Distance training improves autism care, shortens diagnosis time

Study shows good results from ECHO Autism – innovative training for doctors in communities without autism specialists 

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Editor’s note: The following is adapted from a press release by the University of Missouri, whose Thompson Center for Autism & Neurodevelopmental Disorders is one of 14 sites in the Autism Speaks Autism Treatment Network (ATN).

In many communities, it can take months to see a specialist who can formally evaluate a child for autism. That wait can delay children’s treatment and prolong anxiety for their families. As the prevalence of autism has increased, so has the demand for healthcare providers who can address autism’s complexity of medical and behavioral issues.

That’s where ECHO Autism comes in.

Extension for Community Healthcare Outcomes (ECHO) Autism is a new distance-learning program that trains primary care providers in best-practice care for autism. The medical journal Clinical Pediatrics recently published the results of a pilot program evaluating Autism ECHO at the University of Missouri.

The study found that primary care doctors participating in the program showed significant improvements in screening and managing autism, including greater confidence and use of appropriate methods and resources.

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"We are very excited about the initial results from the ECHO Autism model," says pediatrician Kristin Sohl, ECHO Autism’s director. "Children with autism can show symptoms as early as 12 months,” she notes. “However, in too many cases children may not receive a diagnosis until they are 5 years old. Early diagnosis is critical for children with autism, and primary care providers play an important role in that initial process."

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Continued evaluation and development of ECHO Autism is being supported and conducted through the Autism Speaks Autism Treatment Network (ATN) in its role as the federally funded Autism Intervention Research Network for Physical Health (AIR-P). This will include an expansion of the program to ten additional ATN sites across the US and Canada, including:

* Arkansas Children’s Hospital, Little Rock

* Children’s Hospital of Philadelphia

* Cincinnati Children’s Medical Center

* University of Pittsburgh Medical Center

* University of Rochester Medical Center

* Lurie Center for Autism, Boston

* Vanderbilt University Medical Center, Nashville

* Nationwide Children’s Hospital, in Columbus, Ohio

* The Center for Autism and Neurodevelopmental Disorders the University of California, Irvine

* Holland Bloorview Kids Rehabilitation Center, Toronto

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Distance learning for doctors
The ECHO model connects primary care providers to academic medical centers using videoconferencing technology. This allows one-on-one training in diagnosis, screening, treatment protocols and care management.

Sanjeev Arora, of the University of New Mexico created the ECHO prototype and demonstrated its effectiveness in improving treatment of hepatitis C in communities far from a major medical center. It has since been adapted to address other complex medical conditions such as rheumatoid arthritis, diabetes and addiction.

The University of Missouri is the first to adapt and test the ECHO model for improving autism care in rural and other underserved communities.

"Currently there are not enough specialists to manage the number of children with autism who need health care," says child psychologist Micah Mazurek, the study’s lead author. "A real need exists to assist community-based health care providers as they help families get the answers they need without traveling or waiting to see a specialist. Preliminary data from the pilot program suggests ECHO Autism can help with that issue."

ECHO Autism clinics use secure video conferencing to connect participating primary care clinics to a panel of experts based at one of the participating ATN centers.

The autism specialists on each panel include a pediatrician, psychologist, psychiatrist, dietician,  social worker and a parent of a child with autism. The primary-care providers consult with the expert panel to build their understanding and skills in working with their patients who have autism.

In evaluating the program, researchers found that participating primary-care providers demonstrated significant improvements in confidence in all aspects of healthcare for children with autism. This included screening and diagnosis for autism, assessment and treatment of associated medical and psychiatric conditions and knowledge of and referral to appropriate resources in their communities.

ECHO Autism is a partnership between the MU Thompson Center for Autism, MU Health and the Missouri Telehealth Network Show-Me ECHO program The program received financial support from the Health Resources and Services Administration of the US Department of Health and Human Services, the Autism Speaks Autism Treatment Network, the Leda J. Sears Charitable Trust and the WellCare Innovation Institute.