Date of Award

2016

Document Type

Open Access Dissertation

Department

College of Social Work

Sub-Department

Social Work

First Advisor

Robert M. Hock

Second Advisor

Bethany A. Bell

Abstract

Public funding of early intensive behavioral intervention (EIBI) for the 1 in 68 children who meet criteria for autism spectrum disorder (ASD) is rapidly expanding. Evidence indicates that children with ASD experience racial, socioeconomic, and geographic disparities in access to health care services. However, the Interagency Autism Coordinating Committee and the World Health Organization cite disparities in access to early intervention among the most pressing yet understudied areas of research. Currently, ASD service research is dominated by inquiries into the age of diagnosis and enrollment in EIBI. We know little about disparities in the time-lag between diagnosis and treatment onset or treatment utilization trajectories. The aims of this dissertation, which are grounded in the Behavioral Model of Health Services Use, include: 1) to examine the relationship between time to treatment onset and child race and time to treatment onset and neighborhood racial composition, poverty, affluence, and urbanicity; 2) to examine the relationship between treatment utilization trajectories and child race and treatment utilization trajectories and neighborhood characteristics during the first year of treatment; and 3) to identify and describe the type and prevalence of treatment utilization trajectories and the association of child race and neighborhood characteristics with these trajectories during the first year of treatment. To complete this study, paper case records, excel spreadsheets, and electronic records provided by the South Carolina Department of Disabilities and Special Needs, as well as Medicaid claims data and Census data provided by the South Carolina Revenue and Fiscal Affairs Office, were integrated. This unique dataset includes all children with ASD who enrolled in South Carolina’s Pervasive Developmental Disorder (PDD) Program (N=2,338) between its inception (February 6, 2007) and the end of the first quarter of calendar year 2015 (March 31, 2015). The sample for Aim 1 (N=473) includes only those children who were diagnosed after the waitlist was established (August, 2007), placed on a waitlist, and had dates of diagnosis, placement on waitlist, enrollment, assessment, and initial therapy session. Aims 2 and 3 (N=807) include children who received at least one therapy session during a minimum of 26 weeks over the first year of treatment. Statistical analyses include ordinary least squares regression (Aim 1), two-level growth curve models (Aim 2), and latent class growth analysis (Aim 3). The results of Aim 1 indicate that there are not disparities in the time-lag between diagnosis and treatment onset. In Aim 2, although findings point to disparities in the percent of allotted treatment hours children use during their first week of treatment, there is no evidence of disparities in children’s treatment utilization trajectories. However, the results of Aim 3 reveal that there are four treatment utilization trajectory types, and that there are racial and neighborhood disparities in children’s assignment to these trajectory types. Collectively, these findings highlight critical areas for future research, underscore the importance of investigating multiple indicators of access to EIBI, offer theoretical contributions to research on access to EIBI, and provide insight into implications for the provision of publicly-funded EIBI and for social work practice.

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