Distribution of Child Mental Health Workforce and Health Care for Children with Autism

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ABSTRACT It has become an increasingly important public health issue to meet the needs of children with autism and other autism-spectrum disorders (ASDs), which are complex developmental disorders characterized by repetitive behavior and delayed social interaction and communication. Studies have indicated that the prevalence of ASDs among children has more than doubled during the past decade. Recent studies have also found substantial unmet mental health (MH) care needs among children with ASDs. While multiple factors contribute to the unmet needs, one important contributing factor is likely an insufficient child MH workforce, especially a “critical shortage” of child psychiatrists. Yet no work has been done to understand whether MH care is more accessible and patient experience and satisfaction are better for children with autism in areas with higher supply of child MH workforce than in those areas with lower supply. To fill the gap, this study is designed to provide timely empirical evidence of the consequences of child MH workforce supply on MH care for children with autism. Our specific aims are: Aim 1. Examine the relationship between the child MH workforce supply, by discipline, and access to, utilization of, and experience and satisfaction with mental health care for children with autism. Aim 2. Examine the relationship between the child MH workforce supply, by discipline, and family burden of children with autism. Aim 3. Examine whether the effects of child mental health workforce supply on mental health care access, satisfaction, and family burden differ by race and ethnicity or between rural and urban residence. The proposed project is innovative because (1) unlike previous studies, we will examine the supply of multiple disciplines simultaneously, and (2) our structural, econometric model of physician entry and market structure is explicitly causal, thus providing an answer to the most common objections to the methods typically used in the previous studies of association between physician supply and geographic variations in health care. The proposed research is highly significant for multiple reasons. First, without an adequate supply of MH providers, the current efforts to strengthen the public health impact of NIMH supported dissemination of research-tested interventions would not be able to achieve optimal effects. Second, some experts have called for more empirical studies of the challenging issue of insufficient and maldistributed supply of child MH workforce. This proposed study responds to the call, and it will generate empirical evidence that will provide policymakers critical information as they address this challenging issue. To our knowledge, the proposed project will be the first to assess how MH workforce supply affects mental health care access, satisfaction and family burden for children with autism. It will also be the first study to examine whether MH workforce supply ameliorates or exacerbates existing disparities in MH health care among this group of children.