Clinical Care

Beginning in 2012, the Department of Pediatrics at Indiana University School of Medicine created a network of Early Evaluation Hubs throughout the state, stretching from South Bend to Evansville. In 2018, community-based providers at these hubs evaluated more than 900 children. Notably, children seen in the hubs are receiving their diagnoses of autism and/or developmental delay before age three. The goal is to continue to expand this hub model and to further develop a navigation system for families to access evidence-based interventions in a timely manner after their child’s diagnosis.

Early Evaluation Hubs

The Neurodevelopmental Behavioral System of Care is a statewide effort in Indiana to improve early detection and intervention for children ages 1-4 years old with autism or developmental delay. By training primary care physicians throughout the state to recognize the signs and perform an evaluation for autism and other neurodevelopmental conditions, the program addresses the long-standing nationwide problem of long wait times for families who are seeking evaluation for a developmental concern. At Riley Hospital for Children in Indianapolis, prior to the start of this project, the average wait time from referral to patient visit was over a year, meaning many children missed the early-detection window.

After a positive screen by their local pediatrician, children at risk for developmental delay can receive further evaluation and diagnosis at an Early Evaluation Hub within their own communities. The hubs also facilitate referral to Riley Hospital for Children for those who need additional assessments after the hub visit. The system has reduced the wait time for evaluation from one year to less than three months, resulting in reduced age of diagnosis.

The Early Evaluation Hub program has trained and coached 14 practices throughout Indiana to perform early evaluations of young children with developmental concerns. This has decreased the age of diagnosis of developmental delays and autism spectrum disorder among participants to under age three, but there is still additional outreach needed to drop the average age across the whole state.

Important first-step drivers in the health care system for decreasing the age of identification of developmental delay and entry into interventional services are primary care physicians (who provide developmental screening) and diagnosis and evaluation services. The Neurodevelopmental Behavioral System of Care is addressing these drivers through outreach, training and coaching supports to primary care practices to ensure children demonstrating early signs of neurodevelopmental conditions are evaluated appropriately as soon as possible.

Services at Early Evaluation Hubs

At the Early Evaluation Hubs, children receive a Screening Tool for Autism in Toddlers and Young Children (STAT) assessment and diagnostic interview by a trained team of physicians, nurses and care coordinators. The Early Evaluation Hubs help families then navigate local services to get the interventions each child needs. Hub teams participate in a learning community to work on quality and system improvements together

Early Evaluation Hubs Locations

There are currently 14 Early Evaluation Hubs sites. IU School of Medicine recently submitted a funding proposal to add five more in the next five years.