Journal of the American Academy of Child & Adolescent Psychiatry
ReviewSystematic Review: United States Workforce for Autism-Related Child Healthcare Services
Section snippets
Search Strategy and Selection Criteria
We conducted a systematic review of academic literature, in accordance with PRISMA guidelines,17 shown in Supplement 1, available online, targeting peer-reviewed publications. Inclusion criteria were as follows: (1) topically focused on availability and/or distribution of health workforce, including health workforce ability and competency to provide autism-related health services; (2) included one or more of the following nine health workforce provider categories: child psychiatrists, child
Study Inclusion
After the search procedures, we reviewed 867 records: 861 from database searches, and an additional 6 from bibliographic reviews. There was a high degree of interrater reliability (93%) between screeners regarding inclusion of articles for full-text review, and all discrepancies were reconciled.
Following screening, 74 studies were identified for full-text inspection of eligibility. We excluded 750 studies using a stepwise assessment to eliminate studies in the following order: (1) studies that
Discussion
The 33 studies included in this review identify a number of workforce-related challenges for families seeking treatment for children with ASD—including lack of preparation of primary care providers (PCPs) to serve children with ASD, lack of availability of specialty providers, and disparities in access to ASD services by sociodemographic and geographic factors. Each of these underscores key areas for progress in provider training and deployment.
With regard to the role of PCPs, the evidence
References (58)
- et al.
Shared decision making and treatment decisions for young children with autism spectrum disorder
Acad Pediatr
(2016) - et al.
Applied behavior analysis as treatment for autism spectrum disorder
J Pediatr
(2016) - et al.
The continuing shortage of child and adolescent psychiatrists
J Am Acad Child Adolesc Psychiatry
(2006) - et al.
Geographic access to health services and diagnosis with an autism spectrum disorder
Ann Epidemiol
(2011) - et al.
A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in mixed studies reviews
Int J Nurs Stud
(2009) - et al.
Pediatricians’ comfort level in caring for children with special health care needs
Acad Pediatr
(2017) - et al.
Impact of a private health insurance mandate on public sector autism service use in Pennsylvania
J Am Acad Child Adolesc Psychiatry
(2012) - et al.
Parent perceptions of care received by children with an autism spectrum disorder
J Pediatr Nurs
(2016) - et al.
Urban/rural differences in therapy service use among Medicaid children aged 0–3 with developmental conditions in Colorado
Academ Pediatr
(2016) Data and Statistics, Autism Spectrum Disorder (ASD), NCBDDD. 2018
The impact of the medical home on access to care for children with autism spectrum disorders
J Autism Dev Disord
The integration of behavioral health interventions in children’s health care: services, science, and suggestions
J Clin Child Adolesc Psychol
Evidence-based review of interventions for autism used in or of relevance to occupational therapy
Am J Occup Ther
Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model
Pediatrics
A meta-analysis of school-based social skills interventions for children with autism spectrum disorders─2007
Unmet need and problems accessing core health care services for children with autism spectrum disorder
Matern Child Health J
Medicaid waivers targeting children with autism spectrum disorder reduce the need for parents to stop working
Health Aff (Millwood)
Effects of state insurance mandates on health care use and spending for autism spectrum disorder
Health Aff (Millwood)
Committee on Pediatric Workforce, American Academy of Pediatrics. Pediatrician workforce policy statement
Pediatrics
Racial and ethnic differences in subspecialty service use by children with autism
Pediatrics
Role of the medical home in family-centered early intervention services
Pediatrics
PRISMA Statement. 2015
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Parent perspectives on community mental health services for children with autism spectrum disorders
J Child Fam Stud
The medical home for children with autism spectrum disorders: parent and pediatrician perspectives
J Autism Dev Disord
Identifying the barriers to early diagnosis and treatment in underserved individuals with autism spectrum disorders (ASD) and their families: a qualitative study
Issues Ment Health Nurs
Developmental behavioral pediatrician support of the medical home for children with autism spectrum disorders
J Dev Behav Pediatr
Expanding the capacity of primary care to treat co-morbidities in children with autism spectrum disorder
J Autism Dev Disord
Improving access to care at autism treatment centers: a system analysis approach
Pediatrics
Cited by (33)
Mental Health Crises in Autistic Children: A Framework for Prevention and Intervention in Primary Care
2024, Pediatric Clinics of North AmericaAssociation Between In-Home Treatment and Engagement in Psychosocial Services Among Medicaid-Enrolled Youth
2022, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :This 180-day lookback period allowed us to examine and control for their psychosocial treatment history prior to the new episode that was identified after a 90-day period with no treatment. Consistent with prior literature,18 we did not include children with diagnoses of autism spectrum disorder or developmental disability (Table S3, available online) because they have different clinical needs, have different service use patterns, and commonly receive services (such as applied behavior analysis) from a different workforce and from different provider organizations than do youth with other MH problems.27-30 Next, we excluded youth in the top 2.5th percentile of visits per month (10.7 visits per month, n = 1,425) because of concerns that the severity of their MH conditions and patterns of care were substantially different from those of the rest of the population.
Characteristics of Primary Care Providers' Consultations With a Statewide Child Psychiatry Access Program Regarding Autism Spectrum Disorder
2022, Journal of the Academy of Consultation-Liaison PsychiatryCitation Excerpt :However, after controlling for key covariates, the patient having an ASD diagnosis was no longer a significant predictor of the case being comanaged (OR: 1.17, 95% CI: 0.75–1.85). Although there is a paucity of data regarding the availability of ASD-related health-care services,28 particularly MH services,14 our results support that PCPs are contacting CPAPs for consultations to help care for pediatric patients with ASD. Our data also confirm that a consultation for an ASD diagnosis is a significant predictor of a youth being prescribed an antipsychotic medication.
Exploring Factors of Diagnostic Timing Among Black Autistic Youth
2024, Journal of Autism and Developmental DisordersSystematic literature review of healthcare services for the elderly: trends, challenges, and application scenarios
2023, International Journal of Public Health Science
This work was supported by the National Institute of Mental Health (NIMH; R01MH112760).
Dr. McBain served as the statistical expert for this research.
The authors would like to thank Aaron Kofner, MS, of the RAND Corporation, for his involvement in the early conceptualization of this manuscript. They would also like to thank those authors who made the construction of this manuscript possible by conducting research on the availability and quality of autism-related child healthcare services in the US.
Disclosure: Dr. McBain has received research support from NIMH, the Assistant Secretary for Planning and Evaluation, the Health Resources and Services Administration, the Centers for Medicare and Medicaid Services, the Los Angeles County Department of Mental Health, and the US Department of Defense. He is a member of the advisory board of Water Ecuador. Dr. Cantor has received research support from NIMH, the National Cancer Institute, the Pew Charitable Trusts, Los Angeles County, the Centers for Medicare and Medicaid Services, the US Department of Defense, and the Social Security Administration. Dr. Stein has received support from NIMH, the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, the National Institute on Minority Health and Health Disparities, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism. Dr. Yu has received support from NIMH, the National Institute of Minority Health and Health Disparities, and the Agency for Healthcare Research and Quality. Ms. Kareddy has received research support from the United States – India Educational Foundation.