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O’Hagan B, Augustyn M, Amgott R, White J, Hardesty I, Bangham C, Ursitti A, Foster S, Chandler A, Greece J. Using normalization process theory to inform practice: evaluation of a virtual autism training for clinicians. FRONTIERS IN HEALTH SERVICES 2023; 3:1242908. [PMID: 38192729 PMCID: PMC10773704 DOI: 10.3389/frhs.2023.1242908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
Background There is growing demand for developmental and behavioral pediatric services including autism evaluation and care management. Clinician trainings have been found to result in an increase of knowledge and attitudes. This study utilizes Normalization Process theory (NPT) to evaluate a clinician training program and its effects on practice. Methods The year-long virtual training program about autism screening and care management included didactic portions and case presentations. Focus groups and interviews were conducted with primary care clinicians (n = 10) from community health centers (n = 6) across an urban area five months post-training. Transcripts were deductively coded using NPT to uncover barriers to implementation of autism screening and care, benefits of the training program, and areas for future training. Results Participants were motivated by the benefits of expanding and improving support for autistic patients but noted this effort requires effective collaboration within a complex network of care providers including clinicians, insurance agencies, and therapy providers. Although there were support that participants could provide to families there were still barriers including availability of behavior therapy and insufficient staffing. Overall, participants positively viewed the training and reported implementing new strategies into practice. Conclusion Despite the small sample size, application of NPT allowed for assessment of both training delivery and implementation of strategies, and identification of recommendations for future training and practice sustainability. Follow-up focus groups explored participants' practice five months post-program. Variations in participants' baseline experience and context at follow-up to enable application of skills should be considered when using NPT to evaluate clinician trainings.
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Affiliation(s)
- Belinda O’Hagan
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Marilyn Augustyn
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Rachel Amgott
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Julie White
- Center for Continuing Education, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Ilana Hardesty
- Center for Continuing Education, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Candice Bangham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Amy Ursitti
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Sarah Foster
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Alana Chandler
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Jacey Greece
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
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Micheletti M, Brukilacchio BH, Hooper-Boyle H, Basiru T, Brinster MI, Ravenscroft S, Shahidullah JD. Evaluating the Efficiency and Equity of Autism Diagnoses via Telehealth During COVID-19. J Autism Dev Disord 2023:10.1007/s10803-023-05986-9. [PMID: 37074489 PMCID: PMC10115372 DOI: 10.1007/s10803-023-05986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
Given existing barriers to a timely autism diagnosis, this study compares the efficiency and equity of diagnoses conducted in-person vs. telehealth in a developmental behavioral pediatrics setting. The transition to telehealth was prompted by the COVID-19 pandemic. Eleven months of clinic data in electronic medical records were retrospectively analyzed for children diagnosed with autism in-person (N = 71) vs. telehealth (N = 45). Time to autism diagnosis, patient demographics, and deferred diagnoses did not significantly differ across visit types. However, privately insured patients and families living farther from the clinic had a longer time to diagnosis via telehealth vs. in-person. Results of this exploratory study highlight the feasibility of telehealth evaluations for autism and which families may benefit from additional support to ensure a timely diagnosis.
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Affiliation(s)
- Megan Micheletti
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Briana H Brukilacchio
- Lurie Center for Autism, Massachusetts General Hospital, Harvard Medical School, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Haley Hooper-Boyle
- Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX, 78723, USA
| | - Tajudeen Basiru
- Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX, 78723, USA
| | - Meredith I Brinster
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Health Discovery Building, 1601 Trinity St., Bldg B, Z0600, Austin, TX, 78712, USA
| | - Sheri Ravenscroft
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX, 78723, USA
| | - Jeffrey D Shahidullah
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Health Discovery Building, 1601 Trinity St., Bldg B, Z0600, Austin, TX, 78712, USA.
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