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Autism Screening Broadway Clinic QI project 2011-2012

Autism Screening Broadway Clinic QI project 2011-2012.

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Autism Screening Broadway Clinic QI project 2011-2012

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  1. Autism ScreeningBroadway ClinicQI project 2011-2012 ArashSalavitabar, Erin Paul, Anna Hays, Joe Grillo, UchechiAzubuine, Lacy-Ann Landell, Daniel Stephens, Kristal Woldu, Michael Goldman, Emily Whitesel, Lindsay McGann, Lisa LavikoffKurz, Robbie Majzner, Lisa McReynolds, RakheeBowker AnnikaHofstetter, Laura Robbins-Milne, Heidi Beutler, John Rausch, Mariellen Lane, Nan Salamon, RenieEis Ceila Mendez, Blanca Cordero, Reyna, Felipe Joaquin Evelyn Reyes, Iriada Torres, Kenya Rittenburg, Carlos Sepulveda , Tene Jones, ConchitaLaurencioHaydeeBayon, Becky, Sally Ortiz

  2. AIM Statement • Broadway Clinic aims to implement standardized autism spectrum disorder screening using the Modified Checklist for Autism in Toddlers (M-CHAT) for at least 50% of patients at their 18 and 24 month visits.

  3. Developmental Surveillance • “Early Identification of developmental disorders is critical to the well-being of children and their families” - AAP • Missed Opportunities: • Estimated 12-16% of children <3 years have delays, yet EI serves only ~2% • CDC estimate only 50% children with development/behavioral disability are identified prior to entering school

  4. Autism Screening • Neurodevelopmental disability appearing before age 3 • Prevalence 1 in 150 • Difficulties in: • Verbal and Non-verbal communication • Social Interactions • Play Activities

  5. AAP Recommendations • Informal Developmental Surveillance at all well child visits • Formal developmental screening at 9, 18 and 24 months • Standardized autism screening at 18 and 24 months, or with any parental concern

  6. M-CHAT • No one tool has been shown to identify all children: • Denver, the PEDS, Ages and Stages Questionnaire • Why the M-CHAT? • Accessible: Translated into 20+ languages • Easy to Use • Validated in primary care settings • Sensitivity 0.85, Specificity 0.93 • FREE!

  7. Process: • The M-CHAT questionnaires will be distributed by the MAs, reviewed and scored during the patient encounter. The baseline rate of standardized autism screening is 0%. Our aim will be to achieve a 50% completion rate. • Outcome measures include a percent change in both early intervention and audiology referrals.

  8. Baseline Development Screening

  9. PDSA Cycles • PDSA Cycle 1: Is the M-CHAT Doable? • Provider Based Intervention to determine feasibility • Found parents able to complete • Found providers able to grade • Transparencies English and Spanish • PDSA Cycle 2: Can the M-CHAT be done as a pre-Screening? • Incorporate the MAs • 3 cycles

  10. Rate of M-CHAT Distribution

  11. Final Data

  12. Conclusion: Lessons Learned • Autism Screening and the M-CHAT: • Feasible • Survey of providers: • Doesn’t increase provider time • Easy to interpret • Sustainable? • Is this something to continue? • Doesn’t appear to increase our rates of EI referral • Spread: • Have M-CHAT available to be used • MCHAT transparency in English and Spanish in exam rooms

  13. Other interventions at Broadway • Development Guide! • Outpatient handbook • Community Peds Website

  14. EI form now available on Eclipsys in EZVAC!

  15. Thank You • Broadway Clinic! • Mariellen Lane • Laura Robbins-Milne • Celia, Reyna, Blanca, Felipe

  16. References • Management of Children with Autism Spectrum Disorders. AAP. Pediatrics. 2007; 120: 1162-1182 • Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. AAP. Pediatrics. 2006; 118: 405-420. • Robins et al. M-Chat: an initial investigation in the early detection of autism and PDD. J Autism Dev Disord. 2001; 31: 131-144. • Pinto-Martin et al. Screening strategies for autism spectrum disorders in pediatric primary care. J Dev BehavPediatr. 2008. 29: 345-350 • Glascoe et al. Can a broadband developmental-behavioral screening test identify children likely to have ASD? ClinPediatr (Phila). 2007. 46: 801-5. • Screening for ASD in primary care settings. Robins DL. Autism. 12: 537-56. • The M-CHAT: a follow-up study investigating the early detection of ASDs. Kleinman et al. J Autism Dev Disord. 2008. 38: 827-39. • Early screening for ASDs: update on the M-CHAT and other measures. J Dev BehavPediatr. RobinsDL. And Dumont-Mathieu TM. 2006 27 S111-9. • Guidelines for Early Identification, Screening and Clinical Management of Children with ASDs. Greenspan et al. 2008. Pediatrics. 121: 828-831. • Early Autism Detection: Are we ready for routine screening? Al-Qabandi et al. Pediatrics. 128 e211-17. • The Each Child Study: systematic screening for ASDs in a pediatric setting, Miller et al, 2011. Pediatrics. 127: 866-71. • Identification and Evaluation of Children with Autism Spectrum Disorders. Johnson et al. Pediatrics. 2007. 120: 1183-1215. • Developmental Surveillance and Screening of Infants and Young Children Committee on Children with Disabilities. AAP. Pediatrics 2001; 108: 192-196 • Developmental Screening in Early Childhood Systems. Summary Report. AAP. Healthy Child Care America. March 2009

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