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SPHARC Grantee Call: ECHO Autism
December 15, 2015| 2:00-3:00 PM, ET
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Quick Overview How to Use Web Technology
Agenda • Welcome/Roll Call
• HRSA & AMCHP Updates
• Topical Presentation: ECHO Autism Micah Mazurek, PhD, Department of Health Psychology, University of Missouri
• Q&A/Discussion
• Other Technical Assistance Needs
• Evaluation & Adjourn
3
HRSA Updates
4
SPHARC Updates
• Welcome Cori! Cori Floyd, Program Associate, Child & Adolescent Health [email protected]
• Upcoming meeting:
– In-person Grantee Meeting at AMCHP 2016 Conference: Sunday, 1/24/2016 | 11:30AM-1:00PM
– See the files pod for more ASD/DD events
5
ECHO Autism Micah Mazurek, PhD Department of Health Psychology University of Missouri
ECHO Autism
Rising Impact of Autism
1 in 88
2012
Increasing Prevalence
1 in 68
2014
ECHO Autism
Increasing Autism Awareness
ECHO Autism
Supply and Demand
Autism awareness
Referrals
Parents seeking answers
Children needing help
Need for a fully equipped healthcare system
ECHO Autism
Critical Needs: Identification
•Early diagnosis of ASD is essential for: • Facilitating access to early intervention • Reducing long-term costs and burden •Optimal outcomes
•ASD can be diagnosed reliably by age 2 •….yet, the average age of diagnosis is 4-5 years
Unmet Needs
ECHO Autism
Critical Needs: Medical
•Children with ASD have high rates of: •Medical comorbidities
• Sleep Disturbance, GI, Seizures, Diet/Nutrition
• Psychiatric comorbidities • Anxiety, ADHD, Aggression, Mood
•Unmanaged comorbidities lead to: • Increased stress and burden • Increased healthcare costs • Poorer outcomes
Unmet Needs
ECHO Autism
Unmet Healthcare Needs
•Compared to children with other conditions, children with ASD have: •Greater unmet healthcare needs • Less access to medical home • Less coordinated, family-centered care
•Children with ASD from underserved populations face even greater access barriers
Unmet Needs
ECHO Autism
Barriers to Access •Few specialists with ASD expertise
•Geographic/transportation
•Financial
•Cultural
ECHO Autism
How Can we Improve Access?
•Increase local capacity for best-practice care
•How? Who?
•Primary Care Providers (PCP) •Perfectly positioned for care that is:
• Timely • Community-based • Culturally competent
ECHO Autism
Are PCPs Equipped?
•Most PCPs are not following AAP guidelines for autism screening (Self, Parham, & Rajagopalan, 2014)
•PCPs report a lack of confidence (Carbone et al., 2013; Carbone,
Behl, Azor, & Murphy, 2010)
• In identifying ASD symptoms • In treating comorbid conditions in ASD
PCPs also report a desire to improve
ECHO Autism
Extension for Community
Healthcare Outcomes
ECHO Autism
•Developed at the University of New Mexico to improve outcomes for adults with hepatitis C (Arora, Thornton, et al., 2011)
•Purpose: • Expand local capacity for treatment of common and
complex conditions • Improve access for rural and underserved populations • Train community-based providers in best-practice care
Project ECHO
ECHO Autism
Project ECHO Model •Training PCPs in best-practice care
• Using Multipoint Videoconferencing • Expert “Hub” Connecting to PCP “Spokes” • Case-Based Learning • Didactics • Learning Network
ECHO Autism
•ECHO has been effective in: • Improving provider self-efficacy in HCV management
(Arora et al., 2010)
• Improving patient outcomes in HCV (Arora, Thornton, et al., 2011)
•Rapid expansion to other complex medical conditions (Arora, Kalishman, et al., 2011; Colleran et al., 2012; Katzman et al., 2014; Scott et al., 2012)
Project ECHO Model
ECHO Autism
Benefits of ECHO to Providers •“De-monopolizes” knowledge
•Reduced variation in care
•Case based learning (learning by doing)
•Co-management of patients with specialists
•Access to peer network
•No cost CMEs
ECHO Autism
Benefits of ECHO to Patients •Supports the medical home model
•Reduces health disparities
• Increases access to care
•Reduces cost
•Removes burden of travel
•Reduces wait-time for best-practice care
ECHO Autism
ECHO AUTISM • Interdisciplinary Expert Hub:
• Pediatrician specializing in ASD • Clinical Child Psychologist • Child and Adolescent Psychiatrist •Dietician • Social Worker/Resource Specialist • Parent of a child with ASD
•Spokes: • Primary Care Providers caring for children
ECHO Autism
ECHO Autism
ECHO Autism
Learning Loop
ECHO Autism Clinic Format:
• Introductions 10 minutes
• Case #1 35 minutes
• Didactic 20 minutes
• Case #2 35 minutes
• Wrap Up 20 minutes
Case presentation
Mentor Topic
Presentation
Practice
ECHO Autism
Didactic Curriculum 1. ASD Overview 2. Screening & Referral 3. Special Education Process 4. Constipation Screening & Management 5. Sleep Problems Screening & Management 6. Behavioral Strategies & ABA Overview 7. Anxiety Assessment & Management 8. ADHD Assessment & Management 9. Irritability/Aggression Assessment & Management 10. Family/Professional Partnerships 11. Community Resources 12. Feeding Concerns & Pica
ECHO Autism
Pilot Study
•6-Month Pilot Study • Twelve 2-hour ECHO Autism clinics • 2 clinics per month
Aims: 1. Increase PCP self-efficacy in screening and
identification of ASD Symptoms 2. Increase PCP self-efficacy in assessing and treating
common medical and psychiatric comorbidities
ECHO Autism
Measures •Baseline Only
• Demographics
•Each Clinic • Fidelity • De-Identified Case Presentation Data
•Pre- and Post-Test Measures • Self-Efficacy in Screening & Management of ASD • Practice Behavior
• Autism-specific screening at 18- and 24-month well-child visits • Use of autism-specific resources
•Post-Test Only • Satisfaction • Qualitative Interviews
ECHO Autism
Participant Characteristics
•Primary Care Providers • Pediatricians (n = 10) • Family Medicine Physician (n = 1) • Nurse Practitioner (n = 2)
• Other PCP (n = 1)
•Age: 31-57 (M = 40.8) •Years of Practice: 2-29 (M = 6.1) •78.6% Female •92.9% Caucasian
ECHO Autism
Participant Characteristics
79%
21%
Practicing in Health Shortage or Medically Underserved Area
HPSA and/or MUA/MUP Neither
50%
15%
7%
14%
14%
Practice Type
Private Practice or Medical Center Federally Qualified Health Center Community Health Agency
Rural Health
Other
ECHO Autism
Case Presentations (18 Cases)
50% 50%
Primary Presenting Question
Screening/Identification Management of Comorbidities
ECHO Autism
Presenting Problems by Type
0 2 4 6 8 10 12
Diet/Feeding
Sleep Problems
Misc. Medical
Neurological
GI Problems
Obesity
Medical Problems Presented (Number of Cases)
ECHO Autism
Presenting Problems by Type
0 1 2 3 4 5 6
Anxiety
Aggression
Emotion Regulation
Hyperactivity/Impulsivity
Psychiatric Problems Presented (Number of Cases)
ECHO Autism
Presenting Problems by Type
0 1 2 3 4 5
Family Stress/Trauma
School Problems
Sensory Symptoms
Speech-Language
Toileting
Transition
Other
Additional Problems Presented (Number of Cases)
ECHO Autism
Improvement in Overall Self-Efficacy
0
50
100
150
200
250
Total Self-Efficacy
Self
-Eff
icac
y To
tal R
aw S
core
Pre-
Post-
ECHO Autism
Improvement in Self-Efficacy Subscales
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Screening Resources Medical Psychiatric Additional
Self
-Eff
icac
y Su
bsc
ale
Ave
rage
Sco
re
Pre-
Post-
ECHO Autism
Adherence to Autism Screening Guidelines
0%
10%
20%
30%
40%
50%
60%
70%
Pre-Test Post-Test
Percentage of Pediatricians in Compliance with AAP Autism Screening Guidelines*
*Using ASD-specific screening tools at 100% of 18-month and 24-month
well-child visits conducted over the prior 6 month
period.
ECHO Autism
Participant Satisfaction with ECHO Autism Question (strongly agree = 1, strongly disagree = 5)
M SD
Participation in ECHO Autism improved my ability to care for children with autism in my practice 1.57 0.51
I learned best-practice care in autism through participation in EHCO Autism 1.50 0.52
I was able to connect with peers and colleagues through participation in ECHO Autism
1.57 0.51
ECHO Autism specialists provided guidance in managing children with autism 1.36 0.50
I respected the professional advice received from ECHO Autism experts 1.21 0.43
The didactic presentations enhanced my knowledge about autism 1.43 0.51
Discussions with other participants enhanced my knowledge about autism 1.64 0.63
Case-based learning increased my knowledge about autism 1.29 0.47
I have been satisfied with the technology associated with the ECHO Autism clinic 1.43 0.51
The technology for the ECHO Autism clinic functioned smoothly 1.50 0.65
ECHO Autism
Conclusions •Implementation of ECHO Autism was feasible
•PCP participants reported high satisfaction with the program
•PCPs demonstrated improvements in: •Self-efficacy in ASD screening and management •Adherence to AAP autism screening guidelines •Use of ASD-specific resources
ECHO Autism
Long Term Objectives • Improved PCP knowledge and adherence to best-
practice screening guidelines are expected to foster: • Earlier diagnoses •More timely referrals for services • Earlier intervention
• Improved PCP competence in managing co-morbid conditions is expected to result in: • Improved overall health • Reduced health-care costs • Reduced burden on families
ECHO Autism
Limitations and Future Directions •This initial pilot study was limited by:
• A small sample size • Lack of control or comparison group • Lack of direct measures of practice change or patient
outcomes
•We hope that these results will inform future research on the use of this model for increasing access to healthcare for children with ASD •Next Steps:
•Multi-Site Project • 10 ATN/AIR-P Sites, 150 PCP participants • Cluster randomized design • Objective outcome measures
ECHO Autism
Thank you!
Leda J. Sears Trust
ECHO Autism
For More Information: Visit: thompsoncenter.missouri.edu/training/echo-autism
Contact:
Kristin Sohl, MD
Email: [email protected]
Micah Mazurek, PhD
Email: [email protected]
ECHO Autism
Questions?
Thank You!
Please take a moment to send us your feedback: • https://www.surveymonkey.com
/s/SPHARC-Dec2015
