Do Insurance Mandates Affect Racial Disparities in Outcomes for Children with Autism?

2016 ◽  
Vol 21 (2) ◽  
pp. 351-366 ◽  
Author(s):  
Pratik Doshi ◽  
J. Mick Tilford ◽  
Songthip Ounpraseuth ◽  
Dennis Z. Kuo ◽  
Nalin Payakachat
2019 ◽  
Vol 23 (5) ◽  
pp. 704-709
Author(s):  
Pratik Doshi ◽  
J. Mick Tilford ◽  
Songthip Ounpraseuth ◽  
Dennis Z. Kuo ◽  
Nalin Payakachat

2021 ◽  
Author(s):  
Georgina J. Rosenbrock ◽  
Emily R. Jellinek ◽  
Dieu M. Truong ◽  
Shannon L. McKee ◽  
Christian M. Stewart ◽  
...  

Autism ◽  
2020 ◽  
pp. 136236132097674
Author(s):  
Ryan K McBain ◽  
Jonathan H Cantor ◽  
Aaron Kofner ◽  
Timothy Callaghan ◽  
Bradley D Stein ◽  
...  

All 50 US states have enacted mandates requiring insurers to cover autism-related services. We assessed whether and to what extent variation in generosity of state insurance mandates has been associated with rate of growth in the health workforce for children with autism spectrum disorder: including board-certified behavioral analysts, child psychiatrists, and pediatricians. Drawing data from the National Conference of State Legislatures and Area Health Resource Files, we evaluated eight mandate policy features, utilizing a fixed-effect longitudinal regression framework to examine their relationships with workforce growth during a 15-year period (2003–2017) over which 44 states enacted a mandate. Aspects of mandate generosity included ages covered, spending caps, and types of services covered. We found that mandate generosity was closely associated with the magnitude of increase in supply of board-certified behavioral analysts and—to a lesser extent—child psychiatrists. States with the most generous mandates would be expected to have 39% more board-certified behavioral analysts and 17% more child psychiatrists in 2017, compared to states with least generous mandates. We found no association between mandate generosity and supply of pediatricians. Collectively, our results suggest that the degree of generosity afforded by mandates may be as important as the passage of mandate legislation itself for encouraging workforce growth. Lay abstract To improve access to health services for children with autism spectrum disorder, US states have passed laws requiring health insurers to cover autism-related care, commonly known as state insurance mandates. However, the features of mandates differ across states, with some state laws containing very generous provisions and others containing very restrictive provisions such as whether the mandates include children aged above 12 years, whether there is a limit on spending, and whether there are restrictions on the types of services covered. This study examined the relationship between generosity of mandates and growth in the health workforce between 2003 and 2017, a period during which 44 states passed mandates. We found that states that enacted more generous mandates experienced significantly more growth in board-certified behavioral analysts who provide behavioral therapy as well as more growth in child psychiatrists. We did not find differences in the growth of pediatricians, which is a less specialized segment of the workforce. Our findings were consistent across eight different mandate features and suggest that the content of legislation may be as important as whether or not legislation has been passed in terms of encouraging growth in the supply of services for children with autism spectrum disorder.


PEDIATRICS ◽  
2020 ◽  
Vol 146 (4) ◽  
pp. e20200836 ◽  
Author(s):  
Ryan K. McBain ◽  
Jonathan H. Cantor ◽  
Aaron Kofner ◽  
Bradley D. Stein ◽  
Hao Yu

Autism ◽  
2019 ◽  
Vol 24 (5) ◽  
pp. 1152-1163 ◽  
Author(s):  
Jill Locke ◽  
Christina Kang-Yi ◽  
Lindsay Frederick ◽  
David S Mandell

Several interventions have demonstrated efficacy in improving social outcomes for children with autism, but they often are not used in schools. This study examined individual and organizational factors associated with the use of a research-informed social engagement intervention, Remaking Recess, for children with autism in elementary schools. A total of 28 school personnel from 12 schools in 5 districts in the northeastern United States participated. Schools were randomized to (1) training in Remaking Recess only or (2) training in Remaking Recess with implementation support. School personnel rated their attitudes about evidence-based practices, organizational readiness, and fidelity. Independent observers rated school personnel’s fidelity at baseline (pre-intervention training) and exit (post-intervention training). The results suggest that self-rated fidelity was lower when staff perceived the use of Remaking Recess was required; however, observer-rated fidelity was lower when staff rated Remaking Recess as appealing. In addition, self-rated fidelity was higher when there was a sufficient number of staff, positive individual growth, and organizational adaptability. The results also indicated higher observer-rated fidelity when staff perceived a positive influence over their coworkers. The results suggest that both individual (attitudes) and organizational (influence, staffing, growth, adaptability) characteristics may affect implementation success in schools. A collaborative decision-making approach for evidence-based practice use is recommended. Lay abstract Several interventions or treatment programs have been shown through research to improve social outcomes for children with autism, but they often are not used in schools. This study examined individual (school personnel) and organizational (school level) factors associated with the use of a research-informed social engagement intervention, Remaking Recess, for children with autism in elementary schools. A total of 28 school personnel from 12 schools in 5 districts in the northeastern United States participated. Schools were randomly assigned to (1) training in Remaking Recess only or (2) training in Remaking Recess with implementation support (tailored strategies to remove barriers to increase use of Remaking Recess). School personnel rated their attitudes about research-informed interventions, organizational readiness (school’s readiness to use a research-informed intervention), and fidelity or the degree to which an intervention is used as it was originally designed. Observers rated school personnel’s fidelity at baseline (pre-intervention training) and exit (post-intervention training). The results suggest that self-rated fidelity was lower when staff perceived the use of Remaking Recess was required; however, observer-rated fidelity was lower when staff rated Remaking Recess as appealing. In addition, self-rated fidelity was higher when there was a sufficient number of staff, positive individual growth, and organizational adaptability. The results also indicated higher observer-rated fidelity when staff perceived positive influence over their coworkers. The results suggest that both individual (attitudes) and organizational (influence, staffing, growth, adaptability) characteristics may affect implementation success in schools. A collaborative decision-making approach for evidence-based practice use is recommended.


PEDIATRICS ◽  
2018 ◽  
Vol 143 (1) ◽  
pp. e20180654 ◽  
Author(s):  
Molly K. Candon ◽  
Colleen L. Barry ◽  
Steven C. Marcus ◽  
Andrew J. Epstein ◽  
Alene Kennedy-Hendricks ◽  
...  

2011 ◽  
Vol 26 (S2) ◽  
pp. 1839-1839 ◽  
Author(s):  
D. Granpeesheh ◽  
A. Kenzer ◽  
J. Tarbox

IntroductionBehavioral intervention is an evidence-based treatment for children with autism but there still exists some disagreement regarding how intensive the treatment needs to be. Little previous research has directly compared the effects of high to low-intensity behavioral intervention.ObjectivesTo compare the effects of high versus low-intensity behavioral intervention.AimsCompare outcomes in the area of diagnostic classification, intellectual functioning, executive functions, challenging behavior, language, socialization, and independent living skills after two years of treatment.Methods60 children with autism, under five years old, comprised two groups who received behavioral intervention services. The high-intensity group received 25–35 hours per week for two years and the low-intensity group received 8–15 hours per week of treatment. For all participants, a comprehensive battery of assessments was conducted prior to treatment and at annual intervals.ResultsThe high-intensity group outperformed the low-intensity group on all measures after two years of treatment.ConclusionsThis study provides further evidence that high intensity behavioral intervention produces greater gains than low-intensity treatment and the results suggest that children with autism under the age of five years should receive access to high-intensity treatment


Sign in / Sign up

Export Citation Format

Share Document