Pediatric program offers fast-track to diagnosis

April 07-- Apr. 7--For parents wondering if their young child is developmentally delayed, a new program being offered in Fort Smith gives a fast-track to a diagnosis.

CoBALT, a state-funded program through the University of Arkansas for Medical Sciences at Mercy Clinic Pediatric/Internal Medicine, has increased access to diagnosing children with not just autism but any developmental delay.

CoBALT stands for Community Based Autism Liaison and Treatment Project, and is joint venture between the UAMS Department of Pediatrics and Title V Children with Special Health Care Needs within the Arkansas Department of Human Services.

Mandie Williams, APRN at Mercy Clinic Pediatric on Dallas Street in Fort Smith, is one of several CoBALT team leaders in the state and one of two CoBALT team leaders in Fort Smith trained for the program that accepts children 18 months to 4 years old.

CoBALT teams can reduce wait times and travel distances for families -- all with the goal of improving outcomes for patients, a UAMS website notes. There are CoBALT teams in Lowell, Fort Smith, Clinton, Forrest City, El Dorado and Little Rock that can conduct screening for developmental disorders and autism. Teams are made up of physicians or advanced nurse practitioners and other health professionals.

No referral is needed from a physician for a child to see Williams.

She has seen children from within her clinic, other doctors and walk-ins. In addition to seeing the child for a mini-assessment that looks at 16 behaviors, Williams also speaks to the parents for about 45 minutes before the mini-assessment. If the child scores high enough and there may be more than simply a speech delay, an appointment for further review is given.

The CoBALT program was created to take any child that a parent or physician has a concern with on development and be given an evaluation. They identify some of the delays that may be going on to help point them in the right direction to what therapies should be used, Williams said.

Wait times for diagnosis have been "astronomical," she added, and although they have gotten better there is still precious time sometimes lost when someone goes without therapy.

Jayne Bellando, Ph.D., CoBALT co-director and associate professor of pediatric psychology, notes at the UAMS website that many services can begin based on symptoms and do not have to wait for a definitive diagnosis.

"Quicker services often lead to better outcomes, because when you're dealing with children and developmental disorders -- each passing week can mean another missed milestone," Bellando said.

For example, a child waiting for confirmation of a possible autism diagnosis does not have to wait to start speech therapy. But help with payment on these services comes through CoBALT's referrals to in-network providers.

Julie and Eric Garcia brought their 2-year-old son into Mercy Clinic Pediatric for a check up because they were concerned of fluid in his ears. And the parents were not sure if their son was simply having a delay on speech development. They took him to a ear, nose and throat specialist, and his hearing is fine. With a CoBALT test, their son scored high enough on the mini-assessment by Williams to qualify for a diagnostic review.

"He hasn't been diagnosed yet, but I've always had kind of an idea that there was something there," Julie said. "If we hadn't seen Mandie specifically I don't know if we would've gone that direction. We would've just waited for his yearly appointments."

"We just want what is best for our son," Eric said. "We care about him and want him to succeed in the world. We don't know if he has any issues right now, but we want to be proactive about and it and this has been a really good tool to help us figure out what is best for us."

With a referral from CoBALT, the Garcias have been able to get their son into First Connections, which has in-network providers that are covered by insurance and allow therapists to go to their son's daycare. Their son also currently goes to speech therapy once a week and is about to start occupational therapy.

"I think if more people knew about these things it would change their whole world," Julie said.

Williams explained that a diagnosis for the level of autism is helpful in creating an education plan to "reach their optimal level."

"Almost every day we say we would not change anything about him, but if we could know what was wrong with him when he was crying, that's the main thing," Julie said. "We just want to be able to take care of him and give him what he needs and I think we're on the right track with it because of this."

Williams said the word "autism" has some stigma attached to it, although there is such a wide spectrum and many people with autism grow to become fully functioning adults. Things posted on social media usually scare people more than warranted, Williams added. She keeps a list of websites that have evidence-based information to educate parents for their own research to "knock down some of that stigma."

Because of the CoBALT program, the Garcias did not have to drive to Little Rock'sJames L. Dennis Developmental Center for their son's initial assessment. The Dennis Center is the primary center in the state though for diagnostic evaluations on children. This means that many families have to wait a long period of time to be seen by the diagnostic teams at the center. This waiting period can cause children to lose valuable time in getting access to treatment.

While CoBALT teams are able to diagnose autism, their primary goal is to diagnose developmental disorders that are not autism, UAMS states. This helps families find appropriate services in their local community.

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