Despite its high rate of occurrence, autism spectrum disorder (ASD) is

under-diagnosed and under-treated in toddlers, particularly in minority

and disadvantaged populations.
National guidelines recommend routine ASD screening in primary care,
but barriers to referral after positive screens and to receipt of
diagnostic evaluations and services must be addressed.
One potential solution is patient navigation, in which a trained navigator
guides the patient and family through and around barriers to care to
ensure timely diagnosis and treatment.
Patient navigation has improved receipt of preventive care among lowincome, minority children but has not been tested for improving early
identification and treatment of ASD.

The goal of Screening and Linkage to Services for Autism

(SaLSA) is to test the effect of patient navigation on
identification and treatment of ASD within the first three
years of life among minority, disadvantaged children.
SaLSA employs a planning and evaluation approach (REAIM) to increase its potential for widespread application and
public health impact.

El Grupo VIDA, a community-based network of Spanish-speaking

families who have children with disabilities, is collaborating on planning
and evaluation.
Population: Children aged 18-27 months seen for well visits in a large,
urban community health center system (74% Hispanic)

Using a mixed-methods design, a randomized controlled trial of children

who screen positive on the M-CHAT-R is testing the Effectiveness of
patient navigation for:
Reducing the time from screening to indicated referral, diagnostic
evaluation / eligibility determination and initiation of early intervention
services
Reducing the age at which each of these steps occurs
Sustaining family engagement in indicated services
Descriptive and qualitative methods will examine:
Proportion and representativeness of families who participate in the
patient navigation program (Reach)
Delivery of the navigation program and facilitators and barriers to
program implementation (Implementation)
Staff, provider and family perceptions about the program (Adoption,
Maintenance)
Data collection includes:
Linked electronic records of the community health center system and
early intervention provider
Patient navigator records
Standardized interviews with families and clinical and service providers.

This project is of potential interest to clinical and early intervention (EI)

providers, and community health and EI systems, aiming to implement
evidence-based guidelines for early screening and intervention for
children identified with ASD, as well as to other investigators examining
methods to improve this process.
If proven effective, patient navigation could be implemented widely to:
Identify and engage children with ASD in treatment at an earlier age,
particularly children from minority, disadvantaged populations
previously shown to have significant barriers to receipt of ASD
services
Reduce disparities among children with ASD by improving access to
services for children from minority, disadvantaged populations
Improve the health and well-being of children with ASD
Support for this project comes from Health Resources and Services Administration Grant Award #R40MC27702