Presented by Katherine Burns, Jill Fussell, & Eldon Schulz

1. Piloting the Implementation
of an “M-CHAT Clinic”
Katherine Burns, MD
Jill Fussell, MD
Eldon Schulz, MD

2. Description of Need
1 in 145 children in AR have Autism
Spectrum Disorder (ASD)
UAMS Developmental-Behavioral Pediatrics
essentially only current diagnostic referral
option in the state
Delays in diagnosis/initiation of services
Long waitlist for diagnostic evaluation
Tendency for some PCPs to delay referral to Early
Intervention until diagnostic evaluation for ASD

3. “M-CHAT Clinic”
Modified Checklist for Autism in Toddlers
(M-CHAT; Robins, Fein, & Barton, 1999)
Screen young children for Autism Spectrum
Disorders (ASD)
Piloted initially within our DBP clinic, plan to
integrate into community sites
Under the age of 3 years
“failed M-CHAT” or “R/O autism”
Not yet in developmental services

4. “M-CHAT Clinic”
In DBP clinic (current pilot):
Medical and developmental history
Including M-CHAT follow-up structured interview
Clarify responses and elicit examples of target behaviors
DSM-specific interview questions
Physical exam
Review of records of prior assessments
Speech-language evaluation typically
administered
Language assessment, if not previously/recently done
Autism Diagnostic Observation Schedule (ADOS)

5. M-CHAT Clinic Outcomes
Diagnostic conclusions with some cases:
Global developmental delays
ASD (Autistic Disorder)
Language impairments
Disruptive behavior disorders
Leads to discussions of variations of development
in some cases
Temperamental variations, sensory sensitivities, etc.
Plan for follow-up/monitoring
Additional evaluation in some cases
Genetic testing
Referral for other medical subspecialty evaluation
Additional developmental testing

6. M-CHAT Clinic Outcomes
Prioritizing younger children and/or those
not yet in developmental services
Practice/streamlining M-CHAT follow-up
interview, medical/developmental history
Template to be disseminated
Allowing us to see children sooner
Specific recommendations more quickly
Treatment, referral, further evaluation

7. Transitioning M-CHAT Clinic to the
Community
Medical/developmental/M-CHAT follow-up interview
“Step 2 pilot”
PCPs in the community who have voiced interest in having
more DBP in their practice
Fostering partnerships
LEND, state universities/allied health training programs, AR
Autism Outreach and Resource Center (AAROC), State
departments (Dept of Ed, Title V, DDS, Dept of Health)
“Second-tier” regional referral centers
Mid-level assessment option between PCP and tertiary care
center
Provides diagnostic evaluation and care-coordination for
relatively less complex cases of ASD

8. Challenges to Transitioning M-CHAT
Clinic to the Community
Maintain the Medical Home
Funding/Reimbursement
Legislative action, grant funding, contracts
Maintaining Partnerships
LEND, LEDBP, Colleges/departments, State
departments
Awareness that interdisciplinary is ideal