Implementing early autism screening into your practice

Interview transcript (edited for clarity):

Meghan Harrison, DO:

So my name is Meghan Harrison. I'm a pediatrician at Nemours, and I'm a clinical assistant professor of pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University. At Nemours, I work in primary care pediatrics in our resident learning clinic and I also work in developmental medicine. Most of my research has focused on early child development, access to services and autism assessments.

Brittany Perry, DO:

My name is Brittany Perry, and I am a pediatrician at Nemours Children's Health. I also work in primary care and developmental medicine. I'm a clinical assistant professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University. and I do similar research to Dr. Harrison and then I also do some other work in vision screening and Autism Spectrum Disorder.

Contemporary Pediatrics®:

Can you highlight what you presented at the 2023 American Academy of Pediatrics National Conference and Exhibition?

Perry:

Our research is focused on timely autism assessments in primary care. So Dr. Harrison and I, we do all different assessments in our Division of Developmental Medicine and there's very long wait lists to get that evaluation. We wanted to start doing primary care autism assessments to reduce the wait time and improve for access for patients with primary care.

Harrison:

Some of the things that we've noticed, as we really started this new assessment pathway are getting patients seen faster. For those diagnosed with autism, we are seeing that their age of diagnosis is younger than a comparison that we used and certainly then the the national averages that you see in terms of age of diagnosis. We're excited because younger age at diagnosis of autism is associated with improved outcomes for the child and for the family. We're also, within our assessment program, able to incorporate our learners or pediatric residents, so that they're really getting a deeper knowledge of autism and how to speak to families about autism and the assessment process in their training, which we hope will then generalize to better autism care down the road.

Contemporary Pediatrics:

What should general pediatricians take away from your session of early autism screenings and assessments?

Harrison:

This is a problem everywhere, thewait time between when you tell a parent that you see autism characteristics in their child, and when they're going to potentially be assessed has a wait time everywhere. People are really being creative and trying to figure out different ways to address this problem. So my hope would be that people could look at this model as one potential success in working within a primary care setting and really being able to keep the assessment in the medical home, and really learning how to provide the best care for their patients with autism, and potentially eliminate some of the barriers that we often see that lead to long wait times and make it harder for patients to be seen in specialty clinics like transportation difficulties or language difficulties. We really think that looking at how providers can do this in primary care could help to decrease some of those barriers for families and make autism care more equitable.

Perry:

I think the one thing is recognizing that, as a pediatrician, if you identify characteristics of autism in your patient, and then you give that family a referral for an autism assessment at a specialty center, you have to know as the primary care provider that they may not actually make it to that assessment for a variety of reasons that Dr. Harrison mentioned. So having that awareness and thinking about ways to be creative to bring the model to medical home is the goal.

Contemporary Pediatrics:

How can primary health care providers implement early autism screenings into their practices?

Perry:

That's a great question. I think more and more pediatricians are gaining interest in wanting to figure out how to serve their patients. There's a lot of programs that are already available for pediatricians to get extra training. Some of the training that we're using in our model is available for free online, and so it's really I think working with a provider's own center to see how they can get more training, but also seeing what's already out there.

Harrison:

Just being creative with your own clinic and your clinic space and your clinic staff. We are excited just being here to see different models of this. I think the work is out there. So if somebody is interested in learning more and implementing that in their clinic, I think that the people are doing it and finding something that might just kind of fit within the scope of your practice and the providers that your practice, best match your patient population. Just be creative within your own clinic and figure out the way you can do it.

Perry:

It's pretty new. So I think even for us, we're learning what other centers are doing and adapting our model and everyone has to start somewhere. So it can be as simple as you want to make it and just improving your practice or building something bigger.