Examining outpatient occupational therapy utilization among children and youth with special health care needs in South Carolina: A structural equation model of individual- and community-level factors

Disabil Health J. 2025 Jan;18(1):101687. doi: 10.1016/j.dhjo.2024.101687. Epub 2024 Aug 16.

Abstract

Background: Children and youth with special health care needs (CYSHCN) comprise 23 % of the pediatric population in South Carolina (SC), compared to state prevalences of 13.6 %-24 % nationwide. While occupational therapy (OT) is critical to maximizing CYSHCN's participation in daily activities, there are significant disparities in rehabilitation access in the Southeast region.

Objective: This study examines associations between patient-and community-level factors and outpatient OT utilization.

Methods: This study analyzes OT utilization data among CYSHCN (N = 1913) in a health system in SC from 07/01/2022-06/31/2023, merged with Child Opportunity Index 2.0 zip-code level social drivers of health (SDOH) data. SDOH are non-medical factors that affect individual's long-term health, with estimates ranging from "very low" to "very high" opportunity. Structural equation modeling was conducted to understand complex associations between observed and latent variables in a real-world context.

Results: CYSHCN were diagnosed with congenital (40.77 %), developmental (37.87 %), and neurological/neuromuscular conditions (21.36 %). CYSHCN who were non-Hispanic Black or Hispanic and were hospitalized were associated with living in lower opportunity areas. CYSHCN with private or military/other insurance/self-pay were associated with living in higher opportunity areas than Medicaid-insured CYSHCN. CYSHCN who were female and ≥12 years demonstrated lower OT utilization. CYSHCN who participated in speech and/or physical therapy demonstrated higher OT utilization. OT utilization increased with each increase in SDOH.

Conclusion: With these findings, healthcare providers may consider accessibility barriers, including transportation, when referring CYSHCN to OT services. Further research is needed to examine the impact of household-level SDOH on OT access across SC.

Keywords: Children with special healthcare needs; Community health; Healthcare access; Outpatient occupational therapy; Social drivers of health.

MeSH terms

  • Adolescent
  • Ambulatory Care / statistics & numerical data
  • Child
  • Child, Preschool
  • Children with Disabilities* / rehabilitation
  • Children with Disabilities* / statistics & numerical data
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Health Services Needs and Demand / statistics & numerical data
  • Humans
  • Infant
  • Latent Class Analysis
  • Male
  • Medicaid* / statistics & numerical data
  • Occupational Therapy* / methods
  • Occupational Therapy* / statistics & numerical data
  • Outpatients / statistics & numerical data
  • Patient Acceptance of Health Care / statistics & numerical data
  • South Carolina
  • United States