Putting the ‘S’ in EPSDT:
Early Developmental Screening in Alaska
November 2010  AMCHP Webinar
The Governor Council on Disabilities and Special Education
2005 Alaska State Autism Plan
Autism Ad Hoc Committee
Medical &
Health
Funding &
Policy
Family &
Child
Education &
Training
Family Support
Srvs
Alaska State Autism Plan Successes
Universal Screening
- State EPSDT Coordinator
- Alaska Native Tribal Health System Relationships
- PHN Training on MCHAT
Diagnostic Clinic Expansion
- PADN opens
- Outreach Screening Clinics Expand
Enhance Referral and Training
- SESA’s Alaska Autism Resource Ctr in Anchorage & Fairbanks
opens
- SSG – Family Resource Center earmark
Workforce Training
- Academic Developments and 12 Module Set Development
- LEND planning grant award
- Early Intervention – Highly Qualified Worker Goals
- Awareness Campaign: PSA, Autism Awareness Month &
Website
- Trainings, seminars, and workshops
Time Limited Intensive Autism Services
- 2010 AUCD February Regional Summit and June State Plan
Continuation
- Agreement on definition of intensive intervention
Combating Autism Act Initiative
Alaska State Implementation Grant
Goal #1: In rural Alaska, develop new processes to support the system
of early identification, developmental screening and diagnosis of
children suspected with autism and other neurodevelopmental
disorders – partner with Part C services, Providence Autism Diagnostic
Network, Head Start, Alaska Tribal Health Systems, EPDST Coordinators,
Department of Education and Early Development, etc
Goal #2: Children 0 to 3 will be successfully connected with early
intervention services and a medical home, leading to earlier initiation
of services
Goal #3: The project will be aligned with goals established by the
Autism Alliance and the Early Childhood Comprehensive Systems
(ECCS) plan to assure continuity and work collaboratively on a long
term sustainability plan
Early Periodic Screening Diagnosis and Treatment (EPSDT)
Pediatric Neurodevelopmental Outreach & Autism Screening Clinics
Providence Autism Diagnostic Center (PADN)
SOA Autism Plan / Combating Autism Act Initiative / State Demonstration Grant
Early Periodic Screening Diagnosis and Treatment
(EPSDT)
• EPSDT is the child health component of
Medicaid.
• EPSDT is required in every state and is
designed to improve the health of lowincome children, by financing appropriate
and necessary pediatric services.
• EPSDT is designed to address physical,
mental, and developmental health needs.
• http://www.hrsa.gov/epsdt/
2006 State Leadership Workshop on Improving EPSDT
through Medicaid & Title V Collaboration
Alaska’s Five Priority Action Steps:
• Improve data integration
• Strengthen the network of community care
coordinators
• Implement a quality initiative related to EPSDT
screens
• Develop parent-focused initiative to boost parent
informing and engagement
• Support cross system training
• MCHB-HRSA funded project, May 2006
Putting the “S” in EPSDT :
Early Developmental Screening in Alaska
AMCHP Peer to Peer Exchange – Fairbanks
October 2010: Tribal Health and State Leaders met in to discuss
EPSDT curriculum development for rural health care providers
– Seven Tribal Health Organizations (THOs) attended representing 80%+
of AK rural health care providers
– Most of Alaska’s 17 major THOs have no mechanism for EPSDT specific
training for rural health care providers
– Two THOs presented new curriculum developments to share with
other organizations wishing to enhance EPSDT services
– State of Alaska offered materials and support on developmental
screening tools (ASQ-3, AAP Guidelines, First Signs) to interested
organizations
MCHB-HRSA Resources for
State EPSDT Program Development
2009 Final Report on State Leadership
Workshops on Improving EPSDT Programs
Collaboration & Action to Improve Child
Health Systems: Discussion Guide & Toolkit
The Future of EPSDT in Rural AK
Build on Successes:
Address Challenges:
• Renewed Partnerships with
and among Tribal Health
Systems
• Support from Tribal Health
Consortium to integrate
evidence based
developmental screening
into training manual
revision and clinical practice
• Increase training and TA to
address Rural health care
provider overload/burnout
• Build Relationships to reduce
silos and barriers (i.e. Tribal
Health & Part C)
• Raise Awareness and Educate
stakeholders related to
importance of developmental
screening
• Outreach Screening Clinics and
technology to maximize limited
provider resources…
Early Periodic Screening Diagnosis and Treatment (EPSDT)
Pediatric Neurodevelopmental Outreach & Autism
Screening Clinics
Providence Autism Diagnostic Center (PADN)
SOA Autism Plan / Combating Autism Act Initiative / State Demonstration Grant
Pediatric Neurodevelopmental
Outreach & Autism Screening Clinics
A community-based presentation is usually offered one of the clinic evenings.
Staff are available for presentations to providers, agencies, & parent groups on new
developments in autism services in Alaska.
Skills-based training for providers, agencies, business schools, & clinics, are available.
Pediatric Neurodevelopmental
Outreach & Autism Screening Clinics
Preliminary 2010 Clinical Summary
 Approximately 75 % referred to screening
clinics are autism/ASD R.O.
 About 60% referred to diagnostic center in
Anchorage for multidisciplinary evaluation
 The balance are referred for PDD, ADD/ADHD,
and Fetal Alcohol Syndrome/Effect (FAS/E)
Dillingham
•Current population, 2264
•Traditionally a Yup'ik Eskimo area with Russian
influences, Dillingham is now a highly mixed
population of non-Natives and Natives.
•The outstanding commercial fishing
opportunities in the Bristol Bay area are the focus
of the local culture.
Bethel
•Current population, 5803
•The region is fortunate in that rapid
development did not occur before the importance
of protecting Native culture was realized.
•The traditional Yup'ik Eskimo practices and
language remain predominant in the area.
•Subsistence activities and commercial fishing
are major contributors to residents' livelihoods.
Fairbanks
•Current population, 32,506
• Serves as the regional service and supply center
for Interior Alaska, a diverse economy includes
city, borough, state, and federal government,
transportation, communication, manufacturing,
financial, and regional medical services.
•Tourism and mining also comprise a significant
part of the economy.
•Approximately 325,000 tourists visit Fairbanks
each summer
Kenai Peninsula
•Current population, 53,602
•The Kenai Peninsula, located 60 air miles south
of Anchorage; the Kenai River is a major sport
fishing location for Anchorage residents and
tourists.
•The area has a well-capitalized infrastructure of
airports, sports, roads, public schools, and
energy-related facilities.
•The economy of the borough consists of heritage
industries, including commercial fishing, mining,
and timber, as well as tourism and petroleum
industry activities.
Valdez
•Current population, 4498
• During the 1964 earthquake, the original city
waterfront slide into the ocean, killing several
residents. The community was rebuilt on a more
stable bedrock foundation four miles to the west.
•During the 1970s, construction of the TransAlaska Oil Pipeline brought rapid growth to
Valdez.
•In March 1989 it was the center for the massive
oil-spill cleanup after the "Exxon Valdez" disaster.
In a few short days, the population of the town
tripled.
Kodiak
•Current population, 6626
•The local culture surrounds commercial and
subsistence fishing activities.
•The US Coast Guard comprises a significant
portion of the community, and there is a large
seasonal population.
•Kodiak is primarily non-Native, and the
majority of the Native population are Alutiiq. A
significant Filipino population as a subculture
also exists.
•A Russian Orthodox church seminary is based in
Kodiak, one of two existing seminaries in the
U.S.
Barrow
•Current population, 4119
•The majority of residents are Inupiat Eskimos.
•Traditional marine mammal hunts and other
subsistence practices are an active part of the
culture.
•Bowhead, gray, killer, and beluga whales migrate
near Barrow each summer.
•The sale of alcohol is banned in the community,
although importation and possession are allowed.
Ketchikan
•Current population, 7503
•Ketchikan is a diverse community; most Native
residents are Tlingit. The largest collection of
totem poles in the world is found here.
•Ketchikan has a diverse economy and is a major
port of entry into Southeast Alaska. Ketchikan is
supported by a large fishing fleet, fish
processing, tourism, and timber.
•Mainly cruise ships passengers, though also
some independent travelers, visit Ketchikan
Juneau
•Current population 30,661
•As the state capital, Juneau is supported by state and
federal employment and by tourists cruising the Inside
Passage. Over 690,000 visitors arrive by cruise ship
and another 100,000 independent travelers visit
Juneau each year.
•Juneau has a Tlingit history with a strong historical
influence from the early prospectors and boomtown
that grew around full-scale gold mining operations.
•The Mendenhall Glacier and Mount Roberts Tramway
are local attractions.
•Support services for logging and fish processing
contribute to the Juneau economy.
Kotzebue
•Current population, 3154
• The residents of Kotzebue are primarily Inupiat
Eskimos, and subsistence activities are an
integral part of the lifestyle.
•Each summer, the North Tent City fish camp is
set up to dry and smoke the season's catch.
•In 2009, Kotzebue became a "wet" community,
allowing the sale of alcohol at the city-own liquor
store.
•Due to its location at the confluence of three
river drainages, Kotzebue is the transfer point
between ocean and inland shipping.
Nome
•Current population, 3468
•Gold discovered in Nome in 1898 by surveyors
turned an isolated stretch of tundra into a tent
city of 20,000 prospectors, gamblers, claim
jumpers, saloon keepers, and prostitutes
• The population of Nome is a mixture of Inupiat
Eskimos and non-Natives. Subsistence activities
are prevalent in the community.
•Nome is the finish line for the 1,100-mile
Iditarod Trail Sled Dog Race from Anchorage,
held each March
Early Periodic Screening Diagnosis and Treatment (EPSDT)
Pediatric Neurodevelopmental Outreach & Autism Screening Clinics
Providence Autism Diagnostic Network (PADN)
SOA Autism Plan / Combating Autism Act Initiative / State Demonstration Grant
Providence Autism Diagnostic Network
(PADN)
• Autism Diagnosis Overview:
– Multi-disciplinary neurodevelopmental assessment
– Review child's medical and developmental history
– Test child; observe and examine
– Summary report and recommendations given to parent during a meeting
where the parent navigator participates and takes notes.
– PN works to link family and child to community supports, resources and
providers
• Staff
– Pediatric Neurodevelopmental Specialists
– Pediatric Advanced Practice Nurse Practitioner
– SSG parent navigation staff
– Ancillary:
• Pediatric Therapies (OT, PT, Speech)
• Pediatric psychologists
• Pediatric Neurologists
State Board of Education & Early Development adds ANP
to list of medical personnel that can make an autism diagnosis; accepts for service needs
Providence Autism Diagnostic Center
(PADN)
Averages based on SOA PADN Grant Reports
• Seeing steady increase in number of children coming in for diagnosis
with booking for full diagnostic workup about 6-weeks out
• The clinic sees approximately 15 children a month for a full workup and
another 15 children for ASD screenings; the balance of children have
PDD and other neurodevelopmental challenges.
• Approximately 75% of the children evaluated are diagnoses on the ASD
continuum
• Approximately 35% of children have access to private insurance,
including Tricare; 60% are DKC or Medicaid; and the 5% balance are
self-pay.
• Most children come from the Anchorage bowl, then Fairbanks, Kenai,
and finally from “Rural Alaska.”
Reporting procedures cannot tease out and make direct correlation for the referrals made by
the PND outreach and screening clinics
Challenges and Gaps
Meeting the needs of Rural and Urban Alaskans
• Cultural sensitivity &
tribal diversity
• Family and
community readiness
for the ASD DX
• Access to services
that meet the family
needs
• Transition needs
• Ability to pay for
services
• Develop a highly
qualified workforce.
• Keep trained and
experienced staff to
live and work in
remote areas Distance,
costs, and access to
services
• Funding the service
delivery
The Impact of a Comprehensive
Autism Plan in Alaska
…..Chapter 2
an enhanced statewide access to
a fully developed
comprehensive and culturally sensitive
system of care so
that Alaskans with ASD and
related developmental disabilities
will reach their full potential
through timely and coordinated
transitional planning.
Thank you!
Kris Green
State of Alaska - Autism & Parent Services Manager
Kristine.Green@alaska.gov
&
Jimael Lawson
State of Alaska - Combating Autism Public Health Specialist
Jimael.Lawson@alaska.gov
907-269-3400