Echo Autism: Bringing Best Autism Care to Primary Care
Children with Autism Spectrum Disorder (ASD) have limited access to comprehensive medical care in their communities. Children from underserved populations and regions face even greater disparities in access to diagnostic and treatment services. Primary care providers (PCP) report low self-perceived competency and a high need for education about medical management of children with autism. Given limited resources for specialty care, there is a need to increase capacity for PCPs to provide best practice autism care in primary care. Extension for Community Healthcare Outcomes (ECHO®) is a model of telehealth that builds local capacity by teaching best practices using case-based learning, video technology, and outcome evaluation. ECHO Autism was developed in partnership with The Autism Intervention Research for Physical Health/ Autism Treatment Network (AIRP/ATN) to disseminate evidence-based screening and management guidance to community providers.
Objectives: The objective of this project was to recruit PCPs to participate in a 6 month pilot of ECHO Autism to determine if this model was effective in 1) increasing PCP self-efficacy with identification of ASD symptoms in children between 12 months and 18 years of age and 2) increasing PCP self-efficacy in assessing and treating common medical and psychiatric comorbidities in children with autism.
Methods: Fourteen PCPs were recruited to participate in ECHO® Autism clinics facilitated by an interdisciplinary team of autism and behavioral experts. During two hour, biweekly clinics, the expert team facilitated discussion and provided feedback for two PCP generated case-based presentations and delivered a didactic presentation, augmenting case-based learning. Practice behavior and self-efficacy in screening and medical management of children with ASD were measured at baseline and post-intervention. Wilcoxon signed-rank tests were performed with significance set at p < 0.05.
Results: Improvements in Total Self-Efficacy from pre-test (M = 177.15, SD = 46.59) to post-test (M = 227.43, SD = 21.59; Z = -3.06, p= .002) were noted. Improvements in Self-Efficacy were also observed in each of the subscales, including Screening, (Z = -260, p = .009). Resources (Z = -3.11, p = .002), Medical (Z = -2.68, p = .007), Psychiatric (Z = -3.06, p = .002), and Additional (Z = -2.87, p = .004). The percentage of pediatricians reporting full compliance with American Academy of Pediatrics (AAP) guidelines for autism screening increased from 30% to 60% following participation in ECHO Autism.
The ECHO Autism model is an effective model to improve primary care provider self-efficacy with identification and management of autism. This real-time, interactive model offers an efficient and effective support system and fosters networking between all participants. As cases are presented and didactics delivered, PCPs increase their comfort, knowledge and confidence in screening, assessing and treating children and youth with ASD and other developmental concerns. ECHO Autism also is a promising model to improve compliance with AAP screening guidelines. Future research should focus on demonstrating sustainable practice change in primary care that results in improved access and outcomes for individuals with autism.