In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. In many states -- particularly those with large rural populations -- one problem is a shortage of high-quality behavior therapists.
The lay abstract:
This study looked at whether access to Board Certified Behavior Analysts for children with autism spectrum disorder is different between U.S. counties. The study included all U.S. counties and county equivalents in 48 states and D.C. (N = 3108). Between March and May 2019, we combined data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. We assigned Board Certified Behavior Analysts to counties based on their address, matched children in school districts to counties, and determined how many children with autism spectrum disorder there were in a county compared with how many Board Certified Behavior Analysts there were in a county. The results show uneven numbers of Board Certified Behavior Analysts between U.S. counties. More than half of all counties had no Board Certified Behavior Analysts. National maps illustrate clusters of high and low accessibility to Board Certified Behavior Analysts. To improve access to Board Certified Behavior Analysts in underserved areas, we must identify what contributes to the differences in access.
From the article:
Several factors likely influence the uneven distribution of BCBAs at the county level. It appears that rural counties are likely to have lower access than urban counties. Although 42.2% of all counties in the contiguous U.S. are rural, 64.2% of all counties with no BCBAs are rural and 79.0% of all counties with no BCBAs and no neighboring counties with a BCBA are rural (Centers for Disease Control and Prevention, 2014). Considering that historically the accessibility of health care services has been less for rural areas than urban areas (Florence et al., 2012), this is not surprising. To explore additional factors that might be associated with the presence (or lack) of BCBAs, we compared those counties in high-ratio clusters with those counties in low-ratio clusters. All else being equal, higher accessibility counties are wealthier and have smaller uninsured populations; however, there were no measurable racial or ethnic differences between high- and low-accessibility counties. These results add to an already mixed body of literature regarding the association between access to behavioral intervention and the sociodemographic and economic context in which children live, providing justification for further exploration. For instance, although counties with greater BCBA accessibility (lower enrollment to BCBA ratios) did not differ from those with less BCBA accessibility in terms of racial composition, high ASD prevalence counties had larger non-Hispanic White population shares, and smaller non-Hispanic Black and Hispanic population shares may underestimate the prevalence of ASD in these counties and impact ASD/BCBA ratios. In other words, if children who live in counties with larger non-Hispanic Black and Hispanic population shares are less likely to have a primary educational disability of ASD (Morgan et al., 2017), then lower geographic accessibility as measured in n this study by ASD/BCBA ratios may go undetected
