Long-Term Follow-up of Primary Care Workforce Training in ASD Identification in Young Children: Does Advanced Training Facilitate Sustainable Practice Change?

Background:

The increased prevalence of autism spectrum disorder (ASD) and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services.

Objectives:

This study evaluated the long-term effectiveness of a training program designed to enhance autism spectrum disorder identification and diagnosis within community pediatrics and related early intervention system settings across several state systems of care over a 10-year training period.

Methods:

An electronic survey was distributed to 493 participants who completed STAT-MD training designed to teach early identification of ASD for pediatric health care providers and facilitate within practice diagnosis and management of young children with ASD. Participants were asked to detail aspects of practice both prior to and after receiving STAT-MD training, including barriers associated with practice changes.

Results:

At the time of submission, results came from:

• 120 practitioners
• Variety of settings (private practice, academic medicine, military instillations)
• 11 US states, plus Japan, Trinidad and Tobago, and Puerto Rico
• Following training, practitioners reported an increase in comfort level for discussing potential ASD diagnosis with families of children below 36 months of age (p<0.01) and reported an increase in their ratings of appropriateness to provide ASD diagnosis prior to or without referral to tertiary centers (p<0.01). Surveys will continued to be collected until early 2019 to account for practitioners in 2018 training workshops, to include a new program in rural areas of Alaska.

Conclusions:

A percentage of pediatric providers participating in the advanced training reported significant changes in screening and consultation practices following training, with some demonstrating long-term practice change. Such collaborative training methods that allow ASD identification within broader community pediatric settings may help translate enhanced screening initiatives into more effective and efficient diagnosis and treatment. At the same time, potent barriers towards completion of such training and long-term practice change are evident:

• Low response rate to survey itself
• Varied post training practice settings
• Administrative and billing barriers to assessment

These barriers may require novel engagement strategies for sustainable long-term practice change.