McNally Keehn Rebecca, Paxton Angela, Delaney Mary, Ciccarelli Mary
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
J Dev Behav Pediatr. 2024;45(6):e513-e521. doi: 10.1097/DBP.0000000000001313. Epub 2024 Aug 22.
The objective of this study was to describe the development of a primary care professional (PCP) autism diagnosis training model and to report on outcomes related to PCP training and sustained engagement in a longitudinal learning collaborative.
We developed Accelerating the Diagnosis of Autism with Primary care Training (ADAPT), a training program to prepare PCPs to develop independent competency in evaluation of autism in children aged 14 to 48 months. ADAPT includes didactic and case-based modules and practice-based coaching delivered by an expert diagnostic specialist; after training, PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected.
From 2021 to 2023, 13 PCPs completed ADAPT didactic and practicum training to reach competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge after didactic training ( p = 0.02). Scoring agreement on an autism observational assessment tool between clinicians and expert diagnosticians improved over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert diagnosticians. After training, PCPs attended 57% of monthly learning collaborative sessions.
Training PCPs to deliver autism evaluations for young children as part of tiered community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standardized PCP training model that results in achievement of independent competency and sustained engagement in autism evaluation. Effectiveness-implementation studies are needed to ensure scalability and sustainability of training models.
本研究的目的是描述初级保健专业人员（PCP）自闭症诊断培训模型的开发情况，并报告与PCP培训以及在纵向学习协作中持续参与相关的结果。
我们开发了“通过初级保健培训加速自闭症诊断”（ADAPT）项目，这是一个培训计划，旨在使PCP具备对14至48个月大儿童进行自闭症评估的独立能力。ADAPT包括由专家诊断专家提供的理论和基于案例的模块以及基于实践的指导；培训后，PCP参与纵向学习协作。根据基于能力的医学教育标准，收集自闭症评估知识和诊断能力的指标。
2021年至2023年期间，13名PCP完成了ADAPT的理论和实习培训，以达到独立自闭症评估的能力要求。临床医生在理论培训后自闭症知识总量有显著提高（p = 0.02）。在自闭症观察评估工具上，临床医生与专家诊断医生之间的评分一致性在病例观察和实习评估过程中有所提高。同样，PCP的评估能力有所提高，专家诊断医生将其平均评级从高级初学者提升至胜任表现者。培训后，PCP参加了57%的月度学习协作会议。
培训PCP为幼儿进行自闭症评估，作为分层社区护理模式的一部分，是解决可及性和等待名单挑战的一个有前景的解决方案。ADAPT是一个强化的、标准化的PCP培训模型，能够实现独立能力的达成以及在自闭症评估中的持续参与。需要开展有效性-实施研究以确保培训模型的可扩展性和可持续性。
