The Impact of Medical Home on the Early Identification and Intervention Receipt of Children with Autism and Developmental Disabilities

Despite substantial advances in the early identification of children with autism spectrum disorder and developmental disabilities (ASD/DD) the majority of cases are not identified early enough to benefit from interventions during early developmental stages marked by high neuroplasticity. Most early ASD/DD identification research focuses on psychometric studies of screening tools though a multi-disciplinary systems perspective is emerging with a few studies investigating screening within and across community systems. At the same time medical home studies in the ASD/DD literature tend to be descriptive or focus on medical home as an outcome. Despite the understanding that a medical home should engage in developmental screening and monitoring there is little research explicitly showing that having access to a medical home decreases the age at which ASD/DD is identified. Nor are there reports showing that having a medical home results in young children with identified ASD/DD having greater access to EI or community based treatments. The primary purpose of this project is to determine whether having a medical home is associated with earlier identified ASD/DD and whether children with ASD/DD under the age of 5 with a medical home have increased odds of receiving EI or community based treatment compared to children with ASD/DD without a medical home. Furthermore we will seek to determine if having a medical home mediates racial/ethnic disparities in the age of early ASD/DD identification or EI and community based treatment receipt. These analyses align with priority research and surveillance activities in the Autism Cares Act (2019) in that medical home and screening/monitoring are directly relevant to value-based care delivery initiatives and targets a noted health workforce need to improve access to EI and other mental health services for children with ASD/DD. Analyses will use measures available from the National Surveys of Children's Health (NSCH 2016-2020) which are publicly available public health datasets that include variables related to developmental screening and monitoring age of ASD/DD identification medical home early intervention receipt community based treatment receipt and relevant co-variates. To determine the impact of medical home we will conduct a series of regression analyses investigating the relationship between having a medical home and age of identified ASD/DD EI receipt and community based treatment receipt. We will also conduct follow up analyses to determine which medical home subscales are the primary source of variance in age of ASD/DD identification EI receipt and community based treatment receipt. Finally we will conduct mediation analyses to determine if medical home measures mediate racial/ethnic disparities in age of identified ASD/DD EI receipt and community based treatment receipt. These data will help broaden the early identification literature by linking medical home to early identified ASD/DD and crosssystem EI/treatment service receipt. They will also help policy makers determine which aspects of medical home mediate ASD/DD disparities.

Barger, B., Salmon, A. & Moore, Q. Medical Home, Developmental Monitoring/Screening, and Early Autism Identification. J Autism Dev Disord (2023). Https://doi.org/10.1007/s10803-023-06044-0 DOI:https://doi.org/10.1007/s10803-023-06044-0 July 2023 J Autism Dev Disord

Barger, Brian et al. "Correlations Between State-Level Monitoring and Screening Rates and Early Identified ASD/DD Across Racial and Ethnic Groups." Infants & Young Children 37 (2024): 64 - 81. DOI:https://doi.org/10.1097/IYC.0000000000000258 2024 Infants & Young Children