OBJECTIVE A diversity of health professional disciplines provide services for children with autism spectrum disorder (ASD) in the United States. We conducted a systematic review examining the availability, distribution, and competencies of the US workforce for autism-related child health care services, and assess studies' strength of evidence. METHOD We searched PubMed, PsychINFO, Embase, and Google Scholar from 2008 to 2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of prespecified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research. RESULTS Of 754 records identified, 33 studies (24 quantitative, 6 qualitative, and 3 mixed-methods) were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably. The most common specialties studied were pediatricians (n = 13), occupational therapists (n = 12), speech therapists (n = 11), physical therapists (n = 10), and child psychiatrists (n = 8). Topical areas included the following: provider availability by service area and care delivery model; qualitative assessments of provider availability and competency; role of insurance mandates in increasing access to providers: and disparities in access. Across provider categories, we found that workforce availability for autism-related services was limited in terms of overall numbers, time available, and knowledgeability. The greatest unmet need was observed among minorities and in rural settings. Most studies were short term, were limited in scope, and used convenience samples. CONCLUSION There is limited evidence to characterize the availability and distribution of the US workforce for autism-related child health care services. Existing evidence to date indicates significantly restricted availability.

中文翻译：

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系统评价：美国自闭症相关儿童医疗保健服务人员。

目的在美国，多种卫生专业学科可为患有自闭症谱系障碍（ASD）的儿童提供服务。我们进行了系统的审查，审查了美国自闭症相关儿童保健服务的劳动力的可用性，分布和能力，并评估了研究的证据强度。方法我们在2008年至2018年期间对PubMed，PsychINFO，Embase和Google Scholar搜索了相关的美国研究。两名研究人员使用一套旨在整合混合方法研究的框架，根据一组预先确定的纳入标准独立筛选和评估了研究，并评估了证据强度（SOE）。结果在确定的754条记录中，包括了33项研究（24项定量，6项定性和3项混合方法）。相关证据强度低到中等，只有8项研究（24％）满足强国企标准。地域和提供者的干部差异很大。研究的最常见专业是儿科医生（n = 13），职业治疗师（n = 12），言语治疗师（n = 11），物理治疗师（n = 10）和儿童精神科医生（n = 8）。主题领域包括：按服务领域和护理提供模式划分的提供者可用性；对提供者的可用性和能力的定性评估；保险授权在增加提供者获取方面的作用：以及获取方面的差距。在所有提供者类别中，我们发现自闭症相关服务的劳动力可用性在总数，可用时间和知识方面受到限制。在少数民族和农村地区，未满足的需求最大。大多数研究是短期的，范围有限，并使用了便利样本。结论仅有有限的证据来描述美国自闭症相关儿童医疗保健服务的可用性和分布情况。迄今为止的现有证据表明可用性受到严重限制。