ASD Screening and Diagnosis: Increasing Capacity in Community Primary Care Providers
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  • 1. ASD Screening and Diagnosis:  Increasing Capacity in Community  Primary Care Providers Elizabeth Caronna, MD Boston University/Boston Medical Center Developmental Behavioral Pediatrics
  • 2. Screening for ASD in Massachusetts • Since December, 2007 mandated screening for  developmental and behavioral problems with  approved screening tools for children  receiving Medicaid, as part of routine EPSDT  visits linked to reimbursement • Developmental screening follows  recommendations from American Academy of  Pediatrics (Pediatrics, 2006, 2007), except  choice of specific measures are mandated  from approved list
  • 3. Screening for ASD in Massachusetts • M‐CHAT screening now widely used in  pediatric practices throughout the state • Limitations of the M‐CHAT screener result in  increased referrals to specialists on basis of  “failed M‐CHAT” • Delays between parental/primary care  provider (PCP) concern and evaluation by  specialist 
  • 4. Barriers to Timely Diagnosis/Treatment • Many PCPs do not – Feel confident in their ability to identify warning signs  of ASD, or  – Know how to help families access services, even  when they are certain child has ASD • Disparity by SES apparent as level of parental  concern may influence PCPs’ referrals • Diagnosis by a specialist approved by Dept of  Public Health required to access intensive  services for children receiving Early Intervention
  • 5. Increasing Capacity of PCPs • Partnership with PCPs from community health  centers with ties to Boston Medical Center • Goals – Improve clinical skills to identify subtle and overt  signs of ASD in conjunction with use of screeners – Educate PCPs about how to refer children for  treatment, available community resources – Decrease delay in diagnosis and treatment of ASD
  • 6. DBP “Mini Fellowship” • 8 hours per week of DBP time • Formal clinical ADOS training • Weekly clinic session (autism‐specific or   general DBP clinic), evaluating patients with  direct supervision by DBP attending • Weekly afternoon didactic session with DBP  fellows • Weekly one on one case and topic review with  DBP attending 
  • 7. Training Results to Date • First two mini fellows completed program – MD from health center with large Spanish‐speaking  population  – NP practicing at Boston Medical Center to increase  links to primary care community • Since completing program, health center MD can  provide initial diagnosis for children under 3 to  facilitate immediate initiation of intensive Early  Intervention (prior to evaluation by specialist) • NP is first line provider to interact with PCPs who  refer patients for evaluation of ASD,  prioritizes  evaluations
  • 8. Future Plans • Continue “Mini Fellowship” and target specific  health centers to increase capacity in – Bilingual providers – Nurse practitioners • Current mini fellows – 2 NPs from community health center serving  largely Vietnamese speaking population to  increase community linkage
  • 9. Future Plans   • Expand training in health centers regarding  how to access services and how to advocate  for children with ASD • Increase links with NP training programs to  enhance DBP as part of their curriculum