78 - Modifiable Clinician and Practice Factors to Promote Autism Detection in Primary Care: A Mixed-Methods Study

Publication Number: 1070.78

Anisha Srinivasan, University of California, Davis, School of Medicine, Sacramento, CA, United States; Sarah Dufek, UC Davis MIND Institute, Sacramento, CA, United States; Narueporn Likhitweerawong, Chiang Mai University, Sacramento, CA, United States; Yalda Assemi, University of California, Davis, Laguna Hills, CA, United States; Autumn Austin, Drexel University, Philadelphia, PA, United States; Georgina Perez Liz, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States; Andrea T. Wieckowski, Drexel University, Philadelphia, PA, United States; Carol Weitzman, Boston Children's Hospital, Boston, MA, United States; Brian Freedman, Nemours Children's Hospital, Wilmington, DE, United States; Leslie A.. McClure, Saint Louis University, St. Louis, MO, United States; Yasemin Algur, Drexel University, Brooklyn, NY, United States; Daniel T. Vader, Drexel University, Dornsife School of Public Health, Philadelphia, PA, United States; Renee' H. Moore, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States; Diana L. Robins, Drexel University, Philadelphia, PA, United States; Aubyn C. Stahmer, University of California, Davis, School of Medicine, Sacramento, CA, United States

Background: Missed opportunities for early autism detection in primary care contribute to health inequities. Although child-level factors associated with delays are well documented, less is known about which primary care clinician (PCC) and practice factors may improve autism detection in routine practice.

Objective: To identify modifiable clinician and practice factors related to autism detection in primary care.

Design/Methods: We conducted a mixed-methods study of PCCs who care for young children across 40 academic and non-academic clinics (February 2023 - September 2025). We sequentially conducted surveys of 188 PCCs followed by interviews with 10% of PCCs surveyed. Surveys asked about screening strategies (Primary Care Beliefs and Practices Questionnaire), clinician attitudes (Evidence-Based Practice Attitude Scale; EBPAS) and practice capacity (Clinical Sustainability Assessment Tool; CSAT). Interviews expanded on barriers and facilitators to autism screening and post-screening (i.e., making referrals) workflows. Survey data were summarized descriptively; interviews were analyzed using the constant comparative method with triangulation and member checking.

Results: Survey participants were 73% female and 70% pediatricians, with an average of 18 years in practice (range=4-25). Most reported consistent autism screening (94%), positive attitudes towards using evidence-based tools (EBPAS M=3.36, SD=0.51), and moderate practice capacity for implementing practices such as screening (CSAT M=4.45, SD=1.14). Interviews revealed barriers and facilitators to autism screening and post-screening workflows. Screening facilitators included clinician confidence in screening, workflow integration, and quality metrics/incentives. Screening barriers included short appointments and limited language interpretation services. Post-screening facilitators included family factors (English proficiency, psychological readiness, material resources) and practice structures with on-site diagnostic evaluations. Post-screening barriers included inconsistent workflows and limited human resources for referral follow-through.

Conclusion(s): Despite positive clinician attitudes and practice support for screening, appointment time and language interpretation limitations impede screening efforts. Post-screening, inconsistent workflows and insufficient personnel place burden on families to navigate referrals for services. Modifiable practice factors to improve autism detection include extending appointment duration, enhancing interpretation services, supporting on-site diagnostic evaluations, and dedicating human resources for referral follow-through.