Referral & Diagnosis
Referral is a recommendation that a child, who has been screened through a standardized developmental or autism-specific assessment, be further evaluated by a professional qualified to determine a diagnosis and/or eligibility for services.
Diagnosis is based on the assessment of an individual using the criteria in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) developed by the American Psychiatric Association.
Quality Indicators / Problems / Data Drivers
QI 2.1: Families have a range of referral options so that children with disabilities may receive timely and appropriate evaluations.
Problem: Many Georgia families are unfamiliar with where or from whom to seek services when their child is referred for evaluation. There are relatively few providers who have specific training in autism spectrum disorders and many providers do not accept Medicaid. As a result, this may increase the time between initial referral and the completion of a diagnostic evaluation, thus impacting whether or not a child receives early intervention services and possibly negatively impacting developmental outcomes for children with disabilities. Referral and diagnostic services later in life are difficult to access. Eligibility rules for medical and educational services often prevent children from receiving collaborative and comprehensive interventions in schools and childcare facilities.
Data Driver: Early identification of developmental delays, combined with appropriate early intervention supports, improves outcomes for children with disabilities.5, 6 Although people with autism can potentially receive services under Medicaid waivers in some states, many do not because they do not meet eligibility rules or because the states limit enrollment.23
QI 2.2: Autism is best evaluated by a team of knowledgeable professionals using validated methods that identify both the needs and strengths of the child, and can differentially diagnose autism from other developmental concerns.
Problem: here are few multidisciplinary teams in Georgia with the expertise to diagnose autism. Additionally, survey results indicate that many parents are unsure which providers are qualified to provide a diagnosis of autism.
Data Driver: The assessment and diagnosis of autism requires collaboration between multiple care providers and the use of multiple assessment methods rather than just a single snapshot, which can be confusing for parents.7
QI 2.3: Children and families from all racial, ethnic, and cultural backgrounds have access to culturally competent services relating to referral, evaluation, and diagnosis.
Problem: Children and families from diverse backgrounds often face increased difficulty in obtaining timely diagnosis and accessing services. Factors contributing to this disparity have been attributed to combinations of family culture, provider sensitivity, communication styles, and perspectives on child development. Based on our survey, White families (77% of the respondents) generally felt that their services reflected their "family culture, needs, values, and preferences." The majority of Black families who responded disagreed, however, that services reflected their culture and values.