Caregivers as Interventionists and Trainers: Teaching Mands to Children with Developmental Disabilities.

Loughrey et al. (2014) mailed a survey to 383 North Carolina families raising a child with autism.

They asked who gets therapy, who doesn’t, and what makes the difference.

Kids got fewer services if their parents had less school, lived in rural zip codes, or were Black or Latino.

High parent stress also cut service use, even when therapy was available.

Wang et al. (2013) showed the same pattern in claims data: Medicaid kids rack up four times more therapy visits than kids with private plans.

Zhang et al. (2022) later confirmed that private insurance still leaves families with thinner coverage, so the gap is not closing.

Yingling et al. (2023) mapped why geography still matters: most U.S. counties have far more autistic kids than RBTs, so rural families drive hours or go without.

Johnson et al. (2021) gave one answer—train parents. Their FACES program lifted advocacy skills among Black caregivers and boosted service access, proving the racial gap can shrink when we act.

You can spot at-risk families in seconds. Ask four quick questions: rural address, minority status, parent education ≤ high school, high stress. If two or more are true, add an advocacy goal to the behavior plan. Link the family to FACES-style groups, Medicaid Waiver staff, or telehealth RBT slots. One extra referral can double their therapy hours.