Co-Located Behavioral Assessment Services for Children with ASD in Pediatric Primary Care Settings

Background: Within primary care, use of an integrated delivery model is on the rise as being the optimal method of providing behavioral-health services.  Research suggests co-located behavioral-health providers within primary care settings result in earlier diagnosis and management of a range behavior problems (Chomienne, et al., 2011).  Furthermore, physician satisfaction research shows that having the ability to refer patients for rapid assessment and intervention has a major positive impact on their practice (Clatney, et al., 2008).  Few studies have examined physician satisfaction of integrated ASD-specific behavioral services into pediatric primary care practices 

Objectives: The current work examined (1) the feasibility of incorporating ASD-specific assessment and brief treatment services in two primary care clinics (academic faculty clinic, resident clinic) and (2) physician satisfaction with services.

Methods: We physically embedded a psychology provider in two separate primary care clinics associated with our academic medical center (faculty practice, resident clinic).  These providers were physically present in the primary care setting one day per week and made explicitly available for the purposes of providing follow-up to ASD-related concerns (e.g., screening failures, diagnostic issues, behavioral consultation).  To assess feasibility we tracked the nature and type of referrals, show rates, age/latency rates related to diagnosis, and surveyed providers about the benefits and challenges of the embedded service.  Surveys included a 1-5 point Likert Scale assessing satisfaction with these services meeting the needs of the referred families, the quality of services, and collaborative practices.  Physicians were also asked their level of agreement with statements regarding whether integration of behavioral-health providers improves the quality and continuity of healthcare, frees up more time to address medically related issues, reduces added healthcare costs, increases show rates, and increases their own ability to identify and manage behavioral health concerns.

Results: Across the initial 32 weeks of implementation, the integrated behavioral services program was able to see over 60 children with a wide range of behavioral and developmental concerns – with some children seen across repeated sessions.  Show rates for the embedded behavioral service program were considerably higher (91.7%) than those within affiliated tertiary referral clinics at the host university (<75%).  For children referred for assessment of ASD, latency to evaluation and diagnosis was considerably shorter.  All patients referred for ASD evaluation received a diagnosis within 1-2 months of referral with current wait-times for tertiary clinic assessment averaging 6-12 months.  Provider feedback indicated significant improvements related to quality and continuity of care and decreased waits for service.  However, this feedback also indicated concerns regarding financial viability of the program over time, as well as concerns about limited nature of referral service (i.e., 65% of referral issues for embedded service were not related to ASD.

Conclusions: This study provides preliminary support for the value of embedded, co-located behavioral services in meeting the needs of children with ASD in primary care settings.  Such models of care may reduce waits, age of diagnosis, and reduce other service barriers encountered by individuals with ASD and their families seeking services through referrals to traditional tertiary care facilities.