Improving Autism Assessment and Follow-Up

July 16, 2024 by Margie Brenner and Janet Essman Franz 

Two adults smiling and looking at a child who is playing with a toy, with red and blue furniture in the background

Jeremiah Dickerson, M.D., (left) and Molly Bumpas, M.Ed., assess children for autism in the Vermont Center for Children, Youth, and Families. (photo: David Seaver)

Over the past several years, child health professionals have increased their practice of screening young children’s development with validated tools in the medical home. As a result, more young children exhibiting early signs of autism are receiving referrals to child development specialists for appropriate assessment and formal diagnosis. Like subspecialists across the nation, providers at UVM Children’s Hospital Developmental Behavioral Pediatrics division and the Vermont Center for Children, Youth, and Families (VCCYF) saw a significant increase in referrals for autism assessment during the past decade, resulting in extremely long wait times.

“As our referrals kept creeping up and up, we struggled to meet the needs of the state of Vermont,” says Jeremiah Dickerson, M.D., assistant professor of psychiatry and director of the VCCYF autism assessment clinic. “There was this lore that pediatricians and family practice providers couldn’t diagnose, so children would get on a list waiting up to 18 months to see us, when in fact someone could have provided at least a provisional diagnosis a lot earlier to get the ball rolling on intervention.” 

To address this need, the pediatric and psychiatry departments collaborated to restructure the autism assessment program at VCCYF. This involved expanding the clinical team, bringing in specialists from different departments, and streamlining the intake process to reduce paperwork and wait times. “It’s now easier and quicker for children to see a specialist, and a better experience for families,” says Elizabeth Forbes, M.D., M.P.H., assistant professor of pediatrics and division chief for developmental and behavioral pediatrics.

In addition, the Vermont Child Health Improvement Program (VCHIP), in partnership with the Vermont Department of Health, launched a statewide-level initiative to improve rates of developmental screening and remove barriers to autism assessment and diagnosis. VCHIP Executive Director Rachel Garfield, Ph.D., and Heidi Schumacher, M.D., principal investigator at VCHIP, lead this effort with Molly Bumpas, M.Ed., speech language pathologist at VCCYF, and Patricia Prelock, Ph.D., CCC-SLP, professor of communication sciences and disorders and professor of pediatrics.

A person posing for a portrait

Rachel Garfield, Ph.D., executive director of the Vermont Child Health Improvement Program. (photo: David Seaver)

Providers in pediatric and family medicine practices now receive coaching, data support, tools, and training to make screening, diagnostic, and treatment decisions with confidence.

“We see children at 18 and 24 months where we conduct a very basic screen for autism. [In the past,] if it’s a positive screening, we would refer away to an outside specialist. Now, we don’t have to refer away and wait for further evaluation,” says Monica Benjamin, D.N.P., M.B.A., M.S.N., FNP-BC, RN, of Porter Pediatric Primary Care in Middlebury. “Learning the assessment tools has been invaluable, and it feels like it will integrate easily into the flow of the office.”  

Bumpas and Dickerson additionally support parents with young children diagnosed with autism and awaiting assessment, offering group learning sessions where families discuss topics such as social communication strategies and home visits with video feedback and problem-solving. “We want to make things easier for parents and ensure that we are getting children into intervention as early as possible because we know that’s what promotes the best outcomes,” says Dickerson.

 

Learn more about the Vermont Center for Children, Youth, and Families.

Learn more about the Vermont Child Health Improvement Program.

A person posing for a portrait

Elizabeth Forbes, M.D., M.P.H., assistant professor of pediatrics and division chief for developmental and behavioral pediatrics.

“Now, we don’t have to refer away and wait for further evaluation. Learning the assessment tools has been invaluable, and it feels like it will integrate easily into the flow of the office.” 

— Monica Benjamin, D.N.P., Porter Pediatric Primary Care in Middlebury, Vt.