Preliminary Evidence for the Integrated Systems Using Telemedicine.

BACKGROUND: Autism affects as many as 1 in 68 children in the United States. Early identification and access to intervention services promote improved outcomes for children with autism and other developmental delays. Children living in rural and underserved areas have limited access to such services and are diagnosed later than those living more suburban and urban areas. Our Integrated Systems Using Telemedicine (ISUT) Model uses a cost-effective method for families to access diagnostic and other specialty care through telemedicine. This model links families, trained early intervention providers and educators, and university-based medical professionals. MATERIALS AND METHODS: We trained autism diagnostic teams throughout the state who completed diagnostic measures and connected to university medical center teams for final diagnosis of autism and coexisting conditions. We gathered preliminary data to measure the impact of the ISUT model on access to services, potential cost savings for families, and parent satisfaction with the model. RESULTS: Preliminary data indicate that our ISUT model provided families in rural and underserved areas improved access to diagnostic services as well as cost savings for travel. Our satisfaction data indicate that parents are equally satisfied with services received through the ISUT and through the University-Based Medical Center Team Model. CONCLUSIONS: The ISUT model provides a unique collaboration among the family, educational system, autism experts in the community, and the university medical center autism team while providing a cost-effective means for families to access specialty care while promoting coordination of care within the community.

Evaluating interactive videoconferencing for assessing symptoms of autism.

BACKGROUND: Autism affects as many as 1 in 88 children. Best practices recommend early identification and intervention for optimal outcomes. Currently, a gap exists between time of first concern and diagnosis, particularly for families living in rural areas. Telemedicine as a tool for assessment and diagnosis of autism is one way to address this disparity. Emerging evidence suggests telemedicine as a viable option for assessing children with a variety of special needs. MATERIALS AND METHODS: This study expands upon the current literature by investigating clinicians' ability to assess autism via telemedicine. Using interactive videoconferencing, we simulated autism assessment procedures with families with an existing diagnosis (autism or developmental disability) using current gold-standard assessment tools. We compared diagnostic accuracy, item-by-item reliability on the Autism Diagnostic Observation Schedule (ADOS)-Module 1, and the Autism Diagnostic Interview-Revised (ADI-R) as well as parent satisfaction in an in-person and interactive videoconferencing condition. Ten children (3-5 years old) with developmental delays and 11 children matched on chronological age with a diagnosis of autism were assigned to be assessed and interviewed either in-person or over videoconferencing. Clinicians observed both in-person and through videoconferencing regardless of patient assignment. RESULTS: Results indicated no significant difference in reliability of diagnostic accuracy, ADOS observations, ratings for ADI-R parent report of symptoms, and parent satisfaction between conditions. Results indicate adequate clinician agreement and parent satisfaction regardless of observational condition. CONCLUSIONS: Future research should include a larger sample size and assess children without an existing diagnosis.

A Pilot Study on Professional Documentation: Do We Write From a Strengths Perspective?

PURPOSE: There is growing evidence supporting the use of strengths-based practices when serving families. The purpose of this study was to examine the use of strengths-based approaches in the context of written professional documentation. We specifically explored whether or not interdisciplinary clinicians in one university-based medical center clinic write from a strengths perspective (e.g., writing focuses on abilities rather than on deficits) when documenting child behavior in autism diagnostic clinics. METHOD: We gathered narrative-based writing samples (a total of 299 phrases) from 20 patient reports. Using a coding system developed by the research team (intraclass correlation coefficient = .801 on final definitions and coding system), we analyzed the extent to which interdisciplinary clinicians included strengths-based language (e.g., language that emphasizes a person's strengths rather than limitations) in their written documentation. An independent researcher coded a random sample (20% of entire sample) of the data to document reliability of the coded data (97% interrater agreement). RESULTS: Our findings indicated that clinicians in our study used deficit-based language significantly more than neutral and strengths-based language in written documentation. CONCLUSION: This preliminary evidence suggests a need to reflect upon our own understanding of strengths-based practices and the way professionals write about children in clinical documentation.