Engaging Community Service Providers to Improve Earlier Autism Screening and Detection

Background:  It is important to build the capacity of community service providers to recognize the early signs of ASD in order to connect children to early intervention services to have the greatest impact on child and family outcomes. Community Based Participatory Research (CBPR) is used increasingly to address health issues and disparities for children by focusing on social, structural, and physical environmental inequities through active involvement of stakeholders, organizations, and researchers throughout the research process (Israel et al., 2001). CBPR can be used to address challenges to translational research including limited external validity, poor community trust in research, and lack of sustainability of practice change in community settings (Dankwa-Mullan et al., 2014).

Objectives:  To utilize CBPR to engage community service systems in a new web-based professional development course and screening portal for social-communication delays and early signs of autism. 

Methods:  Community service providers (CSPs) from primary care practices, social services, and early learning centers were recruited to participate in this ongoing research. CSPs were invited to Autism Navigator for Primary Care, a web-based professional development course on the early signs of autism using video footage to rapidly build the capacity for early detection and understand how to share screening results with families. CSPs were provided with a tablet computer containing an interactive web platform with an automated screening tool linked to family resources on development and autism. Barriers to screening experienced by CSPs were identified through weekly communication that tapered to monthly over time. Feedback from CSPs was used to improve the screening process and potential access to care.

Results:  To date, 158 CSPs have been recruited from 4 states in this multisite project, 121 from primary care and 37 from social service agencies; 138 CSPs have completed the coursework and screened 1,513 children by 18 months of age. It is anticipated that the number of CSPs and children screened will double in the next 6 months. Demographic information will be provided about CSPs in each service system. Barriers to screening experienced by CSPs and solutions to help CSPs incorporate practice change into their busy workflow will be reported. The most common barriers encountered include time to complete the course, understanding technology, and time to implement universal screening when many tasks must be completed during well-child visits. Strategies to address these barriers include contacting providers via e-mail and phone calls, weekly email blasts to highlight course content, improve user friendliness of portal, developing a briefer version of the course, meeting to troubleshoot problems, offering technical assistance, setting formal training dates and setting completion goals, promoting structured provider communication and partnership with other agencies, identifying staff members willing to engage family in screening while waiting for appointments, and enabling families to complete screening at home.

Conclusions:  These findings will have important implications for bridging the research-to-practice gap and lowering the reachable age of early detection of ASD. Screening by different community service systems provides the opportunity to study strategies to address health disparities in access to early screening, diagnosis, and care.