“If a physician doesn’t understand the culture or speak the language . . . children from non-English speaking families may not be picked up and get the services they need to progress,” said Gabovitch, who is also the Centers for Disease Control and Prevention’s “Learn the Signs, Act Early” autism awareness campaign ambassador to Massachusetts, and the state team leader of the Massachusetts Act Early Coalition. “The pilot will focus on helping pediatric providers overcome cultural barriers during the screening and referral process.”
Varying cultural expectations and/or language differences between physicians and their patients could mean some children from non-English-speaking backgrounds are identified later than recommended, or not at all, Gabovitch said.
The American Academy of Pediatrics (AAP) recommends that pediatricians routinely screen all children for developmental concerns at nine, 18 and 24 or 30 months, and for autism spectrum disorders during well-visits held at the ages of 18 and 24 months using an autism-specific tool.
Massachusetts has become a leader in the early identification of children with autism spectrum disorders. The average age of diagnosis for children receiving early intervention services in Massachusetts is just over age two, compared to 4 years old nationally. But disparities may still remain among immigrant populations.
The project aims to help bridge that gap by creating, implementing and evaluating a culturally competent teaching module for pediatricians.
The grant award will support the design of a training curriculum developed from the Considering Culture in Autism screening kit, already created by Gabovitch and a team through a 2012 grant award from the Association of Maternal and Child Health Programs. That kit is available for download on the Massachusetts Act Early website.
While the training will be designed to help pediatricians deliver culturally competent care to children from any ethnic and linguistic background, four populations will be featured to illustrate such care in practice: Hispanic, Chinese, Haitian Creole and Vietnamese. These linguistic groups were chosen because they represent the leading populations in Massachusetts for whom English is not their first language.
Gabovitch and her multidisciplinary team, all members of the Massachusetts Act Early Coalition, will implement the pilot training program in March of next year at Boston Medical Center and the Floating Hospital for Children at Tufts Medical Center. A total of 60 pediatric residents at both hospitals will participate. A video production company specializing in intercultural communications will film case study video vignettes that will be embedded in the final training module.
“There are a lot of children that don’t get diagnosed, and therefore don’t make it into early intervention programs,” said Gabovitch, director of Family & Community Partnerships at the Shriver Center. She is also an instructor in family medicine & community health.
Studies show that early intervention results in better outcomes for children on the autism spectrum, said Gabovitch, the mother of a teenage son on the spectrum. “We want to support families and make sure these kids have a fair shot at a good quality of life. It’s all about helping kids flourish to their full developmental potential,” she said.
The project is expected to take one year to complete. A report of the results, which will include measures of knowledge and attitude before and after training, will be written in the fall of 2014. The completed module will be submitted to the CDC for possible inclusion in their national Autism Case Training (ACT) curriculum.
Gabovitch hopes to expand the pilot training program in the future, with the help of additional grant awards, to include on-site and online culturally competent training for pediatric medicine professionals.
Kathleen Braden, MD, director of the Shriver Center’s Leadership Education in Neurodevelopmental and Related Disabilities program, will serve as a project advisor. Braden, a developmental and behavioral pediatrician, is a clinical professor of pediatrics.
The Deborah Munroe Noonan Memorial Research Fund, established in 1947, supports innovative research and demonstration projects from nonprofit organizations and academic institutions that serve children with disabilities.