The Periodic Risk Evaluation: A new tool to link Medicaid-enrolled autistic adults to services and support

Background: The Periodic Risk Evaluation (PRE) is a new questionnaire-based tool to identify autistic adults enrolled in Medicaid programs who are at risk for adverse outcomes including mental health and medical conditions, law enforcement interaction, stressful life events, substance use, presence of natural supports, and suboptimal living conditions. The PRE is completed by direct service providers and informs case conceptualization to drive changes in needed supports. Method: The PRE was tested in a sample of 674 autistic adults with a mean age of 31 years across a large, northeastern state. A random forest model was developed to predict complex case status using the PRE items. Sensitivity, specificity, positive predictive value, and negative predictive value for different PRE score cutoffs were evaluated as the performance measures of interest. Expert clinical assessment, the gold standard for case status, identified 131 individuals (19.4 %) as complex cases in need of modified services and supports. Results: The final PRE model identified complex cases in unseen data with 75.5 % accuracy, 71.9 % sensitivity, 76.3 % specificity, 41.8 % positive predictive value, and 92.0 % negative predictive value. Conclusions: The PRE may be a useful tool for triaging service needs and delivery to adults on the spectrum. The use of the PRE in the Medicaid system is critical because Medicaid is among the only insurers available during the transition to and throughout adulthood for autistic individuals. Adequate planning and assessment of risk can assist direct support staff in triaging and mitigating risk to minimize adverse outcomes.