Developmental Screening of Refugees: A Qualitative Study

A Secret Shopper Study of Language Accessibility of Community-based Behavioral Health Services for Children in Families Who Speak Spanish and English

OBJECTIVE

To compare outpatient behavioral health scheduling for children in Spanish-speaking families in Pennsylvania with that for children in families who speak English.

STUDY DESIGN

We made paired English and Spanish telephone calls to outpatient behavioral health facilities using a standardized script, describing a simulated, stable, Medicaid-insured child. Facilities were identified using the Pennsylvania Department of Human Services Online Provider Directory for Mental Health and Substance Abuse Services, which had 288 outpatient facilities with non-duplicate telephone numbers. An English-language caller following a script made up to two call attempts per facility from December 2019 through February 2020. The 126 facilities that did not answer the phone, accept Medicaid, or see children were removed. A Spanish-language caller then made up to two scripted call attempts to the 162 remaining facilities. The primary outcome was whether the facility tried to schedule an appointment for the simulated adolescent.

RESULTS

125 facilities answered both English- and Spanish-language calls. For the English-language caller, 71% of facilities attempted to schedule an appointment and 100% communicated in the caller's preferred language. For the Spanish-language caller, 24% attempted to schedule an appointment (P<0.001) and 25% communicated in the caller's preferred language (P<0.001).

CONCLUSIONS

Among outpatient behavioral health facilities for Medicaid-insured children in Pennsylvania, there were inequities in access to appointments for families who speak Spanish compared with English. This a modifiable barrier to care. Community-based behavioral health care for children should strengthen language access training, contracting, and oversight.

Caregiver Experience with Bicultural, Bilingual Family Navigators to Support Early Childhood Development

Recognizing the inequities in developmental screening and services for children in immigrant families, a pediatric primary care clinic in partnership with a community-based early childhood program co-created a bicultural, bilingual early childhood developmental (ECD) family navigator program in Seattle, Washington. The primary aim of this study is to explore caregivers' perspectives about this program. Twenty-seven caregivers of young children participated in semi-structured interviews that were thematically analyzed. Three key themes were identified: 1) sharing language and culture, 2) facilitating accessibility, and 3) promoting development. Caregivers valued linguistic and cultural concordance between the navigator and the family, the navigator's approach to screening to improve accessibility and reduce barriers, and the focus on supporting early childhood development. Understanding caregivers' experience with the ECD family navigator development program and the aspects they value, informs clinic-based approaches to ensure families of diverse language and cultural backgrounds have accessible development screening and connection to services.

Providing Compassionate, Evidence-Based Care for Refugee, Immigrant, and Migrant Children

Immigrant children experience diverse migration paths to the United States facing unique challenges that impact their health and well-being. This article provides an overview of the pathways to health care and physical, mental, and behavioral health considerations for refugee and immigrant children. Health equity and cultural humility frameworks are reviewed. Approach to care guidance and clinical pearls are provided for the initial medical assessment in addition to medical screening, mental health, education, and developmental health. The importance of health literacy and advocacy are highlighted, emphasizing their ability to address health inequities and improve care.

Exploring Mental Health and Development in Refugee Children Through Systematic Play Assessment

To evaluate a standardized play observation as a measure of young children's mental health and development in a clinical and refugee population. We conducted individual play observations with 70 refugee children aged 3- to 6-years and compared them to a clinical group of 111 age-matched children regarding their level of play development, social interaction during play, traumatic re-enactments, and emotionless-cold play. Additionally, we assessed children's mental health, social-emotional development and markers of adversity by parent and educator report as well as their IQ-test scores and learning performance and related these factors to the play variables. Play variables were significantly correlated with IQ-test scores (r = 0.184, p = 0.037), learning performance (r = 0.208, p = 0.010) and vocabulary (r = 0.208, p = 0.021) in the comparison group and with social-emotional development in educator report (r = 0.368, p = 0.011), time spent in Germany (r = 0.342, p < 0.001) and parental distress (r = - 0.292, p = 0.034) in the refugee group. Children with more parent-reported adverse experiences showed less social-interactive play in the overall sample (r = - 0.178, p = 0.011). Our child-centered approach to standardized play observation augments information obtained from parent and educator reports and can provide valuable insights in subgroups where other commonly used tests are not available or applicable.

Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities

Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identification may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identification of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identified. The goal is to recommend models that are culturally appropriate and scientifically valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identification of ASD. Starting locally by simplifying and demystifying the ASD identification process and building community connections will inform global researchers and policymakers while making a difference in the lives of the children and families affected by ASD.

Infant Saliva Levels of microRNA miR-151a-3p Are Associated with Risk for Neurodevelopmental Delay

Prompt recognition of neurodevelopmental delay is critical for optimizing developmental trajectories. Currently, this is achieved with caregiver questionnaires whose sensitivity and specificity can be limited by socioeconomic and cultural factors. This prospective study of 121 term infants tested the hypothesis that microRNA measurement could aid early recognition of infants at risk for neurodevelopmental delay. Levels of four salivary microRNAs implicated in childhood autism (miR-125a-5p, miR-148a-5p, miR-151a-3p, miR-28-3p) were measured at 6 months of age, and compared between infants who displayed risk for neurodevelopmental delay at 18 months (n = 20) and peers with typical development (n = 101), based on clinical evaluation aided by the Survey of Wellbeing in Young Children (SWYC). Accuracy of microRNAs for predicting neurodevelopmental concerns at 18 months was compared to the clinical standard (9-month SWYC). Infants with neurodevelopmental concerns at 18 months displayed higher levels of miR-125a-5p (d = 0.30, p = 0.018, adj p = 0.049), miR-151a-3p (d = 0.30, p = 0.017, adj p = 0.048), and miR-28-3p (d = 0.31, p = 0.014, adj p = 0.048). Levels of miR-151a-3p were associated with an 18-month SWYC score (R = -0.19, p = 0.021) and probability of neurodevelopmental delay at 18 months (OR = 1.91, 95% CI, 1.14-3.19). Salivary levels of miR-151a-3p enhanced predictive accuracy for future neurodevelopmental delay (p = 0.010, X² = 6.71, AUC = 0.71) compared to the 9-month SWYC score alone (OR = 0.56, 95% CI, 0.20-1.58, AUC = 0.567). This pilot study provides evidence that miR-151a-3p may aid the identification of infants at risk for neurodevelopmental delay. External validation of these findings is necessary.

Communication between parents and neonatal healthcare professionals using pictorial support when language barriers exist – parents’ experiences

Purpose

Method

Results

Conclusion

A Whole-child, whole-family approach to health assessments for asylum-seeking children

In 2020, 21% of people who sought asylum in the UK were children. This population has complex interconnecting health and social needs. Assessment requires a holistic approach, with consideration of physical and mental health in addition to social and developmental well-being, within the whole family group. A trauma-informed life-cycle and intergenerational care approach is important. This article, aimed at all health professionals who may work with asylum-seeking families, outlines the best practice principles for undertaking health assessments in migrant children and young people.

Description of a migrant pediatric population visiting the Toulouse Children's Hospital emergency department

BACKGROUND

Today, one in eight migrants and one in two refugees are children. Since this population has been less studied than the adult population, there is little data available on the state of health of this pediatric migrant population and the reasons they seek care.

OBJECTIVE

The objective of this study was to describe the sociodemographic and medical characteristics of a pediatric migrant population visiting an emergency department in order to better understand their specific needs.

MATERIALS AND METHODS

This was a retrospective observational study using data from medical records and social surveys of migrant children who had visited the Toulouse pediatric emergency department between 1 January 2018 and 31 December 2018.

RESULTS

A total of 203 migrant children, i.e., 344 emergency visits, were analyzed. The average age of the children was 3.3 years old. More than half (58.1%) of the children were from Eastern Europe; 71% visited due to infectious pathologies. The severity of the reasons for visiting (90% of the reasons for visiting had a CCMU (Clinical Classification of Emergency Patients) of 1 or 2) and the hospitalization rate (9%) were not higher in the pediatric migrant population than in the general pediatric population. We discovered associated diagnoses (e.g., scabies, anemia, oral and dental disorders) in connection with migration and/or the resulting vulnerability. There was a language barrier in 78% of the visits analyzed with underuse of professional interpreting (7%).

CONCLUSION

Because of the journey they make, migrant children are likely to have specific health needs and require dedicated care.

Health and service use of newcomers and other adults with intellectual and developmental disabilities: A population-based study

BACKGROUND

This study examines newcomers with intellectual and developmental disabilities compared to other adults with intellectual and developmental disabilities in Ontario, Canada.

METHODS

This population-based retrospective cohort study used linked health and social services administrative data to identify adults with intellectual and developmental disabilities as newcomers, or non-newcomers, and compared their health status and health service outcomes.

RESULTS

Among those with intellectual and developmental disabilities, compared to non-newcomers, newcomers generally had lower or similar rates of health issues, except for higher rates of psychosis. Newcomers also had slightly greater use of community-based health services, but less hospital use.

CONCLUSION

Trends among those with the intellectual and developmental disabilities were consistent with general population trends; newcomers had lower rates of many health issues and lower hospital use. It also underscores the value of understanding drivers of heterogeneity within newcomers, such as the circumstances of admission and settlement in their new country.

Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children

BACKGROUND

Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews.

METHODS

Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach.

RESULTS

Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources.

CONCLUSION

This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers.

Beyond Developmental Supports for a Child Refugee

Zahid is a 10-year-old boy who moved to the United States 18 months ago with his parents and 3 younger siblings. He and his family are refugees from Syria. Zahid was born in Syria after an uncomplicated pregnancy and delivery. Zahid's parents first became concerned about Zahid's development when he was 9 months old because he had not started cooing or babbling and did not respond to his name. At 3 years, a doctor in Syria expressed concern that Zahid may have autism spectrum disorder; however, his parents did not know what symptoms triggered the concern and believed his behavior was because of his ongoing exposure to trauma.Zahid underwent a full evaluation 1 year ago in the United States and was found to meet the criteria for autism spectrum disorder. Coaching was provided to his parents in obtaining appropriate educational support for their son, and a referral was placed for applied behavior analysis (ABA) to be provided by an organization in the community. After several meetings between the parents and school administration, an Individualized Education Program was initiated. Despite acceptance into a community-based ABA program, Zahid has not begun the intervention because of transportation difficulties. In-home ABA was offered but was refused by the family.The family is under significant stress. Zahid is nonverbal and has displayed behaviors affecting safety, including wandering/eloping and turning on kitchen appliances resulting in a kitchen fire. Zahid's mother completed high school, and his father completed sixth grade. Both parents speak limited English, and neither is employed. The family receives financial support through the government, but this will be ending soon. Zahid's father is concerned that employment outside of the home will further limit his ability to transport Zahid to necessary appointments. Zahid's mother does not drive. Zahid's father requests that the physician provide a letter requesting exemption from requirements to participate in work or training programs because of Zahid's needs. How would you respond to this overwhelmed father?

Lead Exposure in Newly Resettled Pediatric Refugees in Syracuse, NY

Lead is a major environmental toxin that presents numerous health consequences for children. Refugee children are at a risk of lead poisoning post-resettlement due to urban housing and environmental inequalities stemming from lack of funding, legislation, and advocacy. This article addresses lead exposure upon arrival and post-resettlement in 705 refugee children (age 0-16 years) attending a university clinic in Syracuse, NY, a city with a large refugee population. 17% of the newly arrived children had elevated blood lead levels (BLLs) (≥ 5 µg/dL); 10% had elevated BLL upon follow-up; 8.3% of the children's follow-up elevated BLL were new exposures. 30% were found to have increased BLL at follow-up regardless of arrival status. An analysis of new exposures found a significant proportion of children would have been missed on routine screening that targets children < 2 years old. Primary prevention efforts are needed to prevent exposure and address risks to improve the health of all children locally, including newly resettled refugees.

Management of mental health conditions in refugee youth: An overview for the psychiatric-mental health nurse practitioner

TOPIC

In 2017, there were a total of 70 million forcibly displaced individuals or refugees, worldwide. Unfortunately, over 50% of refugees are under the age of 18 years. Refugee youth are at-risk for a variety of mental health conditions.

PURPOSE

The purpose of this report is to provide psychiatric-mental health nurse practitioners (PMHNPs) with an understanding of unique cultural implications in refugee youth, risk factors towards the development of psychiatric illness, and means to identify those at-risk for sequelae or those meeting diagnostic criteria. Also presented are foundational treatment and management implications to ensure the provision of culturally sensitive and efficacious care to this unique population.

SOURCES USED

Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications pertaining to mental health issues in refugee youth spanning from 2013 to present. Reference lists of identified articles were also searched.

CONCLUSIONS

A variety of risk and protective factors are discussed, spanning from premigration, during flight, and postsettling periods. PMHNPs must be proficient in screening and diagnosis of mental health conditions in refugee youth and implementation of pharmacological and psychotherapeutic interventions. PMHNPs must also be well versed in community-based resources that can be utilized to promote optimal outcomes.

Providing Care for Children in Immigrant Families

Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non-US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and well-being, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and system-level support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF.

Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments

Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.

Health Considerations for Immigrant and Refugee Children

Immigrant and refugee children are at increased risk for physical, developmental, and behavioral health challenges. This article provides an overview of physical, developmental, and behavioral health considerations for immigrant and refugee children within an ecological framework that highlights family, community, and sociocultural influences. Experiences and exposures relevant to immigrant and refugee children are discussed. Clinical pearls are provided for topics of chronic disease, nutrition, infectious disease, developmental screening, and mental health assessment. Interdisciplinary and community partnerships are emphasized as a means to decrease barriers to care and facilitate family navigation of complex social, educational, and health care systems.

Clinical Tools Working at Home with Immigrants and Refugees

At a time of evolving demographics and turbulent policy changes, pediatric providers have a critical role in the care of all children, regardless of where the child or parent was born. Pediatric providers can facilitate access to high-quality care and critical community-based resources for immigrant children and families. In this article, we delineate the primary domains for clinical care and offer clinical tools to achieve the provision of accessible, comprehensive, high-quality care within a family-centered medical home.

Using the Children with Special Health Care Needs Screener with Immigrant Families: An Analysis of the National Survey of Children's Health

Children in immigrant families are less likely to screen positive with the Children with Special Health Care Needs Screener (CSHCN-S). This may indicate that children in immigrant families are healthier or require fewer health services than non-immigrant peers. Alternatively, the screener may under-identify special healthcare needs in this population. Using the 2011-2012 National Survey of Children's Health, we examined the prevalence of a positive CSHCN-S among children from first, second, and third generation households with an equivalent number of currently diagnosed chronic conditions (0, 1, 2+). Multivariate analyses controlled for sociodemographic factors. Among children with an equivalent number of chronic conditions, fewer children from first and second generation households screened positive with the CSHCN-S relative to children from third generation households. This association remained after adjusting for covariates. The CSHCN Screener may under-identify children from immigrant households, allowing for missed opportunities to allocate health resources.

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Objectif

Fournir un cadre de travail aux prestataires de soins de première ligne pour aborder les déficiences développementales au sein des populations d’immigrants réfugiés et non réfugiés.

Sources d’information

Une recherche a été effectuée dans MEDLINE sur Ovid entre janvier 2005 et février 2017 à l’aide des mots-clés anglais developmental disability, developmental delay, refugee et immigrant pour relever les articles pertinents rédigés en anglais. Le contenu et les recommandations compris dans cet article de synthèse sont pour la plupart tirés du site Web Les soins aux enfants néo-canadiens de la Société canadienne de pédiatrie.

Message principal

Les soins aux familles de nouveaux arrivants n’ayant pas fait l’objet d’un dépistage ou d’un diagnostic de retard ou de déficience développementale peuvent sembler insurmontables aux médecins de famille. La perturbation des familles et de l’éducation, une faible littératie en santé, le fait d’avoir vu des événements traumatisants et certains obstacles culturels précis peuvent influer sur le tableau clinique des problèmes de développement parmi les réfugiés et immigrants. La surveillance et le dépistage des troubles de développement qui accordent une attention particulière au contexte culturel à l’aide d’outils fondés sur les données probantes sont la pierre d’assise de l’intervention précoce.

Conclusion

Pour les réfugiés en particulier, à la lumière des iniquités auxquelles ils ont fait face avant la migration et durant le trajet migratoire, le dépistage des déficiences développementales et l’intervention sont l’occasion d’obtenir des résultats équitables chez les enfants réfugiés et d’optimiser leur santé et leur bien-être.

Approach to developmental disabilities in newcomer families

OBJECTIVE

To provide a framework for primary care providers to approach developmental disabilities in both refugee and nonrefugee immigrant populations.

SOURCES OF INFORMATION

Ovid MEDLINE was searched from January 2005 to February 2017 using subject headings developmental disability, developmental delay, refugee, and immigrant for relevant English-language articles. Most of the content and recommendations in this review are derived from the Canadian Paediatric Society's Caring for Kids New to Canada website.

MAIN MESSAGE

As family physicians, it can be daunting to care for newcomer families who arrive without previous developmental disability or delay screening and diagnoses. Disruption to families and education, decreased health literacy, witnessed traumatic events, and culturally specific barriers can affect the presentation of developmental concerns among refugees and immigrants. Surveillance and screening for developmental concerns in a culturally sensitive manner using evidence-based tools are cornerstones of early intervention.

CONCLUSION

For refugees in particular, in light of the inequities they have faced before migration and during their migration trajectory, screening for developmental disabilities and intervening provides an opportunity to help achieve equitable outcomes for refugee children and optimize their health and well-being.

Finnish-born children of immigrants are more likely to be diagnosed with developmental disorders related to speech and language, academic skills and coordination

AIM

We examined the association between having at least one parent born abroad and being diagnosed with a developmental disorder related to speech and language, academic skills or coordination.

METHODS

This nested case-control study was based on Finnish population records for 1996-2007. Cases from the Finnish Hospital Discharge Register were diagnosed with developmental disorders of speech and language, academic skills and coordination by the end of 2012. We identified 28 192 cases and 106 616 matched controls.

RESULTS

Children were more likely to be diagnosed with developmental disorders if they had an immigrant mother than children with two Finnish-born parents, with an adjusted odds ratio (aOR) of 1.3 and 95% confidence interval (95% CI) of 1.2-1.4, an immigrant father (aOR 1.2, 95% CI 1.1-1.3) or two immigrant parents (aOR 1.5, 95% CI 1.3-1.6). The level of development of the parental country of origin was not associated with receiving a diagnosis.

CONCLUSION

Children of immigrant parents were more likely to be diagnosed with developmental disorders and the association was strongest with regard to speech and language disorders. There were similar adjusted odds ratios for mothers, fathers and both parents. The development level of the country of origin was irrelevant.

Health professional perceptions regarding screening tools for developmental surveillance for children in a multicultural part of Sydney, Australia

Background

Encouraging early child development and the early identification of developmental difficulties is a priority. The Ministry of Health in the Australian State of New South Wales (NSW), has recommended a program of developmental surveillance using validated screening questionnaires, namely, the Parents’ Evaluation of Development Status (PEDS) and Ages and Stages Questionnaire (ASQs), however, the use of these tools has remained sub-optimal. A longitudinal prospective birth cohort “Watch Me grow” study was carried out in the South Western Sydney (SW) region of NSW to ascertain the uptake as well as the strategies and the resources required to maximise engagement in the surveillance program. This paper reports on a qualitative component of the study examining the attitudes, enablers and barriers to the current developmental surveillance practices, with reference to screening tools, amongst health professionals.

Methods

Qualitative data from 37 primary health care providers in a region of relative disadvantage in Sydney was analysed.

Results

The major themes that emerged from the data were the “difficulties/problems” and “positives/benefits” of surveillance in general, and “specificity” of the tools which were employed. Barriers of time, tool awareness, knowledge and access of referral pathways, and services were important for the physician providers, while the choice of screening tools and access to these tools in other languages were raised as important issues by Child and Family Health Nurses (CFHN). The use of these tools by health professionals was also influenced by what the professionals perceived as the parents’ understanding of their child’s development. While the PEDS and ASQs was utilised by CFHNs, both General Practitioners (GPs) and paediatricians commented that they lacked awareness of developmental screening tools and highlighted further training needs.

Conclusions

The results highlight the practical challenges to, and limited knowledge and uptake of, the use of recommended screening tools as part of developmental surveillance. There is a need for further research regarding the most effective integrated models of care which will allow for a better collaboration between parents and service providers and improve information sharing between different professionals such as CFHNs GPs, Practices nurses and Paediatricians involved in screening and surveillance programs.

Adapting an Autism Screening Tool for Use in the DeKalb County Refugee Pediatric Clinic

BACKGROUND

Minimal literature exists regarding Autism Spectrum Disorder (ASD) among refugee children in the United States. Reliable ASD screening tools, such as the M-CHAT-R/F, have yet to be culturally adapted and translated into some languages spoken in the homes of these children.

METHODS

Pediatric refugee patients (n = 13) of caregivers of Bhutanese (Nepali-speaking) descent were screened using a newly translated Nepali M-CHAT-R/F. The M-CHAT-R/F was adapted based on feedback from Bhutanese caregivers and interpreter expertise. Qualitative interviews regarding caregiver awareness of ASD were conducted.

RESULTS

Caregivers understood the majority of M-CHAT-R/F items (91%). Four items required revision. Interviews revealed minimal awareness among Bhutanese caregivers regarding ASD or child development.

DISCUSSION

The M-CHAT-R/F was adapted into Nepali using a combination of translation protocols, and is publicly available for clinical use. Future validation studies are needed which will aid in clinical screening for and epidemiologic research of ASD in this population.