P1009 - Increasing Diagnostic Services for Autism Spectrum Disorder in the Native American Community: A Pilot Collaborative Telecare Model

Background: Autism spectrum disorder (ASD) occurs in 1 in 54 U.S. children, and disparities for rate of diagnosis have been reported based on race, ethnicity, and socioeconomic status. In Arizona, prevalence rates are 1 in 63, with white children being 1.5 times more likely to receive an ASD diagnosis. Little is known about ASD in Native American children, but one study found that Native American children were 13% less likely to be identified with ASD. Access to developmental-behavioral pediatricians and autism specialists is limited in Arizona, with few practicing specialists and long wait times. As many autism specialists are concentrated near metropolitan areas, access is further hindered by travel and time barriers for Native American children living several hours away on the reservation.

Objective: The objective of this program was to improve access to diagnostic evaluation for Native American children with suspected ASD through a telehealth collaboration between a local primary care pediatrician (PCP) and a tertiary care autism specialist.

Design/

Methods: Monthly telehealth clinics over a secure Zoom account included an autism specialist in Philadelphia and an Arizona-based PCP trained in the Screening Tool for Autism in Toddlers (STAT)5. Children referred to the clinic were all Native American and receiving care at a regional health center serving the Navajo and Hopi reservations. Visits consisted of a video interview with parents, including a detailed developmental, behavioral, and medical history and a brief behavioral observation of the child playing with toys. The primary care provider helped facilitate interview and shared observations that were not easily seen over the video session. DSM-5 criteria were used to determine ASD diagnosis.

Results: From May 2019 to March 2020, 30 children were referred and 23 completed virtual diagnostic evaluations (7 no-shows). Days from PCP registered concern to diagnosis ranged from 6-1920 days, and average time to diagnostic clarification decreased from ~600 days to 185 days over the 10 months. Median wait times were reduced from ~270 days at the clinic onset (May to July 2019) to 90 days (February to April 2020). Thirteen children were given a new diagnosis of ASD. Average age at time of diagnostic clarification was 6.4 years (range 2.2-14.5 years). The most common diagnoses given instead of ASD were language disorder, global developmental delay and attention deficit hyperactivity disorder (ADHD).

Conclusion: Telehealth consultation between community-based PCPs and subspecialists may be an effective strategy to reduce disparities and shorten time to ASD diagnosis among Native American children.

Acknowledgements: Funded in part by the NARBHA Institute. Special thanks for the support and guidance of Dr. Mark Carroll and executive sponsorships of Drs. Louis Bell at Children’s Hospital of Philadelphia and Steve Holve at Tuba City Regional Health Care Corporation.