Alice Carter - Addressing Health Disparities in Early Diagnosis and Service Receipt: Implementing...
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• Providers differ in whether they screen by concern or universally. (a) Including screenings as p art of routine activities (intake or re-evaluations) increases rates of completion. (b) A screening tracking systems helps providers kno w who is due for screening. • Spanish-speaking EI providers have increased work demands (large caseloads and more responsibili ties) that affect Spanish-speaking families being screened. (a) Conducted discussion gro ups with these providers to promote & support screenin g (b) Advocated for training op portunities for these providers • New EI providers are unfamiliar with the diagnostic assessment process. (a) Support provide rs in attending assessments, improving their awareness of the range of ASD early presentation. (b) Periodic newsletters from our pro ject remind providers of the visit process. Successes: • The wait time between a positive Stage 2 screen and a diagnostic assessment appointment (Stage 3) is only 17.7 days. • Our numbers suggest that a minimum of 7% of children receiving EI are likely to meet criteria for ASD. • We have held several trainings in the STAT, our Stage 2 screener, training a total of 23 EI providers in this play-based assessment. Challenges and Strategies : • The high turnover among EI providers is a barrier to training EI providers in our screening process. Strategy: We created a training video which is now used in the orientation for all new EI providers. Ad dr ess in g Heal th Dis par it ies in Earl y Di agn os is and Serv ic e Recei pt : Implementing Two-Stage Screening in Early intervention Alice S. Carter, Ph.D., Abbey Eisenhower, Ph.D., Frances Martínez-Pedraza, M.A ., & Angel Fettig, Ph.D. Introduction = Who are we screening? (Stage 1, n=531) Who are we diagnosing? (Stage 3 n=69) Cont’d Challenges and Strategies Through the ABCD Early Screening Project, we attempt to reduce health disparities in the rates and ages of autism spectrum disorder (ASD) diagnosis and service receipt. To do so, we are changing the screening practices implemented by federally mandated early interventio n (EI) agencies serving children ages zero to three. This research was supported by HRSA -funded grant R40MC26195. Acknowledgements: Gender: 64% boys (340 out of 531) Ages: 16 - 33 mo. (Mean = 24 months) Racial or Ethnic Minority: 62% Race: Black or African-American: 34% Asian: 7% White: 54% Bi/Multiracial: 4% Unknown/Not reported: 1% Ethnicity : Hispanic or Latino/a: 35% Language: 35% of children had a primary language other than English (18% Spanish, 17% other). Diagnostic Assessmen t (Toddlers screening positive at Stage 2) Child Testing: ADOS and Mull en Scales ParentInterview Stage 2: Follow-up Consultation Observation (All toddlers screening positive at Stage 1) Screening Tool for Autism in Toddlers (STAT) and/or Provider/ Parent Concerns Stage 1: Screening Questionnaires (14-33 months) Parent Report (POSI and BITSEA) EI Provider Concerns & Parent Concerns Specialty Services 84 Assessed 69 ASD 531 Toddlers Screened 326 STATs Multi-Stage Screening & Assessment Protocol Gender: 87% boys (60 out of 69) Ages: 19 - 36 mo. (Mean = 27.4 mo.s, SD = 5.2) Language: 42% had a pr imary language other than English (24% Spanish, 18% other) Family Income: 58% of families earned < $45,000K (~the poverty level for a family of four) Parent Education: 48% have a high school education or less Asian (6.7%) Black (20%) White- Non-Lati no (21. 7%) Multi- non-Lati no (1.7%) Mul ti -L at in o (3%) Bl ac k- La ti n o ( 5%) Whit e- Lat ino ( 16.7%) Lat ino ( 18%) no race/ethnicity (6.7%) Are we reaching racially diverse families? Implementation: Successes and Challenges Racial or Ethnic Minority: 71% • EI providers vary in their comfort around discussing autism with their client families. Strategies: (a) A website was creat ed with information about ASD and the screening process, (b) Collabora tively develop ed a “scr ipt” for EI providers to broach the subject of autism with families, (c) Hold regular trouble-shooting meetings with providers Training Video: Website for EI Providers: A Recent ABCD Project Newsletter:
description
The ABCD Project is aimed at reducing health disparities in age of autism spectrum disorder diagnosis and service receipt by changing screening practices implemented by Early Intervention (EI) agencies. We will address challenges encountered in the implementation of the above screening and assessment protocol in community EI settings.
Transcript of Alice Carter - Addressing Health Disparities in Early Diagnosis and Service Receipt: Implementing...
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Providers differ in whether they screen by concern or universally. (a) Including screenings as part of
routine activities (intake or re-evaluations) increases rates of completion.
(b) A screening tracking systems helps providers know who is due for screening. Spanish-speaking EI providers have increased work demands (large caseloads and more responsibilities) that affect Spanish-speaking families being screened. (a) Conducted discussion groups with these
providers to promote & support screening (b) Advocated for training opportunities for
these providers New EI providers are unfamiliar with the diagnostic assessment process. (a) Support providers in attending
assessments, improving their awareness of the range of ASD early presentation.
(b) Periodic newsletters from our project remind providers of the visit process.
Successes: The wait time between a positive Stage 2 screen and a diagnostic assessment appointment (Stage 3) is only 17.7 days. Our numbers suggest that a minimum of 7% of children receiving EI are likely to meet criteria for ASD. We have held several trainings in the STAT, our Stage 2 screener, training a total of 23 EI providers in this play-based assessment. Challenges and Strategies: The high turnover among EI providers is a barrier to training EI providers in our screening process.
Strategy: We created a training video which is now used in the orientation for all new EI providers.
Addressing Health Disparities in Early Diagnosis and Service Receipt: Implementing Two-Stage Screening in Early intervention Alice S. Carter, Ph.D., Abbey Eisenhower, Ph.D., Frances Martnez-Pedraza, M.A., & Angel Fettig, Ph.D. Introduction
=
Who are we screening? (Stage 1, n=531)
Who are we diagnosing? (Stage 3 n=69) Contd Challenges and Strategies Through the ABCD Early Screening Project, we attempt to reduce health disparities in the rates and ages of autism spectrum disorder (ASD) diagnosis and service receipt. To do so, we are changing the screening practices implemented by federally mandated early intervention (EI) agencies serving children ages zero to three.
This research was supported by HRSA-funded grant
R40MC26195.
Acknowledgements:
Gender: 64% boys (340 out of 531) Ages: 16 - 33 mo. (Mean = 24 months) Racial or Ethnic Minority: 62% Race: Black or African-American: 34% Asian: 7% White: 54% Bi/Multiracial: 4% Unknown/Not reported: 1% Ethnicity: Hispanic or Latino/a: 35% Language: 35% of children had a primary language other than English (18% Spanish, 17% other).
Diagnostic Assessment (Toddlers screening positive at Stage 2)
Child Testing: ADOS and Mullen Scales Parent Interview
Stage 2: Follow-up Consultation Observation (All toddlers screening positive at Stage 1)
Screening Tool for Autism in Toddlers (STAT) and/or Provider/ Parent Concerns
Stage 1: Screening Questionnaires (14-33 months) Parent Report
(POSI and BITSEA) EI Provider Concerns &
Parent Concerns
Specialty Services
84 Assessed
69 ASD
531 Toddlers Screened
326 STATs
Multi-Stage Screening & Assessment Protocol
Gender: 87% boys (60 out of 69) Ages: 19 - 36 mo. (Mean = 27.4 mo.s, SD = 5.2) Language: 42% had a primary language other than English (24% Spanish, 18% other) Family Income: 58% of families earned < $45,000K (~the poverty level for a family of four) Parent Education: 48% have a high school education or less
Asian (6.7%) Black (20%)
White- Non-Latino (21.7%) Multi-non-Latino (1.7%)
Multi-Latino (3%) Black-Latino (5%)
White- Latino (16.7%) Latino (18%)
no race/ethnicity (6.7%)
Are we reaching racially diverse families?
Implementation: Successes and Challenges Racial or Ethnic Minority: 71%
EI providers vary in their comfort around discussing autism with their client families.
Strategies: (a) A website was created with information
about ASD and the screening process, (b) Collaboratively developed a script for EI
providers to broach the subject of autism with families,
(c) Hold regular trouble-shooting meetings with providers
Training Video:
Website for EI Providers: A Recent ABCD Project Newsletter:
Addressing Health Disparities in Early Diagnosis and Service Receipt: Implementing Two-Stage Screening in Early intervention Alice S. Carter, Ph.D., Abbey Eisenhower, Ph.D., Frances Martnez-Pedraza, M.A., & Angel Fettig, Ph.D.
