Are medical home components associated with educational service use in children on the autism spectrum?

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: NA

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.