally humble takes time and is never "complete," (4) pay attention to all of the steps that families must take to receive autism services and how these steps are even harder for Black individuals, and (5) advocate for your organization to make systems-level changes in their policies and procedures.
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Abstract
Significant disparities exist in early identification of autism spectrum disorder (ASD) for Hispanic and Latinx children. ASD prevalence estimates are approximately identical for White and Black children but lower for Hispanic and Latinx children. Reasons for these racial and ethnic variations are likely multifactorial. This review sought to understand previously described barriers and limitations to accessing ASD diagnostic services in the Latinx and Hispanic communities. Three main categories of existing barriers were identified: (1) parent/family, (2) community, and (3) systemic. These barriers are complex and multifactorial in nature, including circumstantial limitations such as limited English proficiency, noncitizenship, and low-income status. These can limit health care access, and can lead to family and community cultural barriers, poor knowledge about ASD, and social stigma related to disabilities. Understanding and mitigating barriers is essential to reduce disparities to ASD diagnosis in the Hispanic and Latinx community. [Pediatr Ann. 2022;51(4):e167-e171.].
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Truong DM, Barth AM, Mire SS, Ayala ML, Ramclam AN, Tan SXL, McKee SL. Cultural considerations for conducting autism assessment with Asian American and Pacific Islander students. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dieu M. Truong
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Alexandra M. Barth
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Sarah S. Mire
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Mycah L. Ayala
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Ashley N. Ramclam
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Samantha X. L. Tan
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
| | - Shannon L. McKee
- Department of Psychological, Health, and Learning Sciences University of Houston Houston Texas USA
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Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiatry Rep 2021; 23:66. [PMID: 34402984 PMCID: PMC8961310 DOI: 10.1007/s11920-021-01278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. RECENT FINDINGS Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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