Your ATN@Work: Increasing Autism Expertise among Primary Care Doctors

From Autism Speaks, Dec. 16, 2014

By Thompson Center Medical Director Kristin Sohl

“It takes a village” is a phrase often used when discussing how we raise our children. I find it particularly apt when it comes to providing medical care for children with autism. Unfortunately, our “village” needs to expand.

The period from birth to 5 years old is such a crucial time for development and learning. Fortunately, most children see their primary care doctor more regularly during this early period than at any subsequent time in their life. For good reason, many parents – including myself – rely on our pediatrician’s knowledge to ensure our young children’s healthy development.

But did you know that most pediatricians spend less than a month of their residency learning about developmental disorders such as autism? That family practitioners spend even less time than that?

No wonder many primary care doctors feel a lack of confidence when it comes to caring for children with autism. In fact, autism can cloud the way a healthcare provider views the child’s other medical issues and behaviors.

An ear infection may be missed because the related fussiness gets attributed to “problem behavior.” Poor sleep habits that could have been improved with a few sleep-hygiene tips are instead diagnosed as “intractable insomnia” requiring referral to a sleep specialist.

A need for doctor training
Too often, we see general practitioners refer straight-forward medical issues to an autism specialist because they lack the confidence to work with children who have autism. If we can help them gain this confidence, then autism specialists can spend more time managing the complex autism-related issues that truly need our expertise. That, in turn, can increase access and reduce waiting time at autism specialty centers such as those in the ATN.

The ATN steps in
Through the Autism Speaks ATN, we’re doing just that. All our centers are working in various ways to learn about the needs of primary care providers in our communities and help them better serve their patients with autism.

At our center in Missouri, we’re building the nation’s first ECHO-Autism.

ECHO stands for Enhancing Community Healthcare Outcomes. It’s an innovative approach for training primary care providers to deliver specialty care, pioneered at the University of New Mexico. Its goal is to “revolutionize medical education” and work with general practitioners to “provide best-practice specialty care and reduce health disparities.”

The heart of the ECHO model is to provide knowledge-sharing networks led by teams of medical experts who use videoconferencing to conduct virtual training clinics with community providers. (Learn more about Project ECHO Program here.)

Introducing ECHO-Autism
Through our ECHO-Autism program, primary care providers in Missouri will be able to connect to an expert “hub” of autism experts for two-hour training sessions every other week. Participants will discuss their cases and learn from each other and our team of experts. They get help handing these cases with short lectures on key topics. These will focus on important aspects of “whole-person” care for the child with autism. These topics will include evaluation and treatment of autism-related health issues such as constipation, sleep problems and possible side effects of behavioral medications.

This type of case-based learning provides practitioners with an ongoing opportunity to develop their skills and meet our community’s needs. It goes beyond teaching providers how to provide better care. It goes back to building that village.

We are excited to announce that we will be piloting ECHO-Autism from March through August of 2015. We’ll be receiving support from the Autism Speaks ATN, in its role as the federally funded Autism Intervention Network on Physical Health (AIR-P). We’re also receiving funding through Missouri Care, our state’s Medicaid program.

Many primary care physicians have already expressed interest in participating. And we’ve not yet begun formal recruiting!

A stronger village, a brighter future

Through virtual technology and adult learning science, ECHO Autism can help demystify autism for our primary care providers. It will give them the expertise and strategies they need to serve our growing autism community.

Primary care doctors and nurses are the heart and foundation of pediatric medical care. It’s time we start empowering them to take care of children with autism and other complex neurodevelopmental disorders. When our general practitioners feel confident in screening for autism and caring for children affected by it, we’ll see our medical village meet the needs of our children.