P2.085: Autism Navigator Increases Diversity in Patients Diagnosed

Background: Traditionally autism has been a diagnosis of white males. Recently, there has been an increase in autism diagnoses among females and racial and ethnic minorities. At Denver Health (DH), a large Federally Qualified Health Center (FQHC) in Colorado, we have initiated an autism referral system to facilitate autism evaluation and Applied Behavior Analysis (ABA) therapy to better serve our historically underserved patient population. This referral system meets the needs of pediatric patients from three pediatric clinics, five family medicine clinics and 19 school-based clinics.

Methods: A Health Resources and Services Administration (HRSA) grant-funded referral coordinator pilot program from 2021-2023 in the three DH pediatric clinics used medical assistants (MAs) trained to process referrals for autism evaluation and ABA therapy. The referral coordinator pilot program helped to streamline a previously inefficient and non-standardized process which resulted in more patients accessing services. However, there was still a significant attrition rate (only 25% of referrals resulting in services). In January 2024, a full-time autism navigator (AN) was hired to improve the process through building relationships with community agencies and working directly with families on eliminating access barriers.
To assess the reach and scope of these programs, demographics and visit counts from the referral coordinator pilot process (2023) and the AN process (2024) were compiled, as was overall DH pediatric population demographics.

Results: Demographics of those referred by the referral coordinator pilot process (2023) and the AN process (2024) yielded 558 and 983 separate referrals, respectively, for autism diagnostic evaluation, ABA therapy or both. (Table 1). Our AN process (2024) includes a pathway (Image 1). With our autism navigation process, we have more than doubled our referrals initiated and improved upon our rate of services received. (60% of referrals with an agency identified and contacted). Additionally, with our new AN, we have mirrored the demographic shift noted in the national autism diagnoses landscape including an increase in female and minority populations. We have improved access to autism services and increased participation rates in therapy by addressing systemic barriers and offering personalized support to families, thereby optimizing their ability to engage with available services.

Conclusion: Implementing an autism navigator process at a large, diverse FQHC resulted in a more diverse patient population receiving referrals for autism evaluation and ABA therapy, reflecting national trends in the past 15 years. The improvement in the process, from an initial referral coordination pilot program to an autism navigator program, not only streamlines the administrative referral process but also incorporates additional core competencies, such as outreach and collaboration with community providers, along with a more personalized family navigation process. This has resulted in improved access to autism services and greater participation in therapies for the historically underserved groups in the community we serve.