Date of Award

December 2020

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Sciences

First Advisor

Kris A Barnekow

Committee Members

Teal W Benevides, Emmanuel M Ngui, Bonita P Klein-Tasman, Elizabeth R Drame, Victoria A Moerchen

Keywords

Autism, Complex survey, Health Services, IEP, Medical Home, Utilization

Abstract

One in 54 children is diagnosed with an autism spectrum disorder (ASD) in the U.S. The American Academy of Pediatrics (AAP) is a primary care model defined as accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally-effective care for children with ASD, jointly with educational services. Children with ASD use educational services for cognitive, social, and behavioral needs. Educational services include early intervention (EI) through EI plans or school services under special education plans in public schools. Linking health and educational services reduces fragmented care and collaboratively addresses the needs of children with ASD. Although the AAP has asserted efforts to coordinate health and educational services, whether medical home care contributes to educational services use remains unclear. Using the 2016/2017 National Survey of Children’s Health (NSCH), this study measured the association between care that did not meet AAP medical home criteria and educational services use for children aged 1-17 with ASD. Medical home care was operationalized as care that did not meet AAP medical home criteria. Multivariate analyses were performed for two sets of predictive models, with educational services as outcomes: ever had special education or EI plans (n=1,428) and not currently using services under these plans (n=1,248), while controlling for predisposing, enabling, enabling-vulnerability, and need factors in the Andersen behavioral model of health services use with a vulnerability domain. Approximately 68% of children with ASD ever had special education or EI plans, and 10% were not currently using services under these plans, for those without care that met AAP medical home criteria. Medical home care was not significantly associated with ever having special education or EI plans but associated with less likelihood of current service use under these plans (aOR = 0.51, 95% CI [0.29-0.90]). Significant predictors of ever having special education or EI plans were children’s ages, three or more children in households, Black or Other races, decreased maternal health status, single parent families, having public insurance, and age at ASD diagnoses. Children’s ages (aOR = 1.09, 95% CI [1.00-1.18]), maternal health (aOR = 1.88, 95% CI [1.05-3.36]), and children with special healthcare needs status (aOR = 2.58, 95% CI [1.17-5.68]) were associated with greater odds of not currently receiving services under one of these plans. For children with ASD, care that did not meet AAP medical home criteria was not significantly associated with ever having a special education or EI but was significantly associated with not currently receiving services under one of these plans. This study highlights the gaps in access to medical home care that affects educational services access which are another source of crucial services for children with ASD. Policies and practices improving integrated care systems are needed to increase access to medical home care for children with ASD and to provide a gateway to educational services through coordinated care with medical homes.

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