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(SDAS) Racial and Ethnic Disparities in Autism Diagnosis and Educational Therapy Utilization: Quantifying the Contribution of Modifiable Mediators

Age

  • Early Childhood (3-5 years)
  • Middle Childhood (6-11 years)
  • Adolescence (12-18 years)
  • Young Adulthood (19-25 years)

Targeted/Underserved Population

  • African American
  • Hispanic/Latino
  • Asian/Pacific Islander
  • Native American/Alaskan Native

Abstract

The proposed project addresses HRSA-MCH's strategic research interest in work that leads to the development of services and systems of care that eliminate racial and ethnic disparities in health service use for children with autism spectrum disorder (ASD). Many studies have identified disparities in the diagnosis and treatment of ASD. Most have examined racial and ethnic disparities while fewer have examined geographic differences. It is important to rigorously measure both in the same study because the geographic distribution of health resources is one potentially modifiable mediator of racial and ethnic disparities. The overarching aim of our proposed study is to advance understanding of the composition of racial and ethnic disparities in autism diagnosis and treatment among children using the framework and methods put forth in the Institute of Medicine's 2003 report Unequal Treatment. Our target population is children with ASD insured through the Medicaid program in state fiscal year 2013. Through the proposed study we will be able to answer the question, to what extent does geography contribute to racial and ethnic disparities in autism diagnosis and treatment? To address this question, the proposed study has three aims: (1) To describe racial and ethnic disparities in the prevalence of autism service use (developmental assessment, diagnostic services, educational therapies, and case management) among Medicaid-enrolled children with ASD. (2) To describe racial and ethnic disparities in expenditures for autism treatment among Medicaid-enrolled children with ASD. (3) To identify the independent contribution of geography to racial and ethnic disparities in the prevalence of autism diagnosis and expenditures for treatment among Medicaidenrolled children with ASD. We will use a unique set of Medicaid claims data from the State of Illinois. Our data include individual-level claims for services received through health care encounters as well as services received at school as a result of an Individualized Education Plan. Services delivered at school include key autism-related educational therapies including speech and occupational therapies, mental health, social skills, and behavior modification services. In addition we will examine rates of and expenditures on diagnostic and assessment services and case management and service coordination. Our data also permit the use of spatial analytic methods to identify enrolled children according to their school attendance area and school district. The contribution of these geographic characteristics to disparities will be quantified through predictive methods for generalized linear models. The anticipated outcomes of this project are threefold. First, the findings of our work can inform the development of interventions and policy-based solutions for addressing racial and ethnic disparities in the diagnosis and treatment of children with ASD. Second, members of the Illinois Autism Task Force can use findings from this study to deploy diagnosis and treatment resources to areas of the state where geography accounts for a significant proportion of racial and ethnic disparities. Finally, we can work with the Task Force to develop future stakeholder-informed approaches to eliminate disparities that can be tested and disseminated across the country.

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