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David S. Mandell, ScD; Ming Xie, MS; Knashawn H. Morales, ScD; Lindsay Lawer, MA; Megan McCarthy, MA; Steven C. Marcus, PhD

Arch Pediatr Adolesc Med. 2012;166(1):68-73. doi:10.1001/archpediatrics.2011.714

Objective  To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).

Design  Retrospective cohort study using discrete-time logistic regression to examine the association of service use in the preceding 60 days with the risk of hospitalization.

Setting  The Medicaid-reimbursed health care system in the continental United States.

Participants  Medicaid-enrolled children with an ASD diagnosis in 2004 (N = 28 428).

Main Exposures  Use of respite care and therapeutic services, based on procedure codes.

Main Outcome Measures  Hospitalizations associated with a diagnosis of ASD (International Classification of Diseases, 10th Revision, codes 299.0, 299.8, and 299.9).

Results  Each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization in adjusted analysis. Use of therapeutic services was not associated with reduced risk of hospitalization.

Conclusions  Respite care is not universally available through Medicaid. It may represent a critical type of service for supporting families in addressing challenging child behaviors. States should increase the availability of respite care for Medicaid-enrolled children with ASDs. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.

Author Affiliations: Center for Mental Health Policy and Services Research (Drs Mandell and Morales and Mss Xie, Lawer, and McCarthy) and Department of Clinical Epidemiology and Biostatistics (Dr Morales), Perelman School of Medicine, and School of Social Policy and Practice (Dr Marcus), University of Pennsylvania, and Center for Autism Research, The Children's Hospital of Philadelphia (Dr Mandell), Philadelphia, Pennsylvania.

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