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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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slide1

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

slide2
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
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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