Short report: Integrated evaluations for autism spectrum disorder in pediatric primary care clinics

Abstract

Primary care providers are often the first to identify concerns for autism through routine screening in the first 2 years of life. However, most children do not receive a diagnosis until years later resulting in delays accessing appropriate intervention. Delays in diagnosis disproportionately impact those who are otherwise disadvantaged by society based on race or socioeconomic status. Embedding mental health clinicians into primary care clinics offers a promising opportunity to address barriers to accessing diagnostic and intervention services once primary care providers identify concerns. The goal of this study was to assess the Autism in Primary Care program through which embedded mental health professionals in an urban primary care setting, primarily serving Black and Latinx families with Medicaid, were trained to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through Autism in Primary Care program. Wait times to access evaluations in primary care were found to be significantly shorter than through standard avenues of care (e.g. tertiary care clinics). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Embedding autism evaluations into primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being. Lay abstract Primary care providers often screen for autism during well child visits in the first few years of life and refer children for diagnostic evaluations when needed. However, most children do not receive a diagnosis until years later which delays access to services. Racism, socioeconomic status, and other systemic inequalities that limit access to health care further delay diagnostic evaluations. Mental health clinicians who work in primary care clinics can help address barriers to accessing diagnostic evaluation services once they are recommended by their primary care provider. However, mental health clinicians who work in primary care typically do not have training in diagnosing autism. The goal of this study was to evaluate a program training mental health professionals working in an urban primary care setting, primarily serving Black and Latinx families insured by Medicaid, to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through the Autism in Primary Care (APC) program. The wait time to access an evaluation through APC was significantly shorter than through standard avenues of care (e.g. referring to a separate autism clinic). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Conducting autism evaluations in primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.