Pediatricians Empowering Parents (PEP) Talk: Creating A Ripple Effect in Primary Care to Facilitate Access to Early Intervention and School-Based Services for Children with Autism - PROJECT SUMMARY/ABSTRACT Early intervention is critical to improving behavioral health outcomes for children with autism spectrum disorder (ASD). However, more than 50% do not receive mandated early childhood intervention (ECI), which may delay receipt of subsequent school-based services (SBS), particularly in communities with limited access to healthcare. Pediatric primary care providers (PCPs) and parents are the chief initiators of ECI/SBS, but miscommunications during the referral process create a barrier to parents’ actions on ECI/SBS referrals. Strategies at the patient-provider interface that support PCPs in communications with families about ECI/SBS referrals are urgently needed to expedite children’s commencement of these services, maximize long-term benefits of early intervention, and reduce familial and societal costs associated with ASD. We designed the Pediatricians Empowering Parents (PEP) Talk intervention to facilitate and standardize PCP communications with families of young children with ASD/suspected ASD about ECI and SBS in the context of routine clinical care. PEP Talk involves a 1-hour, CME-accredited didactic on ECI/SBS and special-education law/procedures, plus tools within the electronic health record (EPIC) for sharing this information with patients at the point of care. One tool is a smart phrase (SP) that PCPs can opt to use when communicating information on how to initiate ECI/SBS; the other is a Best Practice Advisory (BPA), activated within EPIC for specified well-child visits, that prompts the provider to offer information on initiating ECI/SBS for eligible children. We will evaluate PEP Talk-SP and -BPA versions among PCPs in Texas Children’s Pediatrics, one of the largest pediatric networks in the U.S., through the following specific aims: Aim 1: Assess feasibility of implementing two different PEP Talk strategies for supporting PCPs' provision of ECI/SBS information. Texas Children’s Pediatrics practices (N=24, 129 PCPs) will be randomized to PEP Talk-SP, -BPA, or control, with the provision of information on ECI/SBS tracked via EPIC reports/chart reviews during a 6-month surveillance. Aim 2: Evaluate implementation outcomes and target mechanism of PCP activation through changes in knowledge, confidence, and intervention acceptability. PCPs will complete standardized surveys pre-post intervention (baseline, 4 wks, 12 mos) to assess acceptability, knowledge, and confidence. Aim 3: Conduct preliminary evaluation of implementation impact through parent activation and service connection patterns, examining child and family factors associated with parent action. Parents of patients seen during the 6-month surveillance (expected N=455) will complete surveys post-visit (1wk, 6mos, 12mos) querying their initiation/receipt of ECI/SBS, with latency measured as days between clinic visit and initiation/receipt of services. This hybrid type-2 implementation trial offers a novel, feasible, scalable mechanism for leveraging the PCP-patient relationship to improve ECI/SBS access and behavioral health outcomes for children with ASD. The resulting cohort will enable longitudinal assessment of both implementation outcomes and child development trajectories for U.S. children.
