Applying an Intersectionality Framework to Examine Service Utilization Disparities Among Young Autistic Children Enrolled in Early Intervention

Author

Devon R. Oosting, University of Massachusetts BostonFollow

Date of Award

12-2024

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Clinical Psychology

First Advisor

Alice S. Carter

Second Advisor

Abbey Eisenhower

Third Advisor

Susan Faja

Abstract

Families whose social identities (e.g., race, ethnicity, economic resource access, educational attainment) are societally marginalized demonstrate disproportionately reduced utilization of state-provided early intervention (EI) services for infants and toddlers (Feinberg et al., 2011; Khetani, Richardson, & McManus, 2017). Less is known about disparities in EI service and autism-specialized service utilization of young children enrolled in EI who are already diagnosed with autism spectrum disorder (ASD). Given that autism researchers and professionals recommend early intensive provision of intervention services to young children diagnosed with autism, it is important to better understand intervention service access disparities. Extant research on this topic has almost exclusively examined disparities across groups delineated according to one social identity, like race or economic resource access. Intersectionality framework, in contrast, emphasizes that peoples’ lived experiences differ according to the intersection of multiple identities, given that we all occupy all of our identities simultaneously. Though used in qualitative research about healthcare access among children with autism (e.g., Singh & Bunyak, 2019), an intersectionality framework has yet to be employed in quantitative research on healthcare access among young autistic children. Method. This study applied two intersectionality-aligned analytic methods to generate representations of intersectional identities: two- and three-way interactions and latent class analysis (LCA). These analytic methods were first applied to a large sample of children with autism enrolled in EI, using administrative data routinely collected by the state public health department. In a small subset of that sample who participated in an intensive diagnostic and developmental evaluation as part of a larger study focused on reducing diagnostic disparities, the same analytic methods were used to create intersectionality representations utilizing the detailed identity-related information collected at diagnostic evaluation. Results. Intersectional identities were related to service utilization most consistently when represented through latent class analysis (LCA). LCA-generated classes were delineated according to several identities. LCA models from the administrative and intensive samples included a class with participants characterized as Hispanic or Latiné and a class with participants occupying primarily identities that are associated with societally conferred privilege. Other classes were defined according to family primary language, caregiver educational attainment, and caregiver place of birth. Interaction testing via linear regressions yielded intersectional findings that varied based on the sample and the type of service examined. In the administrative sample, intersectional identities of race and ethnicity and family primary language and ethnicity were related to general EI service utilization, whereas intersectional identity captured via two- and three-way interactions were unrelated to ASD-specific service utilization. In contrast, in the intensive sample, intersectional groups represented by two- and three-way interaction terms were significant predictors of ASD-specific service utilization, and no interaction terms were related to general EI service utilization. Conclusions. This study sought improved understanding of service utilization patterns in early intervention among families with young autistic children using an intersectionality framework. Study results suggest that service utilization differs across intersectional identity groups when these groups are represented in multiple ways analytically, and that these effects are significant above and beyond the impacts of identities examined separately. Broadly speaking, this study offers preliminary evidence that an intersectionality framework is both quantitatively feasible and helpful in understanding service utilization in this population, and that intersectionality is an important framework to apply to quantitative autism research as a means of generating more robust reflections of families’ lived experiences as they relate to access to care variables like service utilization.

Comments

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Recommended Citation

Oosting, Devon R., "Applying an Intersectionality Framework to Examine Service Utilization Disparities Among Young Autistic Children Enrolled in Early Intervention" (2024). Graduate Doctoral Dissertations. 1036.
https://scholarworks.umb.edu/doctoral_dissertations/1036