HJAR Mar/Apr 2025

with autism inArkansas receive their diag- nosis through multidisciplinary team eval- uation at specialty development centers who are overwhelmed with referrals for children with varying symptom presenta- tion. Many families wait for more than a year and must complete at least two visits to receive a diagnosis. It is high time that major stakeholders come together and work on remodeling the system of provid- ing autism care in our state. It is also clear that any realistic solution would necessitate partnerships between generalists and spe- cialists, between state and community. To remodel our system of autism care, the fol- lowing points can be part of the initial plan. But as all homeowners know, remodeling has a way of uncovering more issues and redirecting the plan. 1. Increase knowledge and confidence of our healthcare professionals to pro- vide autism care. a. Infuse ASD-focused courses in undergraduate and postgraduate education. b. Create lab schools that can provide ASD-focused experiences or intern- ships to students and early trainees. c. Provide training to PCPs on autism screening tools designed for primary care (e.g., M-CHAT, SCQ, STAT). d. Provide ongoing support to PCPs who are doing this work to continu- ally boost their knowledge and their confidence (e.g., telehealth consul- tation with specialists, regular tele- education sessions). 2. Initiate early intervention while wait- ing for an evaluation appointment. a. PCPs need to refer children who present with symptoms of autism for developmental evaluation and intervention as soon as possible. b. Equip early childhood teachers, therapy providers, and family/ caregivers with the skills to employ behavior approaches that target the child’s social skills in therapy ses- sions, in the classroom, at home, and in the community (e.g., Early Start Denver Model, Discrete Trial Train- ing, Pivotal Response Treatment). 3. Lay the groundwork for a tiered approach to diagnosis. a. Establish guidelines to help PCPs triage their patients to an autism evaluation in the primary care set- ting or to refer the patient for a spe- cialty evaluation. b. Provide PCPs opportunity to consult with autism specialists (e.g., devel- opmental pediatricians, psychia- trists, psychologists, therapists). c. Establish clear channels of bidi- rectional communication between PCPs and specialists. d. Leverage telemedicine opportu- nities, when prudent, to minimize traveling for families. e. Provide family navigation to help support family through this process. 4. Provide the grease to make it work. a. Modify reimbursement schemes to ensure that all providers can provide autism care in a sustainable way. b. Restructure clinic templates to allow PCPs more time for these specific visits. c. Determine ways that care coordina- tion can be provided to the family and the PCPs. n HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2025 13 Families and healthcare providers encounter many challenges in obtaining developmental evaluations for autism con- cerns. InArkansas, the CoBALT (Community Based Autism Liaison Treatment Project) program attempts to address these issues by bridging children to timelier assessments through further training of pediatric health- care professionals and disseminating foun- dational knowledge on autism using a digi- tal platform-based learning series. Autism spectrum disorder (ASD) is a neu- rodevelopmental disorder with primary fea- tures that relate to difficulties with social reciprocity and restricted, repetitive behav- iors. 1 Aggregate data fromCDC’sAutism and Developmental Disabilities Monitoring (ADDM) Network, show an increase in prev- alence of ASD from 1 in 150 children in 2000, to 1 in 36 children in 2020. 2 InArkansas, the CDC ADDM shows that 1 in 43 8-year-old children were identified with ASD by the ArkansasADDMprotocol in 2020. 3 This rise in prevalence could be possibly attributed to increased awareness and recognition of ASD symptoms by both healthcare provid- ers and the general population. Regardless of the reason, the rate of children awaiting an autism evaluation has increased. The time lag between first concerns about ASD and obtaining an autism evaluation is long. In a first report survey of U.S. autism centers, Kraft, et al., found that almost two- thirds of centers (61.26%) had waiting lists of longer than four months, with 15.32% reporting wait periods of over one year. 4 The UAMS James L. Dennis Developmen- tal Center, the primary autism diagnostic center in the state, has been cognizant of this barrier to a timely autism evaluation. As highlighted in the previous articles in this series, the reasons for this delay include the shortage of subspecialty providers, time- intensive and effort-consuming evaluations, financial burden of care, difficulty accessing available resources and therapies, and pri- mary care physicians (PCPs) expressing a lack of comfort in managing ASD. 5,6,7 With this access to services problem in mind, UAMS Department of Pediatrics, in partnership with the Arkansas Title V The CoBALT Model: Expanding Access to Autism Evaluations in Arkansas and Reducing Wait Times for Diagnosis By Jaimie Flor, MD, and Jayne Bellando, PhD