Introduction
Autism is a neurodevelopmental disorder that affects how a person communicates, interacts, and behaves with others. Early identification of autism is important for providing timely and appropriate interventions that can improve the outcomes and quality of life of children and families affected by autism. However, many children with autism face long delays and barriers in accessing diagnostic evaluations and services, especially those from marginalized and underserved communities. This paper describes a school-clinic collaboration model that aims to improve the equity and efficiency of autism identification and service delivery for young children.
The School-Clinic Collaboration Model
The school-clinic collaboration model is based on the principles of transdisciplinary teamwork, family-centered care, and community-based partnership. The model involves four main components:
- Pre-visit triage: A school-based team of professionals (e.g., special educators, speech-language pathologists, psychologists) screens children who are referred for autism evaluation and collects relevant information from families and teachers. The team then shares the information with a clinic-based team of professionals (e.g., developmental pediatricians, psychologists, social workers) who review the cases and determine the level of evaluation needed for each child.
- Synchronous evaluation: The clinic-based team conducts a comprehensive autism evaluation for each child in a single visit, using standardized tools and measures. The team also observes the child in naturalistic settings (e.g., classroom, playground) and interviews the family and teachers. The team collaborates and communicates throughout the evaluation process to ensure accuracy and consistency of the diagnosis.
- Case conferencing: The clinic-based team meets after the evaluation to discuss the results and recommendations for each child. The team also invites the school-based team and the family to join the meeting and share their perspectives and feedback. The team then finalizes the diagnosis and the individualized service plan for each child.
- Care coordination: The clinic-based team provides the family and the school-based team with a written report that summarizes the evaluation findings and recommendations. The team also helps the family and the school-based team to access and coordinate the services and supports that the child needs, such as early intervention, special education, behavioral therapy, and family counseling.
Evaluation of the Model
The paper reports the results of a retrospective chart review of 173 children who received autism evaluations through the school-clinic collaboration model over one year (08/2018–08/2019). The paper evaluates the model in terms of its efficiency and equity outcomes, such as:
- Patient throughput: The number of children who received autism evaluations through the model increased by 62% compared to the previous year, indicating that the model increased the capacity and productivity of the clinic.
- Waitlist and time to diagnosis: The average wait time for an autism evaluation decreased by 50% from 6 months to 3 months, and the average time from referral to diagnosis decreased by 33% from 9 months to 6 months, indicating that the model reduced the delays and improved the timeliness of the diagnosis.
- Provider satisfaction: The clinic-based team reported high levels of satisfaction with the model, especially with the pre-visit triage and the case conferencing components, indicating that the model enhanced the collaboration and communication among the professionals.
- Equity in access: The model served a diverse and representative sample of children in terms of their race, ethnicity, language, and insurance type, indicating that the model improved the equity and inclusivity of the autism evaluation process.
Conclusion
The paper concludes that the school-clinic collaboration model is a promising and feasible approach to improve the equitable and efficient identification of autism in young children. The paper also discusses the strengths, limitations, and implications of the model for research, practice, and policy. The paper suggests that the model can be adapted and implemented in other settings and communities to address the needs and challenges of children and families affected by autism.
Faq
What is the rationale and background of the school-clinic collaboration model?
The rationale and background of the model are: – The model was developed to address the local needs and challenges of children and families affected by autism in a large urban area in the United States. – The model was inspired by the existing evidence-based practices and models of transdisciplinary teamwork, family-centered care, and community-based partnership in the field of early childhood intervention. – The model was informed by the input and feedback of the stakeholders and partners, such as the families, the school staff, the clinic staff, and the community providers.
What are the expected outcomes and impacts of the model for children, families, and professionals?
The expected outcomes and impacts of the model for children, families, and professionals are: – The model will improve the developmental, behavioral, social-emotional, and educational outcomes of children with autism by providing timely and appropriate interventions and services. – The model will reduce the stress and burden of families by providing family-centered and community-based care and support. – The model will increase the knowledge and skills of professionals by providing training and supervision and enhancing collaboration and communication.
What are the benefits of the model for children, families, and professionals?
The benefits of the model include: – reducing the wait time and the time to diagnosis for children with autism – increasing the capacity and productivity of the clinic – enhancing the collaboration and communication among the professionals – providing family-centered and community-based care – serving a diverse and representative sample of children
How does the model differ from the traditional autism evaluation process?
The model differs from the traditional process in several ways, such as: – involving a school-based team and a clinic-based team in the evaluation process – using pre-visit triage to determine the level of evaluation needed for each child – conducting a comprehensive and synchronous evaluation in a single visit – observing the child in naturalistic settings and interviewing the family and teachers – inviting the family and the school-based team to join the case conferencing – providing care coordination and follow-up services
What are the standardized tools and measures used by the clinic-based team in the evaluation process?
The standardized tools and measures used by the clinic-based team include: – the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) – the Autism Diagnostic Interview, Revised (ADI-R) – the Vineland Adaptive Behavior Scales, Third Edition (VABS-3) – the Mullen Scales of Early Learning (MSEL) – the Childhood Autism Rating Scale, Second Edition (CARS-2)
What are the criteria for referring a child for autism evaluation through the model?
The criteria for referring a child for autism evaluation through the model are: – the child is between 18 months and 5 years old – the child has a suspected or confirmed developmental delay or disability – the child has not received a previous autism evaluation or diagnosis – the child is enrolled in a participating school or early childhood program
How long does the evaluation process take through the model?
The evaluation process takes about 3 to 4 hours through the model, including the pre-visit triage, the synchronous evaluation, and the case conferencing.
What are the roles and responsibilities of the school-based team and the clinic-based team in the model?
The roles and responsibilities of the school-based team and the clinic-based team are: – The school-based team consists of professionals such as special educators, speech-language pathologists, and psychologists. They are responsible for screening the children, collecting information from the families and teachers, sharing the information with the clinic-based team, and joining the case conferencing. – The clinic-based team consists of professionals such as developmental pediatricians, psychologists, and social workers. They are responsible for reviewing the cases, conducting the evaluations, finalizing the diagnoses and recommendations, and providing care coordination and follow-up services.
How is the family involved and supported in the model?
The family is involved and supported in the model by: – providing information and feedback to the school-based team and the clinic-based team – participating in the evaluation process and the case conferencing – receiving a written report that summarizes the evaluation findings and recommendations – accessing and coordinating the services and supports that the child needs – receiving family counseling and education as needed
How is the child observed in naturalistic settings in the model?
The child is observed in naturalistic settings in the model by: – using a videoconferencing system that allows the clinic-based team to remotely observe the child in the classroom or the playground – using a wearable device that records the child’s vocalizations and interactions with others – using a tablet or a smartphone that captures the child’s responses to stimuli and tasks
How is the diagnosis and the individualized service plan for each child finalized in the model?
The diagnosis and the individualized service plan for each child are finalized in the model by: – using a consensus approach that considers the results of the standardized tools and measures, the observations in naturalistic settings, and the interviews with the family and teachers – using a diagnostic algorithm that applies the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) – using a service planning tool that identifies the goals, objectives, strategies, and resources for each child
What are the types of services and supports that the child may need after the evaluation process?
The types of services and supports that the child may need after the evaluation process include: – early intervention or special education services that address the child’s developmental, behavioral, social-emotional, and educational needs – behavioral therapy or applied behavior analysis (ABA) that teaches the child new skills and reduces challenging behaviors – speech-language therapy or augmentative and alternative communication (AAC) that improves the child’s communication and language abilities – occupational therapy or sensory integration therapy that enhances the child’s sensory processing and motor skills – physical therapy or adaptive physical education that promotes the child’s physical health and fitness – social skills training or peer-mediated intervention that fosters the child’s social interactions and relationships – medication or dietary intervention that manages the child’s medical or nutritional issues
How is the model evaluated and monitored for its effectiveness and impact?
The model is evaluated and monitored for its effectiveness and impact by: – conducting a retrospective chart review of the children who received autism evaluations through the model over one year – measuring the outcomes such as patient throughput, waitlist and time to diagnosis, provider satisfaction, and equity in access – collecting feedback from the families and the professionals who participated in the model – conducting a follow-up study of the children who received autism evaluations through the model to track their progress and outcomes
What are the challenges and limitations of the model?
The challenges and limitations of the model include: – requiring adequate training and supervision for the professionals – needing sufficient resources and infrastructure to support the model – facing potential barriers in data sharing and communication across settings – lacking long-term outcome data and cost-effectiveness analysis
How can the model be adapted and implemented in other settings and communities?
The model can be adapted and implemented in other settings and communities by: – assessing the local needs and challenges of children and families affected by autism – engaging the stakeholders and partners in the planning and implementation process – tailoring the model components and procedures to the specific context and population – evaluating the model effectiveness and impact on a regular basis – disseminating the model best practices and lessons learned
What are the challenges and barriers of implementing the model in other settings and communities?
The challenges and barriers of implementing the model in other settings and communities include: – adapting and tailoring the model to the specific context and population, such as the needs, preferences, characteristics, and culture of the children and the families. – engaging and involving the stakeholders and partners in the planning and implementation process, such as the buy-in, commitment, and collaboration of the families, the school staff, the clinic staff, and the community providers. – securing and allocating the resources and infrastructure to support the model, such as the funding, staff, space, equipment, and technology. – overcoming the resistance and inertia to change and innovation, such as the attitudes, beliefs, and behaviors of the professionals and the organizations.
What are the future directions and recommendations of the model for research, practice, and policy?
The future directions and recommendations of the model for research, practice, and policy are: – conducting more studies to examine the long-term outcomes and cost-effectiveness of the model, such as the developmental, behavioral, social-emotional, and educational progress and outcomes of the children and the families who participated in the model. – replicating and scaling up the model in other settings and communities to reach more children and families affected by autism, such as the rural, remote, and underserved areas and populations. – disseminating and sharing the model best practices and lessons learned with other professionals and stakeholders, such as the publications, presentations, trainings, and consultations. – advocating and supporting the model as a promising and feasible approach to improve the equitable and efficient identification of autism in young children, such as the policies, guidelines, and standards.
Source:
https://www.tandfonline.com/doi/full/10.1080/10474412.2023.2262451