Effectiveness of a Supported Screening in the Identification of Latino Children At Risk for ASDs

Background: Screening in pediatric primary care is a key step in identifying young children with Autism Spectrum Disorders in order to expedite early behavioral and educational interventions that can improve outcomes.  However, despite evidence that formal screening tools improve accuracy of identification over informal clinical assessment, the use of these tools to identify autism and other developmental delays in primary care is low.  Moreover, there is strong evidence of disparities in rates of identification and service utilization for Latino children as compared to non-Latino white children.  This presentation will present evidence for the effectiveness a Supported Screening—a multi-pronged intervention developed through a community participatory process including formative research with families and primary care providers (PCPs) and staff--to enhance identification of children at risk for ASDs seen in a large primary care center serving a primarily Latino population. 

Objectives: The goals of Supported Screening are to enhance the identification of ASDs and other developmental delays in Latino children by increasing: (1) screenings conducted at 18- and 24-month well-child visits; (2) positive screens; and (3) successful referrals and timely evaluations. 

Methods: Supported Screening has been implemented at the Upper Cardozo site of Unity Health Care (UC-UHC) the largest provider of medical care in the District of Columbia and includes three main components: (1) outreach activities focusing on developmental milestones for families; (2) hands-on training for primary care providers (PCPs), involving 5 75-minute sessions covering a review of ASDs, screening with the adapted M-CHAT, interpretation and referral, engaging and activating families as well as addressing barriers identified in formative research; and (3) ongoing care coordination and support to families with a child identified at risk or diagnosed with ASD or other developmental delays by family navigators with lived experience participated.  Screens and referrals are tracked for the approximately 6000 0-36 month old children per year who receive care at UC-UHC (80% are identified as Latino). 

Results: Pre-post training and follow-up evaluations showed significant increases in PCP knowledge of autism, the rationale and skills for evidence based screening and methods to increase disclosure of developmental concerns by families as well as positive changes in organizational climate attitudes toward screening process.  The rate of M-CHATs completed for eligible children ad 18 and 24 months has shown rapid growth, increased from less than 5% prior to the onset of Supported Screening to approximately 60% after 3 months of implementation to almost 100% 6 months into the intervention.  No such changes were seen in other Unity Care sites.  Referral completion following positive screens increased and satisfaction with family navigation services was high. 

Conclusions: Universal screening for ASDs and developmental delays in primary care is facilitated by initial assessment of community/provider needs to inform outreach, family engagement, screening instruments and procedures and staff training.  Attention to these issues can increase disclosure of developmental concerns by Latino families, produce positive changes in organization climate and attitudes of providers and families toward early screening and referral for ASDs, helping to reduce disparities in rates of diagnosis and treatment.