State-level variations in perceived unmet therapy need among infants and toddlers with special health care needs

No population-based studies have looked at unmet therapy need among infants and toddlers with developmental disabilities, whose primary source of therapy is Part C Early Intervention (EI). Furthermore, while state-level policies have been associated with therapy utilization in this population, it is unclear how such policies are related to unmet therapy need. Objectives: The purpose of this study is to describe state-level differences in parent-reported unmet therapy need, and examine the association between perceived unmet therapy need and state-level policies among a cohort of children with special health care needs (CSHCN). Methods: Using the 2009-2010 National Survey of CSHCN, we created a sample (n=746) of children less than three years old, with a parent-reported need for physical, occupational or speech therapy services. Hierarchical logistic regression will be employed to account for the fact that children within states share similar social and political environments, which may make them more alike than children between states. Four random-intercept models will be fit: Model 1 will describe the overall between-state variability in parent-reported unmet therapy need; Model 2 will adjust for individual-level characteristics; Model 3 will further adjust for state-level characteristics (Part C EI and Medicaid/SCHIP eligibility criteria); and Model 4 will assess interactions between individual- and state-level characteristics. Conclusions: Identifying and reducing health-related disparities is a public health priority. Understanding the association between state-level policy and unmet need for therapy services is critical, especially as states are increasingly called upon to cover and provide services for CSHCN in the face of diminishing budgets.