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. 2020 Jan;59(1):113-139.
doi: 10.1016/j.jaac.2019.04.027. Epub 2019 May 29.

Systematic Review: United States Workforce for Autism-Related Child Healthcare Services

Ryan K McBain  1 , Vishnupriya Kareddy  2 , Jonathan H Cantor  3 , Bradley D Stein  4 , Hao Yu  4
Affiliations

Systematic Review: United States Workforce for Autism-Related Child Healthcare Services

Ryan K McBain et al. J Am Acad Child Adolesc Psychiatry. 2020 Jan.

Abstract

Objective: A diversity of health professional disciplines provide services for children with autism spectrum disorder (ASD) in the United States. We conducted a systematic review examining the availability, distribution, and competencies of the US workforce for autism-related child health care services, and assess studies' strength of evidence.

Method: We searched PubMed, PsychINFO, Embase, and Google Scholar from 2008 to 2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of prespecified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research.

Results: Of 754 records identified, 33 studies (24 quantitative, 6 qualitative, and 3 mixed-methods) were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably. The most common specialties studied were pediatricians (n = 13), occupational therapists (n = 12), speech therapists (n = 11), physical therapists (n = 10), and child psychiatrists (n = 8). Topical areas included the following: provider availability by service area and care delivery model; qualitative assessments of provider availability and competency; role of insurance mandates in increasing access to providers: and disparities in access. Across provider categories, we found that workforce availability for autism-related services was limited in terms of overall numbers, time available, and knowledgeability. The greatest unmet need was observed among minorities and in rural settings. Most studies were short term, were limited in scope, and used convenience samples.

Conclusion: There is limited evidence to characterize the availability and distribution of the US workforce for autism-related child health care services. Existing evidence to date indicates significantly restricted availability.

Keywords: autism; autism spectrum disorder; health care access; health care availability; health disparities.

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Figures

Figure 1.
Figure 1.
Flow Diagram
Figure 2.
Figure 2.. Methodological Approach of Included Studies by Year
Note: Publications in 2018 are excluded from this figure in order to show time trends in publications. Data analysis was conducted part-way through 2018.
See this image and copyright information in PMC

References

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