Respite Care Found to Cut ASD Hospitalizations

Community-based services, such as respite and home health care, are not widely available for children with autism spectrum disorders (ASDs), a paucity that may make children with ASDs much more likely than children with other psychiatric and developmental disorders to be hospitalized for psychiatric reasons.

Would increasing spending on respite-care programs and therapeutic services decrease psychiatric hospitalizations among children, adolescents, and young adults with ASDs? That’s what a group of researchers at the Center for Mental Health Policy and Services Research at the University of Pennsylvania’s Perelman School of Medicine recently sought to determine.

As a source of information, they used the Medicaid Analytic eXtract database from 2004; data in the file are obtained from the Bureau of the Census, the AMA, the American Hospital Association, and the Centers for Disease Control and Prevention, among other agencies. Their study sample included the 28,481 Medicaid-enrolled children, adolescents, and young adults aged 5 through 21 on January 1, 2004, who had at least two outpatient claims on different days from May 1 through October 31, 2003, that were associated with a primary diagnosis of autistic disorder or Asperger disorder/pervasive developmental disorders not otherwise specified. To be included in the sample, patients had to be continuously enrolled in Medicaid during the entire study period.

Their findings? Among the young Medicaid-enrolled patients in their sample, 2.4 percent experienced at least one psychiatric hospitalization in 2004 associated with a diagnosis of ASD. After adjusting for many patient- and state-level characteristics, increased use of respite and home- and community-based aide services was associated with a decrease in the risk of psychiatric hospitalizations for children, adolescents, and young adults with an ASD. And there was a financial benefit from respite care as well—each $1,000 increase in respite expenditures in the preceding 60 days was associated with an 8 percent decrease in the odds of hospitalization.

The researchers theorized that the challenges of raising a child with an ASD might be to blame for a substantial number of the hospitalizations: “In many cases, hospitalization may result as much from the stress the child’s behavior places on the family as from the behavior per se,” wrote David Mandell, Sc.D., an associate director of the Center for Mental Health Policy and Services Research and an associate professor of psychiatry and pediatrics at the University of Pennsylvania’s Perelman School of Medicine, and his colleagues. “Respite care and home- and community-based aides may considerably reduce stress on families, leading to reduced hospitalization rates.”

Mandell and his colleagues believe their results have important implications for state policy and practice, noting that the study offers evidence in support of the need to expand community-based service options for children with an ASD.

An abstract of “The Interplay of Outpatient Services and Psychiatric Hospitalization Among Medicaid-Enrolled Children With Autism Spectrum Disorders” is posted at http://archpedi.ama-assn.org/cgi/content/short/166/1/68 .