Improving Early Access to Care in Underserved Communities

Background:  Early diagnosis of autism is associated with earlier access to intervention which increases optimal outcomes, yet research suggests that racial and income disparities exist in early detection of developmental disabilities including autism. While symptoms of autism may be noted as early as 12 months of age, the average age of diagnosis is 4-5 years and is significantly higher among African American and Hispanic children. This delay means that young children with ASD might not get the help they need. Children with low SES, racial and ethnic minorities and those with limited English proficiency are less likely to be identified with ASD despite no known prevalence differences. When identified as having ASD, those with low SES, racial or ethnic minorities are often identified at later ages. Reasons for disparities in identifying autism and developmental disabilities are varied and may include access difficulties due to insurance or transportation issues as well as lack of available local service providers.

Objectives:  A model program was created to provide free community-based developmental screening within underserved communities in order to improve early access to care.

Methods:  Target sites for screening clinics were located primarily in low income cities having large percentages of racial minority, Hispanic/Latino, and/or Spanish-speaking households. The free clinics were held in locations near public transportation and easily accessible such as libraries, recreation or community centers or daycare centers.  Screening staff had expertise in child development and provided screenings to children ages 11-66 months in English or Spanish. The Ages and Stages Questionaire-3 (ASQ-3) was administered interactively with the child and accompanying parent/guardian. Resources to promote child development and anticipatory guidance were provided to all families and those screened as at risk were also given resources for further evaluations and information to be shared with their healthcare provider. Phone follow up for those at-risk was provided one month following screening to determine if further help was needed to access services.

Results:  715 children were screened, with 50.3% found to be at risk. The children identified as at risk had not been previously seen by a developmental specialist. At one month follow up, 59% of those at risk were able to be contacted. Those not contacted had disconnected phones or did not respond to 3 phone messages.Of those contacted, 96.3% had arranged diagnostic evaluation, early intervention, and/or school-based services.

Conclusions:  A model developmental screening program was created to reduce healthcare disparities in early access to care among an underserved population. Provision of free, quick interactive bilingual screenings in easily accessible community locations eliminated access barriers such as insurance, transportation, and difficulty finding services, and resulted in identification of young children not previously identified as at risk for developmental disabilities including ASD. Of note is that the ASQ-3 allows for alternative administration methods and materials for children from different cultural backgrounds and was normed with culturally diverse populations. Cross-cultural considerations of screening programs will be discussed.