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Autism Summit 2014 - Dr. Jean Frazier, CANDO, UMass Medical School
1. What’s New in Autism in Central
Massachusetts?: A look at CANDO
CANDO
Center for Autism and Neurodevelopmental Disorders
UMASS Medical School and UMass Memorial Health Care
January 28, 2014
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2. Extent of the Challenge
• 1 in 50 youth have an Autism Spectrum Disorder
(recent CDC survey of parents)
• This rate has been increasing by 20% per year!
• 75% of children with ASD have a comorbid behavioral and physical
diagnoses
• Behavioral = anxiety, ADHD, mood disorder, speech and
language, sensory processing
• Physical = sleep, gastrointestinal (GI), seizures
• One of the most challenging disorders for families and providers
• Emotional toll – “my child is in there somewhere”, strained
relationships, increased stress on siblings and other family members
• Financial Costs - $1.4 million to care for person with autism over their
lifetime; $2.3 million if there is also intellectual disability
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4. National Survey on Child Health (Gurney et al, 2006)
Children with autism vs. typical children had more:
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Depression or Anxiety
Behavior or Conduct Problems
Physician Visits
Treatment for Emotional, Developmental or Behavioral
Problems (75.4% vs. 7.0%)
• Prescribed Medications (51.4% vs. 14.5%)
5. Extent of the Challenge
• In Central Massachusetts, the majority of children receive their
initial diagnosis through evaluations from Primary Care
Physicians (PCP)
• Most PCP’s are challenged to secure assistance in making the
initial and differential diagnoses and in the development and
implementation of an individualized treatment plan
• Therefore, families are typically referred to and are required to
travel to Boston clinics for further or confirmatory diagnostic
evaluations, where the average wait time is 9 – 18 months
•This is particularly challenging for families with limited
financial resources and/or family support
•More PT1 Vouchers are used to transport families to Boston
from Central MA, thus costing the state more money
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6. Clinic Access
Limited availability of diagnostic clinics in central and western MA
Autism Consortium Symposium
October 25, 2011
Boston, MA
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7. Objectives
• Introduction of CANDO within the Division of Child and
Adolescent Psychiatry at UMASS Medical School and UMass
Memorial Health Care, University Campus
• Provide cost-effective and clinically-sound evaluation and
short-term treatment for children with complex comorbid
medical and behavioral presentations, which allows for
efficient servicing of more children
8. CANDO Team
Vice Chair & Medical Director - Jean A. Frazier, MD
Executive Director UMMBHS- William O’Brien, MSW
Program Director – Mary Beth Kadlec, ScD, OTR/L
Assistant Medical Director – David M. Cochran, MD, PhD
Pediatric Neurologist – Christy Stine, MD, PhD
Pediatric Neurologist – Andy Zimmerman, MD
Speech/Language Pathologist – Susan Swanson, MA, CCC-SLP
Autism Resource Specialist – Kelly Hurley
Executive Secretary – Stephanie Hitchew-Marazoff
Currently interviewing for:
Board Certified Behavior Analyst (BCBA)
Occupational Therapist
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10. Service Delivery Drivers
• Caregiver’s Capacity
•Do the caregivers understand and agree with report findings?
• Coordinated Care
•Were caregivers concerns addressed in the evaluation process?
•Were practical strategies recommended and resources
provided for families?
• Age of Child
• Insurance
• Town
12. Waiting for Validation and Services
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Waitlist can be up to 1.5 years for an evaluation
Families seek alternative means to get a diagnosis
Child and family miss out on valuable services
More difficult and more expensive when there is a
delay in diagnosing and treating
• Family health is negatively impacted
14. Solution = CANDO
Long term
Provide a permanent integrated clinical, research and
teaching clinic for patients with ASD and
Neurodevelopmental Disorders across the lifespan.
Most Immediate
Launched a first-ever single point of entry in Central
and Western Massachusetts for interdisciplinary
evaluations, short term treatment, and care coordination
for youth and their families with complex comorbid
medical and behavioral presentations.
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15. CANDO Clinical Approach
• Families identify their hopes and expectations for the evaluation
• This information drives the evaluation and treatment for each
youth and family. Family members actively participate in the
evaluation and treatment to provide strategies that are relevant
for them and their situation
• Focus is on accurate diagnosis with effective and comprehensive
short-term treatments
• Taking referrals for youth who have a PCP with a UMASS
affiliation
• Applicable clinical activities will be billed to available insurers
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16. Evaluation and Treatment Model
Stage 1 – Evaluation
Required Specialties
Family Members
Psychiatrist
Neurologist
Developmental Behavioral
Pediatrician (DBP)
Occupational Therapist
Speech and Language
Therapist
Family Resources Specialist
Stage 2 – Treatment
Required Specialties
Family Members
Psychiatrist
Occupational Therapist
Speech and Language Therapist
Stage 3 - Transition
Required Specialties
Family Members
Psychiatrist
Occupational Therapist
Speech and Language Therapist
Developmental Pediatrician
Family Resources Specialist
Family Resources Specialist
Board Certified Behavior
Analyst (BCBA)
BCBA
BCBA
Case Manager
Case Manager
Case Manager
Utilized as Needed
Utilized as Needed
Utilized as Needed
Sleep Expert
Geneticist
Gastroenterologist
Sleep Expert
Sleep Expert
Gastroenterologist
Gastroenterologist
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18. “Tapas” Menu
• Evaluation and short term intervention
•Anxiety Disorders
•Psychosis
•Autism – Psychiatry and Neurology
•ADHD Clinic
•Speech and Language Therapy
•Occupational Therapy
• To Start within the next 6 months
•Mood Disorders Clinic
•Consult Liaison Continuity Clinic
•High End Neuropsychological Testing Clinic
•BCBA
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19. CANDO Location and Contact Information
• Located on the 7th floor of the Medical School building
•55 Lake Avenue North, S7-714
Worcester, MA 01655
• Phone 774-442-2263
•Fax 774-442-2270
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20. Light it Up Blue
Celebrating Autism
Awareness and Acceptance
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