Community Training Outreach: The Utah Network for Early Autism Response

Background: The rising prevalence of autism spectrum disorder (ASD) creates critical need for widespread expertise to recognize and respond to earliest signs of the disorder. The Autism and Developmental Disabilities Monitoring Network (ADDM; Biao, 2014) reported that Utah had the lowest proportion (33%) of children with ASD receiving  comprehensive evaluations prior to age 3 among eleven sites surveyed (based on health/education records). The median age of ASD diagnosis in Utah, as reported by ADDM, was 53 months of age. Solving these problems requires novel solutions to capacity issues, roles, and gaps in knowledge about screening and early symptoms among the broader early childhood community.

Objectives: The aim of this study was to examine professional practices and competencies around early identification and treatment of ASD prior to and following a one-day, intensive, interactive training to professionals across Utah who work with children under 5 years of age. We sought to improve recognition of subtle signs and ASD symptoms in early childhood, increase comfort levels talking about ASD risk with parents, and increase knowledge about systematic screening, follow up and referral.

Methods: A free, one-day, interdisciplinary training was offered in 3 urban/suburban and 3 rural/semi-rural locations statewide during summer 2015. Participants included pediatric health care providers, early childhood educators, and early intervention and special education professionals, totaling approximately 500 statewide. Training was provided by ASD specialists (all faculty members at major universities) with extensive training and clinical experience in early diagnosis and treatment of ASD. Prior to the workshop, attendees completed a survey (based on Swanson et al., 2013) about current practices, prior knowledge and participation in early ASD identification and intervention. The survey is also being administered at 4, 8 and 12 months post-workshop, to identify changes in practice. The first two follow-up phases will be completed by 12/28/15 and 4/28/16, respectively.

Results: Preliminary data analyses indicated that prior to training, the majority of professionals reported they were not comfortable identifying risk for ASD (72%), screening for ASD (66%), or discussing ASD diagnoses with families (74%).  Twenty percent of professionals reported they currently screen children for ASD using the M-CHAT; 33% of those who screen reported using the M-CHAT follow-up questionnaire, and 15% using the M-CHAT reported they screen all children they see. Other screeners were used by 53%, primarily the Ages and Stages Questionnaire.  Following positive screens, 49% of respondents reported they typically refer to early intervention or for further evaluation.  In relation to treatment of ASD, 65% of attendees reported they were “not at all” comfortable speaking to parents about ASD evidence-based practices. Post-workshop changes in each of these areas will be reported. 

Conclusions: The need for early child professionals to increase their level of training and comfort in screening, early identification, and evidence-based practice statewide is substantial and may be related to the identification of children younger than 3. Community training outreach from specialists at university centers may be one effective approach to address these needs and increase ASD identification rates before age 3.