Presenter Biography
Gabriella Tangkilisan is an undergraduate research intern with the OHSU Doernbecher General Pediatrics department under the mentorship of Dr. Katharine Zuckerman. She is a pre-medine student interested in research that focuses on improving equitable healthcare, and will be graduating from undergrad in June 2024.
Program/Major
Biology and Public Health
Student Level
BS
Presentation Type
Presentation
Start Date
4-4-2024 4:04 PM
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Persistent Identifier
https://archives.pdx.edu/ds/psu/41992
Subjects
Developmental delays, early intervention services, referral rate, Chart Stimulated Recall exercise
Abstract
Background:
Early detection and treatment of developmental disabilities (DD), including Autism Spectrum Disorder (ASD), improves language, IQ, and adaptive outcomes. Guidelines recommend immediate referral to Early Intervention (public developmental therapy services) upon positive ASD/DD screening in infant/toddler well child checks. However, children screening positive for ASD/DD are not always referred for Early Intervention services. This project aimed to understand why pediatricians do and do not refer children with positive DD/ASD screens to early intervention.
Methods:
We conducted qualitative interviews with pediatricians who participated in a randomized trial investigating family navigation for children with autism risk. We determined pediatrician referral rates for positive ASD or DD screening using previously-collected data, then selected pediatricians with a range of referral rates for videoconference interviews. Interview guide questions probed the referral decision-making process; a Chart Stimulated Recall exercise explored clinical reasoning and management of 2 patient cases with positive screens. A coding framework was created by 3 team members. Transcripts were coded by 2 team members using a phenomenological approach; the coding framework was improved as themes emerged. Coding discrepancies were discussed by 2-3 team members and resolved by consensus.
Results:
15 pediatricians participated from 7 Oregon clinics. Analysis of interviews is ongoing. Initial results indicate 3 major themes interact to influence referral decisions: screening test results, provider’s clinical observations, and level of parental concern. Future analysis will expand these themes and evaluate the relationship between a provider’s referral rate and their decision-making process.
Conclusion:
Early Intervention referral decision making is complex. Provider perspectives may provide opportunity for targeted intervention.
Understanding Variation in Provider Referral Rates to Early Intervention for Children with Developmental Delays
Background:
Early detection and treatment of developmental disabilities (DD), including Autism Spectrum Disorder (ASD), improves language, IQ, and adaptive outcomes. Guidelines recommend immediate referral to Early Intervention (public developmental therapy services) upon positive ASD/DD screening in infant/toddler well child checks. However, children screening positive for ASD/DD are not always referred for Early Intervention services. This project aimed to understand why pediatricians do and do not refer children with positive DD/ASD screens to early intervention.
Methods:
We conducted qualitative interviews with pediatricians who participated in a randomized trial investigating family navigation for children with autism risk. We determined pediatrician referral rates for positive ASD or DD screening using previously-collected data, then selected pediatricians with a range of referral rates for videoconference interviews. Interview guide questions probed the referral decision-making process; a Chart Stimulated Recall exercise explored clinical reasoning and management of 2 patient cases with positive screens. A coding framework was created by 3 team members. Transcripts were coded by 2 team members using a phenomenological approach; the coding framework was improved as themes emerged. Coding discrepancies were discussed by 2-3 team members and resolved by consensus.
Results:
15 pediatricians participated from 7 Oregon clinics. Analysis of interviews is ongoing. Initial results indicate 3 major themes interact to influence referral decisions: screening test results, provider’s clinical observations, and level of parental concern. Future analysis will expand these themes and evaluate the relationship between a provider’s referral rate and their decision-making process.
Conclusion:
Early Intervention referral decision making is complex. Provider perspectives may provide opportunity for targeted intervention.
