Given the increasing prevalence of autism, currently 1 in 36 children, and the awareness of the importance of early intervention, it is vital that we as providers guide families appropriately when this concern is brought up. In the primary care setting this often starts with a screening tool based on the child’s age. For older children the Social Communication Questionnaire (referenced below) or Social Responsiveness Scale (referenced below) can play a role in screening.
For years, the answer to the statement “I am concerned my child has autism” was a referral to the local Regional Center for further assessment and intervention. As medical insurances have become mandated to provide autism assessment and intervention, this automatic referral has shifted as the Regional Center has become the payor of last resort for autism assessment and intervention. It behooves us as providers to direct families first to their medical insurance when this concern comes up. Lets look at this in more detail (https://www.sdrc.org/apply).
When there is concern a child under the age of 3 is at risk for autism, a referral to Early Start which falls under Regional Center, is warranted, as they contract with providers to can complete assessments and provide intervention which can include parent education, infant education, speech therapy and occupational therapy.
This changes dramatically after a child reaches the age of 3. When there is a concern about autism in a child older than the age of 3, the first step is referral to the child’s medical insurance for an autism assessment. Many providers only assess children up to a certain age, so when a child reaches late childhood, it can be tricky to find a provider to complete an autism assessment, especially for a child with Medi-cal. In these cases, sometimes the Regional Center, as the payor of last resort, might be the quickest option, although they will often still have a long waitlist.
Once a child has an autism diagnosis, the next step is to help connect the family to intervention. This can take some time depending on the family’s grieving and acceptance process. Again intervention is primarily mandated through medical insurance so that is the place to start. Sometimes the same provider completes autism assessments and provides intervention but often this involves a referral to another provider. There are different types of autism intervention that vary from a more behavioral approach (ex. ABA) to a more developmental relationship based approach (ex. Relationship Development Intervention, DIR FloorTime), which will be a topic discussed in more detail in a future BHCS newsletter. Additionally the intervention can be home-based or center-based depending on goals and family preferences. There is a varying amount of parent participation that is expected but research has shown that parent participation is hugely beneficial to achieving goals and helping parents feel empowered. (https://www.smartcarebhcs.org/the-importance-of-parent-participation-in-autism-intervention-10-23-24).
School-aged children should also be referred to their school IEP team for an assessment to determine if they can qualify for school based interventions through an IEP or 504 plan. These additional supports are available through age 21 and can include vocational training. The Regional Center can provide funding for ancillary supports including respite care services, social/recreational programming, and social skills groups. Importantly, the Regional Center also takes over for day programming needs and other adult supports over the age of 21.
For many families the local autism society is an additional source of support in terms of support groups, meet ups, and resources. There are many other aspects of autism assessment and intervention that could be discussed in this newsletter. We hope we achieved our goal as an introduction for next steps when there is a concern raised by a family with the take home message to start with a screening if you are comfortable and then referral to the family’s medical insurance. Feel free to call us at SmartCare Behavioral Health Consultation Services Provider Line to discuss specific cases or share our Parent Line information with families for help them find referrals.
References:
https://assets-global.website-files.com/600754479f70fb2c4d356be6/64740987101c81b742992e54_SCQ.pdf
https://www.wpspublish.com/srs-2-social-responsiveness-scale-second-edition
AUTHOR:
Charmi Patel Rao MD, DFAACAP
Co-Medical Director, Vista Hill Foundation
Health Science Clinical Professor, UCSD Department of Psychiatry
President, San Diego Academy of Child and Adolescent Psychiatry