Improving Screening and Early Identication Practices for
Children with Autism Spectrum Disorders in State Public Health
Oces
Eric G. Kurtz, Ph.DLeadership Education in Neurodevelopmental
Disorders (SD LEND)Center for Disabilities (SD UCEDD), Department
of Pediatrics at the University of South Dakota Sanford School of
Medicine
BACKGROUND:While the prevalence of children identied with Autism
Spectrum Disorder (ASD) is continually on the rise, there remains
much needed improvement in diagnosing the disorder early (by age
3). Symptoms of ASD present themselves as early as 18 months of
age, sometimes earlier. All children are able to be reliably
diagnosed by the age of 2 years. This delay in diagnosis results in
children lacking appropriate early intervention, which leads to a
higher risk for negative outcomes throughout the life course. Some
of the barriers to early diagnosis include providers waiting for
parents to communicate concerns, lack of time or reimbursement for
screening procedures, lack of providers with expertise in ASD, and
children not making it to a diagnostic evaluation after high risk
screening results. These barriers become even more pronounced in
rural and frontier locations and other underserved populations.
PURPOSE: Design and implement a training and technical
assistance program to improve
screening and early diagnosis of ASD Collaborate with Title
V/public health oces to address barriers to screening and
early identication eorts
PARTICIPANTS: 141 nurses, dieticians, social workers and clinic
administrators from 67 oces across
South Dakota All participants serve patients from rural,
low-income, underserved and
underrepresented populations
METHOD: Full day training to enhance ASD knowledge base,
identify early warning signs,
eective screening procedures, and communicating concerns to
parents Trainings were conducted through didactic instruction,
interactive discussion, and
case studies Initial training followed by individual technical
assistance to participants Pretest-posttest design was used to
measure impact TRAINING MATERIALS: Centers for Disease Control and
Preventions (CDC) Learn the Signs Act Early website
and materials Autism Case Training (ACT)
Module 1: Early Warning Signs of AutismModule 2: Screening for
AutismModule 3: Communicating Concerns: Screening and Diagnosis
ResultsModule 5: Early Intervention and Education
RESULTS:Impact and outcome measures of the program indicate
signicant increases in perceived knowledge base and understanding
of ASD, recognizing the early warning signs, comfort level and
ability to implement eective screening practices for ASD, and
communicating results and recommendations to parents.
Results of additional analyses indicate a signicant increase in
the implementation of Evidence-Based Practices (EBP) after the
training was provided. A comparison in the means between Q11(The
degree to which you and your organization implemented EBP to screen
children that were suspected of Autism Spectrum Disorder BEFORE the
training) and Q20 (The degree to which you and your organization
implemented Evidence-Based Practices to screen children that were
suspected of Autism Spectrum Disorder AFTER the training) indicates
the degree to which EBP were implemented before and after the
training participants received: Mean Q11 = 2.64 Mean Q20 = 3.09 A
paired t-test was conducted to determine whether there was any
signicant dierence in the way in which each participant perceived
there to be a dierence in the degree to which they implemented EBP
before and after the training. Results were t = -.15; df = 55; p
< .005. In combination with the means this suggests there was a
statistically signicant dierence in the degree to which
participants improved their implementation of EBP following the
training. An eect size is the magnitude or strength of the dierence
resulting from the training. Cohens d for paired samples was
computed (d =.42) which indicates a moderate level of eect.
DISCUSSION:Through a targeted training and technical assistance
plan, signicant improvements can be made in the implementation of
eective screening practices for ASD in underserved and
underrepresented populations. While the results of this project are
very promising, eorts must be expanded and monitored. Additional
plans include formulating individualized technical assistance plans
for each public health oce aimed at addressing the specic barriers
to improving screening rates of children, and sustaining the
progress accomplished. Rates of screening must be monitored across
the state, and additional study must be conducted to examine the
direct impact of these eorts for children and families.
Outcome / Impact Percentage
Increased and/or improved professional knowledge, skills and
capacity for screening for ASD.
85%
Improved reliability and validity of screening results 75%
Enhance overall ability for screening for ASD 98%
Increased frequency of implementation of EBPs for screening for
ASD
47%
Increased capacity to identify and implement eective practices,
interventions, resources and supports for youth/children with
ASD
75%
Improve outcomes for youth and adults with ASD and other
developmental disabilities
74%
