Arash Salavitabar, Erin Paul, Anna Hays, Joe Grillo, Uchechi Azubuine, Lacy-Ann Landell, Daniel Stephens, Kristal Woldu, Michael Goldman, Emily Whitesel, Lindsay

McGann, Lisa Lavikoff Kurz, Robbie Majzner, Lisa McReynolds, Rakhee Bowker Annika Hofstetter, Laura Robbins-Milne, Heidi Beutler, John Rausch, Mariellen

Lane, Nan Salamon, Renie EisCeila Mendez, Blanca Cordero, Reyna, Felipe Joaquin

Evelyn Reyes, Iriada Torres, Kenya Rittenburg, Carlos Sepulveda , Tene Jones, Conchita Laurencio

Haydee Bayon, Becky, Sally Ortiz

Autism ScreeningBroadway Clinic

QI project 2011-2012

AIM StatementBroadway Clinic aims to implement

standardized autism spectrum disorder screening using the Modified Checklist for Autism in Toddlers (M-CHAT) for at least 50% of patients at their 18 and 24 month visits.

Developmental Surveillance“Early Identification of developmental

disorders is critical to the well-being of children and their families” - AAP

Missed Opportunities:Estimated 12-16% of children <3 years have

delays, yet EI serves only ~2%CDC estimate only 50% children with

development/behavioral disability are identified prior to entering school

Neurodevelopmental disability appearing before age 3

Prevalence 1 in 150Difficulties in:

Verbal and Non-verbal communication

Social InteractionsPlay Activities

Autism Screening

AAP RecommendationsInformal Developmental Surveillance at

all well child visitsFormal developmental screening at 9, 18

and 24 monthsStandardized autism screening at 18 and

24 months, or with any parental concern

M-CHAT• No one tool has been shown to identify all

children:• Denver, the PEDS, Ages and Stages

Questionnaire• Why the M-CHAT?

• Accessible: Translated into 20+ languages• Easy to Use• Validated in primary care settings

• Sensitivity 0.85, Specificity 0.93• FREE!

Process:• The M-CHAT questionnaires will be distributed

by the MAs, reviewed and scored during the patient encounter. The baseline rate of standardized autism screening is 0%. Our aim will be to achieve a 50% completion rate.

• Outcome measures include a percent change in both early intervention and audiology referrals.

Baseline Development Screening

Developmental Screening

Language Screening

17-20 mo 40/40 37/40

100% 92.5%

22-30 mo 39/40 37/40

97.5% 92.5%

PDSA CyclesPDSA Cycle 1: Is the M-CHAT Doable?

Provider Based Intervention to determine feasibility Found parents able to complete Found providers able to grade

Transparencies English and Spanish

PDSA Cycle 2: Can the M-CHAT be done as a pre-Screening?Incorporate the MAs3 cycles

Rate of M-CHAT Distribution

Block 8 Block 9 Block 100

5

10

15

20

25

30

35

40

M-CHAT Distribution

M-CHAT Distribution

Final Data

% Patients Language

Delay

% Total EI referrals

% New EI Referrals

% New Audiology Referrals

0

5

10

15

20

25

Pre-Intervention

% Patients with language delay

with new or pre-existing EI referral

0

20

40

60

80

100

Conclusion: Lessons LearnedAutism Screening and the M-CHAT:

FeasibleSurvey of providers:

Doesn’t increase provider time Easy to interpret

Sustainable? Is this something to continue?Doesn’t appear to increase our rates of EI referral

Spread:Have M-CHAT available to be usedMCHAT transparency in English and Spanish in

exam rooms

Other interventions at BroadwayDevelopment Guide!

Outpatient handbookCommunity Peds Website

EI form now available on Eclipsys in EZVAC!

Thank YouBroadway Clinic!

Mariellen LaneLaura Robbins-Milne Celia, Reyna, Blanca, Felipe

References Management of Children with Autism Spectrum Disorders. AAP. Pediatrics. 2007; 120: 1162-

1182 Identifying infants and young children with developmental disorders in the medical home: an

algorithm for developmental surveillance and screening. AAP. Pediatrics. 2006; 118: 405-420. Robins et al. M-Chat: an initial investigation in the early detection of autism and PDD. J Autism

Dev Disord. 2001; 31: 131-144. Pinto-Martin et al. Screening strategies for autism spectrum disorders in pediatric primary care.

J Dev Behav Pediatr. 2008. 29: 345-350 Glascoe et al. Can a broadband developmental-behavioral screening test identify children likely

to have ASD? Clin Pediatr (Phila). 2007. 46: 801-5. Screening for ASD in primary care settings. Robins DL. Autism. 12: 537-56. The M-CHAT: a follow-up study investigating the early detection of ASDs. Kleinman et al. J

Autism Dev Disord. 2008. 38: 827-39. Early screening for ASDs: update on the M-CHAT and other measures. J Dev Behav Pediatr.

Robins DL. And Dumont-Mathieu TM. 2006 27 S111-9. Guidelines for Early Identification, Screening and Clinical Management of Children with ASDs.

Greenspan et al. 2008. Pediatrics. 121: 828-831. Early Autism Detection: Are we ready for routine screening? Al-Qabandi et al. Pediatrics. 128

e211-17. The Each Child Study: systematic screening for ASDs in a pediatric setting, Miller et al, 2011.

Pediatrics. 127: 866-71. Identification and Evaluation of Children with Autism Spectrum Disorders. Johnson et al.

Pediatrics. 2007. 120: 1183-1215. Developmental Surveillance and Screening of Infants and Young Children Committee on Children with Disabilities.

AAP. Pediatrics 2001; 108: 192-196 Developmental Screening in Early Childhood Systems. Summary Report. AAP. Healthy Child

Care America. March 2009