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Reducing Barriers to Autism Screening in Community Primary Care: A Pragmatic Trial Using Web-Based Screening

  • Author Footnotes
    1 Contributed equally.
    Kyle J. Steinman
    Correspondence
    Address correspondence to Kyle J. Steinman, MD, MAS, Seattle Children's Hospital, 4800 Sand Point Way NE, Neurology, MB 7.420, Seattle, WA 98105
    Footnotes
    1 Contributed equally.
    Affiliations
    Department of Neurology, University of Washington (KJ Steinman), Seattle, Wash

    Department of Psychiatry & Behavioral Sciences, University of Washington (KJ Steinman), Seattle, Wash

    Department of Pediatrics, University of Washington, Seattle Children's Hospital (KJ Steinman), Seattle, Wash

    Center for Integrative Brain Research, Seattle Children's Research Institute (KJ Steinman), Seattle, Wash
    Search for articles by this author
  • Author Footnotes
    1 Contributed equally.
    Wendy L. Stone
    Footnotes
    1 Contributed equally.
    Affiliations
    Department of Psychology, University of Washington (WL Stone, LV Ibañez, and SM Attar), Seattle, Wash
    Search for articles by this author
  • Lisa V. Ibañez
    Affiliations
    Department of Psychology, University of Washington (WL Stone, LV Ibañez, and SM Attar), Seattle, Wash
    Search for articles by this author
  • Shana M. Attar
    Affiliations
    Department of Psychology, University of Washington (WL Stone, LV Ibañez, and SM Attar), Seattle, Wash
    Search for articles by this author
  • Author Footnotes
    1 Contributed equally.
Published:April 22, 2021DOI:https://doi.org/10.1016/j.acap.2021.04.017

      Abstract

      Objective

      To determine whether an intervention addressing both logistical and knowledge barriers to early screening for autism spectrum disorder (ASD) increases evidence-based screening during 18-month well-child visits and primary care providers' (PCPs’) perceived self-efficacy in caring for children with ASD.

      Methods

      Forty-six PCPs from 10 diverse practices across four counties in Washington State participated. PCPs attended a 2-hour training workshop on early recognition and care for toddlers with ASD and use of a REDCap-based version of the Modified Checklist for Autism in Toddlers–Revised with Follow-up (webM-CHAT-R/F) that provided automated presentation and scoring of follow-up questions. Data were collected at baseline and 6 months following each county's training window. PCPs’ screening methods and rates and perceived self-efficacy regarding ASD care were measured by self-report and webM-CHAT-R/F use was measured via REDCap records.

      Results

      At follow-up, 8 of the 10 practices were using the webM-CHAT-R/F routinely at 18-month visits. The proportion of PCPs reporting routine M-CHAT screening increased from 82% at baseline to 98% at follow-up (16% increase, 95% confidence interval [CI] 3%–28%; McNemar exact P = .02). The proportion using the M-CHAT-R/F follow-up interview questions increased from 33% to 82% (49% increase, 95% CI 30%–68%, exact McNemar test, P < .001). Significant increases in self-efficacy were found for all seven areas assessed (Ps ≤ .008).

      Conclusions

      This brief intervention increased PCPs’ self-reported valid use of the M-CHAT-R/F at 18 months and their self-efficacy regarding ASD care. Combining educational information with a web-based ASD screen incorporating the M-CHAT-R/F follow-up questions may increase universal ASD screening with improved fidelity.

      Keywords

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