Post on 22-Feb-2020
Identifying Autism in Primary Care: Screening Tool for Toddlers and Young Children (STAT)
• Hilary Duckworth, PsyD, Behavioral Health Consultant• Kate Christian, LCSW, Behavioral Health Consultant• Eboni Winford, Ph.D., Behavioral Health Consultant
Cherokee Health Systems
Session # A2
CFHA 20th Annual ConferenceOctober 18-20, 2018 • Rochester, New York
Faculty DisclosureThe presenters of this session have NOT had any relevant financial relationships during the past 12 months.
Conference ResourcesSlides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=Resources_2018
Slides and handouts are also available on the mobile app.
Learning ObjectivesAt the conclusion of this session, the participant will be able to:
•List two advantages of embedding BHCs into pediatric Well Child Check exams.
•Describe the rationale for implementing the STAT-BHC within Well Child Check exams.
•Describe two ways to utilize community health workers as extenders of the primary care team to reinforce autism spectrum interventions.
1. Stone, WL, McMahon, CR, Henderson, LM. (2008). Use of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months: an exploratory study. Autism: International Journal of Research Practice, 12(5), 557-573.
2. Zwaigenbaum, L et al. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136, S41-S59.
3. Pinto-Martin, J., Young, L., Mandell, D., Poghosyan, L., Giarelli, E., & Levy, S. (2008). Screening strategies for autism spectrum disorders in pediatric primary care. Journal of Developmental and Behavioral Pediatrics, 5, 345-350.
4. Chlebowski, C., Robins, D. L., Barton, M. L., & Fein, D. (2013). Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics, 131(4), e1121-e1127.
5. Guevara, J.P., et al. (2013). Effectiveness of developmental screening in an urban setting. Pediatrics, 131(1), 30-37.6. Robins, D., et al. (2016). Universal autism screening for toddlers: Recommendations at odds. Journal of Autism and
Developmental Disorders, 46(5), 1880-1882.7. Glascoe, F. P. (2015). Evidence-based early detection of developmental behavioral problems in primary care: What
to expect and how to do it. Journal of Pediatric Health Care, 29(1), 46-53.
Bibliography / Reference
Learning AssessmentA learning assessment is required for CE credit.
A question and answer period will be conducted at the end of this presentation.
Greetings from East Tennessee!
Our Mission…To improve the quality of life
for our patients through the blending of primary care and behavioral health.
Together… Enhancing Life
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Primary Service Area
HAMILTON
Te n n e s s e e
K e n t u c k y
G e o r g i a
HAMBLENGRAINGER
CLAIBORNE
MCMINN MONROE
LOUDON BLOUNTSEVIER
KNOXCOCKE
JEFFERSON
UNION
CAMPBELL
ANDERSON
N o r t hC a r o l i n a
V i r g i n i a
A r k a n s a s
M i s s i s s i p p i A l a b a m a
M i s s o u r i
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Cherokee Health SystemsCurrent Number of Employees: 715Current Annual Payroll: $41,390,679
Provider Staff:Psychologists - 47 Cardiologist - 1 Psychiatrists - 8Primary Care Physicians - 27 Nephrologist - 1 NP (Psych) - 9NP/PA (Primary Care) - 53 Pharmacists - 13 LCSWs - 68Community Workers - 37 RNs - 81 Dentists-2
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Giving our Best for Those Most in NeedImproving Access and Outcomes for the
Underserved
Calendar Year 2017
78,611 Patients Seen
409,363 Services Provided
25,242 New Patients
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Populations/Communities Served
• Rural Appalachian• Black/African American• Migrant/Agricultural Farm Workers• Latino/Hispanic• Homeless• Public Housing• Refugee – Africa, Middle East, Eastern Europe/Russia
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Setting the Stage
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Screening vs. Assessment
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Pediatric Well Child Checks
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Why WCCs?
• Routine points in medical/physical care • Wellness promotion, broad screening, further engagement of children
and families
• Appropriately matched assessment of wellness goals and health education at each stage of development
• BHC enhances visits with PCP • Generates awareness of our greater role within the primary care team,
services available, and critical tasks in healthy biopsychosocial development.
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WCC Primary Targets
• Healthy nutrition/activity level• Social development• Academic concerns• Behavioral and/or emotional support needs• SAFETY at all ages• Parent-child normative transitions/dynamic relationships• Caregiver skills/patient skills
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Examples of Stage-Matched Education and Intervention
Newborn
2 weeks
2 months
6 months9 months
Crib SafetyPostpartum depression
Feeding
Vocal productionIntroduction of new foods
Mobility
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12 months
18 months
24 months
30 months36 months
Examples of Stage-Matched Education and Intervention
Language developmentGross and fine motor skills
Autism screenings
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4-6 years (annually)
7-12 years (annually)
13-17 years (annually)
Examples of Stage-Matched Education and Intervention
School readinessSleep and
bedtime routinesConsistent limit-
settingElectronic limits
Injury preventionETOH, drugs, tobaccoSexual development
DrivingOnline safetyAutonomous
decision-makingSexual education
and health
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More on the Autism Screenings
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The STAT BHC
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• Used with a refined, autism-specific parent questionnaire and interview
• 12 play-based items assessing key social-communicative behaviors
• ~20 minutes• Target age range: 24 to 36 months, can also be used
from 14 to 47 months• Strong psychometric properties
The Screening Tool for Autism in Toddlers and Young Children
(STAT, STAT-MD, STAT-BHC)
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Results: Using a rapid diagnostic model, diagnostic clarity (i.e., ASD vs. no ASD) determined within the initial consult session for 59% of the children. Latency to diagnosis was less than two months, compared with a minimum of 6 months for tertiary clinic assessment. The median age at diagnosis (32 months) was considerably lower than the national average of approximately 50 months.
“A Pilot Model for Embedding ASD Diagnosis within the Medical Home”, Unpublished Manuscript, Hine et. al.
Vanderbilt Kennedy Center
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BHCs• 3-hour training on autism• Periodic half hour training sessions on specific issues, like
sleep, behavior management, and feeding• Two-day training specific to the STAT • Periodic email updates on experience with the STAT• Access to the Developmental Psychology Team• Developmental psychologists consult on unclear STATs
STAT-BHC: Training and Quality Assurance
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STAT-BHC: Implementation
Failed MCHAT (or any
concern about autism)
STAT-BHC Rule ASD in or out
Small % receive further testing (ADOS,
BASC)
Intervention targets for all
kiddos focusing on
strengths and challenges
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Community Health Coordinators:• 3-hour training on Autism• 3-hour training on the STAT process and community resources• Assist parents as indicated with completion of developmental
questionnaire• Active involvement in the “next steps” discussion• Meet with the parents to review next steps• Collaborate with parents to refine topics for discussion with
providers
STAT-CHC: Training and Quality Assurance
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Primary care at CHS Non-primary care
Prior to STAT BHC 154 days (n=20) 134 days (n=20)STAT BHCAs of 3/27/17
34 days (n=20) 71 days (n=82)
Average Wait from Referral to Diagnosis or Rule Out
After implementing the STAT, Primary Care kids get in 52% quicker than non-primary care kids.
47% reduction in time till diagnosis
81% reduction in time till diagnosis
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Developmental Psychology
Team Referral
Cognitive Testing
Review CDI + STAT
ADOS (Structured
Play Assessment)
Play Observations
BASC-3
When the STAT is Unclear…
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• How often do we need a more in-depth evaluation?• Are we accounting for “restrictive, repetitive
patterns….?”• Is our diagnostic rate changing?• What happens to kids who are referred but don’t
come?• Can we spend more time doing intervention?
Common Questions About Using the STAT-BHC
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• Continue to collect data• Ongoing training and research• Expand to all pediatric clinic sites within our system• Continue to shorten the diagnostic delay
Next Steps
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Zachary Warren, Ph.D. and Amy Swanson, M.A.Vanderbilt Kennedy Center, Treatment and Research Institute for Autism Spectrum Disorder
vkc.mc.vanderbilt.edu/vkc/triad/training/stat Phone: (615) 322-6533 Email: STAT@vanderbilt.edu
For more information about the STAT:
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Session Evaluation
Use the CFHA mobile app to complete the evaluation for this session.
Thank you!