spharc grantee call: echo autismdec 15, 2015  · autism 1.57 0.51 echo autism specialists provided...

SPHARC Grantee Call: ECHO Autism

December 15, 2015| 2:00-3:00 PM, ET

Dial for Audio: (888) 450-5996 Passcode: 353323

• Press *6 to mute/unmute your line. Or use your phone’s mute button.

• If you need to step away from the phone, please do not put the call on hold. Hang up and join again.

• Ask questions/make comments throughout the call:

•Use *6 to unmute your line or

•Submit questions/comments the call in the chat box at the lower, right-hand side of your screen.

• This call will be recorded and materials will be shared via email.

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 cfloyd@amchp.org

• 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: sohlk@health.missouri.edu

Micah Mazurek, PhD

Email: mazurekm@missouri.edu

ECHO Autism

Questions?

Thank You!

Please take a moment to send us your feedback: • https://www.surveymonkey.com

/s/SPHARC-Dec2015