When Patients Screen In
Over referring patients is always acceptable and certainly preferable to under referring, and is necessary for any screening procedure. Unfortunately, long waits and shortages of specialists create a challenge in most regions. Regardless, the provider's clinical judgment is required, and children with identified risk will need further testing.
At Boston Children's Hospital, providers were told they were not required to refer anyone based on the results of the screener. For example, if a child "failed" the M-CHAT but the provider was confident that the child was on-target developmentally, then close follow up without immediate referral was acceptable to the practice. We also emphasized that most children with failed M-CHAT's would need evaluation, but not necessarily a specialist evaluation for autism. In many cases, Early Intervention evaluation focused on language skills would be most appropriate. For those with concerns for autism, we were lucky to have a developmental pediatrician available in the clinic, a luxury we realize many don't have.
For any practice, a flexible and well-communicated policy that reflects the realities of local availability should help decrease initial resistance and increase the success of the program.
- Children who are not developing typically in your estimation should be referred, regardless of parent survey answers.
- A failed autism screener does not mean the child necessarily has autism, but rather that the child is at increased risk for having the diagnosis.
- Clinical care is improved with use of validated tools.