Optimizing an intervention to reduce disparities in timely autism diagnosis
Intensive services for very young children with ASD have strong evidence of improving child outcomes. Because a formal diagnosis is required to access such services, interventions that improve timely diagnosis are necessary to address existing disparities among low-income and minority children with ASD, who are diagnosed later than their white, more financially advantaged peers.
We describe the development of a family navigation intervention through two pilot randomized controlled trials. Family navigation is a time-limited care management strategy that addresses family-specific barriers to accessing a defined set of services. In these studies, the navigation period began with a failed ASD screen and ended with diagnostic resolution.
The results of the first pilot study showed that family navigation improved time to diagnosis and was well received by participants. The second pilot study addressed 3 areas identified for improvement: 1) integrating the intervention within the child’s medical home, which has improved communication with the child’s PCP; 2) implementing best practices for ASD screening, which was accomplished by using the MCHAT-Revised with Follow-Up to identify children most at risk for ASD; 3) decreasing the time to diagnostic resolution for all, which was addressed by changing the clinic scheduling procedures and has resulted in a decrease in mean to time to diagnosis from 146 days to 78 days.
Pilot studies supported optimization of an intervention with scale-up potential. The optimized family navigation intervention is being tested in a multi-site RCT comparing the effectiveness of family navigation to conventional care management.
Learning Areas:Public health or related research
Discuss the significance of the disparities that exist in early identification of Autism Spectrum Disorders (ASD). Explain the use of family navigation in the context of ASD diagnosis. Describe the role of pilot studies and improvement processes in optimizing intervention delivery.
Keyword(s): Child Health, Health Systems Transformation
Qualified on the content I am responsible for because: I began working on these studies as a research assistant in November 2013 and was the project coordinator of the second pilot study starting in June 2014. I was directly involved in implementing the process improvement changes between the two studies.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.