Peoria, Ill.-based OSF HealthCare built a program to screen children who may have autism spectrum disorder and need an earlier evaluation, using referrals from primary care rather than requiring families to navigate a separate developmental pediatrics system on their own.
The program, called EASE — Embedded Autism Screening and Evaluation — places an advanced practice nurse directly within primary care, allowing families to access autism evaluation services closer to home and in a timely manner, Amy Zimmerman, APRN, the program’s project manager, told Becker’s.
“How can we meet the patients and families where they are,” Ms. Zimmerman said of the program’s goal, noting EASE is meant to complement — not replace — more extensive interdisciplinary evaluation teams. The goal is to evaluate children who may not need a deeper level of assessment, which can free up capacity for children who do.
“The second part of this is to help support our primary care [providers], because they’re also getting lots of questions and concerns from families, so [this] increases their comfort level and education as well. It’s really that partnership between everyone,” she said.
How it works
Primary care providers refer children to EASE through Epic, and the referral first goes through OSF’s Autism Pathways team, which confirms the child meets criteria for the program. OSF’s Autism Pathways connects patients diagnosed with autism spectrum disorder and their families to local resources through personalized needs assessments, but does not provide diagnoses or ongoing therapy.
OSF uses a stoplight system to sort referrals: Children flagged “green” are referred to EASE right away. “Yellow” referrals, where there is some concern but the child does not clearly meet criteria, are triaged by Ms. Zimmerman. “Red” referrals are routed elsewhere, with Autism Pathways helping make that connection, ensuring the child is not lost to follow-up.
“OSF wants to make sure children get to the right place,” Ms. Zimmerman said. “So if the patient is not appropriate for EASE, how can we ensure that they do get to developmental behavioral pediatrics? How can we make sure they do get to those interdisciplinary teams, but then also not forgetting our providers, who are on the front lines of these kids, to help them be comfortable and bring that conversation?”
Once a referral clears, it lands in a work queue in Epic, and the child is scheduled for evaluation. OSF is also working toward a centralized scheduling system as the program expands into more regions, she said.
The evaluation itself was originally a single 90-minute appointment but has since been split into a 60-minute initial evaluation and a 30-minute follow-up, with an optional third appointment if needed. The first appointment covers developmental and medical history and a physical exam, along with standardized measures such as the Vanderbilt screening tool, the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Childhood Autism Rating Scale, Second Edition (CARS-2).
The follow-up appointment, typically scheduled one to two weeks later, reviews the case against the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, to determine whether the child meets criteria for an autism diagnosis.
It also includes recommendations regardless of the outcome, as many children referred to EASE also show signs of conditions such as attention-deficit/hyperactivity disorder, anxiety or developmental delays. The program currently evaluates children ages 2 to 6.
Recommendations are sent back to the child’s primary care provider, and Autism Pathways patient navigators follow up with the family within about one to two weeks to connect them with community support and services. Ms. Zimmerman also recommends families follow up with their primary care provider within a month of the evaluation to act on those recommendations.
The results so far
Since launching in September, EASE has received more than 250 referrals and completed more than 200 evaluations, according to Ms. Zimmerman. The program started in two OSF Ministry offices and has since expanded across all OSF Ministry locations statewide, as well as some outside “good neighbor” locations that also use OSF’s Epic system.
Wait times for an EASE evaluation are typically 15 days or fewer, according to Ms. Zimmerman, and can occasionally occur the same day. That compares with wait times that can exceed 12 to 18 months for traditional developmental or interdisciplinary evaluation teams, though Ms. Zimmerman noted the teams’ goals for patients may differ.
Ms. Zimmerman said feedback from families and primary care providers has been positive. She sends a monthly newsletter to primary care providers and is launching open office hours, a 30-minute informal virtual session over lunch for providers to ask questions or discuss specific cases.
Ms. Zimmerman distinguished between screening tools such as the M-CHAT, which flag children who may need a deeper evaluation, and tools such as the CARS-2 or ADOS, which are more autism-specific and validated for diagnostic use under DSM-5 criteria. In Illinois, most insurers also require CARS or Autism Diagnostic Observation Schedule results for a child to access Applied Behavior Analysis services, she said.
At the end of an evaluation, Ms. Zimmerman also asks families to name two things their child does well. “I do want to recognize that every child has strengths and challenges,” she said.
The program is also expanding its use of telehealth for evaluations for families who live farther away or face transportation or childcare barriers, though in-person visits have so far been used for initial appointments, she said.
OSF is also looking to replicate the EASE model in its Western Illinois region, following the same referral process with a different provider. She said the longer-term goal is to reach communities that are considered medical deserts.
“We started really locally and small,” Ms. Zimmerman said. “I was passionate about having a firm foundation, having those processes in place, and then hopefully we can go ahead and replicate those throughout the state.”
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