Alison Jenkins, BA Family Resource Coordinator, Centralia School District

Nikki Young, BSN, RN Case Management/ Care Coordinator Northwest Pediatric Center

Kate Orville, MPH Co-Director, WA State Medical Home Partnerships Project for CYSHCN University of WA

Get SMART- School and Medical Collaboration to

Evaluate Children for Autism

7th Annual Southwest Washington Autism Conference,

Centralia WA October 27, 2017

School Medical Autism Review Team

(SMART)

Lewis County/Washington State model to build on and

develop community capacity in rural or underserved

communities without a “bricks and mortar’

multidisciplinary diagnostic center

Get 360 view of child from parents, school, medical and

other health care professional to enable timely,

thorough, local evaluation and diagnosis

Purpose of Workshop

Increase awareness and use of School Medical Autism

Review Team (SMART) option among families and

providers in Lewis County and surrounding communities

Support new communities starting a SMART process

(including Cowlitz, Pacific, Grays Harbor/Mason)

Increase Medical-School-Family collaboration to better

serve our shared children

Lewis County SMART – it all started here

How and Why:

Lewis County Autism Coalition

Workgroup to address challenges families faced to get timely

ASD diagnoses:

Long wait lists at Mary Bridge and Seattle Children’s, UW

Travel issues for families to go out of county – cost, time

Support and encouragement from MB, Children’s, UW, Dept

of Health that this could be done locally.

Workgroup with help from Amy Carlsen, RN and UW graduate

fellows created forms, processes

Who’s SMART? MD from NW Peds (Dr. Polley)

RN Care Coordinator (Nikki) donated by NW Pediatrics

Mary Chmelik, ARNP from MCHB Dev & Behavioral Peds

Special Education Director

School Psychologists

Speech Therapists

Birth to Three: InTot and Centralia School District (Alison)

Basics NW, ABA Therapist

Others at times: OT, other school/medical, LINK/parent

Process

Child referred (pediatrician, parent, educator, therapist etc)

Release of information forms signed by family

at time of referral

or sent by care coordinator

SMART forms filled out by relevant people (school district, from IEPS/IFSPs

and evaluations, teachers, therapists, medical providers, mental health counselor etc)

Family brings forms to NW Peds or mails in

Forms reviewed by team at next meeting.

Next Steps – 3 pathways

1. If enough info available: Appointment with Mary Chmelik,

ARNP in Centralia

2. If information clearly does not support further ASD

evaluation: family and referrer informed

3. If need more information:

Refer to school district/early intervention for

developmental screenings/evaluations if not already

done

Autism screenings/tools:

Screening Tool for Autism in Toddlers (STAT) done at NW Pediatrics or EI Program

Social Responsiveness Scale (SRS) by parent or teacher

Autism Diagnostic Observation Schedule (ADOS) - Mary Chmelik,ARNP

Evaluation Outcomes

If child diagnosed with ASD:

Given information and connections to LINK, ABA therapy, schools

If child not diagnosed with ASD:

May be deferred until more information available (e.g. time in EI program, preschool etc)

May be referred to Neurodevelopmental specialist

Discuss other options/referrals: schools, therapists, mental health; Often other conditions (e.g. ADHD, mental health, complicated health issues)

Outcomes Data

2015 2016

Patients diagnosed 20 23

Patients whose SMART Team

review did not indicate need

for further evaluation

4 8

Patients evaluated for Autism

but did not meet criteria

3 3

Total 27 34

Evolving Process

Forms, including SMART tool, revised a few times

Mental Health not well represented at the table

DDA has not accepted all diagnoses (ARNP vs.

Neurodevelopmental Ped)

Schools/others have not always received results

Other Recent Opportunities

Northwest Pediatrics has become a Health Care Authority

(Medicaid) Autism Center of Excellence for the purpose of being

able to prescribe Applied Behavioral Analysis (ABA) therapy for

patients on Medicaid.

Early Intervention Program, NW Peds and some local families are

participating a study with training from the UW Readi Lab. Screen

Refer Treat (SRT) Grant- Early screen, early refer, early treat.

Why SMART Works

Local people with passion

Know many of the children and families

Variety of agencies with broad knowledge – child development,

medical, educator, IEP/evaluations etc.

Care Coordinator keeps us organized and connects with

families and agencies.

Open discussion – all input welcome and valued

BENEFITS wider than autism-

sharing info, knowledge, resources

More willing to reach out for help, collaborate in other ways

Ferry

Lincoln

Adams

Pend

Oreille

Stevens

Spokane

Whitman

Whatcom

Skagit

Snohomish

King

Clallam

Jefferson

Mason

Kitsap

Grays

Harbor Fall ‘17

Pacific Fall ‘17

Klickitat

Skamania

Pierce Thurston

Lewis

Cowlitz fall 2017

Clark

San Juan

Island

Wahkiakum

Garfield

Columbia

Asotin

Douglas

Chelan

Kittitas

Yakima

Grant

Franklin

Benton Walla Walla

Okanogan

THE PICTURE STATEWIDE

Community Asset Mapping (CAM) Child

Health Coalitions

Established SMART Team

Exploring/developing SMART Team

10/26/2017 medicalhome.org

S.Sound ASD Coalition

Variation - Community Resources and Need

Criteria for children seen

Age, specific to practice or insurance, ASD concerns or broader

Care Coordinator

Role and funding

Diagnosis/eligibility for what systems/services – depends on who diagnoses

For Developmental Disability Administration (DDA)? For Medicaid? For other insurance? For Special Education Services under the Autism category?

Outcome from evaluation

Final Diagnosis or clear pathway to further evaluation

Further Information

Lewis County Autism Coalition SMART

Nikki Young NYoung@nwpeds.com

Alison Jenkins ajenkins@centralia.wednet.edu

UW Medical Home Partnerships Project

Amy Carlsen carlsa@uw.edu

Kate Orville orville@uw.edu

http://medicalhome.org/stateinitiatives/community-asset-mapping/school-medical-autism-review-team-smart/

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Questions/ Discussion