Objectives: Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures. Methods: Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18). Results: The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making. Conclusion: Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.

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There is a growing emphasis in U.S. schools to focus on the social-emotional issues of rural students. Specifically, the effect of mental health issues on school success underscores the importance of collaboration between, and among, educators and specialized support personnel (SSP; e.g., school counselors). In rural areas, school counselors and school psychologists are positioned to assist students and their families to provide support within and surrounding the school environment. The purpose of this paper is to: (1) discuss students’ social-emotional needs and SSP-educator collaboration in the context of rural schools, and (2) to discuss promising and best practices in collaboration to address students’ social-emotional well-being.

Middle school students' responses to the self-introduction of a student with autism: Effects of perceived similarity, prior awareness, and education message.

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