South Carolina's Use of Presumptive Eligibility to Improve Early Identification and Intervention for Young Children with ASD

Background:  Implementing practices through which young children at risk for ASD receive early intervention as young as possible poses significant challenges for pediatricians, service providers and the systems responsible for early intervention.  AAP efforts have addressed the rationale for and recommended practices through which children can be identified, screened and referred for diagnostic evaluation for ASD.  However, these recommendations for screening in pediatric practices are significantly more difficult to implement than would be considered ideal.  Concern has also been raised that use of brief assessment models would result in increased errors in definitive classification (Swanson et al 2013) and that it may not be realistic for service systems to revise eligibility and service models to accommodate the use of a briefer assessment model.  

Objectives:  While these concerns are well founded, this poster provides an example of the successful implementation of a statewide two-tiered screening model with accompanying training and policy efforts that provided for “presumptive eligibility” for early intensive behavioral intervention (EIBI) for young children at risk for ASD via the Part-C program in South Carolina (BabyNet).  

Methods:  Under the South Carolina BabyNet and presumptive eligibility procedures, the Modified Checklist for Autism (M-CHAT, Robins, Fein, Barton & Green, 2001) is administered to children based upon recommended guidelines adopted by BabyNet .If the M-CHAT is failed, the child is immediately referred for the M-CHAT follow up questions and the Screening Tool for Autism in Toddlers and Young Children (STAT, Stone, Coonrod & Ousley, 2000). The STAT is then administered by professionals who have completed STAT training and are determined eligible to administer by the SC Department of Disabilities and Special Needs (DDSN). Children determined to be at risk for ASD based on the STAT are presumed eligible for EIBI services funded through BabyNet. EIBI services are then initiated in conjunction with a referral for a full ASD diagnostic evaluation. If the evaluation results in a formal diagnosis of ASD or determination of eligibility through South Carolina’s DDSN, the child continues to receive EIBI through BabyNet and continue then with DDSN after age 3. 

Results:  Implementation of this process has increased the number of children determined eligible for and receiving EIBI services through BabyNet from 61 children in 2011 prior to implementation of presumptive eligibility to 267 children determined eligible through presumptive eligibility and 294 children total receiving EIBI services at the current time. The false positive rate of children identified through presumptive eligibility but not subsequently diagnosed with ASD via comprehensive evaluation is approximately 1%. 

Conclusions:  Presumptive eligibility for EIBI has proved to be dramatically effective in South Carolina for serving young children at risk for ASD. While this contradicts the “conventional wisdom” that use of a screening process would produce high false positive rates, the results in South Carolina are likely due to the two-tiered screening system that includes quality control measures for the STAT training and STAT provider eligibility.