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Jennifer Twachtman-Bassett, M.S. CCC-SLP Department of Speech-Language Pathology PowerPoint PPT Presentation


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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.

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Jennifer Twachtman-Bassett, M.S. CCC-SLP Department of Speech-Language Pathology

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Jennifer twachtman bassett m s ccc slp department of speech language pathology

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


Jennifer twachtman bassett m s ccc slp department of speech language pathology

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

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 result1

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

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 timeframes1

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 of our satellites (average wait 14 days)

  • This program could be replicated in other locations


Referral scheduling process

Referral & Scheduling Process


The team

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

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

Clinical Diagnostic Tools

DSM-IV TR (2000)/DSM-V (2013)

Criteria review/clinical judgment

ADOS-2 (2012) – direct assessment instrument

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

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

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

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

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

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

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

[email protected]

Thank you!

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

Questions?


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