Mental health hospitalizations and follow-up care in autistic adults

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PROJECT ABSTRACT Autistic adults experience higher rates of co-occurring mental health conditions than their peers, impacting quality of life and increasing the complexity and cost of health care. Experiences of adversity, isolation, and stigma may place autistic people at increased risk for mental health concerns. Mental health services can play a key role in supporting people to cope with mental health concerns. When mental health is not adequately addressed, issues frequently escalate to crisis level and treatable mental health conditions become more severe and disabling over time. While there is no centralized system mental health crisis system in the U.S., emergency and inpatient hospitalization is an integral part of crisis care for many people. There is limited understanding of hospitalization in autistic adults, but preliminary findings suggest mental health conditions, including mood disorders and schizophrenia, are among the most common reasons for inpatient hospitalization in autistic adults. While hospitals are a common source of emergency and crisis care for mental health, they are often not equipped to provide quality care. This is a problem amplified in autistic patients because of lack of provider knowledge of autism, high prevalence of multiple co-occurring conditions, and autism characteristics complicating care including sensory sensitivity and difficulty with new routines and unknown places. Therefore, care immediately following hospitalization is an important part of addressing the crisis and working towards maintenance care. People who do not receive appropriate follow-up care are more likely to cease care and experience hospital readmissions, service and medication non-compliance, and self-injurious and dangerous behaviors. Because hospitalization may be particularly traumatic for autistic adults, appropriate follow-up care is vitally important. Very little is known about mental health care in autistic adults, including hospitalization for and follow-up care after mental health hospitalization. But the picture of limited provider availability, lack of provider knowledge, and siloed service systems suggest that care can be vastly improved. The purpose of this study is to examine the mental health hospitalizations of autistic adults and the care patterns following crisis compared to other adults hospitalized for mental health conditions. We will do this using two national sources of data: an all-payer hospital readmissions database and Medicaid claims. Using national all-payer hospitalization data allows a complete picture of experiences to inform improvement, while focusing on Medicaid claims allows a complete investigation of patterns and predictors of follow-up care service use and readmission. The ultimate goal is to inform service delivery system changes that increase care appropriateness and improve quality of life in autistic adults.