An Integrated Health Care Model for Patients with Autism Spectrum Disorder

Background: More than 70% of children with Autism Spectrum Disorder (ASD) have a co-occurring psychiatric or medical condition, requiring frequent access of the healthcare system over a range of sub-specialties (Dang et al., 2017). Due to the complexity of navigating care for this population (Fig. 1), the majority of families with children with ASD are more likely to experience delays in care and lower satisfaction with the care they do receive (Kogan et al., 2008).

The Integrated Care Model involves a coordinated and co-located collaboration between primary care and mental health providers working together to care for the patient (Ader, 2015). Outcomes in the general population have demonstrated significant improvements in the mental health of youth in an integrated compared to a standard setting (Asarnow et al., 2015), however there is a gap in the literature when it comes to patients with ASD.

Objectives: To develop, implement, and assess an integrated model of care within an existing behavioral health clinic focused on the care of individuals with ASD and other developmental disabilities with the aim of improving patient care and outcomes.

Methods: Development of the model to integrate medical services into the existing behavioral health clinic began in May 2018. To track client utilization a referral tracking system was built into the clinics Electronic Health Record system. A staff survey was designed to assess buy-in, feedback, and perceived needs/benefits of the introduction of the model. Additionally, the Parental Stress Index (PSI) and Youth Satisfaction Survey (YSS) were selected to assess the impact of the integrated model on the clients and their families. Integrated services began being offered at the clinic in August 2018.

Results: Over the past year, 245 individuals with ASD were seen at the clinic (82.9% male; age range 3-54 years, M=13.9, SD=7.45). Nearly half (48.8%) of clients who were assessed at intake reported concerns over additional health problems, with the most commonly reported related to speech problems, dental issues, asthma, and vision problems. Feedback from staff surveys suggest strong buy-in with 93% reporting that they were likely-very likely to utilize the new medical services. The pediatrician currently is on-site once a week to provide services and clinic staff are already regularly utilizing this resource for consultation on client issues. Additionally, monthly educational sessions are hosted by the pediatrician for the staff to discuss medical topics of interest. Data collection is ongoing and analyses on referrals, PSI, YSS, and staff surveys will be conducted to explore the impact of the introduction of the model on the clients.

Conclusions: Building on the current work of the clinic, the team is streamlining workflows, and incorporating systems for assessment of the impact of the model. Providing an integrated care model to families will allow them to receive efficient, coordinated and holistic care at one site. Should our integrated model prove effective at improving access to care and the quality of life of families impacted by ASD, we hope the integrated care model becomes a common practice for ASD clinics.