Kristen R Choi1,2, Bhumi Bhakta2, Elizabeth A Knight3, Tracy A Becerra-Culqui2,4, Teri L Gahre4, Bonnie Zima5, Karen J Coleman2,4. 1. School of Nursing, University of California, Los Angeles, Los Angeles, CA. 2. Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA. 3. Kaiser Foundation Health Plan, Oakland, CA. 4. Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA; and. 5. Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA.
Abstract
OBJECTIVES: The purpose of this study was to examine patterns of service receipt and patient outcomes for children receiving applied behavior analysis (ABA) for autism spectrum disorder (ASD) in an integrated health care system in which commercially insured children were covered by a state autism mandate. METHODS: This retrospective, observational study used a random sample of children with ASD (3-17 yrs) who were members of a large integrated health care system in Southern California and referred for ABA between January 2016 and November 2018. From the 4145 children referred, a random stratified sample of 334 was selected to extract data from clinical reports over 24 months of services. The primary outcome measures were time in ABA and child adaptive behavior. RESULTS: Thirteen percent of the sample never received ABA after referral. Of those who were referred for ABA, 66% initiated ABA and remained in services for 12 months, whereas less than half (46%) remained in services for 24 months. Having a history of special education was associated with longer time spent in ABA, whereas having a single parent was associated with discontinuation of ABA. A minority of children received a full ABA dose (28%), but the lowest functioning children still experienced clinically significant adaptive behavior gains after 24 months of ABA (p = 0.02). CONCLUSION: In a health system implementation of ABA for children with ASD, there were high rates of ABA discontinuation and low ABA dosing. These challenges may diminish the potential benefits of ABA, even in a context in which there is mandated commercial insurance coverage.
OBJECTIVES: The purpose of this study was to examine patterns of service receipt and patient outcomes for children receiving applied behavior analysis (ABA) for autism spectrum disorder (ASD) in an integrated health care system in which commercially insured children were covered by a state autism mandate. METHODS: This retrospective, observational study used a random sample of children with ASD (3-17 yrs) who were members of a large integrated health care system in Southern California and referred for ABA between January 2016 and November 2018. From the 4145 children referred, a random stratified sample of 334 was selected to extract data from clinical reports over 24 months of services. The primary outcome measures were time in ABA and child adaptive behavior. RESULTS: Thirteen percent of the sample never received ABA after referral. Of those who were referred for ABA, 66% initiated ABA and remained in services for 12 months, whereas less than half (46%) remained in services for 24 months. Having a history of special education was associated with longer time spent in ABA, whereas having a single parent was associated with discontinuation of ABA. A minority of children received a full ABA dose (28%), but the lowest functioning children still experienced clinically significant adaptive behavior gains after 24 months of ABA (p = 0.02). CONCLUSION: In a health system implementation of ABA for children with ASD, there were high rates of ABA discontinuation and low ABA dosing. These challenges may diminish the potential benefits of ABA, even in a context in which there is mandated commercial insurance coverage.
Authors: C H Chatham; K I Taylor; T Charman; X Liogier D'ardhuy; E Eule; A Fedele; A Y Hardan; E Loth; L Murtagh; M Del Valle Rubido; A San Jose Caceres; J Sevigny; L Sikich; L Snyder; J E Tillmann; P E Ventola; K L Walton-Bowen; P P Wang; T Willgoss; F Bolognani Journal: Autism Res Date: 2017-09-21 Impact factor: 5.216
Authors: Bradley D Stein; Mark J Sorbero; Upasna Goswami; James Schuster; Douglas L Leslie Journal: J Am Acad Child Adolesc Psychiatry Date: 2012-06-29 Impact factor: 8.829
Authors: Colleen L Barry; Andrew J Epstein; Steven C Marcus; Alene Kennedy-Hendricks; Molly K Candon; Ming Xie; David S Mandell Journal: Health Aff (Millwood) Date: 2017-10-01 Impact factor: 6.301
Authors: Elisabetta Carli; Marco Pasini; Francesca Pardossi; Isabella Capotosti; Antonio Narzisi; Lisa Lardani Journal: Children (Basel) Date: 2022-04-10