Creating a More Efficient and Equitable Autism Evaluation Pathway Through Integrated Behavioral Health in Pediatric Primary Care.

BACKGROUND: Long wait times for autism spectrum disorder diagnostic evaluations delay access to early intervention and disproportionately affect Hispanic families and families who speak a primary language other than English. Integrated behavioral health models in pediatric primary care offer an opportunity to improve early identification, streamline referrals, and reduce inequities in access to specialty care. METHODS: We describe the implementation of a tiered, integrated autism screening and diagnostic pathway within Hasbro Children's Pediatric Primary Care Clinic in Providence, Rhode Island. The pathway embeds behavioral health consultation and secondary autism screening into routine well-child visits for children ages 0-3. Children identified as at risk for autism receive expedited referral to specialty diagnostic evaluation using gold-standard assessment tools available in English and Spanish. Program evaluation includes comparison with two historical control groups (2018 pre-COVID and 2022 post-COVID) on wait times to specialty contact and diagnostic evaluation, as well as referral completion and connection to services. Patient experience is assessed using quantitative satisfaction measures and qualitative interviews within a quality improvement framework. RESULTS: The clinical pathway is currently active, and data collection is underway. Outcome data are not yet available. Early implementation demonstrates the feasibility of embedding secondary autism screening and care coordination within pediatric primary care and highlights the role of behavioral health integration in addressing delays in access to specialty services. CONCLUSIONS: A tiered, integrated autism evaluation pathway within pediatric primary care has the potential to reduce diagnostic delays, improve equity, and enhance family-centered care. Findings from ongoing evaluation will inform refinement and replication of this model in other primary care settings.