P3.E099: Assessing Geographic Provider Access by Therapist Type for Children with Autism in Missouri

Background: Children who have been diagnosed with Autism Spectrum Disorder (ASD) may require specialized therapy or care not widely available. Limited therapists can hinder access, especially in rural areas, or by marginalized communities. Understanding where different types of therapists are located in relation to such communities is critical for gaining insight into where targeted support can be provided to improve access. Our objective with this study was to analyze the distribution of four different types of healthcare services supporting children with ASD throughout the state of Missouri: applied behavior analysts (ABA), occupational therapists (OT), physical therapists (PT), speech language pathologists (SLP), in relation to children with an IEP code for ASD by their local school district, in the year 2020.

Methods: By examining the number of autistic children in Missouri in relation to these four therapy types, a needs assessment can be performed to find health care gaps. This project is modeled from previous geographic needs assessments done in rural communities around care distribution (Carson et al 2021). An additional layer added to this analysis is the inclusion of multiple therapist types. The count of each therapist by county was identified using the Summarize Within tool in ArcGIS Pro, and then compared to the number of children identified in the county listed as having ASD.

Results: For ABA therapists (Figures 1 & 2), most counties throughout the state of Missouri lacked the appropriate number of therapists to adequately service the number of students with an IEP for Autism. Most counties did not even have one ABA therapist. For OT services (Figures 3 & 4), there were counties without OTs, particularly clustered in the rural northern and southern regions of Missouri. For PT (Figures 5 & 6), despite a broader distribution of at least one county retaining a PT, only in the urban areas of the state are there more than enough PT options. For SLPs (Figures 7 & 8) need is concentrated in the urban areas.

Conclusion: While need for a range of services is clearly an issue throughout the state, there is a clear urban-rural divide dependent on the type of service needed. St. Louis, Kansas City, Columbia, and Springfield – population centers in the state – all have adequate numbers of physical and occupational therapists based on recommended PT and OT usage, but this reverses when looking at ABA and speech language pathologists. While ABA therapists are needed everywhere, the lack of provision is starker in urban areas, where the number of patients and their recommended therapy time cannot be accommodated by the current supply. This preliminary analysis is a step forward in recognizing the level of need throughout the state.