title: Reducing Disparities in Timely Autism Diagnosis Through Family Navigation: Results From a Randomized Pilot Trial.
abstract: Emerging evidence suggests that autism spectrum disorder (ASD) can be diagnosed by age 18 months and that early intensive behavioral intervention positively affects ASD core deficits. This pilot randomized controlled trial examined the feasibility of using an adapted form of patient navigation, Family Navigation (FN), to improve timely diagnosis of ASD in low-income families from racial-ethnic minority groups.
  
  
  
  Forty children referred for an ASD diagnostic assessment were randomly allocated to receive FN or usual care. The primary outcome, time to diagnostic resolution, was assessed with survival analysis.
  
  
  
  Nineteen of 20 FN children completed the diagnostic assessment, compared with 11 of 19 children receiving usual care (hazard ratio=3.21, 95% confidence interval=1.47-6.98, p<.01). In regard to engagement of participants, 17 of 20 families (85%) met with the navigator for the targeted three in-person visits (median=4, range 1-9).
  
  
  
  FN may be a promising intervention to address barriers that impede timely ASD diagnosis.
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Emily
authors.initials: E
authors.lastname: Feinberg
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Marcela
authors.initials: M
authors.lastname: Abufhele
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Jenna
authors.initials: J
authors.lastname: Sandler
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Augustyn
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Ning
authors.initials: N
authors.lastname: Chen
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Yaminette
authors.initials: Y
authors.lastname: Diaz Linhart
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Zhandra
authors.initials: Z
authors.lastname: Cesar Levesque
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Megan
authors.initials: M
authors.lastname: Aebi
authors.affiliation: Dr. Feinberg, Ms. Sandler, and Dr. Cabral are with the School of Public Health, Boston University (e-mail: emfeinbe@bu.ed ). Dr. Feinberg is also with Boston University School of Medicine, Boston Medical Center, where Dr. Augustyn, Ms. Diaz Linhart, and Dr. Silverstein are affiliated. Dr. Abufhele is with the Department of Child and Adolescent Psychiatry, Clinica Alemana, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile. Ms. Chen is with the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Ms. Cesar Levesque is with the National Institute of Child Health Quality, Boston. Ms. Aebi is with Safe Haven, New York City.
authors.forename: Michael
authors.initials: M
authors.lastname: Silverstein
mesh_terms: D000067877:Autism Spectrum Disorder / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008913:Minority Groups; D010043:Outcome and Process Assessment, Health Care; D062526:Patient Navigation / Q000379:methods*; D010865:Pilot Projects; D011203:Poverty