Treatment Management of Foster Youth with Autism Spectrum Disorders

Background and Purpose:  Autism spectrum disorder (ASD) is a chronic developmental condition that tends to affect individuals throughout the life course.  Educational interventions are considered the cornerstone of management for ASD.  These interventions include behavioral strategies and  habilitative therapies such as speech, physical, and occupational therapy.  Because the prevalence of ASD in the child welfare system has mirrored and even exceeded the prevalence in the general population, health care systems for children with ASD in foster care need to understand the extent of Medicaid reimbursed service available to children. The purpose of this paper is to describe service use (educational interventions) for Illinois foster children during FY 2013.  Children in care with ASD are compared with children in care with other developmental diagnoses (DD) and children without ASD or other DD.  

 

Methods:  The study uses linked administrative data from two state agencies in Illinois.  The study population includes 9,818 children between the ages of 3 and 21 who were continuously eligible for Medicaid through the child welfare system during state fiscal year (FY) 2013.  Linked Medicaid claims were used to identify 459 children with ASD based on claims with ICD-9-CM diagnosis codes 299.0, 299.8, or 299.9.  Another 3,161 youth had a developmental diagnosis other than ASD during FY 2013.  Rates of service utilization are compared with data from of a nationally representative survey of US children with ASD, and logistic regression is used to identify demographic and child welfare related factors associated with the odds of service use.  

Results:  One third of children ages 3-21 with ASD in the study population received some speech therapy during the FY (33%) while only 11.3% received occupational or physical therapy.  Just under half (49.5%) received some type of mental health, social skills, or behavioral modification service.  When compared with nationally representative rates of service use, foster children with ASD tend to have lower rates of speech and occupational therapy, but equal or higher rates of mental health, social skills or behavioral modification services.  Transition-aged youth (18-21) had some of the lowest rates of service, particularly mental health, social skills, and behavioral modification (22.7%).  After controlling for demographic and placement characteristics, children with ASD were 13% more likely to receive at least one of the services examined when compared with children with other DD (Odds Ratio, 1.13, p<0.0001).  Transition-aged youth were less likely to be receiving at least one of these services than younger children after controlling for other demographic and placement characteristics.

Implications:  The low rates of speech and occupational therapy among foster youth with ASD when compared to the general population is concerning.  If youth in foster care with ASD do not receive the necessary treatment to manage their condition and minimize core deficits, their prospects for independence are compromised.  Child welfare systems have an incentive to attend to the specific service needs of the increasing numbers of children with ASD in order to improve outcomes for these children at discharge or during the transition to adulthood.