Educational Webinars on Autism Screening, Diagnosis, and Referral Practices for Pediatric Primary Care Providers - Examining Uptake, Learning and, Provider Feedback

• In Event: Improving Health System Care Access for Diverse Children and Families at Risk for Developmental Disabilities

Abstract

Diagnostic prevalence of autism spectrum disorder (ASD) has doubled over the past ten years, now affecting 1 in every 54 children (Maener et al., 2020). Although core symptoms of ASD are usually observed in the first year or two of life, the median age of ASD diagnosis in the U.S. is 51 months (Maenner et al., 2020); children from low-income families and children of color receiving diagnoses at significantly later ages (Durkin et al., 2017). Pediatric primary care providers (PPCPs) frequently are the first point of contact when caregivers have developmental or behavioral concerns. While rates of ASD-screening at well-child visits are high, few pediatric primary care providers (PPCPs) make ASD-specialist referrals following a failed screen, and even fewer evaluate for ASD themselves (Monteiro et al., 2019; Wallis et al., 2020). Although PPCPs report an eagerness to improve services for patients with ASD, barriers include a lack of adequate diagnostic training and insufficient knowledge of treatment information (Rhoades et al., 2007; Mazurek et al., 2017).
To address these barriers, members of our team developed and implemented a three-part ASD educational webinar series (Screening, Diagnosis, and Referral). In addition to providing knowledge, we investigated PPCP perspectives on the value and utility of this approach to training and explored changes in knowledge and confidence about ASD-screening, diagnostic, and referral practices following training participation. PPCPs from a hospital-affiliated pediatric network were invited to participate. A second group of providers from an integrated medical home were invited, as well, in response to their request for ASD training. Pre- and post-test measures of knowledge and confidence were collected for each webinar (Screening, Diagnosis, Referral) and open-ended feedback was optional after completion of measures. PPCPs were incentivized with one continuing medical education (CME) credit for each webinar completed, as well as downloads of each presentation. Of 291 PPCPs invited, 37 (12.7%) completed Screening; 31 (10.7%) completed Diagnosis; and 28 (9.6%) completed Referral. Paired samples t-tests revealed statistically significant pre-post increases (p< .001) in Knowledge and Confidence scores for each webinar. Chi-square analyses comparing pre-post proportions of correct versus incorrect responses showed larger proportions of correct responses post-test. Additionally, themes and subthemes identified in analyses of provider feedback reflected high utility and acceptability, though inclusion of community resources was requested for improvement.
Results indicated substantive gains in PPCPs’ knowledge and confidence across webinars, suggesting their value as a training tool. Future research should investigate sustainability of these effects, as well as whether increased knowledge and confidence influence their practices. Novel delivery methods (e.g., Podcasts) that would allow for access and reference ‘on-the-go’ warrant future research, as does evaluation of the usefulness of supplemental resources to assist providers with implementation of best practices in-clinic. Evidence-based educational tools targeting families’ PPCPs are greatly needed to address barriers to early identification and treatment, particularly for sociodemographically diverse children, which positively affects developmental outcomes.

Authors

• Mycah L. Ayala, University of Houston
  Presenting Author

• Katherine C Bergez, University of Houston/Baylor College of Medicine/Texas Children's Hospital
  Non-Presenting Author

• Sarah S. Mire, Baylor University
  Non-Presenting Author

• Robin Goin-Kochel, Baylor College of Medicine
  Non-Presenting Author

• Leandra Berry, Texas Children's Hospital
  Non-Presenting Author

• Sonia Monteiro, Baylor College of Medicine/Texas Children's Hospital
  Non-Presenting Author