South Carolina Autism Treatment Network: Using Telepsychiatry to Increase Early Identification and Screening In Pediatric Practices

Background:  New data suggests that approximately 1 in 110 children have an ASD (MMWR, 58(SS10);1-20). Currently, there is no cure for ASDs. However, with early screening, identification, and intervention children with an ASD can progress developmentally and learn new skills. Thus, it is important to screen early and continuously survey for ASD. This ensures children are identified and receive access to services as early as possible to maximize the short and long term outcomes for these children. In South Carolina the individuals on the frontlines of early screening and surveillance are pediatricians. Unfortunately, much work remains in educating physicians to recognize and care for ASD patients. 

Objectives:  (1) Develop the South Carolina Autism Treatment Network (SCATN), a provider network of ASD consultants and pediatric practices in urban and rural areas willing to provide medical homes for underserved children with autism. (2) Increase early screening and surveillance for ASD. (3) Provide the pediatric practices support and consultation (assessment, diagnosis, behavioral and pharmacologic intervention, genetics) via telemedicine and continuing medical education.

Methods:  The SCATN is a collaboration of ASD specialists from the USC School of Medicine and the Greenville Hospital System University Medical Center. SCATN contacted developmental pediatric practices to gauge their interest in the SCATN and to illicit names of other pediatric practices that might be interested. Initially there were 18 practices contacted and invited to join the network. Pediatricians in the SCATN are provided with (1) specialized training with an emphasis on early screening to help them provide medical homes before and after diagnosis; (2) computers with videoconferencing capability to talk to ASD consultants; (3) a monthly newsletter with clinical updates on evidence based screening and treatment of individuals with an ASD; (4) weekly videoconferencing for behavioral, psychopharmacologic, genetic or diagnostic consultations; and (5) access to the SCATN website. 

Results:  The SCATN enrolled 15 of the 18 pediatric practices contacted, totaling 53 pediatricians across South Carolina.  Prior to joining the SCATN in September 2009, only 2 practices had ever used the MCHAT, though not consistently. Participation in the SCATN required each practice to submit monthly a log with the number of MCHATs completed at 18 and 24 months, the number of positive MCHATs, and the types of referrals made (80% compliance rate); and attend  the 4 CME conferences.  As of November 2010, 1027 18month MCHAT and 1099 24month MCHAT were completed (3% were a positive screen) and 197 referrals made.  Videoconsulations have been provided weekly with the most popular being psychopharmacology.  The website, part of the USC School of Medicine website, has been extensively visited by both the SCATN pediatricians and other interested parties. 

Conclusions: The SCATN has worked to initiate early screening, referral and provision of medical homes for children with ASD.  The SCATN has significantly increased screening for ASD but also increased the number of referrals for other pediatric services. Future focus includes expanding access to clinical community resources, reimbursement on the state level for video consultation and partnering with additional medical practices and state agencies.