Integrated Healthcare for People with ASD

Abstract:
This blog is trying to introduce a model of interdisciplinary teamwork for Autism Spectrum Disorder. Most of the content is retrieved from the book – Handbook of Interdisciplinary Treatments for Autism Spectrum Disorder. To look at more details, please visit: https://link.springer.com/book/10.1007/978-3-030-13027-5 

What is interdisciplinary healthcare?
Integrated healthcare, often referred to as interprofessional healthcare or interdisciplinary healthcare, is an approach characterized by a high degree of collaboration and communication among health professionals and families. What makes integrated health care unique is the sharing of information among team members related to patient care and the establishment of a comprehensive treatment plan to address the biological, psychological, and social needs of the patient. The interprofessional healthcare team includes a diverse group of members (e.g., physicians, nurses, psychologists, and other health professionals), depending on the needs of the client (American Psychological Association, 2013). 

Why is it important for people with ASD?
People with ASD experience a variety of physical needs and mental health needs, and the health care system set up in the U.S is fragmented. In most cases, caregivers themselves have to actively manage these care interactions with multiple health care providers, which can be confusing and stressful for families.  In the beginning, most families are unaware of what services are available to help their children and are even less aware of how to go about receiving these services. Following a diagnosis, caregivers will typically go through a series of stages in which they first begin to take all the advice from experts and begin to learn as much as they can (Rieske, 2019). In the final stage, many caregivers become the “expert” in what treatments are beneficial to their children and are more knowledgeable about the treatments available. Unfortunately, as the burden for determining appropriate care is often placed solely on the caregiver, it is most common for caregivers to never actually make it to the final “expert” stage (Rieske, 2019).

A high rate of co-occurring mental health disorders, which can be hard to identify until they become almost a crisis point, requires a wide range of treatments. While interventions for ASD are typically individualized to address specific concerns, the identification and consideration of concomitant concerns are essential for providing effective treatment aimed at optimizing outcomes (Rieske, 2019). 

• Neurodevelopmental disorders (Intellectual Disability, ADHD, Other.)
• Medical Concerns (Seizures, Gastrointestinal Issues, Sleep Problems, Genetic Disorders, Allergies and Asthma.)
• Health concerns that may obscure an ASD Diagnosis (Hearing Impairments, Vision Impairments)
• Challenging Behaviors
• Comorbid Psychopathology (Anxiety, Depression, ODD)

Therefore, an interdisciplinary team can develop treatment plans precisely and effectively for each family/client, which not only reduces the heavy burden on parents but also provides more timely and comprehensive support to clients.

What kind of discipline is involved in the integrated health team?

Handbook of Interdisciplinary Treatments for Autism Spectrum Disorder p.176

Note: All the professionals included in this picture are potential providers, an interdisciplinary team will be created based on the patient’s needs. 

Family
Family is the most important part to build an effective team since each family has different culture, challenges, strengths, and beliefs. Interdisciplinary teams must employ a family-centered perspective to create treatment goals and make ongoing decisions based on the needs of the family. 

Primary Care Physician (PCPs) and Subspecialty Pediatricians
PCPs have a responsibility to assess for symptoms and risks of ASD during early childhood development, such as developmental delays, family history of neurological disorders, and genetic signs. In addition, PCPs‘ knowledge of complex medical concerns can contribute to some comorbid medical difficulties, such as nutrition, seizures, and allergies.

Developmental-Behavioral Pediatricians (DBPs)
A DBP is someone who received subspecialty training and focuses on the assessment and management of children with behavioral problems. DBPs may also be necessary for the interdisciplinary team due to their ability to evaluate and write comprehensive reports (e.g. individualized educational reports (IEP)). 

In addition to DBPs, other general subspecialties including nurse practitioners, neurologists, medical geneticists, and gastroenterologists can play an important role in treating different symptoms of ASD.

Psychologists
Psychologists play a significant role in diagnosing and providing treatment for people with ASD. Their training and experience are particularly helpful in diagnosis, assessment of comorbid disorders, and provide insights for other mental health needs. Addressing comorbid symptoms, such as anxiety, depression, and emotional dysregulation, is important because these mental health disorders may prevent individuals from benefiting ASD-specific interventions and affect their life significantly. Therefore, psychologists should communicate with family members and other professionals thoroughly and frequently to come up with an individualized treatment plan. 

Note: Clinical social workers and licensed professional counselors can also provide assessment, diagnosis, and treatment services. In practice, there are a lot of overlaps between those professionals and it should not be assumed that the explanations are exhaustive. Things need to be considered in particular service contexts to achieve better outcomes.

Social Workers
The role of social work on an interdisciplinary treatment team is “to assess, to support, and to empower the child’s family so they have the understanding, the resources, and initiative to maximize their child’s growth and development”. Raising a child with ASD can change the family dynamics, meaning that unpredictable challenges to parents’ stress and financial strain would affect the ability of the family to overcome difficult situations. Social workers’ training provides a multisystem and ecological perspective in understanding and addressing difficulties within the family. Their ability to provide mental health support and connect the school or other outside resources can directly support the family for what they need. 

Educational Team
According to the Individuals with Disabilities Act, the law requires public schools to provide special education services to students with ASD, but the criteria include a description of the particular disability “that adversely affects a child’s educational performance” (National Archives and Records Administration, 2006), which differs from the definition in DSM-5 for ASD. Such disparity may imply that the needs of this population are underestimated and undertreated in the school settings. Therefore, for the educational team, professionals would assist children with ASD to go through the evaluation process to receive a positive behavior support (PBS) plan, or individualized education program (IEP), or 504 plans. However, if the children are not eligible for the category of “autism”, they can still receive support and services under different categories, such as language impairment or developmental delay. (More information about navigating the school system can be found here.)

Special Education Teachers
Special education teachers play a key role in providing evidence-based practices and support for students with disabilities in school settings. For children diagnosed with ASD, they can develop appropriate IEP goals and assist families with the IEP process, provide academic and behavioral interventions for students who struggle with academic and behavioral difficulties, and collect data to evaluate children’s progress toward mastery of goals. 

Behavior Analysts
Board Certified Behavior Analysts (BCBAs) are specialized behavioral health service providers who provide evidence-based behavioral support and teach effective learning strategies for people with ASD. 

Speech-Language Pathologists (SLPs)
Early developmental delays in language and deficits in social communication are both major signs of ASD. Therefore, the speech therapist can be a critical part of the team. SLPs can assess and treat the clients’ language delay, and can also provide nonspeech communication skills such as gestures, facial expressions, and knowledge of understanding social context. Currently, many of the interventions available to speech therapists are evidence-based and there are a large number of different models and programs that are being improved and innovated based on the different needs of the clients/family. 

Occupational and Physical Therapists
Occupational Therapists (OT)
Usually, OTs’ work focuses on the following areas: “activities of daily living, instrumental activities of daily living (IADLs), rest and sleep, education, work, play, leisure, and social participation” (Rieske, 2019). They work with clients to improve their social skills and daily performance, such as daily routines, habits, and adaptability to transitions. In addition, OTs can also provide therapeutic and adaptive options for sensory sensitivity in autistic patients as a way to reduce environmentally induced stress responses.

Physical therapists
“Research suggests that children with ASD may have poor upper- and lower-limb coordination on tasks requiring visual-motor dexterity as well as balance, agility, and speed” (Rieske, 2019). PTs’ main job is to help clients to improve their functional mobility in adults and motor skills in children. In addition, the interventions they use are increasingly incorporating treatment options for sensory issues. The Ayers Sensory Integration Intervention (ASII) is a great example. This intervention assists clients to “register, process, integrate, and adequately respond to internal and external sensations” that occur in their daily life (Rieske, 2019). 

Other important providers
Nutrition and Feeding Therapists
Psychiatrists
Transitional Care specialists
Vocational consultant 

Conclusion
Understanding the differing roles of professionals on an interdisciplinary team is an invaluable resource for families. While not every provider will be necessary, parents can seek out the appropriate professionals and request that they communicate with other providers to create an integrated team.

References:
American Psychological Association. (n.d.). Integrated Health Care. https://www.apa.org/health/integrated-health-care Rieske, R. D. (2019). Handbook of interdisciplinary treatments for autism spectrum disorder. Springer.