Embedded Behavioral-Health Services for Children with ASD in Pediatric Primary Care: Feasibility and Resident Training

Background:  Prior research suggests that behavioral health problems are diagnosed earlier and better managed when behavioral health providers are integrated within primary care settings (Chomienne et al., 2011) and that physicians report satisfaction regarding the ability to refer patients to behavioral health providers for rapid assessment and intervention (Clatney et al., 2008). Similar results were obtained when examining ASD-specific behavioral services in a pediatric primary care practice (Herrington et al., 2016). However, little research has examined similar outcomes among physicians in training(i.e., medical residents). Medical residents report low comfort levels regarding ASD (Broder-Finger et al., 2014), and investigations are lacking regarding residents’ satisfaction and learning associated with working alongside behavioral health providers to treat patients with ASD.

Objectives:  The current study aimed to extend previous research by (1) collecting additional information about the feasibility and outcomes associated with incorporating ASD-specific assessment and brief intervention services in a primary care clinic and (2) surveying residents who work alongside a behavioral health provider about their training experiences, perceived comfort in working with individuals with ASD, and further training needs.

Methods:  A psychology provider was physically embedded in a resident primary care clinic associated with an academic medical center one day per week. The provider was available solely for providing follow-up for ASD-related concerns (e.g., failed screenings, diagnostic referrals, behavioral consultation). Data about referral types, show rates, and latency to consultation and diagnosis were used to assess feasibility and impact. In addition, medical residents were asked to complete surveys comprised of 1-5 point Likert items examining their perceptions of the benefits of the embedded psychologist; comfort level in screening, diagnosing, providing recommendations, and managing behaviors of children with ASD during appointments; and training needs. Residents’ training experiences, familiarity, and comfort level specific to ASD also were compared with those related to commonly encountered medical diagnoses (e.g., diabetes).

Results:  Preliminary data show the integrated behavioral health provider within the resident pediatric primary care clinic was able to see 75 children referred due to concerns for ASD over ten months; 33 of these children (44%) were diagnosed with ASD. It was possible to make a diagnosis within the initial consult session for 67% of the children; further testing was required for the remaining children. The latency to evaluation and diagnosis for referred children was less than two months, compared with a minimum of 6-7 months for specialty clinic assessment. Similarly, the median age at diagnosis (34 months) was considerably lower than the national average of approximately 50 months. Updated clinical data and additional data regarding resident’s perceived comfort and training needs associated with working with patients with ASD will be provided in detail.

Conclusions:  This study extends support for the value of embedding behavioral health services for children with ASD within pediatric primary care settings.