Making Access to Pediatric Rehabilitation Therapy More Equitable
For many children with disabilities, access to rehabilitation like physical, occupational, and speech therapy is a necessity; however, a recent study from Pitt’s Department of Physical Medicine and Rehabilitation and Department of Occupational Therapy reveals how families face substantial challenges to accessing therapy appointments, especially those of marginalized groups.
The study was conducted by having callers pose as mothers of children with cerebral palsy seeking outpatient therapy. Over the course of eight weeks, the simulated mothers contacted clinics in the tri-state area of Pennsylvania, Ohio, and West Virginia to schedule an appointment. The difficulty of making an appointment was determined by the number of calls the simulated mother had to make and the wait time before the next available appointment.
Four different types of family units were created to simulate the experiences of various identities, including White, African American, Hispanic, and Muslim. The four categories of family units were also separated into families with public insurance and private insurance. Finally, the family units were randomly assigned to four types of rehabilitation clinics: non-rural lifespan clinics, non-rural pediatric clinics, rural lifespan clinics, and rural pediatric clinics.
In the protocol, an outcome was considered reached if the caller received an appointment date, was turned down due to their insurance type, or was informed that the clinic was fully booked and not accepting new patients. To achieve these outcomes, the callers made five calls to the clinic. If these first five calls did not result in an outcome, the caller was to find a substitution within their assigned clinic type.
In total, there were 173 simulated families and 251 calls. Only 91 of the simulated families were able to successfully schedule an appointment, resulting in access to appointments being a problem for 47.4% of families. Additionally, 31.2% of the simulated families had to see a substitute clinic.
Difficulty accessing an appointment was a common issue for all the simulated families, but certain groups experienced more difficulty than others. The location of the clinic was the most significant variable in obtaining an appointment, with 40.9% of the simulated mothers in Pennsylvania and Ohio scheduling an appointment. Meanwhile, only 24.3% of mothers in West Virginia were able to obtain an appointment time. The second most significant variable was the identity of the family, with only 34.3% of Hispanic and Black families getting an appointment, compared to 50.7% of White and Muslim families. However, despite the hypothesis that insurance type would influence the difficulty, insurance type was not a predictor of whether or not a family could attain an appointment.
The study acknowledges its limitations due to the results being confined to the tri-state area region. Additionally, some clinics required families to complete intake forms. Finally, although simulated families were given names meant to signal the identity of the family, the recipient of the call may not ascribe an identity to the caller.
Ultimately, the study displays the difficulty all families face in obtaining rehabilitation for children with disabilities, as well as how identities like race, ethnicity, and socioeconomic status intersect with disability. The results underscore the importance for clinics to be aware of these challenges and strive to make their services more equitable for all patients, particularly those from marginalized backgrounds.
Read the full paper here.