A population approach to understanding children's access to assistive technology

Purpose. To determine whether service delivery system factors, including having a quality medical home, access to therapeutic services, or enrolment in early intervention/special education services, are associated with meeting children's needs for assistive technology (AT). Method. Data were analysed for children 0-17 years of age participating in the 2001 US National Survey of Children with Special Health Care Needs who required AT services (N=18,372) and a subgroup of children needing assistive devices typically provided by rehabilitation professionals (N=4429). AT needs included vision or hearing aids or care, communication or mobility devices, or other medical equipment. Unmet need was defined as not receiving all needed services. Estimates were generated of the per cent of children needing and having unmet needs for services. Associations between the medical home, therapy and education variables and having an unmet need for AT were assessed using logistic regression. Results. An estimated 49% of children with special health care needs require AT services. Twelve per cent require AT services typically provided by rehabilitation professionals. Of the latter group, 14% had unmet needs. The likelihood of having unmet AT needs was greater for children lacking a quality medical home (a.O.R.=3.27 [95% C.I.=2.29-4.66]) and/or those not receiving needed therapy services (a.O.R.=3.52 [95% C.I.=2.25-5.48]) than for children whose medical home and therapy service expectations were met. Enrolment in early intervention/special education was not associated with having unmet needs for AT. Conclusions. Promoting quality care within a complex service delivery system is critical to meeting the AT needs of children and their families. Changes in the structure and processes of care, including facilitating access to a quality medical home and needed therapy services would likely increase access to needed AT.