Racial and Ethnic Disparities in Community Mental Health Use Among Autistic Adolescents and Young Adults

Teal W Benevides; Jennifer E Jaremski; Ed-Dee Williams; Wei Song; Hoangmai H Pham; Lindsay Shea

doi:10.1016/j.jadohealth.2024.01.036

Racial and Ethnic Disparities in Community Mental Health Use Among Autistic Adolescents and Young Adults

J Adolesc Health. 2024 Mar 16:S1054-139X(24)00087-9. doi: 10.1016/j.jadohealth.2024.01.036. Online ahead of print.

Authors

Teal W Benevides¹, Jennifer E Jaremski², Ed-Dee Williams³, Wei Song⁴, Hoangmai H Pham⁵, Lindsay Shea⁴

Affiliations

¹ Institute of Public and Preventive Health, Augusta University, Augusta, Georgia. Electronic address: tbenevides@augusta.edu.
² Institute of Public and Preventive Health, Augusta University, Augusta, Georgia.
³ School of Social Work, Boston College, Chestnut Hill, Massachusetts.
⁴ A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania.
⁵ Institute for Exceptional Care, Washington, D.C.

PMID: 38493400
DOI: 10.1016/j.jadohealth.2024.01.036

Abstract

Purpose: The purpose of this cohort study was to evaluate differences in rate of co-occurring mental health (MH) conditions among transition-age autistic youth (TAYA) who are Black, indigenous, and other people of color, and to identify enabling variables associated with any community MH visit in this population.

Methods: Medicare-Medicaid Linked Enrollees Analytic Data Source 2012 data were used for this study. TAYA 14-29 years old who received fee-for-service Medicare, Medicaid, or both were included. Predisposing, enabling, and need variables associated with both presence of MH conditions and any community MH visit were examined with general linear modeling.

Results: N = 122,250 TAYA were included. Black, Asian/Pacific Islander, and Hispanic TAYA were significantly less likely than White TAYA to have a diagnosis of substance-use, depressive, anxiety, attention-deficit hyperactivity disorder, or post-traumatic stress disorders. These groups were also significantly less likely to have had a community MH visit in the past year after controlling for predisposing, enabling, and need variables. Enabling variables associated with greater use of at least one community MH visit included dual enrollment in both Medicare and Medicaid and 12+ months of enrollment in 1115 or 1915(C) Medicaid waivers.

Discussion: Service delivery factors are an important area of future research, particularly dual enrollment and coverage disparities for Black, indigenous, and other people of color TAYA. Examining coverage of managed care enrollees, including differences by state, may offer additional insights on how these factors impact care.

Keywords: Adolescents; Autism; Community services; Health service access; Medicaid; Medicare; Mental health; Racial disparities; Transition-age youth; Young adults.