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This paper describes the (Sin Exclusión) Transdisciplinary Autism Assessment and Resources ([S]TAAR) model and presents early metrics tracking efficiency and equity in access to high-quality comprehensive autism evaluations for young children. Retrospective chart reviews over one year (08/2018–08/2019) with n = 173 children were reviewed. Through care coordination with community providers, the model was developed to meet local needs by increasing throughput of children (< 4 years old) evaluated by a transdisciplinary team. Team-based processes included pre-visit triage, synchronous evaluation procedures, case conferencing, huddles, and care coordination. The model led to increased patient throughput, reductions in waitlist and time to diagnosis, and improved provider satisfaction. Improvements in access to care were equitable across patient race, ethnicity, language, and insurance type.

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.

Objective Children with a history of prematurity are at increased risk for neurodevelopmental disorders, including autism. This case series describes four patients with comparable prenatal and divergent neonatal histories who were referred for comprehensive autism evaluations between 21-36 months of age by a NICU follow-up program. Method Patients were born at approximately 25 weeks gestation (i.e. extremely premature) following otherwise uncomplicated pregnancies and weighed less than 1000 grams at birth (i.e. extremely low birth weight). Patients A and B experienced significant neonatal complications (e.g. hemorrhage, respiratory failure). Children were later evaluated for autism by an interprofessional team affiliated with a children’s hospital. Results Patient A had average intellectual, motor, and language abilities with mild symptoms of autism on a standardized rating scale. Patient B had impaired intellectual, motor, and language abilities with severe symptoms of autism on the same rating scale. Patient C had average intellectual abilities, borderline language and motor abilities, and did not display autism features. Patient D had borderline intellectual abilities, low average receptive and expressive language, and also did not display autism features. Conclusions All patients presented with developmental delays in at least one domain. Those who experienced complications in the NICU met DSM-5 criteria for Autism Spectrum Disorder. However, patients with similar prenatal histories who did not face additional complications in the NICU presented with comparatively intact social communication and behavior. This case series suggests the relative importance of peri- and neonatal factors in the etiology of autism in children with a history of extreme prematurity.

CASE:Sam is an 11-year-old young boy with autism spectrum disorder (ASD), unspecified anxiety disorder, and attention-deficit/hyperactivity disorder, combined presentation. He was initially diagnosed with ASD at 6 years of age after evaluation by a developmental-behavioral (DB) pediatrician. He presents to the DB pediatrics clinic to reestablish care. He established care with psychiatry 5 months ago after his school referred him to a hospital-school-community telepartnership bridge program following statements of self-harm and numerous concerns with his behavior, including elopement.Sam currently receives special education support under the classifications of "Emotional Disturbance" and "Speech Impairment." His parents report significant challenges with having his medical diagnosis of autism recognized by the school, which has impeded him receiving educational support as a student with autism. This has resulted in Sam being penalized for challenging behaviors related to his neurodevelopmental disorder. He is not currently making meaningful progress in the school setting. Sam currently demonstrates avoidance, physical and verbal aggression, and difficulty adapting to change across settings. In addition to difficulties advocating for more individualized support at school, Sam has never received applied behavior analysis (ABA) therapy because of challenges obtaining insurance approval. There are no additional barriers to accessing care, such as language, geographic, or socioeconomic factors.Sam's visit to reestablish care with DB pediatrics consisted of an individual clinician evaluation model. The Childhood Autism Rating Scale, Second Edition, (CARS-2) and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), were administered, and Sam continued to meet DSM-5 criteria for ASD following reevaluation. A new referral for ABA therapy was submitted. Shortly afterward, his family received an insurance denial letter specifying that additional developmental testing was needed before ABA therapy would be approved. His clinician called the insurance company to appeal this decision but was unsuccessful. Sam was then seen by the DB pediatrics embedded psychologist, who completed additional testing, including assessment of cognitive functioning, administration of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and autism-specific rating scales. This process led to further delays in access to ABA services. Throughout this process, the parents reported feeling helpless and frustrated given the barriers faced in receiving appropriate services. What are your next steps to advocate for supports through the school and insurance company?

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Autism spectrum disorder (ASD) is a neurodevelopmental disability affecting 1 in 44 children nationally. Timely referral to intervention and support services for ASD has consistently demonstrated significant long‐term positive effects on symptoms and subsequent skills and family outcomes. This paper highlights a novel and innovative approach of short‐term consultations for best practices to ultimately increase access to timely ASD evaluations and support through a state‐wide school telehealth initiative. The goal of the initiative was to facilitate rapid access to ASD evaluation and support (within 2 weeks of referral in school‐age youth) among under‐resourced school systems in Central Texas. First, this paper provides background relative to current disparities that many children face when attempting to obtain ASD evaluations and support. Second, a statewide legislative response is described that created a mental health consortium targeting increased access to broad‐based mental health services and supports, particularly in underserved areas. Next, the Texas Child Health Access Through Telemedicine (TCHATT) program is outlined with a particular focus on day‐to‐day operationality and concentrated efforts to increase mental health literacy among school teams relative to ASD symptoms and co‐occurring behavioral health concerns. Year 1 utilization data metrics (September 2020–May 2021) and representative case examples are presented. Finally, early “lessons learned” and future directions are discussed.

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