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| Title and abstract |
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| Title | Evaluation of Clinician Training in Autism Screening, Care Management, and Patient Education | |||
| Abstract | Objective: The demand for pediatric developmental evaluations has far exceeded the workforce available to perform them, which creates long significant wait times for services. A year-long clinician training using the Extension for Community Healthcare Outcomes (ECHO®) model with monthly meetings was conducted and evaluated for its impact on primary care clinicians’ self-reported self-efficacy, ability to administer autism screening and counsel families, professional fulfillment, and burnout. Methods: Participants represented six community health centers and a hospital-based practice. Data collection was informed by participant feedback and the Normalization Process Theory via online surveys and focus groups/interviews. Twelve virtual monthly trainings were delivered between November 2020 and October 2021. Results: 30 clinicians participated in data collection. Matched analyses (n = 9) indicated statistically significant increase in self-rated ability to counsel families about autism (Pre-test Mean = 3.00, Post-test Mean = 3.89, p = 0.0313), manage autistic patients’ care (Pre-test Mean = 2.56, Post-test Mean = 4.11, p = 0.0078), empathy toward patients (Pre-test Mean = 2.11, Post-test Mean = 1.22, p = 0.0156) and colleagues (Pre-test Mean = 2.33, Post-test Mean = 1.22, respectively, p = 0.0391). Unmatched analysis revealed increases in participants confident about educating patients about autism (70.59%, post-test n = 12 vs. 3.33%, pre-test n = 1, p = 0.0019). Focus groups found increased confidence in using the term “autism”. Conclusion: Participants reported increases in ability and confidence to care for autistic patients, as well as empathy toward patients and colleagues. Future research should explore long-term outcomes in participants’ knowledge retention, confidence in practice, and improvements to autism evaluations and care. | |||
| Introduction |
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| Problem formation | There is currently a lack of available developmental services to care for autistic patients. Wait times for developmental evaluations and services are long, which could be a detriment to patients as early autism-related support is the key to positive outcomes. | |||
| Purpose or research question | The current evaluation aims to assess the effectiveness of a virtual clinician training program in building capacity of clinicians in administering autism screenings and managing care of autistic patients, including patient counseling and education. | |||
| Methods |
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| Qualitative approach and research paradigm | Focus group and interview guide was developed informed by survey findings and the Normalization Process Theory (NPT) framework due to its focus on practice change and its mechanisms [27] . Transcripts were coded using a deductive approach. | |||
| Researcher characteristics and reflexivity | JG and BO facilitated focus groups and interviews. JG is clinical associate professor with over 15 years of experience in mixed methods research and evaluation. BO is a junior research scientist with three years of experience in qualitative research. | |||
| Context | Focus groups and interviews were conducted virtually using the Zoom teleconferencing software and in-person based on participants’ availability. | |||
| Sampling strategy | A convenience approach was used to recruit participants who attended trainings. | |||
| Ethical issues pertaining to human subjects | The evaluation procedures were reviewed and approved as exempt by the Boston University Medical Campus and Boston Medical Center Institutional Review Board (IRB H-40718). Focus group and interview sessions started with a review of consent and participants had the opportunity to ask questions throughout the session. | |||
| Data collection methods | Focus groups and interviews were audio recorded and field notes were taken. | |||
| Data collection instruments and technologies | JG and BO developed the focus group guide using information from survey findings and the NPT framework [27] . Focus group guide was not pilot tested. However, questions in each focus group may be revised based on participant responses. | |||
| Units of study | We conducted two focus groups (n = 4, n = 2) and four interviews in March 2022. Questions were organized using the NPT framework [27] to gather context about participants’ changes in self-reported ability and confidence in administering autism screenings and care. | |||
| Data processing | Audio recordings were transcribed and verified for accuracy by two different research assistants. | |||
| Data analysis | NPT framework [27] constructs were used as codes and deductively applied to transcripts. | |||
| Techniques to enhance trustworthiness | Each transcript was double coded by two authors. Three authors met to review and discuss the coding until a consensus was reached. The third author who did not initially coded the transcript served as a tiebreaker if needed. | |||
| Results/findings |
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| Synthesis and interpretation | Participants provided context about their interests and motivation in learning more about autism screening and care management. They also shared about the benefits of participating in the training such as increased confidence in discussing autism with patients and their families. However, larger structural barriers (e.g., lack of available long-term services, difficulties with external entities such as insurance) to care persisted, which could not be fully addressed by clinician trainings. | |||
| Links to empirical data | Coherence: “Being able to think and understand how pediatricians approach a patient, as well as the concerns and challenges they face in thinking from that behavioral health lens…. What could we do? What could we hold with them so they’re not holding it alone?” Cognitive participation: “… Better able to talk about like what’s available in the moment… For instance, Early Intervention for the younger kids or school and getting them set up at schools, and then again like the ABA for afterwards.” Collective action: “There’s talk at the clinic of expanding the training for other providers including the pediatricians themselves to become more skilled with the RITA-T and the CARS…” Reflexive working: “… It’s always nice to hear about things run differently in different clinics, because you start to realize well, maybe we could be more efficient in this way.” | |||
| Discussion |
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| Integration with prior work, implications, transferability, and contribution(s) to the field | Similar to research on other autism-focused trainings using the ECHO model, participants reported increases in self-reported ability to screen and care for autistic patients. Knowledge and skills gained from the training could result in faster autism diagnosis. However, other system-level improvements are needed to address remaining barriers to care. | |||
| Limitations | There was no comparison group and participants self-selected to participate in the trainings. It is unclear if our findings would be transferrable to clinicians who were invited but opted not to participate in the training. | |||
| Other |
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| Conflicts of Interest | The authors declare that they have no competing interests. | |||
| Funding | This evaluation was supported by the Deborah Munroe Noonan Memorial Research Fund. | |||
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