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Mirzaian CB, Deavenport-Saman A, Hudson SM, Betz CL. Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders' Perspectives. Community Ment Health J 2024:10.1007/s10597-024-01262-x. [PMID: 38619698 DOI: 10.1007/s10597-024-01262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/25/2024] [Indexed: 04/16/2024]
Abstract
Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.
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Affiliation(s)
- Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sharon M Hudson
- AltaMed Institute for Health Equity, AltaMed Health Services, Los Angeles, CA, USA
| | - Cecily L Betz
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #76, Los Angeles, CA, 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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2
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Huntjens A, van den Bosch LMCW, Sizoo B, Kerkhof A, Smit F, van der Gaag M. The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: a pragmatic randomized controlled trial. Psychol Med 2024:1-12. [PMID: 38606582 DOI: 10.1017/s0033291724000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUNDS Many autistic people in mental health are suicidal. This study evaluated the effectiveness of dialectical behavior therapy (DBT) v. treatment as usual (TAU) in reducing suicidal ideation and suicide attempts. METHODS At six Dutch mental health centers, 123 outpatients (18-65 years) with DSM-5 diagnosed autism spectrum disorder (ASD) and suicidal behavior were randomly assigned to the DBT intervention group (n = 63) or TAU control group (n = 60). Assessments were conducted at baseline, post-treatment at 6 months and 12-month follow-up. The primary outcomes were severity of suicidal ideation and frequency of suicide attempts. The severity of depression and social anxiety were secondary outcomes. RESULTS At end-of-treatment, DBT significantly reduced both suicidal ideation (z = -2.24; p = 0.025; b = -4.41; s.e. = 197.0) and suicide attempts (z = -3.15; p = 0.002; IRR = 0.046; s.e. = 0.045) compared to TAU, but lost statistical significance at the 12-month follow-up. Depression severity significantly decreased with DBT (z = -1.99; p = 0.046: b = -2.74; s.e. = 1.37) remaining so at 12 months (z = -2.46; p = 0.014; b = -3.37; s.e. = 1.37). No effects were observed on social anxiety. Severe adverse events included two suicides in the TAU condition. CONCLUSIONS DBT is an acceptable, safe, and short-term effective intervention to reduce suicidal ideation and suicide attempts in autistic adults with suicidal behavior.
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Affiliation(s)
- Anne Huntjens
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | | | - Ad Kerkhof
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Filip Smit
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
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3
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Bone ME, O'Connor Leppert ML. Autism Spectrum Disorder at Home and in School. Pediatr Clin North Am 2024; 71:223-239. [PMID: 38423717 DOI: 10.1016/j.pcl.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The diagnosis of autism spectrum disorder (ASD) brings a lifetime of considerations for individuals and their families. The core symptoms of ASD vary in severity and influence behavior and function across all environments. Co-occurring medical, mental health, cognitive, language, learning, and behavioral differences add challenges to those associated with core symptoms. Navigating the preschool, school, and transition ages in the educational setting requires continual reassessment of the strengths, weaknesses, and needs of the student to provide appropriate placement and services.
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Affiliation(s)
- Megan E Bone
- Department of Neurology, Johns Hopkins University School of Medicine; Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.
| | - Mary L O'Connor Leppert
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine
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Vasa RA, Neamsapaya K, Cross EA, Kalb L. Mental Health Crises in Autistic Children: A Framework for Prevention and Intervention in Primary Care. Pediatr Clin North Am 2024; 71:269-282. [PMID: 38423720 DOI: 10.1016/j.pcl.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Children with autism are at high risk for experiencing a mental health crisis, which occurs when psychiatric and behavioral symptoms become a danger and caregivers do not have the resources to safely manage the event. Our current mental health systems of care are not fully prepared to manage crisis in autistic individuals, due to the shortage of available mental health providers and programs that are tailored for autistic children. However, new strategies to address crisis are gradually emerging. This article provides a framework to define crisis and implement prevention and intervention approaches that could potentially mitigate risk for crisis.
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Affiliation(s)
- Roma A Vasa
- Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD 21211, USA.
| | - Kate Neamsapaya
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8527, Baltimore, MD 21205, USA
| | - Elizabeth A Cross
- Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD 21211, USA
| | - Luther Kalb
- Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD 21211, USA
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5
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Wachtel LE, Escher J, Halladay A, Lutz A, Satriale GM, Westover A, Lopez-Arvizu C. Profound Autism: An Imperative Diagnosis. Pediatr Clin North Am 2024; 71:301-313. [PMID: 38423722 DOI: 10.1016/j.pcl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Profound autism refers to a subset of individuals with autism spectrum disorder who have an intellectual disability with an intelligence quotient less than 50 and minimal-to-no language and require 24-hour supervision and assistance with activities of daily living. The general pediatrician will invariably work with autistic children across the spectrum and will likely encounter youth with profound autism. Awareness of profound autism as a real entity describing autistic children with concomitant intellectual disability and language impairment who require 24-hour care is the first step in developing a solid pediatric home for these youth.
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Affiliation(s)
| | - Jill Escher
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
| | - Alycia Halladay
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
| | - Amy Lutz
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
| | - Gloria M Satriale
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA
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Cantor J, Schuler MS, Matthews S, Kofner A, Breslau J, McBain RK. Availability of Mental Telehealth Services in the US. JAMA HEALTH FORUM 2024; 5:e235142. [PMID: 38306092 PMCID: PMC10837750 DOI: 10.1001/jamahealthforum.2023.5142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Importance Telehealth utilization for mental health care remains much higher than it was before the COVID-19 pandemic; however, availability may vary across facilities, geographic areas, and by patients' demographic characteristics and mental health conditions. Objective To quantify availability, wait times, and service features of telehealth for major depressive disorder, general anxiety disorder, and schizophrenia throughout the US, as well as facility-, client-, and county-level characteristics associated with telehealth availability. Design, Settings, and Participants Cross-sectional analysis of a secret shopper survey of mental health treatment facilities (MHTFs) throughout all US states except Hawaii from December 2022 and March 2023. A nationally representative sample of 1938 facilities were contacted; 1404 (72%) responded and were included. Data analysis was performed from March to July 2023. Exposure Health facility, client, and county characteristics. Main Outcome and Measures Clinic-reported availability of telehealth services, availability of telehealth services (behavioral treatment, medication management, and diagnostic services), and number of days until first telehealth appointment. Multivariable logistic and linear regression analyses were conducted to assess whether facility-, client-, and county-level characteristics were associated with each outcome. Results Of the 1221 facilities (87%) accepting new patients, 980 (80%) reported offering telehealth. Of these, 97% (937 facilities) reported availability of counseling services; 77% (726 facilities), medication management; and 69% (626 facilities) diagnostic services. Telehealth availability did not differ by clinical condition. Private for-profit (adjusted odds ratio [aOR], 1.75; 95% CI, 1.05-2.92) and private not-for-profit (aOR, 2.20; 95% CI, 1.42-3.39) facilities were more likely to offer telehealth than public facilities. Facilities located in metropolitan counties (compared with nonmetropolitan counties) were more likely to offer medication management services (aOR, 1.83; 95% CI, 1.11-3.00) but were less likely to offer diagnostic services (aOR, 0.67; 95% CI, 0.47-0.95). Median (range) wait time for first telehealth appointment was 14 (4-75) days. No differences were observed in availability of an appointment based on the perceived race, ethnicity, or sex of the prospective patient. Conclusions and Relevance The findings of this cross-sectional study indicate that there were no differences in the availability of mental telehealth services based on the prospective patient's clinical condition, perceived race or ethnicity, or sex; however, differences were found at the facility-, county-, and state-level. These findings suggest widespread disparities in who has access to which telehealth services throughout the US.
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Kalb LG, Contractor A, Engel C. Advancing Collaborative Care for Autistic Children and Adolescents. JAMA Pediatr 2023; 177:1125-1126. [PMID: 37782492 DOI: 10.1001/jamapediatrics.2023.3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
This Viewpoint discusses an implementation strategy for the Collaborative Care Model to address the need for proper evaluation and treatment for autistic children with a co-occurring mental health condition.
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Affiliation(s)
- Luther G Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Almira Contractor
- Department of Pediatrics, WellSpan Community Health Center, York, Pennsylvania
| | - Charles Engel
- Department of Psychiatry and the Behavioral Sciences, University of Washington, Seattle
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Cervantes PE, Conlon GR, Seag DEM, Feder M, Lang Q, Meril S, Baroni A, Li A, Hoagwood KE, Horwitz SM. Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:704-713. [PMID: 35893840 PMCID: PMC9880247 DOI: 10.1177/13623613221112202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
LAY ABSTRACT Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state's mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers' knowledge and confidence in working with autistic youth are improved.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Greta R. Conlon
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Dana E. M. Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Michael Feder
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Qortni Lang
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Samantha Meril
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Kimberly E. Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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Roudbarani F, Tablon Modica P, Maddox BB, Bohr Y, Weiss JA. Clinician factors related to the delivery of psychotherapy for autistic youth and youth with attention-deficit hyperactivity disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:415-427. [PMID: 35786029 DOI: 10.1177/13623613221106400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Autistic children and youth often experience mental health problems, such as anxiety, depression and behavioural challenges. Although there are therapy programmes that have been found helpful in reducing these issues, such as cognitive behaviour therapy, autistic children often struggle to receive adequate mental health care. Clinicians' knowledge, attitudes, confidence and beliefs about treating mental health problems in autistic people may be related to their choices in providing psychotherapy. Across Ontario, Canada, 611 mental health clinicians, working in publicly funded agencies, completed an online survey about their experiences and opinions on delivering therapy for autistic clients compared to those with attention-deficit hyperactivity disorder. Clinician knowledge was associated with their intention to treat autistic clients or clients with attention-deficit hyperactivity disorder, partly because of their attitudes and the social pressures or values they felt. Clinicians reported feeling less intent on providing therapy to autistic youth compared to youth with attention-deficit hyperactivity disorder because of differences in their attitudes, social pressures and knowledge. This research can inform the training and educational initiatives for mental health practitioners.
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10
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McMaughan DJD, Jones JL, Mulcahy A, Tucker EC, Beverly JG, Perez-Patron M. Hospitalizations Among Children and Youth With Autism in the United States: Frequency, Characteristics, and Costs. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:484-503. [PMID: 36454617 DOI: 10.1352/1934-9556-60.6.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/15/2022] [Indexed: 06/17/2023]
Abstract
National estimates of hospitalization diagnoses and costs were determined using the 2016 HCUP Kids' Inpatient Database. Children and youth with autism were hospitalized over 45,000 times at over $560 million in costs and 260,000 inpatient days. The most frequent principal diagnoses for hospitalizations of children and youth with autism were epilepsy, mental health conditions, pneumonia, asthma, and gastrointestinal disorders, which resulted in almost $200 million in costs and 150,000 inpatient days. Mental health diagnoses accounted for 24.8% of hospitalizations, an estimated $82 million in costs, and approximately 94,000 inpatient days. Children and youth with autism were more likely hospitalized for epilepsy, mental health diagnoses, and gastrointestinal disorders, and less likely for pneumonia and asthma compared to other children and youth.
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Cummings JR, Shellman MH, Stein BD, Asplund J, Lin H, Serban N. Association Between In-Home Treatment and Engagement in Psychosocial Services Among Medicaid-Enrolled Youth. J Am Acad Child Adolesc Psychiatry 2022; 61:1351-1361. [PMID: 35427731 DOI: 10.1016/j.jaac.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Prior studies have identified low rates of engagement in mental health (MH) services in clinic settings among children enrolled in Medicaid. Yet, little is known about whether the delivery of in-home MH treatment (in which the clinician travels to the child's home) improves engagement for this population. This study examines the association between the delivery of in-home psychosocial treatment and engagement in services among Medicaid-enrolled youth. METHOD We used 2010 to 2014 Georgia Medicaid claims data to identify 53,508 children and adolescents (aged 5-17 years) with a MH diagnosis that initiated new psychosocial treatment. We estimated regression models controlling for covariates to examine the relationship of the receipt of any in-home psychosocial treatment in the home setting with 3 outcome measures of engagement: receipt of at least 4 psychosocial visits during the first 12 weeks; total number of psychosocial visits during the first 12 weeks; and total duration of service use. RESULTS Those who received any in-home psychosocial treatment (compared to those who did not) had 4.3 times the odds (odds ratio = 4.3, 95% CI = 4.0, 4.7) of receiving at least 4 visits during the first 12 weeks, had 4.5 (95% CI = 4.3, 4.7) more predicted visits during the first 12 weeks, and had a longer treatment episode duration (mean rate ratio = 1.54, 95% CI = 1.48,1.59). CONCLUSION Although many Medicaid-enrolled youth do not receive a sufficient number of MH services to achieve positive outcomes, our findings suggest that providing in-home psychosocial treatment can improve service engagement and potentially help address this challenge.
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Affiliation(s)
- Janet R Cummings
- Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Melody H Shellman
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
| | | | - John Asplund
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta; Metron, Inc., Reston, Virginia
| | - Hannah Lin
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
| | - Nicoleta Serban
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta
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12
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Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries. Mol Psychiatry 2022; 27:4172-4180. [PMID: 35768640 DOI: 10.1038/s41380-022-01630-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Autism spectrum disorder (ASD) substantially contributes to the burden of mental disorders. Improved awareness and changes in diagnostic criteria of ASD may have influenced the diagnostic rates of ASD. However, while data on trends in diagnostic rates in some individual countries have been published, updated estimates of diagnostic rate trends and ASD-related disability at the global level are lacking. Here, we used the Global Burden of Diseases, Injuries, and Risk Factors Study data to address this gap, focusing on changes in prevalence, incidence, and disability-adjusted life years (DALYs) of ASD across the world. From 1990 to 2019, overall age-standardized estimates remained stable globally. Both prevalence and DALYs increased in countries with high socio-demographic index (SDI). However, the age-standardized incidence decreased in some low SDI countries, indicating a need to improve awareness. The male/female ratio decreased between 1990 and 2019, possibly accounted for by increasing clinical attention to ASD in females. Our results suggest that ASD detection in low SDI countries is suboptimal, and that ASD prevention/treatment in countries with high SDI should be improved, considering the increasing prevalence of the disorder. Additionally, growing attention is being paid to ASD diagnosis in females, who might have been left behind by ASD epidemiologic and clinical research previously. ASD burden estimates are underestimated as GBD does not account for mortality in ASD.
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13
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Cantor J, McBain RK, Kofner A, Hanson R, Stein BD, Yu H. Telehealth Adoption by Mental Health and Substance Use Disorder Treatment Facilities in the COVID-19 Pandemic. Psychiatr Serv 2022; 73:411-417. [PMID: 34407631 PMCID: PMC10695271 DOI: 10.1176/appi.ps.202100191] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined temporal and geographic trends in telehealth availability at U.S. behavioral health treatment facilities and risk factors for not offering telehealth. METHODS Longitudinal data on 15,691 outpatient behavioral health treatment facilities were extracted daily from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Services Locator between January 20, 2020, and January 20, 2021. Facilities operated by the Department of Veterans Affairs were excluded. Bivariate analyses were used to assess trends in telehealth availability in 2020 and 2021. Multivariable regression analysis was used to examine facility- and county-level characteristics associated with telehealth availability in 2021. RESULTS Telehealth availability increased by 77% from 2020 to 2021 for mental health treatment facilities and by 143% for substance use disorder treatment facilities. By January 2021, 68% of outpatient mental health facilities and 57% of substance use disorder treatment facilities in the sample were offering telehealth. Mental health and substance use disorder treatment facilities that did not accept Medicaid as a form of payment were less likely to offer telehealth in 2021, compared with facilities that accepted Medicaid. Mental health and substance use disorder treatment facilities that accepted private insurance were more likely to offer telehealth in 2021, compared with facilities that did not accept private insurance. CONCLUSIONS Although 2020 saw a dramatic increase in telehealth availability at behavioral health treatment facilities, 32% of mental health treatment facilities and 43% of substance use disorder treatment facilities did not offer telehealth in January 2021, nearly 1 year into the pandemic.
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Affiliation(s)
- Jonathan Cantor
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Ryan K McBain
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Aaron Kofner
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Russell Hanson
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Bradley D Stein
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
| | - Hao Yu
- RAND Corporation, Santa Monica, California (Cantor, Hanson), Boston (McBain), Arlington, Virginia (Kofner), and Pittsburgh (Stein); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Yu)
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14
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Hsu YH, Chen CW, Lin YJ, Li CY. Urban-Rural Disparity in the Incidence of Diagnosed Autism Spectrum Disorder in Taiwan: A 10-Year National Birth Cohort Follow-up Study. J Autism Dev Disord 2022; 53:2127-2137. [PMID: 35132529 DOI: 10.1007/s10803-022-05453-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Autism spectrum disorder (ASD) is reportedly more prevalent in urban areas partly because of better accessibility and affordability to healthcare. With universal health insurance coverage in Taiwan, a previous study has shown no urban-rural disparity in the utilization rate of a child's preventive healthcare. Under this circumstance, we followed a birth cohort of 176,273 live births from 2006 to 2015 to detect the differences in ASD incidence between urbanicities. After adjusting for socioeconomic factors, children were 1.28 (95% confidence interval (CI): 1.13-1.44) and 1.54 (95% CI: 1.36-1.75) more likely to acquire ASD in satellite and urban areas compared with those in rural areas, respectively. A gradient association between parental educational attainment and ASD incidence was also noted. Greater ASD incidences in more urbanized areas and more advanced educated parents' children were detected under a circumstance with low barriers to healthcare.
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Affiliation(s)
- Yuu-Hueih Hsu
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, 112, Taiwan
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan, 704302, Taiwan. .,Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Rd., Taichung, 40402, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, No. 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
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Cervantes PE, Li A, Sullivan KA, Seag DEM, Baroni A, Horwitz SM. Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting. J Autism Dev Disord 2022; 53:1755-1763. [PMID: 35122186 DOI: 10.1007/s10803-022-05448-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.
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Affiliation(s)
- Paige E Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Katherine A Sullivan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Dana E M Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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16
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Dilly LJ, Pavlov A. Assessing students in foster care for autism spectrum disorders. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Laura J. Dilly
- Department of PediatricsMarcus Autism Center, Emory University School of MedicineAtlantaGeorgiaUSA
| | - Alexis Pavlov
- Department of PediatricsMarcus Autism Center, Emory University School of MedicineAtlantaGeorgiaUSA
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17
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Ault S, Breitenstein SM, Tucker S, Havercamp SM, Ford JL. Caregivers of Children with Autism Spectrum Disorder in Rural Areas: A Literature Review of Mental Health and Social Support. J Pediatr Nurs 2021; 61:229-239. [PMID: 34153794 DOI: 10.1016/j.pedn.2021.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM Caregivers of children with Autism Spectrum Disorder (ASD) report high levels of stress, social isolation, and poor mental health. Social and emotional support may buffer negative effects of stress for caregivers of children with ASD, however, those living in rural areas may be disadvantaged due to social isolation and increased distance from resources. This scoping review examined the literature regarding the mental health and impact of support for rural caregivers of children with ASD. ELIGIBILITY CRITERIA Articles were limited to those available in the English language and conducted in a high income country. Articles had to include a population of rural caregivers of children with ASD and focus on caregiver mental health and/or the impact of support on caregiver mental health. SAMPLE Searches were conducted with Embase, PubMed, CINAHL, ERIC, and PsycINFO and 22 articles were included. RESULTS Study findings indicate overall poor mental health for rural caregivers of children with ASD. Formal and informal support appear to be beneficial in decreasing stress for rural caregivers of children with ASD. However, a few studies indicated that formal support may add stress to rural caregivers. CONCLUSION There is limited information regarding support needs and the impact of support services on the mental health of rural caregivers of children with ASD. IMPLICATIONS There is a need to increase access to support resources in rural areas for caregivers of children with ASD. Healthcare professionals, including nurses, can play a fundamental role in supporting, educating, and connecting caregivers to other support services.
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Affiliation(s)
| | | | | | | | - Jodi L Ford
- College of Nursing, The Ohio State University, USA
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18
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Abstract
BACKGROUND Autism spectrum disorder (ASD) is a common and lifelong neurodevelopmental disorder with the hallmark features of social impairment and restricted and repetitive patterns of behaviour. Individuals with ASD often experience co-occurring mental health difficulties, some of which may obfuscate the ASD features themselves. Although there is a high need for mental health services for autistic adults, there are surprisingly few evidence-based treatments (EBTs) available; moreover, many mental health practitioners who are well-trained in EBTs shy away from treating autistic individuals due to lack of training in ASD. AIMS The aim of the current study was to evaluate the feasibility and acceptability of dialectical behaviour therapy skills training (DBT-ST) in a sample of autistic adults without intellectual disability. METHOD Sixteen adults with ASD were recruited from a treatment waiting list to enrol in this study, which included 24 weeks of DBT-ST delivered in a group setting. Feasibility and acceptability were assessed using retention and attendance data and a participant satisfaction questionnaire. RESULTS Retention (81.3%) and attendance data (mean 87.5%) provided support for the feasibility of this intervention. Overall satisfaction ratings were high (mean 4.5 out of 5), and participants reported that they felt that DBT-ST would probably be helpful for others with ASD (mean 4.5 out of 5). CONCLUSIONS The study findings provide preliminary evidence of (1) the feasibility of providing DBT-ST for autistic adults in community-based clinics, and (2) the perceived benefit of DBT-ST for this under-served population. Recommended modifications to the standard DBT-ST materials are discussed.
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19
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Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiatry Rep 2021; 23:66. [PMID: 34402984 PMCID: PMC8961310 DOI: 10.1007/s11920-021-01278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. RECENT FINDINGS Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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20
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Cantor J, Laurito A. The new services that opioid treatment programs have adopted in response to COVID-19. J Subst Abuse Treat 2021; 130:108393. [PMID: 34118694 PMCID: PMC8032476 DOI: 10.1016/j.jsat.2021.108393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 01/20/2023]
Abstract
COVID-19 has exacerbated the opioid epidemic and transformed how programs treat opioid use disorder. In response to the pandemic, the federal government modified guidelines to allow opioid treatment programs (OTPs) greater flexibility in the provision of medication for opioid use disorder. We conducted a telephone survey of 31.10% of OTPs in the contiguous United States between June and July 2020. We contacted a random sample of 477 facilities and obtained responses from 373. The survey asked questions about new patient intake, screening for COVID-19, social distancing measures, as well as new treatments offered due to changes in federal government policy. We calculated percentages of positive and nonpositive responses to each survey question. We estimated logistic regressions of facility-, county- and state-level predictors of each treatment approach. Most OTPs are taking new patients (91%). Roughly 83% of them screen for COVID-19 symptoms for in-person visits and about 92% use social distancing measures. More than half of OTPs provide curbside treatment (83%) or telehealth (81%). Less than a quarter of OTPs offer medication drop off (21%) or pick up by a trusted person (32%) when patients need to quarantine due to COVID-19. Results from multivariable logistic regressions show that OTPs in states that had a shelter-in-place policy are more likely to socially distance for in-person visits than those in states without such a policy.
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Affiliation(s)
- Jonathan Cantor
- RAND Corporation, Santa Monica, CA, 1776 Main Street, m5159, Santa Monica, CA 90401, USA.
| | - Agustina Laurito
- Department of Public Administration, University of Illinois at Chicago, 412 S. Peoria St., 136, Chicago, IL 60607 (MC 278), USA.
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21
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Cantor J, McBain RK, Kofner A, Stein BD, Yu H. Where are US outpatient mental health facilities that serve children with autism spectrum disorder? A national snapshot of geographic disparities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:169-177. [PMID: 34120484 DOI: 10.1177/13623613211024046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT There has been a rise in the observed prevalence of autism spectrum disorder among children. Existing studies show the share of counties with a treatment facility that offers care for children with autism spectrum disorder. However, no estimates exist of the share of US outpatient mental health treatment facilities that provide services for children with autism spectrum disorder. We identified key facility-level characteristics in offering mental health care for children with autism spectrum disorder. We used a telephone survey to contact almost all outpatient mental health treatment facilities in the contiguous United States. We asked the facilities if they provided mental health care for children with autism spectrum disorder. We took the results of this survey and estimated multivariable regressions to examine county- and facility-level predictors of offering services. We found that over half (50.3%) of the 6156 outpatient facilities reported offering care for children with autism spectrum disorder. Non-metro counties, counties with a lower percentage of non-White residents, counties with a higher percentage of uninsured residents, and counties with a higher poverty rate had fewer outpatient mental health treatment facilities providing care for children with autism spectrum disorder. Facilities accepting Medicaid as a form of payment, offering telehealth, and private for-profit facilities were more likely to provide services for children with autism spectrum disorder. Because only half of outpatient mental health treatment facilities offer care for children with autism spectrum disorder, public health officials and policymakers should do more to ensure that this vulnerable population has access to mental health services.
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Affiliation(s)
| | | | | | | | - Hao Yu
- Harvard Medical School, USA
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22
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Broder-Fingert S, Lindly O, Zuckerman KE. Variability in Expenditures for Autism: A Canary in the Coal Mine for Disparities in Care? Psychiatr Serv 2021; 72:98-99. [PMID: 33384002 DOI: 10.1176/appi.ps.202000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sarabeth Broder-Fingert
- Department of Pediatrics, Boston University, and Department of Pediatrics, Boston Medical Center, Boston (Broder-Fingert); Department of Health Sciences, Northern Arizona University, Flagstaff (Lindly); Department of Pediatrics, Oregon Health and Science University, Portland (Zuckerman)
| | - Olivia Lindly
- Department of Pediatrics, Boston University, and Department of Pediatrics, Boston Medical Center, Boston (Broder-Fingert); Department of Health Sciences, Northern Arizona University, Flagstaff (Lindly); Department of Pediatrics, Oregon Health and Science University, Portland (Zuckerman)
| | - Katharine E Zuckerman
- Department of Pediatrics, Boston University, and Department of Pediatrics, Boston Medical Center, Boston (Broder-Fingert); Department of Health Sciences, Northern Arizona University, Flagstaff (Lindly); Department of Pediatrics, Oregon Health and Science University, Portland (Zuckerman)
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23
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Cervantes PE, Matheis M, Estabillo J, Seag DEM, Nelson KL, Peth-Pierce R, Hoagwood KE, Horwitz SM. Trends Over a Decade in NIH Funding for Autism Spectrum Disorder Services Research. J Autism Dev Disord 2020; 51:2751-2763. [PMID: 33040269 DOI: 10.1007/s10803-020-04746-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
Investments in autism spectrum disorder (ASD) research, guided by the Interagency Autism Coordinating Committee (IACC), have focused disproportionately on etiology over a well-established stakeholder priority area: research to improve accessibility and quality of community-based services. This study analyzed National Institutes of Health ASD services research funding from 2008 to 2018 to examine funding patterns, evaluate the impact of IACC objectives, and identify future directions. Approximately 9% of total funds were allocated to services research. This investment remained relatively stable across time and lacked diversity across domains (e.g., area of focus, ages sampled, implementation strategies used). While advancements were observed, including increased prevalence of projects focused on adult samples and on dissemination/implementation and prevention areas, greater investment in service research is critically needed.
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Affiliation(s)
- Paige E Cervantes
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA.
| | - Maya Matheis
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jasper Estabillo
- Tarjan Center, Jane & Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Dana E M Seag
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | | | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA
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24
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McBain RK, Cantor JH, Kofner A, Stein BD, Yu H. State Insurance Mandates and the Workforce for Children With Autism. Pediatrics 2020; 146:peds.2020-0836. [PMID: 32900876 PMCID: PMC7546088 DOI: 10.1542/peds.2020-0836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND State mandates have required insurance companies to provide coverage for autism-related child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs). METHODS We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017. RESULTS From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: -0.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply. CONCLUSIONS State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.
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Affiliation(s)
| | | | | | | | - Hao Yu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Harvard University, Boston, Massachusetts
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