Policy and Practice Barriers to Early Identification of Autism Spectrum Disorder in the California Early Intervention System.

Autism spectrum disorder can be reliably diagnosed prior to age 2, and early, intensive intervention has been found to improve long-term outcomes. Nonetheless, most children with ASD do not receive a diagnosis until after age 3, with even later diagnoses for children from non-white ethnic groups. This study conducted telephone surveys with California Part C early intervention managers regarding policies and practices for early identification and intervention for ASD. Findings indicated that 85% of agencies conduct screening for ASD, but only 39% conduct ASD diagnostic assessments prior to age 3. Recommendations for policy changes to align Part C practices with best practice guidelines are provided.

Broad Developmental Screening Misses Young Children With Social-Emotional Needs.

Many pediatricians use a broad developmental screening test as part of well-child care, but do not specifically screen for behavioral and emotional disorders. Parents at 2 urban community agencies completed both the Ages and Stages Questionnaire (ASQ-3) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) for 608 children, ages 2 to 60 months; 51.8% in Spanish. Less than half of the children with a positive screen on the ASQ:SE would have been identified as needing additional assessment or intervention if only the ASQ-3 had been administered. Younger children with positive ASQ:SE screens were significantly less likely to be referred for mental health services compared with older children. Physicians should consider screening all young children for social-emotional and behavioral needs, and referring those identified for infant and early childhood mental health services.

Unique system of care issues and challenges in serving children under age 3 and their families.

This article addresses the primary modifications necessary for system change to better meet the mental health needs of children under the age of three. The role of risk and resiliency factors in the young child, family and community and the necessity for a comprehensive community infant-family mental health system with a focus on the whole family are addressed. Barriers to care within early childhood systems of care are examined, including stigma, community referral and collaboration, diagnostic concerns during infancy, issues around family engagement, empowerment and partnership, funding of comprehensive and well coordinated infant-family services, workforce capacity and evaluation. Recommendations for implementation of system changes at the community and federal levels are proposed.

Use of a noncycloplegic autorefractor to perform vision screening in preschools.

Early detection and treatment of vision disorders in children are important to avoid lifelong visual impairment; however, preschool vision-screening rates are low. Traditional methods of screening lack the precision of objective tests and are difficult to administer in preschoolers. This study adopted a method using school nurses to conduct vision screening in preschoolers with a portable autorefractor. In addition, the effectiveness of the school nurse in conducting follow-up was evaluated. In a sample of 600 children, more than 98% completed the screening, and 7% were referred for follow-up evaluation. Seventeen percent of parents had plans to follow-up after receiving a brochure indicating that their child would benefit from a comprehensive eye exam. However, after a conversation with the school nurse, 86% had plans to schedule an evaluation with an eye care professional. Of the 15 students with known follow-up, 10 received glasses. The described method is effective in identifying young children with potential vision problems and facilitating their correction after contact made by the school nurse.

Feasibility of expanding services for very young children in the public mental health setting.

OBJECTIVE: A quality-improvement study evaluated the feasibility of training mental health providers to provide mental health screening and relationship-based intervention to expand services for children 0 to 5 years of age in eight California county mental health systems from November 2002 to June 2003. State-level training was provided to more than 582 participants and county-level training to more than 5425 participants, including ongoing supervision. METHOD: Direct services and use of collateral services were tracked. Psychiatric symptoms were screened with new Mental Health Screening and Risk Assessment tools for 388 children (mean age, 34 months). At intake and after intervention (mean of 22 visits), an index sample (93 children) were further characterized by the Diagnostic Classification for Zero to Three and DSM-IV, and parent-child relationship was characterized by the Diagnostic Classification for Zero to Three Parent-Infant Relationship Global Assessment Scale. Providers reported that 41% of their service time was directed to the parent and child together, 35% to the parent alone, and 24% to the child alone. RESULTS: The 93 index children and 295 children in a clinic reference sample were comparable, supporting generalizability. After intervention, Mental Health Screening and Risk Assessment scores were significantly lower. Global Assessment of Functioning scores improved (effect size, 0.35), as did the relationship (Parent-Infant Relationship Global Assessment Scale effect size, 0.16). CONCLUSION: Training mental health staff to provide treatment to infants and preschool children and families in public mental health settings is feasible and leads to an increase in numbers of children served.