Safety-Net Program Participation and Material Hardship Among Transition Age Youth with Autism

Background and Purpose.  A handful of studies have documented high financial burden associated with caring for transition age youth (TAY) with autism. Yet we know little about the impact that federal safety-net programs have in alleviating material hardship of families.  This study used data from the 2016 National Survey of Children’s Health to identify factors that contribute to participation in federal safety-net programs among TAYA and evaluate the relationship between program participation and material hardship. We hypothesized that households of TAY with autism will experience greater rates of material hardship relative to households of children with other special healthcare needs (SHCN), even after adjusting for covariates. We further hypothesized that poverty level and safety-net program participation would be associated with greater adjusted odds of material hardship.

Methods. Our focal sample comprised of 586 households of TAY, ages 13-17 years, with parent reported ASD. We compared findings to a heterogeneous sample of households of TAY with other SHCN (N= 5,295). We first used descriptive analysis to generate national point estimates across several domains of material hardship including: getting basic needs met, affording healthcare, food insecurity and family financial burden. Then, we employed multivariate tests of significance to compare outcomes by disability group and safety-net program participation (cash assistance, free or reduced-cost meals at school and public health insurance), adjusting for covariates. Finally, we employed multiple logistic regression to identify factors associated with material hardship.

Results. Roughly 75% of households of TAY with ASD experienced at least one type of material hardship compared to 59% households of TAY with other SHCN. In particular, a significantly larger proportion of households of TAY with ASD reported family financial burden and health care hardship (19% versus 16% and 28% versus 10%, comparatively). In spite of this, households of TAY with ASD reported significantly higher levels of participation across all safety-net programs. There were no group differences in household poverty.  Households of TAY with ASD that received safety-net benefits reported greater difficulty with getting basic needs met and higher food insecurity but lower rates of health care hardship and family financial burden, than households of TAY with ASD that did not receive benefits. The ASD group had higher odds of health care hardship (OR=2.53, p<.001) and family financial burden (OR=3.13, p<0.001), even after adjusting for covariates.

 

Significance.  The high proportion of households of TAY with ASD that participate in safety-net programs, coupled with high rates of material hardship among this population, warrants the further investigation of antipoverty programs and ASD.