Browsing by Author "James, Cristina"

Now showing 1 - 7 of 7
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    A Quality Improvement Network for Interdisciplinary Training in Developmental Disabilities
    (American Academy of Pediatrics, 2022-11-09) Smith, Jennifer D.; Nidey, Nichole; Chödrön, Gail S.; Czyzia, Jackie; Donahue, Michelle L.; Ford, Kristie; James, Cristina; Klimova, Oksana; Macias, Michelle M.; Rabidoux, Paula; Whitaker, Toni M.; Brosco, Jeffrey P.; Pediatrics, School of Medicine
    Children with developmental disabilities (DD), such as autism spectrum disorder (ASD), have complex health and developmental needs that require multiple service systems and interactions with various professionals across disciplines. The growing number of children and youth identified with ASD or DD, including anxiety and depression, has increased demand for services and need for highly qualified pediatric providers. Federally funded Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs across the United States address today's health care shortages by providing comprehensive, interdisciplinary training to providers from multiple pediatric disciplines who screen, diagnose, and treat those with ASD and DD. Each LEND program develops training methods independently, including quality improvement efforts. In 2014, LEND programs began designing and validating common measures to evaluate LEND training. The LEND Program Quality Improvement (LPQI) Network was established in 2016. Participating LEND programs in the LPQI Network administer validated trainee self-report and faculty-observation measures that address skills in key competency domains of Interdisciplinary or Interprofessional Team Building, Family-Professional Partnerships, and Policy. This study reports data from faculty and trainees from 22 LEND programs that participated in the LPQI Network across the 5-year data collection period. The main outcome of this study was the change in trainee knowledge, skills, and attitudes scores in key competency domains across programs. Overall, trainees made significant knowledge, skills, and attitude gains based on both self-report and faculty observation scores for all 3 competency domains. Data demonstrate the value of LEND programs and feasibility of a national quality improvement approach to evaluate interdisciplinary training and systems-level improvement.
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    Evaluation of the Feasibility and Perceived Value of Integrating Learn the Signs. Act Early. Developmental Monitoring Resources in Early Head Start
    (Springer, 2021-08-16) Abercrombie, Julia; Pann, James; Shin, Faith; Taylor, Elizabeth; Brisendine, Anne E.; Swanson-Holm, Rachell; James, Cristina; Viehweg, Stephan; Chödrön, Gail; Pediatrics, School of Medicine
    Many children with developmental disabilities are not identified before age 3 years of age, preventing them from being able to fully benefit from early intervention services. Early childhood educators, particularly those in Early Head Start (EHS) programs, are important partners in the early identification of children with developmental delays. Learn the Signs. Act Early. (LTSAE) is a program of the U.S. Centers for Disease Control and Prevention that provides free developmental monitoring resources to increase the early identification of children with developmental delays and disabilities. This paper presents findings from the first evaluation of the use of LTSAE resources in EHS, which was conducted across four states and 11 EHS programs from fall 2018 through spring 2019. Surveys (n = 448) and interviews (n = 39) with EHS management, staff, and parents indicated that LTSAE resources were valued and accepted, and their use in EHS considered feasible. Importantly, families and staff reported the LTSAE materials provided shared language to help them more effectively discuss development. These findings inform EHS and other early education programs that wish to enhance developmental monitoring, screening, and referral.
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    Provider and Caregiver Satisfaction with Telehealth Evaluation of Autism Spectrum Disorder in Young Children During the COVID-19 Pandemic
    (Springer, 2022) Reisinger, Debra L.; Hines, Elesia; Raches, Christine; Tang, Qing; James, Cristina; Keehn, Rebecca McNally; Pediatrics, School of Medicine
    The present study examines provider and caregiver satisfaction with telehealth evaluation of autism spectrum disorder (ASD) in young children during the coronavirus SARS-CoV-2 (COVID-19) pandemic. A telehealth model of ASD evaluation was implemented with 308 children ages 14 to 78 months between May 2020 to June 2021. Data were gathered from electronic health records, autism-specific telehealth diagnostic tools, and post-evaluation surveys. Overall, the majority of providers and caregivers were satisfied with telehealth ASD evaluation. Multiple variables were associated with ratings of satisfaction, differing by providers and caregivers. Findings have important implications for the feasibility and acceptability of telehealth ASD evaluations, in addition to key factors to consider in optimizing and sustaining telehealth evaluations beyond the COVID-19 pandemic.
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    Rapid deployment of neurodevelopmental telehealth evaluation services in response to COVID-19: Lessons learned and implications for future clinical innovation
    (2021-12) McNally Keehn, Rebecca; Curtin, Michelle; Enneking, Brett; Rouse, Maura; Hines, Elesia; Raches, Christine; James, Cristina; Tang, Qing; Paxton, Angela; Ramaker, Margo; Fitterling, Caroline; Jones, Alyssa; Blewitt, Audra; Etling, Allison; Tomlin, Angela
    Children with autism spectrum disorder frequently experience unmet needs. This presentation will describe a model of care navigation delivered to families of children receiving virtual ASD evaluation. Outcomes regarding caregiver engagement and satisfaction with care navigation, as well as enrollment in recommended services and supports and barriers encountered, will be reported.
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    Tele-assessment of young children referred for autism spectrum disorder evaluation during COVID-19: Associations among clinical characteristics and diagnostic outcome
    (Sage, 2023) McNally Keehn, Rebecca; Enneking, Brett; Ryan, Tybytha; James, Cristina; Tang, Qing; Blewitt, Audra; Tomlin, Angela; Corona, Laura; Wagner, Liliana; Pediatrics, School of Medicine
    The diagnosis of autism spectrum disorder (ASD) has traditionally been made through in-person evaluation. While the COVID-19 pandemic disrupted access to ASD services, there has been remarkable growth in research focused on novel ASD diagnostic practices, including the use of telemedicine. We implemented a standard ASD tele-assessment evaluation procedure, including use of a novel remote clinician-coached, caregiver-delivered ASD assessment tool (TELE-ASD-PEDS; TAP), with the goal of continuing to provide diagnostic services to young children and their families during the pandemic. We examined the relationship between child characteristics and diagnostic outcome for 335 children, ages 14-78 months, who received ASD tele-assessment conducted by psychologists and pediatricians in an outpatient clinic of a Midwestern academic medical center. We found that clinicians could make a determination about ASD diagnosis for most children (85%) evaluated using tele-assessment. Child clinical characteristics, including TAP scores and clinician ratings of ASD symptoms, were related to diagnostic outcome (i.e. diagnosis of ASD, no ASD, and Unsure about ASD). When all clinical characteristics were examined together, the presence of specific repetitive behaviors predicted ASD diagnosis. We also found that the TAP is effective for making an ASD diagnosis when used as part of comprehensive tele-assessment evaluation in children ⩾ 36 months of age with delayed language. Our study adds to an increasing body of research supporting use of tele-assessment for diagnosis of ASD. Although further research is needed, telemedicine may help families from different backgrounds and geographic locations to access high-quality diagnostic services.
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    Telehealth evaluation of autism spectrum disorder during COVID-19: Comparative outcomes from implementation of the TELE-ASD-PEDS
    (2021-05) McNally Keehn, Rebecca; James, Cristina; Tang, Qing; Paxton, Angela; Enneking, Brett
    OBJECTIVES 1) Compare clinician- and caregiver-reported outcomes between ASD evaluations using the TELE-ASD-PEDS (TAP) and telehealth as usual (TAU). 2) For children receiving TAP evaluations, examine associations between: • TAP risk classification and diagnostic outcome • Child characteristics and diagnostic outcome
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    Telehealth Evaluation of Pediatric Neurodevelopmental Disabilities During the COVID-19 Pandemic: Clinician and Caregiver Perspectives
    (Wolters Kluwer, 2022-06) McNally Keehn, Rebecca; Enneking, Brett; James, Cristina; Tang, Qing; Rouse, Maura; Hines, Elesia; Raches, Christine; Etling, Allison; Pediatrics, School of Medicine
    OBJECTIVE: The objective of this study was to present clinician and caregiver perspectives regarding telehealth neurodevelopmental evaluation delivered at the onset of the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we sought to describe telehealth neurodevelopmental evaluations, examine associations between child characteristics and diagnostic factors, determine the impact of technology and family barriers, and report on clinician and caregiver satisfaction with telehealth evaluation. METHODS: In response to the COVID-19 pandemic, in-person clinical services at a large children's hospital neurodevelopmental clinic were transitioned to telehealth. Data are presented for 254 remote evaluations of children (18-212 months; referral concern: 51% autism spectrum disorder [ASD], 24% developmental delay/intellectual disability, 25% other neurodevelopmental concern) conducted from May to July 2020. Data were gathered from electronic health records as well as clinician and caregiver surveys. RESULTS: A clinical diagnosis was provided in 72% of telehealth evaluations. Clinicians rated diagnostic certainty as "completely" or "somewhat" certain in 74% of evaluations. Certainty ratings were higher for evaluations in which a diagnosis of ASD was provided. Although technology and family challenges were reported, clinicians rarely identified these as disruptive to the evaluation process. Clinicians reported satisfaction with various aspects of delivering telehealth. Caregivers endorsed high satisfaction with receipt of telehealth and reduced travel burden. CONCLUSION: The COVID-19 pandemic has rapidly transformed service delivery for individuals with neurodevelopmental disabilities and provided an unprecedented opportunity to evaluate the deployment of telehealth evaluation to meet the need for ongoing diagnostic care. Our findings suggest that telehealth holds significant promise for neurodevelopmental assessment both within the context of a global pandemic and beyond.