(PS4-73) The Effects of Service Payer on the Use of Intervention Strategies for Autistic Youth

Autism is associated with various mental health, behavioral, social, and developmental needs that affect the daily lives of autistic youth (Rosen et al., 2018; Lord et al., 2021). As a result of these needs, autistic youth exhibit among the highest service use needs of any population (Zablotsky et al., 2015), with substantial service costs distributed across a range of payer systems (e.g., public, private, school). These services represent a wide range of strategies, with research indicating such strategies often cohere in communities into “practice sets” representing similar approaches used by providers (i.e., if they use one, they use a specific set of others; Drahota et al., 2023; Lerner et al., 2023). While studies indicate that provider and client characteristics may impact use of these practice sets, the impact of payer system on use remains unknown. As treatment for a wide range of conditions varies substantially by payer (e.g., Torio & Moore, 2016; Domino et al., 2009), it is especially important to examine the degree to which service payer impacts strategy use for autistic youth    

The Usual Care for Autism Study (UCAS) surveyed professionals across disciplines (e.g., psychologist, social worker, special education) working with autistic youth (ages 7 – 22). Respondents (n=701) were asked personal and client-related demographic questions, including the typical payer for the services they provide for autistic youth. Additionally, respondents reported use of the 4 empirically dominant community practice sets for autistic youth: Consequence-Based Strategies (CBS; e.g., reinforcement, token economy), Cognitive-Behavioral and Therapy Strategies (CBTS; e.g., psychoeducation, special-interest incorporation), Antecedent-Based Strategies (ABS; e.g., modeling, providing choices), and Teaching Strategies (TS; e.g., shaping, peer modeling; Drahota et al., 2023). To examine the association between payer type and frequency of strategy use, ANOVAs were run with all payer types in the model predicting each practice set. 

CBS use was more frequent when private insurance was an endorsed payer (B = -0.02. p =.001). CBTS use was more frequent with out of pocket (B =-0.40, p < .001) or public insurance (B=-0.33, p=.002) payer types, but less frequent when the school district was an endorsed payer (B=0.25, p=.011). TS use was more frequent when state-funded disability services were an endorsed payer (B=-.24, p=.031). 

Findings indicate associations between the typical payer of services for autistic youth and the frequency with which CBS, CBTS, and TS. Of note, CBTS use was associated with three payer conditions: more frequently with out-of-pocket and public insurance payment, but less frequently with school district payment, suggesting that school-funded services may in some cases preclude access to CBT without additional training (Lovell & Richards, 2000). No common association across practice sets was observed, suggesting discrete associations between services utilized and payer type; future work should seek to ascertain the factors that may mediate these relations. These results also suggest that changing payment type may yield loss of access to specific services, regardless of efficacy or need, highlighting the role of p</span>ayer in access gaps.