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

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

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.

Contd Challenges and Strategies

Providers differ in whether they

Gender: 87% boys (60 out of 69)
Are we reaching racially diverse families?
screen by concern or universally.
Ages: 19 - 36 mo. (Mean = 27.4 mo.s,
(a)Including screenings as part of
SD = 5.2)
routine activities (intake or reLanguage: 42% had a primary
evaluations)
= language other than English (24%
increases rates of completion.
Spanish, 18% other)
(b)A screening tracking systems helps
providers
know
who
is
due
for
Family Income: 58% of families
Racial or Ethnic Minority:
screening.
earned
< $45,000K
71%

(~the
poverty
level
for
a
family
of
four)
Multi-Stage Screening & Assessment Protocol
Implementation: Successes and Challenges
Parent Education: 48% have a high
school education or less
Successes:
531
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.
326
We have held several trainings in the STAT, our Stage 2 screener, training a
total of 23 EI providers in this play-based assessment.
Toddlers
Screened

STATs

84
Assessed

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).

Challenges and Strategies:

Training Video:

The high turnover among EI providers

is a barrier to training EI providers
in our screening process.
Strategy: We created a training video
which is now used in the orientation
for all new EI providers.

Website for EI Providers:

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
A Recent
ABCD Project Newsletter:
ASD early presentation.
(b)Periodic newsletters from our project
remind providers of the visit
process.

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

Acknowledgements:
This research was
supported by HRSAfunded grant
R40MC26195.