Factors Associated with Social Services Use Among Individuals with Developmental Disabilities in Korea: Multigroup Structural Equation Modeling By Disability Subtypes

Background and Purpose:  An estimated 72% of individuals with developmental disabilities (DD) in Korea do not engage in formally seeking help with social services despite their lifelong and pervasive difficulties in self-care and continued needs for individually planned and coordinated services. Few studies examined factors that facilitate or inhibit their social services use. More specifically, it is unknown whether factors associated with social services use differ by subtypes of DD defined by the Welfare Law for People with Disabilities of Korea (WLPDK)—intellectual disabilities (ID) and autistic spectrum disorders (ASD). This study addresses these gaps in the literature.

Methods:  Using data from the 2012 National Survey on People with DD in Korea, analysis included 1,500 individuals with DD. Guided by the Andersen’s Behavioral Model of Services Use, exogenous variables were organized as predisposing (age, gender, educational attainment), enabling (household income, National Basic Livelihood Security (NBLS) status, living situation, social relationship), and need (needs for social services, disability severity, disability subtypes) factors. Social services use as defined in this study included formal care services delineated in the WLPDK (community rehabilitation, day care, physical activity, residential care, independent housing, and personal assistance services). A count variable of social services in use was employed in analysis. Structural path invariance testing across disability subtypes were conducted using multigroup structural equation modeling (SEM), with chi-square difference tests to compare nested models. 

Results:  Of the 1,500 individuals with DD, 80.4% were diagnosed with ID and 19.6% were diagnosed with ASD. Average age was 31.26 and about 64.5% were males. Approximately 35.5% were recipients of the NBLS. Variations in the paths to social services use emerged across disability subtypes; the NBLS status, needs for social services, and disability severity were responsible. Among individuals with ASD, receiving the NBLS was negatively related to greater use of social services (ß = -.13) whereas receiving the NBLS was positively related to greater services use among those with ID (ß = .07). The positive association between higher needs for social services and greater services use was significant for individuals with ASD (ß = .16) whereas the association remained insignificant for those with ID. The positive relationship between higher disability severity and greater social services use was stronger for individuals with ASD (ß = .28) than those with ID (ß = .12). There were paths that differed across disability subtypes although the group variations were not statistically significant. Among individuals with ID, younger age (ß = -.13), living without family (ß = -.15), and having social relationship with individuals with disabilities (ß = .11) were respectively associated with greater social services use whereas such associations were not significant for those with ASD. 

Conclusions and Implications:  Factors associated with social services use varied between individuals with ID and those with ASD. However, the WLPDK has treated them as a homogenous group and failed to consider distinctive disability features and unique pathways to formal care services. The findings imply a need for the design and provision of social services tailored to the varied, particular needs of the target population.