25567
Impact of a Supported Screening Program to Increase Identification and Assessment of Latino Children at Risk for ASD
Screening in primary care is an important step in identifying young children with ASDs, expediting early behavioral and educational interventions. However, despite evidence that formal screening improves accuracy of identification over informal clinical assessment, there is far from universal use of ASD-specific screening tools with use is lower still with Spanish-speaking patient populations. Moreover, there continues to be strong evidence of disparities in identification, age at the time of initial diagnosis, referral, and treatment for Latino children compared to non-Latino white. Here, we present evidence for the effectiveness of an 18-month trial of Supported Screening (SS)—developed and implemented through a community participatory process to enhance the uptake of universal screening for ASDs in a large primary care center serving a primarily Latino population and increase identification and further assessment of children with ASD.
Objectives:
The goals of SS are to enhance the identification of ASDs and other developmental delays in Latino children by increasing: (1) screenings conducted at 18- and 24-month well-child visits; (2) positive screens; and (3) successful referrals and timely evaluations.
Methods:
SS was implemented at a large Federally Qualified Health Center serving a primarily urban Latino population in Washington, D.C and involved formative research with families, primary care providers (PCPs) and staff to inform: (1) family outreach activities and resources; (2) practice-wide training for PCPs and staff, and (3) services of Family Navigators (FN) with lived experience who provided support to families with a child identified at risk for ASD as well as ongoing care coordination with early intervention and medical providers. Screens and referrals were tracked for the approximately 7000 0-36 month old children per year, 70% of whom were identified as Latino.
Results:
Formative research, including cognitive interviewing, resulted in adaptation of M-CHAT and its administration (verbal, combined screening and follow-up, implementation by FNs and PCPs) and comprehensive training emphasizing engaging families/addressing barriers, coupled with available consultation. Training resulted significant increases in staff knowledge of autism, screening and factors that increase caregiver disclosure of developmental concerns. The percentage of children screened rose from under 10% prior to the onset of SS to almost 90%. PCPs completed only a small number of screens at the onset of SS but almost 50% by the end. Records indicated that no children were identified at risk for ASD in the year prior to SS; however, by the end of the trail 4% of eligible children screened positively on the M-CHAT and were referred for services, a rate comparable to those found in other Spanish language populations.
Conclusions:
Universal screening for ASDs in a center serving predominantly Latino families and successful follow-up of positive screens was facilitated by assessment of community/provider needs, increased staff skills in culturally appropriate family engagement, screening, and referral, and FNs integrated into the health provider system. Attention to these issues increase disclosure of developmental concerns by Latino families, produced improved attitudes of providers and families toward early screening and referral for ASDs, helping to reduce disparities in rates of diagnosis and treatment.