Underutilization of Early Intensive Behavioral Intervention Among 3-Year-Old Children with Autism Spectrum Disorder.
Even when EIBI is fully funded, kids receive less than half of authorized hours—monitor utilization, not just approval.
01Research in Context
What this study did
The team looked at 108 three-year-olds with autism. Each child had a Medicaid waiver that paid for full Early Intensive Behavioral Intervention (EIBI).
Researchers counted how many of the authorized hours families actually used. They also checked if race, ethnicity, or zip code changed the numbers.
What they found
Kids received only 24–48 % of the hours written on their plans. That is less than half of what the state agreed to fund.
Use was equally low across all racial and neighborhood groups. Poverty, language, or distance did not explain the gap.
How this fits with other research
Linstead et al. (2017) showed more hours and longer treatment produce the biggest skill jumps. E et al. now reveal many kids never get that chance, even when the money is ready.
Långh et al. (2021) found quality, not just quantity, predicts gains. Low uptake makes both problems worse—fewer hours and shaky program quality.
Slater et al. (2020) tested 15 vs 25 hours in an RCT and saw added benefit only for mild-symptom toddlers. Their data assume families can actually attend the assigned hours; E et al. show real life often falls short.
Why it matters
A signed waiver does not equal treatment. If you oversee preschool cases, track delivered hours each week. Call families when attendance drops, problem-solve transportation or scheduling, and re-stock the bench of therapists. Closing the 50 % gap could double the dose that drives language and cognitive gains shown in earlier studies.
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02At a glance
03Original abstract
Funding for early intensive behavioral intervention (EIBI) for children with autism spectrum disorder is rapidly expanding. Yet we know little about children's utilization, and research on inequities in utilization is lacking. We examined the relationship between utilization during the first year of EIBI and (a) child race-ethnicity and (b) neighborhood characteristics. Using a sample of children eligible for a Medicaid waiver through a novel policy of presumptive eligibility (N = 108), we estimated a series of two-level growth curve models. Children's average utilization ranged between 24 and 48% of weekly hours, and utilization did not differ by race-ethnicity or neighborhood during the first year. Findings underscore the need to monitor utilization of EIBI and warrant research on the feasibility of EIBI provision in the general population.
Journal of autism and developmental disorders, 2019 · doi:10.1097/DBP.0000000000000136