420 - Primary Care Training for the Evaluation of Toddlers at High-Risk for ASD with the RITA-T

Poster Number: 420
Publication Number: 420.485

Background: In many areas in the US, the wait times for an ASD evaluation is more than 12 months for a toddler with concerns for this disorder. The RITA-T (Rapid Interactive Screening Test for Autism in Toddlers) is an interactive and observational tool that has consistent ASD risk cut off scores for those ages 18-36 months, such as a score >16 is substantial risk for ASD.

Objective: Develop a primary care training program for the evaluation of toddlers at risk for ASD that integrates the RITA-T.

Design/Methods: Over two years, twelve primary care providers, MD and NP, participated in this training. They came from community health centers, a private practice, and an academically based clinic. Training included monthly meetings with shared material and resources to review. We started by training the group reliably on the RITA-T and set up screening systems in their practices. Toddlers evaluated with a score >16 were further diagnosed for ASD by this group in their practices, whereas those with scores < 16 were referred to ASD specialists. One practice partnered with their Early Intervention (EI) program who completed the RITA-T for them and referred to them those with a score >16. Over the first 6 months of training, we reviewed the behavioral observations for ASD, setting up clinics for evaluations, the Childhood Autism Rating Scale (CARS-2ST), and the DSM-5 interview. We reviewed report writing, recommendations for services, scheduling templates, and billing. Over the next 6-18 months, we observed evaluations, discussed presentations and results. We sought feedback from providers and from families diagnosed through this model.

Results: 97 toddlers received the RITA-T by this primary care group, not including those screened by the EI program partnering with one practice. A total of 85 toddlers from all those screened, met criteria for primary care ASD diagnostic evaluation. They were evaluated on average within 3 months of initial concerns, and all received a diagnosis of ASD. Providers reported challenges with changing their clinic templates, as well as initial difficulties with using the CARS-2ST. Parents expressed satisfaction with this process being within their medical home. They felt there was continuity of care, however, they expressed further need for support after a diagnosis and more knowledge about resources in their areas.

Conclusion(s): This primary care training model including the RITA-T can be integrated within the medical home and supports partnerships with local EI programs. Further support on resource identification and increased access to training on the CARS-2ST are needed.