School Medical Autism Review Team (SMART)

Coordinated by

Amy Carlsen, RN www.doh.wa.gov

a healthy dose of
information

A Virtual Interdisciplinary Process for Autism Assessment in Washington State

The Need The SMART Solution Care Coordination for the SMART Process
Early identification of autism spectrum disorder (ASD) is School Medical Autism Review Team (SMART) is a: Four communities in Washington State are using the School Medical Autism PEND
WHATCOM
essential to ensure that children can access specialized, Process where primary care providers, schools, Early Intervention agencies, and families come Review Team(SMART) process to provide a comprehensive assessment for ASD OKANOGAN
FERRY
OREILLE

San Juan
evidence-based interventions that can help to optimize long- together and share records in order to facilitate a virtual, comprehensive assessment of a child for children in their local community. SKAGIT
STEVENS

term outcomes. (Zwaigenbaum, L, Bauman, M, et al. Early

ISLAND

Process that provides a close link between a childs primary care provider (PCP) and school team, Families are tasked with collecting all of the records from the primary care CLALLAM SNOHOMISH

Identification of Autism Spectrum Disorder: Recommendations CHELAN DOUGLAS

who sees the child on a daily basis provider, the school, and other places where they receive services. The success JEFFERSON

for Practice and Research. Pediatrics. 2015;136;S10) KITSAP LINCOLN SPOKANE

of SMART is dependent on the ability of families to gather all of these records. KING

In Washington State, Model that builds community capacity in rural and underserved communities who dont have access This is often a barrier for families to get a timely evaluation. The mitigate this GRAYS
HARBOR
MASON
KITTITAS GRANT ADAMS

Applied Behavior Analysis (ABA) to a local multidisciplinary diagnostic center problem, communities have supported a care coordinator locally to support
PIERCE WHITMAN

The waitlist for an THURSTON

autism evaluation at is the application of the principles Mechanism that allows children to qualify for ABA therapy that is covered by Medicaid families in understanding the SMART process and collecting the necessary PACIFIC LEWIS FRANKLIN GARFIELD
YAKIMA

a multidisciplinary of learning and motivation records. These local coordinators are registered nurses or community health BENTON
COLUMBIA

This process reaches families who would be unable to get access to a timely assessment for autism WAHKIAKUM
COWLITZ
SKAMANIA WALLA ASOTIN

diagnostic center is from Behavior Analysis, and workers. WALLA

and connected to services because of: KLICKITAT

between six to twelve the procedures and technology The MHPP staff surveyed the four local
CLARK
Relationship of hours spent in care coordination
derived from those principles, to distance to available diagnostic centers
months. and # of evaluations in community coordinators to find out how much time
the solution of problems of social lack of transportation 50
they were spending supporting families in CAM communities using the SMART tool
Access to Applied significance. Many decades CAM Communities who are starting to pilot the SMART tool
Behavioral Analysis language barriers 40 gathering records for the SMART process.
of research have validated
(ABA) therapy for treatments based on ABA.
30
It is notable that Whatcom Countys CAM community has a much higher number of referrals,
children on Medicaid 20 evaluations, and other indicators compared to the other three CAM communities. This is because
The SMART tool
www.centerforautism.com/aba-therapy.aspx
can take as long as 2 10 they have a full-time care coordinator (37.5 hours/week), while the other communities each have
years. 5 or fewer hours/week available for care coordination. Rural CAM communities (Island, Skagit) get
Using a shared document, the SMART tool, families are able to collect records of evaluations from 0
Island Skagit Lewis Whatcom
fewer referrals than CAM communities in more densely populated counties (Whatcom, Lewis).
their school, Early Intervention agency, local providers, and pediatrician to inform an interdisciplinary
The Background diagnosis of autism.
# of hours spent on care coordination per week

# of children evaluated between Jan 1-March 22, 2017

The Community Asset Mapping (CAM) project is a collaboration # of referrals between Jan 1-March 22, 2017

between local communities and Washington State Maternal and

Child Health Title V partners. These partners include the Washington SMART tools Results
State Department of Health, the Washington State Medical Home The SMART tool is available in English and Spanish and is a fillable online form. The SMART process has strengthened community collaborations and partnerships
Partnerships Project (MHPP), and the University of Washington
Leadership Education in Neurodevelopmental and Related Communities reported:
Disabilities (LEND). crea
te d by M
aure
en T
u r n er, Psy
.D.

Most referrals come from primary care providers with a smaller number coming from parents/legal guardians and schools.
ion Tool Adapted from Autism Communication Tool created by Maureen Turner, Psy.D.
icat
mun __
____

CAM staff and a network of state partners help communities

Com ____

Funding for the local coordinators comes from a variety of sources ranging from in-kind (Island) to multiple federal and community level
utism ____
mA __
Autism Observation Checklist
p te d fro
list B ____ _ _ ____
Ada c k O _ _
Childs onName __ D ____
Che _________________________________________________________ DOB ____________________
va ti _ _ _____ _ _ _ ____
r _ _ _

strengthen local systems to screen, evaluate, diagnose and

bse ____ at e
__ D
funding sources (Whatcom). Skagit uses funding from Maternal and Child Health Block grant funds they receive from WA Department
sm O ____ by ________________________________________________________
P
A uti
__ _ _ _ _
Completed
_ ____ _ _
_ SL ___
Date ____________________
__
____ ____ ____
____ Relationship _ _ _ _to child: P T _ _ _ _
____
_ ____
__ ___
____ Medical Provider
_ _ ____ _ _
__Parent Child Care
T Provider
_ _ _ OT PT SLP

provide timely intervention services to children with autism and

_ _ ___ O _ _
____ ____ ____

of Health, and Lewis work is supported by the pediatric practice in which they are located.
_ _ _ _ _ _ Teacher er School _ _ _
Psychologist Other __________________________________________________
___ ____ vid ___
s N ame _ _ ____ ic a l Pro ________
_ _ d _ Please check all items that apply
Child _ _ _ ____ Me
r _ ____
_
a t a pply
by r th e th
leted vide O tems ents

other developmental disabilities. CAM is a process and forum for m p h ild : P r o a ll i m mCommunication
Co c a re i s t k C o
ip to Child C ycholog he c
tion
ionsh s se c icatotal

The biggest challenges are:

la t o l P le a Delay in,n or lack of, the development of spoken language Comments
Re nt Sc h o P
m m u e
a r e C o u a g
P cher lang

communities to identify issues around serving all children, but Te a Delayke innspeaking first words
s p
fDelay o
e n
t o in combining words
mm ents
v e lopm Delay in current language ability (quantity C oor quality)
de
o f, the

not enough time for the local coordinators

lac k Difficultyaholding lity) conversation Comments

especially children with special healthcare needs and their families. Dela
D
y in
el a y
, o
in s
i n
r

c
total

o
p ea
first
king words
mbin nguag
t
ing
l a
w ord s
bility
ea
nt i t y o r qu
(qua Does not make small talk (just to be friendly)
Rarely/never initiates conversation
Difficulty sustaining conversation
el a y ation

urren

This is done through a community-driven process of identifying

dly)
D l ay i n c n v e r s e frienDifficulty discussing topics chosen by another person

a lack of needed specialty providers and services for families

D
e
d in g co
(j u s t to b
Says inappropriate things mm ents
h o l l k o n n C o
ulty al l t a ersa
ti Doesn't e rs o
punderstand sarcasm/humor
Diffic m a ke sm es conv tion n o t h er
not itiat ersa by a

assets and challenges in how children are currently being identified

D oes never in g conv chosen Unusual or repetitive language Comments
/ i n s
arely y sustain ng topic

R lt si r Repeats what others say often (e.g., movies, people, etc.)
ifficu y discus te things m/humo

D tc.) (e.g., she instead of I)

getting accurate and timely information needed from families and community provider partners
l t s Uses incorrect pronouns

ifficu ppropri nd sarca
a
p l e, e ts
men
D o
e overly formal way
na rsta e Speaks s, p
iein an
ays i

and served, prioritizing opportunities to improve care, and moving

d e u a g o v C o m
S 't u n ang ., m
gUnusual f I)
volume, rate, or pitch
oesn ive l n (e. stead o

D e t it f t e
rep say o
she i n
u su a l or t o thers ns (e.g., Play that is not developmentally appropriate Comments
Un t s w h a
r o n ou l w ay
a p a

forward as a community to pilot and implement improvements.

ep e re c t form h Doesn't imitate te (e.g., vacuuming, phone, etc.)
R es incor n overly , or pitc p riapretend
U s a t e No/limited
p ro play (e.g., doll, action figure, etc.)nts
ks in , ra llyNo ap me
pea l volume
.) ts
S e n t a
imaginarye , e t cplay
, e tc.) pretending
(e.g., e t c.) an object
/M oveanother,
is men
etc.)
s u a o p m h o n u r e e r , o r s o m
U
n u v el ing ,
p
on fi
g o t h v i C
is n ot d e a c uum oll, acti bject Restricted, i s an
ed Beha
Repetitive, Stereotyped Behaviors/Movements
that .g., v
.g., d an o ty p
Play te (e play (eInterests dingthat are ,narrow ereoin focus, intense, or unusual

Next Steps
t Comments

In response to the need to get children assessed for autism

m i t a t e n S
titive
't i en d p re
D oesn ed pret y (e.g., e p e s u a l
u toys (e.g., lining up toys)
it d, R playnwith ts
, or u
la Nonfunctional
o/lim men

a ry p cteRepeatedly s e
N i ma gi n t r i e n watching individual scenes in movies o m
s, int onuone
o Re s
ys) C
N n foSo cufocused g p to thing s to the exclusion of others
i i n i e

spectrum disorder as soon as possible within the local community,

w v
narro g ., l i n s i n m o e r s
a r e y
Unreasonable
o s (e. ceneinsistence oth on sameness/routines Comments
t s t h at y w ith t
d u al s usion of
r e s p l a d i v i x c l
Inte tiona
l n
ingi Rituals/routines
t he e es er
n func ly watch thing to s s / outinneed tor be
rthat y/ord in a particular way/order
adone
o ne minor change w ts
men
Plans are underway to pilot the SMART process in Chelan-Douglas Counties using HIPAA compliant ZOOM video conferencing to support
N peated on one Difficulty mewith
la
rticu in routine

the Lewis County Autism Coalition developed the School Medical

sa p a o m
R focused
e on if objects
ce Upset
a
e inare rearranged C
S o si s t en e don transitions
e in Difficultyto b with
t ine
nabl

a s o a t need e in rou
Unre t h Repetitive g motor mannerisms Comments
n es han

virtual meetings. This will support the SMART team in doing community assessments via telemedicine.
routi minor c rranged

Autism Review Team (SMART). SMART is both a process and a

l s / 1
it u a h a
R fficulty w cts a
it re reHand flapping or wringing
i je ns walking
D set if ob h tra nsitio Toe
s
p
U fficulty w
it Head
a n n erism banging
D
i rm

tool for families, schools, and primary care providers to share iv e moto w ri n
ging
e t i t o
7-1-16r 1
Rep ppin
g
a n d fla g
H e w al ki n i ng
o g
T ad b an

information about a child to inform an assessment of ASD. 7 -1 -1

6
H e