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Research Objectives
To examine which medical home care components (i.e., personal doctor or nurse, usual
source of sick care, family centered care, difficulty getting referrals, effective
care coordination, and shared decision-making), are associated with the likelihood
of current educational service use, after controlling for sociodemographic and clinical
factors, in children and youth on the autism spectrum.
Design
Cross-sectional study using pooled data from the 2016 through 2019 National Survey
of Children's Health (NSCH).
Setting
The NSCH is fielded yearly to households in the U.S. and District of Columbia.
Participants
Caregivers of children and youth on the autism spectrum, ages 1-17 years (n=1,922).
reported on their child or youth's current educational service use.
Interventions
N/A.
Main Outcome Measures
Current educational service use under an individualized family service plan (IFSP)
or an individualized education program (IEP).
Results
After controlling for sociodemographic and clinical factors, caregiver-reported difficulty
getting referrals (aOR= 2.93, 95% CI [1.33, 6.41], p = .007) and not receiving shared
decision-making (aOR= 2.93, 95% CI [1.10, 3.44], p = .016) was associated with higher
likelihood of current educational service use in children and youth on the autism
spectrum. Sociodemographic factors significantly associated with lower likelihood
of current educational service use were older children (aOR= 0.91, 95% CI [0.85, 0.97],
p = .003). Children and youth on the autism spectrum with moderate/severe autism had
higher likelihood of current educational service use (aOR= 1.80, 95% CI [1.10, 2.95],
p = .019).
Conclusions
Caregivers reporting greater difficulty with referrals or who lacked shared decision-making
with medical providers were more likely to report their children and youth on the
autism spectrum had current educational service use under an IFSP or an IEP. Although
counter-intuitive, these findings warrant exploration to examine caregiver strategies
for navigating educational services considering limited medical home care.
Author(s) Disclosures
The authors declare no conflicts of interest.
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Copyright
© 2022 Published by Elsevier Inc.
