Home language and diagnostic co-morbidity predict neuropsychological evaluation recommendation uptake among low income families.

Background

Rates of recommendation uptake following a neuropsychological evaluation are low, and are even lower for families living in socioeconomic disadvantage. To identify families most at risk, we explore rates and socioeconomic predictors of uptake in a sample of families receiving low/no-fee evaluations. Additionally, we characterize reported barriers to uptake.

Methods

Participants included 2,126 children/families who completed both a neuropsychological evaluation in a hospital-based clinic and an annual Individualized Education Program (IEP) meeting following evaluation. Evaluation in this clinic includes free and optional educational advocacy support. Data regarding rates of and barriers to recommendation uptake were gathered using patient questionnaires and medical records. Predictors of recommendation uptake were investigated using multiple logistic regression analyses.

Results

Following evaluation, 40% of families had all recommendations implemented and 54% had recommendations deemed essential by their clinician implemented. Families who spoke mostly Spanish at home were significantly less likely to have all recommendations implemented (OR = 2.22, B = 0.797, p = .005). Children who received more diagnoses after evaluation were significantly more likely to have all essential recommendations implemented (OR = 0.88, B = -0.131, p = .023). The two most commonly reported barriers to recommendation uptake were: (1) parents failing to follow up with clinic staff and (2) clinic-school disagreement regarding services needed.

Conclusion

This study is one of the first to examine predictors of recommendation uptake among families living in socioeconomic disadvantage. Families facing language barriers were less likely to access services. Additionally, youth with fewer diagnoses and thus potentially less severe challenges were less likely to have recommendations implemented. Future research should test interventions, such as educational advocacy, to mitigate the impact of these risk factors.