Piloting the Implementation
  of an “M-CHAT Clinic”
      Katherine Burns, MD
         Jill Fussell, MD
       Eldon Schul...
Description of Need
1 in 145 children in AR have Autism
Spectrum Disorder (ASD)
UAMS Developmental-Behavioral Pediatrics
e...
“M-CHAT Clinic”
Modified Checklist for Autism in Toddlers
(M-CHAT; Robins, Fein, & Barton, 1999)
  Screen young children f...
“M-CHAT Clinic”
 In DBP clinic (current pilot):
   Medical and developmental history
     Including M-CHAT follow-up struc...
M-CHAT Clinic Outcomes
 Diagnostic conclusions with some cases:
   Global developmental delays
   ASD (Autistic Disorder)
...
M-CHAT Clinic Outcomes
 Prioritizing younger children and/or those
 not yet in developmental services
 Practice/streamlini...
Transitioning M-CHAT Clinic to the
Community
 Medical/developmental/M-CHAT follow-up interview
 “Step 2 pilot”
   PCPs in ...
Challenges to Transitioning M-CHAT
Clinic to the Community
 Maintain the Medical Home
 Funding/Reimbursement
   Legislativ...
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Piloting the Implementation of an “M-CHAT Clinic”

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Presented by Katherine Burns, Jill Fussell, & Eldon Schulz

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Piloting the Implementation of an “M-CHAT Clinic”

  1. 1. Piloting the Implementation of an “M-CHAT Clinic” Katherine Burns, MD Jill Fussell, MD Eldon Schulz, MD
  2. 2. Description of Need 1 in 145 children in AR have Autism Spectrum Disorder (ASD) UAMS Developmental-Behavioral Pediatrics essentially only current diagnostic referral option in the state Delays in diagnosis/initiation of services Long waitlist for diagnostic evaluation Tendency for some PCPs to delay referral to Early Intervention until diagnostic evaluation for ASD
  3. 3. “M-CHAT Clinic” Modified Checklist for Autism in Toddlers (M-CHAT; Robins, Fein, & Barton, 1999) Screen young children for Autism Spectrum Disorders (ASD) Piloted initially within our DBP clinic, plan to integrate into community sites Under the age of 3 years “failed M-CHAT” or “R/O autism” Not yet in developmental services
  4. 4. “M-CHAT Clinic” In DBP clinic (current pilot): Medical and developmental history Including M-CHAT follow-up structured interview Clarify responses and elicit examples of target behaviors DSM-specific interview questions Physical exam Review of records of prior assessments Speech-language evaluation typically administered Language assessment, if not previously/recently done Autism Diagnostic Observation Schedule (ADOS)
  5. 5. M-CHAT Clinic Outcomes Diagnostic conclusions with some cases: Global developmental delays ASD (Autistic Disorder) Language impairments Disruptive behavior disorders Leads to discussions of variations of development in some cases Temperamental variations, sensory sensitivities, etc. Plan for follow-up/monitoring Additional evaluation in some cases Genetic testing Referral for other medical subspecialty evaluation Additional developmental testing
  6. 6. M-CHAT Clinic Outcomes Prioritizing younger children and/or those not yet in developmental services Practice/streamlining M-CHAT follow-up interview, medical/developmental history Template to be disseminated Allowing us to see children sooner Specific recommendations more quickly Treatment, referral, further evaluation
  7. 7. Transitioning M-CHAT Clinic to the Community Medical/developmental/M-CHAT follow-up interview “Step 2 pilot” PCPs in the community who have voiced interest in having more DBP in their practice Fostering partnerships LEND, state universities/allied health training programs, AR Autism Outreach and Resource Center (AAROC), State departments (Dept of Ed, Title V, DDS, Dept of Health) “Second-tier” regional referral centers Mid-level assessment option between PCP and tertiary care center Provides diagnostic evaluation and care-coordination for relatively less complex cases of ASD
  8. 8. Challenges to Transitioning M-CHAT Clinic to the Community Maintain the Medical Home Funding/Reimbursement Legislative action, grant funding, contracts Maintaining Partnerships LEND, LEDBP, Colleges/departments, State departments Awareness that interdisciplinary is ideal

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