The Interplay of Outpatient Services and Psychiatric Hospitalization Among Medicaid-enrolled Children with Autism Spectrum Disorders

Overview

Journal Arch Pediatr Adolesc Med

Publisher American Medical Association

Specialty Pediatrics

Date 2012 Jan 4

PMID 22213753

Citations 29

Authors

David S Mandell

Ming Xie

Knashawn H Morales

Lindsay Lawer

Megan McCarthy

Steven C Marcus

Affiliations

Soon will be listed here.

Abstract

Objective: To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).

Design: Retrospective cohort study using discrete-time logistic regression to examine the association of service use in the preceding 60 days with the risk of hospitalization.

Setting: The Medicaid-reimbursed health care system in the continental United States.

Participants: Medicaid-enrolled children with an ASD diagnosis in 2004 (N = 28 428).

Main Exposures: Use of respite care and therapeutic services, based on procedure codes.

Main Outcome Measures: Hospitalizations associated with a diagnosis of ASD (International Classification of Diseases, 10th Revision, codes 299.0, 299.8, and 299.9).

Results: Each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization in adjusted analysis. Use of therapeutic services was not associated with reduced risk of hospitalization.

Conclusions: Respite care is not universally available through Medicaid. It may represent a critical type of service for supporting families in addressing challenging child behaviors. States should increase the availability of respite care for Medicaid-enrolled children with ASDs. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.

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References

Botuck S, Winsberg B . Effects of respite on mothers of school-age and adult children with severe disabilities. Ment Retard. 1991; 29(1):43-7. View

Goldberg K, Norman R, Hoch J, Hoch J, Schmitz N, Windell D . Impact of a specialized early intervention service for psychotic disorders on patient characteristics, service use, and hospital costs in a defined catchment area. Can J Psychiatry. 2007; 51(14):895-903. DOI: 10.1177/070674370605101405. View

McCracken J, McGough J, Shah B, Cronin P, Hong D, Aman M . Risperidone in children with autism and serious behavioral problems. N Engl J Med. 2002; 347(5):314-21. DOI: 10.1056/NEJMoa013171. View

Lord C, Wagner A, Rogers S, Szatmari P, Aman M, Charman T . Challenges in evaluating psychosocial interventions for Autistic Spectrum Disorders. J Autism Dev Disord. 2006; 35(6):695-708. DOI: 10.1007/s10803-005-0017-6. View

Shattuck P, Grosse S, Parish S, Bier D . Utilization of a Medicaid-funded intervention for children with autism. Psychiatr Serv. 2009; 60(4):549-52. DOI: 10.1176/ps.2009.60.4.549. View

Croen L, Najjar D, Ray G, Lotspeich L, Bernal P . A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics. 2006; 118(4):e1203-11. DOI: 10.1542/peds.2006-0127. View

Mandell D . Psychiatric hospitalization among children with autism spectrum disorders. J Autism Dev Disord. 2007; 38(6):1059-65. PMC: 2862976. DOI: 10.1007/s10803-007-0481-2. View

Stahmer A . The basic structure of community early intervention programs for children with autism: provider descriptions. J Autism Dev Disord. 2006; 37(7):1344-54. PMC: 2084486. DOI: 10.1007/s10803-006-0284-x. View

Rupp K, Davies P, Newcomb C, Iams H, Becker C, Mulpuru S . A profile of children with disabilities receiving SSI: highlights from the National Survey of SSI Children and Families. Soc Secur Bull. 2006; 66(2):21-48. View

10.

Kuipers E, Fowler D, Garety P, Chisholm D, Freeman D, Dunn G . London-east Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. III: Follow-up and economic evaluation at 18 months. Br J Psychiatry. 1998; 173:61-8. DOI: 10.1192/bjp.173.1.61. View

11.

Mandell D, Palmer R . Differences among states in the identification of autistic spectrum disorders. Arch Pediatr Adolesc Med. 2005; 159(3):266-9. DOI: 10.1001/archpedi.159.3.266. View

12.

Stahmer A, Mandell D . State infant/toddler program policies for eligibility and services provision for young children with autism. Adm Policy Ment Health. 2006; 34(1):29-37. PMC: 1764439. DOI: 10.1007/s10488-006-0060-4. View

13.

Harrison-Read P, Lucas B, Tyrer P, Ray J, Shipley K, Simmonds S . Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough. Psychol Med. 2002; 32(3):403-16. DOI: 10.1017/s0033291702005305. View

14.

Sawyer M, Bittman M, La Greca A, Crettenden A, Harchak T, Martin J . Time demands of caring for children with autism: what are the implications for maternal mental health?. J Autism Dev Disord. 2009; 40(5):620-8. DOI: 10.1007/s10803-009-0912-3. View

15.

Baca-Garcia E, Perez-Rodriguez M, Basurte-Villamor I, Quintero-Gutierrez F, Sevilla-Vicente J, Martinez-Vigo M . Patterns of mental health service utilization in a general hospital and outpatient mental health facilities: analysis of 365,262 psychiatric consultations. Eur Arch Psychiatry Clin Neurosci. 2007; 258(2):117-23. DOI: 10.1007/s00406-007-0763-x. View

16.

Leslie D, Martin A . Health care expenditures associated with autism spectrum disorders. Arch Pediatr Adolesc Med. 2007; 161(4):350-5. DOI: 10.1001/archpedi.161.4.350. View

17.

Volkmar F, Lord C, Bailey A, Schultz R, Klin A . Autism and pervasive developmental disorders. J Child Psychol Psychiatry. 2004; 45(1):135-70. DOI: 10.1046/j.0021-9630.2003.00317.x. View

18.

Mihalopoulos C, Harris M, Henry L, Harrigan S, McGorry P . Is early intervention in psychosis cost-effective over the long term?. Schizophr Bull. 2009; 35(5):909-18. PMC: 2728818. DOI: 10.1093/schbul/sbp054. View

19.

Callahan K, Henson R, Cowan A . Social validation of evidence-based practices in autism by parents, teachers, and administrators. J Autism Dev Disord. 2007; 38(4):678-92. DOI: 10.1007/s10803-007-0434-9. View

20.

Dingfelder H, Mandell D . Bridging the research-to-practice gap in autism intervention: an application of diffusion of innovation theory. J Autism Dev Disord. 2010; 41(5):597-609. PMC: 3077435. DOI: 10.1007/s10803-010-1081-0. View