283 - Collaborative Telehealth Care on the Navajo Nation: Increasing Access to Autism Services

Poster Number: 283
Publication Number: 283.346

Amanda E. Bennett, The Children's Hospital of Philadelphia, Newtown Square, PA, United States; Margaret Ray, Tub City Regional Health Care Corporation, Tuba City, AZ, United States; John Chuo, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, PA, United States

Background: Prevalence of Autism spectrum disorder (ASD) is 1 in 44 children in the United States (Centers for Disease Control and Prevention [CDC], 2021), and racial, ethnic, and socioeconomic disparities for time to diagnosis have been reported (Wiggins et al. 2020). Arizona prevalence rates are 1 in 40 at 8 years and 1 in 99 at 4 years, with white children 1.3 times more likely to receive an ASD diagnosis (CDC 2021). Little is known about ASD prevalence in Native American children. One study found that Native American children were 13% less likely to be identified as having ASD (Drexler 2018). Access to autism specialists is limited in Arizona, with few practicing specialists and long wait times. Concentration of autism specialists near urban centers further hinders access, adding travel and time barriers for Native American children living many hours away on the reservation.

Objective: This program’s objective 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, Stone et al. 2004). Children referred to the clinic were all Native American and receiving care at a regional health center serving Navajo and Hopi reservations. Visits consisted of a caregiver interview, including detailed developmental, behavioral, and medical history, and a brief behavioral observation of the child playing. DSM-5 criteria were used to determine ASD diagnosis.

Results: From May 2019 to January 2022, 53 children completed virtual diagnostic evaluations. Age at time of diagnosis ranged from 2-17.6 years (mean 6.3 years). Forty-three children (81%) received an ASD diagnosis, and the other 10 children were identified as having another developmental or behavioral diagnosis. Average number of days from PCP-registered concern to evaluation decreased from 417 days to 61 days during the clinic’s first 4 months. The wait time rose briefly due to clinic closures during the COVID19 pandemic but has decreased to 62 days over the last 6 months (Figure 1).Conclusion(s): PCP and subspecialist telehealth collaboration may be an effective strategy to reduce disparities and shorten time to ASD diagnosis among Native American children.
Figure 1Days from suspected ASD diagnosis until Autism Specialist Evaluation.