Community Based Autism Liaison & Treatment Project (CoBALT): Decreasing Wait Time and Increasing Access to Services
Families can face barriers in obtaining an evaluation for their child for suspected Autism Spectrum Disorder (ASD). If medical professionals are not comfortable in identifying developmental delays (DD) or ASD, they refer to the primary developmental center in the state, UAMS J. Dennis Developmental Center (DDC). This creates longer wait times for evaluations. Children from medically underserved populations often have additional difficulties in accessing services (i.e. transportation, financial constraints).
CoBALT is a capacity-building program that trains teams of physicians, speech pathologists, or behavioral health professionals to conduct Tier II screenings for possible DD/ASD diagnoses. Teams are located throughout the state of Arkansas in order to screen/diagnose and refer for appropriate treatment in their home community. Tier II screening closer to the child’s home can may make it easier for families to begin the evaluation process in order to obtain needed services.
To determine 1) referral concerns from PCPs; 2) if the CoBALT model allows quicker access to screening; and 3) diagnostic outcomes of CoBALT screenings. For children who were additionally referred to the DDC, agreement in CoBALT and subspecialty team’s diagnoses was assessed.
CoBALT teams completed QI outcome data for a 12 months period on all children referred. For children also referred to the DDC by CoBALT teams, QI data was also completed by the DDC team to check for agreement of diagnoses rendered by the subspecialty team vs. CoBALT teams. Frequency data was calculated for all outcome measures.
In the one year period, 96 children were evaluated in CoBALT clinics (mean age = 3.2 years, 80% male). PCP primary presenting problems were Speech concerns (74%), ASD (43.8%), and DD (33.3%). Primary diagnoses given by CoBALT teams were DD (31.3 %), suspected ASD (20.8%), and Speech Delay (16.7%).
Families were seen within 65.3 days on average and drove approximately 14.3 miles to their local CoBALT clinic. This is compared to an average wait of 171 days for an ASD full team evaluation through the state primary diagnostic center and an average of 54.5 miles traveled by families for that evaluation.
Of the 96 CoBALT children, 37 (38%) were deemed in need of a comprehensive developmental evaluation. Currently, 21 of referred children have been evaluated at the state diagnostic center. The agreement between CoBALT and developmental center diagnoses are high (80%).
The CoBALT model is promising for a rural, medically underserved state in achieving the mission of ASD screening and helping “whittle down the wait time” for access to services. However, more needs to be done to educate and train medical professionals. Additional educational supports are being created in the state of Arkansas for this purpose.