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J Am Acad Child Adolesc Psychiatry. 2019 May 28. pii: S0890-8567(19)30351-X. doi: 10.1016/j.jaac.2019.04.027. [Epub ahead of print]

Systematic Review: United States Workforce for Autism-Related Child Healthcare Services.

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RAND Corporation, Boston, MA. Electronic address:
RAND Corporation, Boston, MA.
RAND Corporation, Santa Monica, CA.
RAND Corporation, Pittsburgh, PA.



A diversity of United States health professional disciplines provide services for children with autism spectrum disorder (ASD). We conducted a systematic review examining the availability, distribution and competencies of the U.S. workforce for autism-related child healthcare services, and assess studies' strength of evidence.


We searched PubMed, PsychINFO, Embase and Google Scholar from 2008-2018 for relevant US-based studies. Two investigators independently screened and evaluated studies against a set of pre-specified inclusion criteria and evaluated strength of evidence (SOE) using a framework designed to integrate a mixed-methods research.


Of 754 records identified, 33 studies-24 quantitative, 6 qualitative and 3 mixed-methods-were included. Strength of evidence associated was low-to-moderate, with only 8 studies (24%) satisfying criteria for strong SOE. Geographies and provider cadres varied considerably: The most common specialties studied were: pediatricians (n=13), occupational therapists (n=12), speech therapists (n=11), physical therapists (n=10), and child psychiatrists (n=8). Topical areas included provider availability by service area and care delivery model, qualitative assessments of provider availability and competency, the role of insurance mandates in increasing access to providers, and disparities in access. Across provider categories, we found workforce availability for autism-related services was limited-in terms of overall numbers, time available and knowledgeability. Greatest unmet need was observed among minorities and in rural settings. Most studies were short-term, limited in scope, and used convenience samples.


There is limited evidence to characterize availability and distribution of the U.S. workforce for autism-related child healthcare services. Existing evidence to-date indicates significantly restricted availability.


autism; autism spectrum disorder; health disparities; healthcare access; healthcare availability


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