Addressing Health Disparities in Early Diagnosis and Service Receipt:

Implementing Two-Stage Screening in Early intervention

Alice S. Carter, Ph.D., Abbey Eisenhower, Ph.D., Frances Martnez-Pedraza, M.A., & Angel Fettig, Ph.D.

Introduction

Through the ABCD Early Screening Project, we

attempt to reduce health disparities in the rates
and ages of autism spectrum disorder (ASD)
diagnosis and service receipt.

To do so, we are changing the screening

practices implemented by federally mandated
early intervention (EI) agencies serving children
ages zero to three.

Multi-Stage Screening & Assessment Protocol

Stage 1: Screening Questionnaires (14-33 months)
Parent Report
(POSI and BITSEA)

EI Provider Concerns &

Parent Concerns

531
Toddlers
Screened

Stage 2: Follow-up Consultation Observation

(All toddlers screening positive at Stage 1)

326

Screening Tool for Autism in Toddlers (STAT)

and/or Provider/ Parent Concerns

STATs

Diagnostic Assessment
(Toddlers screening positive at Stage 2)
Child Testing:
ADOS and Mullen Scales

84
Assessed

Parent Interview

Specialty
Services

69
ASD

Who are we screening?

(Stage 1, n=531)

Gender: 64% boys (340 out of 531)

Ages: 16 - 33 mo. (Mean = 24 months)
Racial or Ethnic Minority: 62%
Race: Black or African-American: 34%
Asian: 7%
White: 54%
Bi/Multiracial: 4%
Unknown/Not reported: 1%
Ethnicity: Hispanic or Latino/a: 35%

Language: 35% of children had a primary

language other than English (18% Spanish, 17%
other).

Who are we diagnosing? (Stage 3 n=69)

Gender: 87% boys (60 out of 69)

Are we reaching racially diverse families?
Ages: 19 - 36 mo. (Mean = 27.4 mo.s, SD = 5.2)
Asian (6.7%)
Black (20%)
Language: 42% had a primary language
White- Non-Latino (21.7%)
Multi-non-Latino (1.7%)
other than English (24% Spanish, 18% other)
Multi-Latino (3%)
Black-Latino (5%)
=
White- Latino (16.7%)
Latino (18%)
Family Income: 58% of families earned
no race/ethnicity (6.7%)
< $45,000K (~the poverty level for a family of
four)
Racial or Ethnic Minority: 71%
Parent Education: 48% have a high school
education orImplementation:
less
Successes and Challenges

Successes:

The wait time between a positive Stage 2 screen and a diagnostic assessment
appointment (Stage 3) is only 17.7 days.
Our numbers suggest that a minimum of 7% of children receiving EI are likely to meet
criteria for ASD.
We have held several trainings in the STAT, our Stage 2 screener, training a total of 23 EI
providers in this play-based assessment.

Challenges and Strategies:

Training Video:

The high turnover among EI providers

is a barrier to training EI providers
in our screening process.

Providers differ in whether they screen by

concern or universally.
(a) Including screenings as part of
routine activities (intake or re-evaluations)
increases rates of completion.
(b) A screening tracking systems helps
providers know who is due for screening.

Spanish-speaking EI providers have

increased work demands (large caseloads
and more responsibilities) that affect
Spanish-speaking families being screened.

(a) Conducted discussion groups with these

providers to promote & support screening
(b) Advocated for training opportunities for
these providers
New EI providers are unfamiliar with the
diagnostic assessment process.
(a) Support providers in attending
assessments, improving their awareness
of the range of ASD early presentation.
(b) Periodic newsletters from our project
remind providers of the visit process.

A Recent ABCD Project Newsletter:

Strategy: We created a training video

which is now used in the orientation
for all new EI providers.

Website for EI Providers:

Contd Challenges and Strategies

EI providers vary in their comfort around

discussing autism with their client families.

Strategies:
(a) A website was created with information
about ASD and the screening process,
(b) Collaboratively developed a script for EI
providers to broach the subject of autism
with families,
(c) Hold regular trouble-shooting meetings
with providers

Acknowledgements:

This research was supported

by HRSA-funded grant
R40MC26195.