Filling a Need to Reduce Wait Time for Autism Assessments: The - PowerPoint PPT Presentation

Filling a Need to Reduce Wait Time for Autism Assessments: The Autism Spectrum Assessment Program at Connecticut Children’s Medical Center Jennifer Twachtman-Bassett, M.S. CCC-SLP Department of Speech-Language Pathology Lead Clinician ~ Autism Spectrum Assessment Program

ASAP  Goal: Obtain a diagnosis “as soon as possible” in order to jump-start intervention  Objective 1: Design a diagnostic program that provides a thorough evaluation for the child and an accurate diagnostic result  Objective 2: Ensure a short timeframe from referral to scheduling to appointment to results  Objective 3: Provide preliminary parent training and support for next steps

1. Thorough Evaluation & Accurate Result  Information from primary care physician:  M-CHAT (if between 16 and 30 months of age)  Hearing test  Lead level (particularly for young or impaired children)  Results of other relevant tests (e.g., Fragile X)  Information from families/other providers:  Parent questionnaire  School questionnaire  Recent evaluations (children five years of age and over) Obtained before appointment is scheduled, age 6 and up Age 12 months-5 years: Obtained by appointment time

1. Thorough Evaluation & Accurate Result • Extensive training of clinicians involved in ASAP – Symptom presentation, with research updates – Diagnostic tools – Disorders with symptom overlap • Multiple diagnostic tools • Access to medical specialties if needed

Objective 2: Short timeframes • Effective use of clinical resources: – More SLPs than developmental-behavioral pediatricians – Informal analysis has indicated: • High level of diagnostic agreement between SLP and DBP • Specific types of patients that need coordinated appointments: – Children under 2 ½ years of age – Medically complex children (e.g. seizures) – PCP/family seeking to have a diagnosis of ASD removed – History of prematurity <30 weeks – Psychiatric component

Objective 2: Short timeframes • More efficient to have developmental-behavioral pediatrician available when needed • This has allowed us to open up more slots for appointments. • Autism Specialist evaluations are now offered in all of our satellites (average wait 14 days) • This program could be replicated in other locations

Referral & Scheduling Process • Family/Caregiver reports Signs/Symptoms concerns • M-CHAT screening by PCP of ASD • Individual working with observed/reported family reports concerns of ASD • Contact PCP to request referral. • Once script received -> paperwork sent to family • Script is triaged by speech dept. Referral via brief interview • Questionnaires to be completed by family and school. • Once paperwork is received (script, Appointment questionnaires, previous evaluations for children Scheduled ≥5 years)appointment is scheduled

The Team  Patient’s families/caregivers  Primary care providers  Educators and other outside clinicians  Autism specialist (Speech-Language Pathologist with specialized training in diagnosis of ASDs)  Developmental-behavioral pediatrician

ASAP Process • Review of provided documentation – Parent and school questionnaires – Medical/health reports – Screeners/referral – Developmental/academic reports (testing, service provision) • Confirmatory interviews • Direct assessment • Summary and recommendations

Clinical Diagnostic Tools 1. DSM-IV TR (2000)/DSM-V (2013) – Criteria review/clinical judgment ADOS-2 (2012) – direct assessment instrument 2. Other instruments, as appropriate: – Gilliam Asperger’s Disorder Scale (GADS, 2001) – Childhood Autism Rating Scale, Second Edition (CARS-2, 2009) – Children’s Communication Checklist (CCC, 1998) – Other formal tests for older children • Social Language Development Test (Elementary or Adolescent)

Objective 3: Preliminary Parent Training and Support for Next Steps  Results sheet, and, if DBP directly involved, receipt of copy of consult letter sent to referring pediatrician  Resource list for ASD  Parent training handouts  Follow-up appointment for short-term intervention and direct parent training

Results Sheet: Given to Family • Tests administered • Diagnosis (ASD or not) – Brief description of relevant symptoms – Space for consideration of other diagnoses (e.g., apraxia, ADHD) • Recommendations – Speech Therapy (individual or group) – Community-based services (Birth-to-Three, school) – Subspecialty evaluation referrals – Local support organizations – Resources (books, clinical)

Parent Training Handouts • Establishing Intentional Communication • Responding to Joint Attention • Making Social Connections with Your Kids • Using a Visual Schedule System • Expanding Object Play • Symbolic Play • Teaching Kids to Solve Problems • The Art of the Play Date

Younger Child: Follow-Up & Treatment at CCMC • Follow-up scheduled – If diagnosed under two years of age, reevaluation in one year – Reevaluation for diagnostic follow-up either through coordinated ASAP appointment or the speech department only in 6-12 months • Outpatient speech/language therapy – Individual • Family training and support (short-term) • Establishing functional communication • Supporting generalization into the home – Group • Readiness for group established (social language level and behavioral regulation )

Older Child: Follow-up & Treatment at CCMC  Follow-up offered as regular DBP continuity care  Outpatient speech/language therapy  Additional speech and language testing  Outpatient social language therapy  Individual  Social communication (conversation, negotiation, basic needs)  Problem solving  Comprehension and use of nonverbal signals  Parent training  Group  Readiness for group established (social language level and behavioral regulation)  Peer modeling  Generalization of skills

Meeting Community Needs • Our triage program has resulted in increased capacity: – Wait time has been reduced from an average of 66 days in FY 2011 to an average of 32 days in FY 2012 (all appointment types combined) – In FY 2013: Increased referral volume due to grant exposure, separated appointment types. Working to reduce wait time for >5 age group and combined MD/SLP appointments (49 days), but wait for Autism Specialist appointments is 14 days.

Thank you! The Connecticut Children’s Team: Sarah Schlegel, MD; Susan Roman, MPH, RN; Ann Milanese, MD Questions? jtwachtman@ccmckids.org