Laura Grofer Klinger Kevin FitzGeraldNicole Dreiling

laura_klinger@med.unc.edu

Project ECHO Autism: Building Capacity for Integrated Healthcare Services for Individuals

with ASD in North Carolina

Vision for Medicaid Transformation in North Carolina

“Improving the health and well-being of North Carolinians through an innovative, whole-person centered and well-coordinated system of care that addresses both medical and non-medical drivers of health.”

The Role of Teleconsultation in the Era of Medicaid Transformation

What is Project ECHO?

• Through telementoring, ECHO creates access to high quality specialty care in local communities.

• Knowledge sharing network creates a learning loop among specialists and community providers.

University Role in Creating, Implementing, & Researching Systems Change

Meeting North Carolina’s Health and Health Workforce Needs Since 1972

6,000 Providers Served215,811 Professionals Trained Annually

Mission

Creating and disseminating community-

based services, training programs, and

research to enhance the quality of life of

individuals with Autism and their families.

Enhancing the Quality of Life for Individuals with Autism Since 1972

7 Regional Outpatient ClinicsEmployment & Residential Program

International Training Program (100 NC Counties, 18 States, & 13 Countries)

Innovative Partnerships

Autism ECHO Pilot Projects

Specific Aims

Implement a Project ECHO Teleconsultation Program to:• Improve ASD-specific knowledge and

treatment self-efficacy of rural primary care providers in North Carolina.

• Improve the quality of lifespan care received by individuals with ASD by increasing provider diagnostic screening and treatment of common medical and behavioral health comorbidities.

Autism ECHO North Carolina Partners

Team Leadership• Nicole Dreiling (UNC TEACCH)• Laura Klinger (UNC TEACCH)• Rob Christian (UNC CIDD)• Celeste Carter (UNC TEACCH)

Community Advisory Board• Aleck Myers (ASNC)• Kim Tizzard (ASNC)• Kerri Erb (ASNC)• Karen Luken• Lorrie Basnight (Eastern AHEC)• Debby Futrell (Area L AHEC)• Alice Schenall (Area L AHEC)

• External Evaluator• Gary Walby

Funding Support• NCCDD• NC DHHS• NC AHEC

Innovative Partnerships: Coalition of Autism Experts

Coalition of Autism Experts: National Autism ECHO Collaborative

• University of Missouri• Cincinnati Children’s Hospital• Children’s Hospital of

Philadelphia• Nationwide Children’s Hospital• University of Alabama at

Birmingham• University of Rochester• University of Virginia• University of Washington• University of Wyoming

Innovative Partnerships:Continuing Education Expertise

What Did We Create?

Project ECHO Pilots

• Developed a 6 month (12 session) Autism ECHO program in North Carolina targeting providers in Eastern North Carolina.

• Created 3 Project ECHO Curriculums:• Medical Providers

• Mental Health Providers• Military Providers

Womack Army Medical Center

Autism ECHO North Carolina Pilot Projects

5 cohorts have been recruited across 20 counties in Eastern North Carolina: 31 Medical providers

(2 cohorts) 22 Military medical

providers (1 cohort) 39 Mental health providers

(2 cohorts)

1. Brief Didactic (~30 minutes)2. Patient Case Presentation (1-2

per session)- Allows for both expert and

spoke questions and recommendations

- Follow up recommendations are summarized and emailed to presenter

Nuts and Bolts of TeleECHO Sessions

Curriculum List

• What is Autism and While You Wait• Autism Screening (MCHAT) and Follow-Up• Parent Support• What is ABA and Structured TEACCHING Strategies• Resources- Local, State, Regional, and National• ADHD &Autism: Differential Diagnosis & Medication Management• Feeding Issues and Autism• Sleep and Autism• Anxiety, Autism: Differential Diagnosis & Medication Management• Behavior from the ASD Perspective- Irritability, transitions, and sensory issues• What is an IEP?• Transition to Adulthood

What Does the Data Say?Preliminary as all not cohorts have finished

Did They Like It?Did They Learn Something?Did They Change Their Behavior?

Participant Feedback

The most valuable aspect of this project was learning about the resources available for me and my patients. I've also enjoyed how there is a team giving their unique feedback based on different roles caring for the patient. This has helped me broaden my vision of the care required for best outcomes.

Participant Feedback

• “I cannot speak highly enough of this opportunity, the ECHO Project service/technology, and the team of specialists who led this endeavor. I came in with basic, and largely limited, knowledge of how best to assess for and identify ASD and after having been a part of this program, have successfully identified ASD in several of my pediatric patients, which has lent way to linking they and their families with resources, support, and more extensive evaluative services.”

Participant Feedback

I have gained a wealth of knowledge regarding interventions and approaches to interventions. This training is truly insightful, practical, and empowering. Hands down, this training is an effective use of time and is yielding fruitful results. I feel very fortunate to have the opportunity to participate in this training with such experts in the field!”

Changes in Provider Autism Knowledge

Chart1

MedicalMedicalMedical

Mental HealthMental HealthMental Health

Pre

Post

VIQ < NVIQ

% Correct

45

64.5

56.5

73

Sheet1

PrePostVIQ < NVIQ

Medical4564.523.9

Mental Health56.57327.8

To resize chart data range, drag lower right corner of range.

Changes in Screening for Autism at 18 & 24 MonthsModified Checklist for Autism in Toddlers (M-CHAT)

Chart1

% of Screening at 18 and 24 Months% of Screening at 18 and 24 Months

Pre

Post

% of Screenings

0.56

0.9

Sheet1

PrePost

% of Screening at 18 and 24 Months56%90%

Medical Provider Self-Efficacy

Chart1

ScreeningScreening

ResourcesResources

MedicalMedical

PsychiatricPsychiatric

Pre

Post

Subscale Total Score

25.7

30.3

25

34

46.4

63.7

31.1

41.1

Sheet1

PrePostVIQ < NVIQColumn1Column2

Screening25.730.323.9

Resources253427.8

Medical46.463.7

Psychiatric31.141.1

Additional22.828.8

Mental Health Provider Self-Efficacy

Chart1

ResourcesResources

PsychiatricPsychiatric

Pre

Post

Subscale Total Score

23.7

29.8

42.1

55.7

Sheet1

PrePostVIQ < NVIQColumn1Column2

Resources23.729.827.8

Psychiatric42.155.7

What’s Next?Continued Support for Autism ECHO Participants

• Primary Care and Military Cohorts • Complete by June 2019

• Continued Support for Autism ECHO Participants

• Access to expert referrals (e.g., referral to local TEACCH clinic when additional services are needed).

• Access to NC Pediatric Access Line (NC PAL) for consults.

What’s Next: Project ECHO Expansion

• Partner with PHPs to offer provider access to Autism ECHO to primary care providers across the state.

• Create Autism ECHO programs outside of primary care settings.

• Family Support ECHO• Department of Public Instruction

Autism ECHO for Educators

Project ECHO Autism: Building Capacity for Integrated Healthcare Services for Individuals with ASD in North CarolinaVision for Medicaid Transformation in North CarolinaThe Role of Teleconsultation in the Era of Medicaid Transformation�What is Project ECHO?University Role in Creating, Implementing, & Researching Systems Change�Slide Number 6Slide Number 7Innovative Partnerships�Autism ECHO �Pilot Projects Specific Aims Autism ECHO North Carolina PartnersSlide Number 12Coalition of Autism Experts: �National Autism ECHO CollaborativeInnovative Partnerships:�Continuing Education ExpertiseWhat Did We Create? Project ECHO PilotsAutism ECHO North Carolina Pilot Projects Nuts and Bolts of TeleECHO SessionsCurriculum ListWhat Does the Data Say?� �Preliminary as all not cohorts have finished Participant Feedback Participant Feedback Participant FeedbackChanges in Provider Autism KnowledgeChanges in Screening for Autism at 18 & 24 Months�Modified Checklist for Autism in Toddlers (M-CHAT) Medical Provider Self-EfficacyMental Health Provider Self-Efficacy What’s Next?�Continued Support for Autism ECHO ParticipantsWhat’s Next: Project ECHO Expansion