Utilization of special services among children and youth with special healthcare needs: A time-to-event analysis of the national survey of children's health data, 2016-2022.

This study looked at how many children with special needs receive therapies like speech, occupational, or physical therapy. Out of over 63,000 families surveyed, about 42% of children with special needs received these services. Children with Down syndrome (91%) and cerebral palsy (90%) were much more likely to receive services than children with autism (88%) or other conditions (34%). Boys, younger children (0-5 years), and families with consistent health insurance were more likely to access services.

This large-scale analysis of 63,734 caregivers examined special services utilization among children and youth with special healthcare needs using 2016-2022 National Survey of Children's Health data. Overall, 41.9% of children with special healthcare needs received special services (physical, occupational, speech, or behavioral therapies). Utilization rates varied significantly by condition: 91.4% for Down syndrome, 90.3% for cerebral palsy, 88.0% for autism, and 34.1% for other conditions. Children with Down syndrome and cerebral palsy accessed services earlier than those with autism.

Key predictors of service use included male gender, younger age (0-5 years), consistent insurance coverage, and condition complexity. These findings emphasize the need for tailored approaches to optimize service access across different special healthcare needs.

Findings suggest need for targeted outreach to ensure equitable access to special services, particularly for children with autism who may face delays. Early intervention programs should prioritize 0-5 age group. Insurance stability appears crucial for sustained service access, highlighting importance of coverage continuity in care planning.

Study relies on caregiver self-report which may introduce recall bias. Cross-sectional design limits causal inferences about timing and determinants. Service quality and intensity not assessed. The study period spans COVID-19 which may have affected service access patterns.

Special services including physical, occupational, speech, or behavioral therapies are associated with enhanced long-term functioning and well-being of children and youth with special healthcare needs (CYSHCN). Yet, there is a lack of recent evidence on the utilization of these services, and the age at which CYSHCN first receive them. This study assessed the distribution, timing, and determinants of special services utilization across different types of special healthcare needs. Data from 63,734 caregivers of CYSHCN aged 0-17 years from the 2016-2022 National Survey of Children's Health were analyzed using Rao-Scott Chi-Square, Log-rank, and Cox proportional hazard tests.

Overall, 41.9 % of CYSHCN ever received special services, including 91.4 %, 90.3 %, 88.0, and 34.1 % of children and youth with Down syndrome, cerebral palsy, autism, and other special healthcare needs (OSHCN), respectively. Children with Down syndrome and cerebral palsy received special services earlier than those with autism or OSHCN. Utilization of special services was higher among male children and youth (aHR 1.41; 95 % CI: 1.33-1.49), aged 0-5 years (aHR: 4.70; 95 % CI: 4.32-5.11), second or later born children (aHR: 1.18; 95 % CI: 1.10-1.26), from families with low-income (aHR: 1.14; 95 % CI: 1.04-1.24), living with married parents (aHR: 1.11; 95 % CI: 1.04-1.19), consistently insured (aHR: 1.24; 95 % CI: 1.08-1.42), and with a more complex health condition (aHR: 3.40; 95 % CI: 3.13-3.70) compared to their counterparts. These findings highlight the necessity of adopting tailored approaches for children with different special healthcare needs to optimize and sustain the utilization of special services.