In order to approximate which disabled children participated in more than one service, the descriptive variables available to us were examined by single service and multi-service categories. In table 16, the distribution of the primary characteristic is presented for all special education children, as well as special education children participating in more than one service. Only multi- service use involving AABD and the Medicaid program is presented because it represents the majority of the multi-service utilization. In each of the fiscal years, the majority of children in both special education and AABD were those with mental retardation. Over time, however, children with learning disabilities and severe emotional disturbance were more likely to participate in AABD an special education simultaneously. By FY 1994, 35.1% of the children in both special education and AABD were mentally retarded, 30.9% were learning disabled, and 15% were severely emotionally disturbed. In terms of the utilization of the Medicaid program and special education, the patterns of service utilization for different categories of the children varied over time. Mentally retarded and SED children became less likely to use Medicaid reimbursed services while participating in special education. In FY 1990, 25.4% and 25.3% of the children participating in both services were respectively mentally retarded and SED while in FY 1994 only 19.5% and 17.4% of children in both services were respectively mentally retarded and SED. Learning disabled children were more likely to represent children participating in special education and receiving Medicaid reimbursed services over time. The increase was especially pronounced between FY 1992 when 15.9% of children in both services were learning disabled and FY 1993 when 24.4% of children were indicated as learning disabled in special education.
Children participating in the Medicaid program were similarly examined by single and multiple service categories. In FY 1990, the children who received Medicaid reimbursed services and special education looked very different from children who received Medicaid reimbursed services and AABD (Table 17a-17e). The majority of children participating in both the Medicaid program and special education were receiving service under special categories of service (14.6%), for multiple diagnoses (14.2%), and for other mental disorders (13.9%). Children receiving Medicaid reimbursed services and AABD were most likely to be treating infantile cerebral palsy (16.5%) and multiple diagnoses (15.0%) within fiscal year 1990. In terms of the type of Medicaid recipient with the highest degree of multi-service utilization, infantile cerebral palsy was highest with 80.9% of children in FY 1990 participating in multiple services. Children with multiple diagnoses and developmental speech or language disorders also had substantial multi-service use.
These patterns begin to change in FY 1992. In FY 1992, children participating in the Medicaid program and special education are more likely to have been identified by multiple diagnoses, other mental disorders, and developmental speech and language disorders. By FY 1994, the majority of children participating in the Medicaid program and either special education or AABD were being treated for mental disorders. By 1994, the percentage of children with both mental disorders and multiple diagnoses who used special education or AABD had increased during the period. This increase, however, is due in part to the changing composition of the Medicaid population after the Medicaid community mental health services program began. Without controlling for other factors, it is not clear whether the increase is due to changes in multi-service use or to changes in the composition of the population. This hypothesis will be tested using multivariate methods with regard to AABD participation specifically.