Browsing by Author "Paxton, Angela"

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    143 Training & Sustaining: Training and learning collaborative outcomes across a statewide network for early diagnosis of children with autism
    (Cambridge University Press, 2024-04-03) McNally Keehn, Rebecca; Paxton, Angela; Delaney, Mary; Ciccarelli, Mary; Pediatrics, School of Medicine
    OBJECTIVES/GOALS: Community-based primary care autism diagnostic models are one promising solution to delays in autism diagnosis. Our objective is to describe the development and report on outcomes related to primary care professional (PCP) training and sustained engagement in a longitudinal learning collaborative across a statewide network for autism diagnosis. METHODS/STUDY POPULATION: We developed ADAPT (i.e., Accelerating the Diagnosis of Autism with Primary care Training), a training program to prepare PCPs to develop independent competency in evaluation of autism in children ages 14-48 months. ADAPT includes didactic and case-based modules and expert practice-based coaching delivered by a diagnostic specialist; following 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. RESULTS/ANTICIPATED RESULTS: To date, 13 PCPs have completed ADAPT didactic and practicum training reaching competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge following didactic training (p=.02). There was an overall trend toward increased scoring agreement on an autism observational assessment 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 trainers. Following training, PCPs attended 57% of monthly learning collaborative sessions. DISCUSSION/SIGNIFICANCE: Training PCPs to deliver autism evaluations as part of community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standard PCP training model which results in achievement of independent competency and sustained engagement in in autism evaluation.
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    Diagnostic Accuracy of Primary Care Clinicians Across a Statewide System of Autism Evaluation
    (American Academy of Pediatrics, 2023) McNally Keehn, Rebecca; Swigonski, Nancy; Enneking, Brett; Ryan, Tybytha; Monahan, Patrick; Martin, Ann Marie; Hamrick, Lisa; Kadlaskar, Girija; Paxton, Angela; Ciccarelli, Mary; Keehn, Brandon; Pediatrics, School of Medicine
    Objectives: To evaluate the diagnostic accuracy of the Early Autism Evaluation (EAE) Hub system, a statewide network that provides specialized training and collaborative support to community primary care providers in the diagnosis of young children at risk for autism spectrum disorder (ASD). Methods: EAE Hub clinicians referred children, aged 14 to 48 months, to this prospective diagnostic study for blinded follow-up expert evaluation including assessment of developmental level, adaptive behavior, and ASD symptom severity. The primary outcome was agreement on categorical ASD diagnosis between EAE Hub clinician (index diagnosis) and ASD expert (reference standard). Results: Among 126 children (mean age: 2.6 years; 77% male; 14% Latinx; 66% non-Latinx white), 82% (n = 103) had consistent ASD outcomes between the index and reference evaluation. Sensitivity was 81.5%, specificity was 82.4%, positive predictive value was 92.6%, and negative predictive value was 62.2%. There was no difference in accuracy by EAE Hub clinician or site. Across measures of development, there were significant differences between true positive and false negative (FN) cases (all Ps < .001; Cohen's d = 1.1-1.4), with true positive cases evidencing greater impairment. Conclusions: Community-based primary care clinicians who receive specialty training can make accurate ASD diagnoses in most cases. Diagnostic disagreements were predominately FN cases in which EAE Hub clinicians had difficulty differentiating ASD and global developmental delay. FN cases were associated with a differential diagnostic and phenotypic profile. This research has significant implications for the development of future population health solutions that address ASD diagnostic delays.
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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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    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