Increasing Access to Autism Spectrum Disorder Diagnostic Consultation in Rural and Underserved Communities: Streamlined Evaluation Within Primary Care

Hine, Jeffrey F.; Allin, Jessica; Allman, Angela; Black, Michelle; Browning, Brooke; Ramsey, Bobbie; Swanson, Amy; Warren, Zachary; Zawoyski, Andrea M.; Allen, William C.

doi:10.1097/dbp.0000000000000727

Cited by 33 publications

(23 citation statements)

References 26 publications

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“…Additional research has revealed promising utility for an extended age range of 14 to 47 months. 26,40,41 , and local community organizations (n = 60). Medical presentations were delivered at 73 events (see Fig 1A).…”

Section: Eae Hub Clinical Pathwaymentioning

confidence: 99%

“…Across the EAE Hubs, the mean age at evaluation was 30 months (see Table 3), significantly less than the national average of 4 to 5 years of age 8 and consistent with existing reports of community-based diagnostic models. [24][25][26][27] Compared to historical 9-to 12-month wait times estimated across tertiary outpatient clinics, the median latency from referral to EAE Hub evaluation (ie, wait time) was 62 days. This finding of improved access through implementation of ASD evaluation in the primary care setting has been found across several smaller studies.…”

Section: Eae Hub Clinical Pathwaymentioning

confidence: 99%

“…This finding of improved access through implementation of ASD evaluation in the primary care setting has been found across several smaller studies. [26][27][28][29] Decreasing wait times for evaluation services provided in children's local communities has the important potential of increasing access to early intervention and supportive services.…”

Section: Eae Hub Clinical Pathwaymentioning

confidence: 99%

“…A second strategy for decreasing the age of ASD diagnosis is to improve access to diagnostic evaluations. The field has seen an emergence of promising research on training primary care providers (PCPs), [22][23][24][25] embedding behavioral health providers in primary care, 26,27 and using telemedicine-based diagnostic procedures. 28,29 Many studies employ an evaluation model in which diagnosis is based on developmental history as well as administration of the Screening Tool for Autism in Toddlers and Young Children (STAT), 30 a level 2 ASD screening measure.…”

mentioning

confidence: 99%

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A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder

et al. 2020

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Although autism spectrum disorder (ASD) can be reliably detected in the second year of life, the average age of diagnosis is 4 to 5 years. Limitations in access to timely ASD diagnostic evaluations delay enrollment in interventions known to improve developmental outcomes. As such, developing and testing streamlined methods for ASD diagnosis is a public health and research priority. In this report, we describe the Early Autism Evaluation (EAE) Hub system, a statewide initiative for ASD screening and diagnosis in the primary care setting. Development of the EAE Hub system involved geographically targeted provision of developmental screening technical assistance to primary care, community outreach, and training primary care clinicians in ASD evaluation. At the EAE Hubs, a standard clinical pathway was implemented for evaluation of children, ages 18 to 48 months, at risk for ASD. From 2012 to 2018, 2076 children were evaluated (mean age: 30 months; median evaluation wait time: 62 days), and 33% of children received a diagnosis of ASD. Our findings suggest that developing a tiered system of developmental screening and early ASD evaluation is feasible in a geographic region facing health care access problems. Through targeted delivery of education, outreach, and intensive practice-based training, large numbers of young children at risk for ASD can be identified, referred, and evaluated in the local primary care setting. The EAE Hub model has potential for dissemination to other states facing similar neurodevelopmental health care system burdens. Implementation lessons learned and key system successes, challenges, and future directions are reviewed.

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Section: Eae Hub Clinical Pathwaymentioning

confidence: 99%

Section: Eae Hub Clinical Pathwaymentioning

confidence: 99%

Section: Eae Hub Clinical Pathwaymentioning

confidence: 99%

mentioning

confidence: 99%

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A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder

et al. 2020

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“…Consistently, there appears to be a sizeable portion of young children for whom marked social communication impairments and restrictive and repetitive behaviors clearly indicative of ASD can be accurately recognized in a variety of community settings. In addition, these novel assessment models may be quite capable of identifying children who ultimately need more specialized assessments to resolve ambiguity, identified either on review of the initial referral or following a community evaluation (Hine et al, 2020; Mazurek et al, 2019). In these contexts, such expert evaluation can represent an important ‘safety net’ that can mitigate against misclassification.…”

Section: Understanding and Embracing Heterogeneitymentioning

confidence: 99%

Commentary: Embracing innovation is necessary to improve assessment and care for individuals with ASD: a reflection on Kanne and Bishop (2020)

Zwaigenbaum

Warren

2020

Child Psychology Psychiatry

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This commentary is offered in response to Kanne and Bishop (2020) who urge caution in adopting new devices and processes for ASD assessment and advocate that that comprehensive, expert‐driven, diagnostic models for ASD remain essential to maintain quality standards. While we agree that there is a critical shortage in current care, we propose that developing suites of tools and innovative approaches for screening, risk‐classification, formal diagnosis, and rich assessment of abilities and challenges may be of great value to families and necessary to improve current systems of care. As well, the evaluation of ‘assessment quality’ should take into consideration both content and process, with a focus on achieving meaningful outcomes and optimizing family experience.

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Addressing current barriers to autism diagnoses through a tiered diagnostic approach involving pediatric primary care providers

et al. 2022

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Formal autism diagnosis from a specialist trained in autism assessment is customary prior to a child accessing early, intensive autism‐specific services. However, long wait lists for diagnostic evaluations and limited specialty workforce have created substantial delays. Additionally, lengthy multidisciplinary evaluations are costly to insurers, inconvenient to families, and disproportionally impact under‐resourced families. Diagnostic delays can impede access to intervention services. These barriers, combined with evidence regarding the importance of receiving early, autism‐specific treatment, demand new approaches enabling access to autism specific services before comprehensive evaluation. Pediatric primary care providers (PCPs) are often the only health care professionals with whom a family interacts during early childhood and can play a crucial role in helping children with autism symptoms access services. Many strategies for autism diagnosis in primary care are being developed and tested; however, they have yet to be broadly adopted by PCPs, primarily due to critical implementation barriers in primary care settings. There is also not enough evidence on the accuracy of PCPs' diagnostic impressions without extensive specialty support, resulting in PCP hesitancy in diagnosing ASD, as well as family and service provider hesitancy in accepting a PCP autism diagnosis. In this commentary, we explore the acute need for shortening waitlists for autism evaluations through a tiered diagnostic approach, in which PCPs can rule in or rule out autism in children, for whom diagnosis is clear, and refer more complex cases for specialist evaluations, and explore implementation challenges to this approach.

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Increasing Access to Autism Spectrum Disorder Diagnostic Consultation in Rural and Underserved Communities: Streamlined Evaluation Within Primary Care

Abstract: Objective: Preliminary feasibility and clinical utility research has demonstrated that implementation of a streamlined diagnostic model embedded within primary care clinics promotes

Cited by 33 publications

References 26 publications

A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder

A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder

Commentary: Embracing innovation is necessary to improve assessment and care for individuals with ASD: a reflection on Kanne and Bishop (2020)

Addressing current barriers to autism diagnoses through a tiered diagnostic approach involving pediatric primary care providers

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