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Echo Autism Transition: An Innovative Approach for Increasing Access to Healthcare for Adolescents and Young Adults with Autism Spectrum Disorder
Dramatic increases in the prevalence of autism spectrum disorder (ASD) have been accompanied by a rising tide of adolescents with ASD who are entering adulthood. With well-documented shortages in the provider workforce, training of community healthcare providers to serve the unique needs of transition-age youth with ASD in geographic, racial, ethnic, and economically diverse communities requires novel approaches.
Objectives:
Project Extension for Community Healthcare Outcomes (Project ECHO) framework is an approach that has proven successful in increasing the role and expertise of the practicing community-based primary care provider (PCP). Project ECHO uses secure multi-point videoconferencing technology to create a learning community, connecting PCPs in local communities (“spokes”) to an interdisciplinary team of experts (“hub”) through regular recurring sessions. During these sessions, learning is facilitated through brief evidence-based didactics, case-based learning (during which PCPs present their own cases for discussion and co-management), collaborative mentorship, and guided practice.
In ECHO Autism (Clinical Pediatrics, 56(3): 247-256, 2017), significant improvements were observed in self-efficacy, adherence to ASD screening guidelines, and use of ASD-specific resources, with high satisfaction reported by participants. We now describe the development and implementation of an innovative approach to increasing access to healthcare for adolescents with ASD, entitled ECHO Autism Transition.
Methods:
In Summer 2018, the planning team, including hub team members, developed a template for presentation along with didactic presentations and materials to measure outcomes. In Fall 2018, PCPs were recruited for the program through several routes including community-based referral sources, national provider organizations, and social media. A total of 12 weekly 1-hour sessions are being conducted, in which a series of didactic presentations are given by hub team members on topics related to transition-age years. Case presentations are delivered by spoke participants that allow for discussion between hub members and participants. Recommendations are discussed and formally given to the case presenter. Recommendations and resources are available online for participants to access at any time. Participants receive CME for participation, and outcome measures regarding participant satisfaction, confidence, and knowledge are being collected (to be completed in early 2019).
Results:
A total of 15 PCPs were recruited nationally and meet weekly for the ECHO sessions. Didactic sessions include topics such as medical and psychiatric co-occurring conditions, behavior management in primary care, supporting families through transition, life skills development, supporting the self-advocate, guardianship, education, housing, and sexuality. Case presentations highlight challenges facing adolescents and their families as they transition to adulthood. Data regarding participation rate, provider satisfaction, provider confidence and knowledge, and common themes of case presentations are being collected and will be presented.
Conclusions:
To our knowledge, ECHO Autism Transition is the first of its kind to focus on the transition to adulthood in ASD. We have successfully developed and launched a case presentation template, outcomes measures, and didactic presentations and have enrolled a cohort of participants. We will present additional outcomes data paralleling that published previously for ECHO Autism. ECHO Autism initiatives illustrate evidenced-based approaches in building workforce capacity and access to quality care in individuals with ASD.