Abstract
This study explored predictors of service use among 174 transition-age youth (age 16–30) with an Autism Spectrum Disorder using Andersen’s (J Health Soc Behav 36(1):1–10, 1995) healthcare utilization model. Family caregivers were interviewed about past 6-month use of 15 services. On average, youth used 6.1 and needed 3.2 additional services. Greater service use was associated with two predisposing (caregiver college educated, caregiver not married/partnered), two enabling (youth has Medicaid waiver, youth in high school), and one need factor (lower adaptive functioning). Use of specific services was most strongly related to enabling (Medicaid waiver, in high school) and need factors (lower adaptive functioning, comorbid mental health diagnosis). Findings provide a snapshot of the “service cliff” faced by families and highlight the need for additional research.
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Notes
Although this score is typically subtracted from 100 to yield an index that becomes more negative with greater levels of maladaptive behavior, the original summary score was used to simplify interpretation.
Although number of services is technically a discrete count, OLS regression was justified on the basis that: (a) Values in the sample extended the full range (0-15) and were approximately normally distributed (M = 6.13, SD = 3.23, skewness = 0.27, kurtosis = -0.53); (b) predicted values generated using the final model were approximately normally distributed (M = 6.13, SD = 2.05, skewness = 0.29, kurtosis = 0.63), did not extend beyond the range of possible values, and did not include negative values (range = 1.96 to 11.72); and (c) model residuals were normally distributed and no influential outliers were detected (leverage values all < .20). A sensitivity analysis was conducted to evaluate the potential for bias resulting from the use of OLS. A logistic regression model with aggregated data was determined to be the most appropriate alternative model. In such a model, each of the 15 services is regarded as a trial, the number of trials is fixed, the trials are independent, and the probability of “success” (i.e., use) is the same for each service. The model estimates the effect of each predictor on the odds of using an additional service.
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Funding
This project was supported by a Mt. Sinai Catalytic Autism Research Award through the International Center for Autism Research & Education, Case Western Reserve University; and a Research Development & Training Grant Award from the Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University (PI: David E. Biegel).
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All authors made a substantial, direct intellectual contribution to this work. All participated in study conceptualization. KJI, DEB, FW, and TO devised the analysis plan. KJI supervised the statistical analyses. All contributed to the interpretation of results; SL and RK especially helped to formulate study implications. KJI, DEB, and FW drafted the manuscript. All authors provided critical revisions and approved the final manuscript.
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Ishler, K.J., Biegel, D.E., Wang, F. et al. Service Use Among Transition-Age Youth with Autism Spectrum Disorder. J Autism Dev Disord 52, 1051–1065 (2022). https://doi.org/10.1007/s10803-021-04999-6
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DOI: https://doi.org/10.1007/s10803-021-04999-6