Filling a Need to Reduce Wait Time for Autism Assessments: The - - PowerPoint PPT Presentation

Filling a Need to Reduce Wait Time for Autism Assessments: The Autism Spectrum Assessment Program at Connecticut Children’s Medical Center

Jennifer Twachtman-Bassett, M.S. CCC-SLP

Department of Speech-Language Pathology Lead Clinician ~ Autism Spectrum Assessment Program

ASAP

Goal: Obtain a diagnosis “as soon as possible” in order to jump-start intervention

Objective 1: Design a diagnostic program that provides a thorough evaluation for the child and an accurate diagnostic result Objective 2: Ensure a short timeframe from referral to scheduling to appointment to results Objective 3: Provide preliminary parent training and support for next steps

• 1. Thorough Evaluation & Accurate Result

 Information from primary care physician:

 M-CHAT (if between 16 and 30 months of age)  Hearing test  Lead level (particularly for young or impaired children)  Results of other relevant tests (e.g., Fragile X)

 Information from families/other providers:

 Parent questionnaire  School questionnaire  Recent evaluations (children five years of age and over)

Obtained before appointment is scheduled, age 6 and up Age 12 months-5 years: Obtained by appointment time

• 1. Thorough Evaluation & Accurate Result
• Extensive training of clinicians involved in

ASAP –Symptom presentation, with research updates –Diagnostic tools –Disorders with symptom overlap

• Multiple diagnostic tools
• Access to medical specialties if needed

Objective 2: Short timeframes

• Effective use of clinical resources:

– More SLPs than developmental-behavioral pediatricians – Informal analysis has indicated:

• High level of diagnostic agreement between SLP and DBP
• Specific types of patients that need coordinated appointments:

– Children under 2 ½ years of age – Medically complex children (e.g. seizures) – PCP/family seeking to have a diagnosis of ASD removed – History of prematurity <30 weeks – Psychiatric component

Objective 2: Short timeframes

• More efficient to have developmental-behavioral

pediatrician available when needed

• This has allowed us to open up more slots for

appointments.

• Autism Specialist evaluations are now offered in all
• f our satellites (average wait 14 days)
• This program could be replicated in other locations

Referral & Scheduling Process

Signs/Symptoms

• f ASD
• bserved/reported
• Family/Caregiver reports

concerns

• M-CHAT screening by PCP
• Individual working with

family reports concerns of ASD

Referral

• Contact PCP to request referral.
• Once script received ->

paperwork sent to family

• Script is triaged by speech dept.

via brief interview

• Questionnaires to be completed

by family and school.

Appointment Scheduled

• Once paperwork is

received (script, questionnaires, previous evaluations for children ≥5 years)appointment is scheduled

The Team

Patient’s families/caregivers Primary care providers Educators and other outside clinicians Autism specialist (Speech-Language Pathologist with specialized training in diagnosis of ASDs) Developmental-behavioral pediatrician

ASAP Process

• Review of provided documentation

– Parent and school questionnaires – Medical/health reports – Screeners/referral – Developmental/academic reports (testing, service provision)

• Confirmatory interviews
• Direct assessment
• Summary and recommendations

Clinical Diagnostic Tools

• 1. DSM-IV TR (2000)/DSM-V (2013)

– Criteria review/clinical judgment ADOS-2 (2012) – direct assessment instrument

• 2. Other instruments, as appropriate:

– Gilliam Asperger’s Disorder Scale (GADS, 2001) – Childhood Autism Rating Scale, Second Edition (CARS-2, 2009) – Children’s Communication Checklist (CCC, 1998) – Other formal tests for older children

• Social Language Development Test (Elementary or

Adolescent)

Objective 3: Preliminary Parent Training and Support for Next Steps

Results sheet, and, if DBP directly involved, receipt of copy of consult letter sent to referring pediatrician Resource list for ASD Parent training handouts Follow-up appointment for short-term intervention and direct parent training

Results Sheet: Given to Family

• Tests administered
• Diagnosis (ASD or not)

– Brief description of relevant symptoms – Space for consideration of other diagnoses (e.g., apraxia, ADHD)

• Recommendations

– Speech Therapy (individual or group) – Community-based services (Birth-to-Three, school) – Subspecialty evaluation referrals – Local support organizations – Resources (books, clinical)

Parent Training Handouts

• Establishing Intentional Communication
• Responding to Joint Attention
• Making Social Connections with Your Kids
• Using a Visual Schedule System
• Expanding Object Play
• Symbolic Play
• Teaching Kids to Solve Problems
• The Art of the Play Date

Younger Child: Follow-Up & Treatment at CCMC

• Follow-up scheduled

– If diagnosed under two years of age, reevaluation in one year – Reevaluation for diagnostic follow-up either through coordinated ASAP appointment or the speech department only in 6-12 months

• Outpatient speech/language therapy

– Individual

• Family training and support (short-term)
• Establishing functional communication
• Supporting generalization into the home

– Group

• Readiness for group established (social language level and

behavioral regulation)

Older Child: Follow-up & Treatment at CCMC

Follow-up offered as regular DBP continuity care Outpatient speech/language therapy Additional speech and language testing Outpatient social language therapy

 Individual

 Social communication (conversation, negotiation, basic needs)  Problem solving  Comprehension and use of nonverbal signals  Parent training

 Group

 Readiness for group established (social language level and behavioral regulation)  Peer modeling  Generalization of skills

Meeting Community Needs

• Our triage program has resulted in increased

capacity:

– Wait time has been reduced from an average of 66 days in FY 2011 to an average of 32 days in FY 2012 (all appointment types combined) – In FY 2013: Increased referral volume due to grant exposure, separated appointment types. Working to reduce wait time for >5 age group and combined MD/SLP appointments (49 days), but wait for Autism Specialist appointments is 14 days.

jtwachtman@ccmckids.org

Thank you!

The Connecticut Children’s Team: Sarah Schlegel, MD; Susan Roman, MPH, RN; Ann Milanese, MD

Questions?