Evaluation of ASD Tele-Assessment in Underserved Communities
Abstract
Although there is evidence that autism spectrum disorder (ASD) can be accurately identified during the second year of life and that early intervention can improve developmental outcomes, many children in the United States are not diagnosed with ASD until much later. Families seeking ASD evaluation often face barriers such as low availability of specialists, lengthy waitlists, and long distances to tertiary care diagnostic centers. This is especially true for children from underserved groups and rural communities. Without an innovative approach for prompt identification of ASD in young children, families, and clinicians will continue to struggle with accessing and providing care. Telemedicine offers tremendous potential for addressing this need. In prior work, we have shown that many children with ASD can be accurately identified using tele-assessment procedures (both in Part C centers and home settings), that participating families report high levels of satisfaction with tele-assessment services, and that deploying such systems in rural settings has the potential to dramatically reduce wait times for identification and service. Moreover, subsequent unanticipated broad dissemination of our telemedicine measure (the TAP) during COVID-19 revealed potential widespread value to providers and families. Although extremely promising, this work has not yet demonstrated the value and impact of ASD tele-assessment for those underserved and under- resourced families most likely affected by existing barriers to traditional evaluation, nor have we established a replicable, sustainable strategy for implementation in real-world settings with limited resources. In the current study, we will partner our state Part C early intervention (EI) system to deploy a tele-assessment program, inclusive of the TAP, across four of the most rural and medically underserved regions of Tennessee. This project is aligned with the FY22 ARP Clinical Trial Award Area of Interest: Improve diagnosis and access to services across the life span. We will study the gradual rollout of this telemedicine paradigm examining data prior to and after rollout. We will study the child, family, provider, and system-level impact of use across the entire population served by these districts over several years. Using input from key stakeholders and characteristics of individual sites, we will present guidelines for implementing a model of ASD tele-assessment that is responsive to the needs and limitations of service providers and then deploy and evaluate its performance, usability, and cost-effectiveness relative to traditional systems of care. We will gather critical information regarding systems-level referral data, stakeholder input, model implementation, and model acceptance to understand and optimize uptake within real-world settings. We will also assess clinical outcomes associated with the implementation model to better understand benefits for underserved families. This work will provide a critical test of the potential true impact of tele-assessment on care for toddlers with ASD in underserved, rural settings. If successful, the components of this model could be rapidly disseminated nationally across Part C early intervention programs and, potentially, military early assessment programs.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310460
Entities
People
- Zachary Warren
Organizations
- United States Army
- Vanderbilt University