Assessing Accessibility and Equity of Autism Spectrum Disorder Screening Tools

Introduction: Disparities to accessing autism spectrum disorder (ASD) screening tools have been demonstrated across race, ethnicity, socioeconomic status, and language. Additionally, there are concerns that existing screening tools are not as accurate for minoritized individuals. Thus, it is likely that level 1 screening tools must be adapted and developed for, and with, marginalized populations in the United States to promote increased levels of universal screening access and accuracy among minoritized populations. Methods: Using the PRISMA scoping review checklist, an initial search produced 1880 unique records. Following title and abstract review, 35 articles met criteria for full manuscript review. Finally, 7 articles met criteria for chart review. Inclusion criteria included: 1) original peer-reviewed research study, 2) level 1-behavioral screener; 3) for ASD; 4) must be either an adaptation or creation for a diverse population; and 5) research must have taken place in the United States. Results: Seven studies met full inclusion criteria. Preliminary data demonstrates multiple translations, into Spanish and Nepali, as well as the development of a pictorial-based screening tool, the Developmental Check-In (DCI). Adaptations and creations target language, parent education and literacy level. Conclusions: Preliminary conclusions demonstrate a paucity of level 1, ASD-specific, screening tools adapted or developed with or for marginalized populations in the United States – despite the demonstrated need for these tools. We conclude that more research in this area is necessary to address known barriers to access and accuracy of current level 1 screening tools for autism for the diverse population within the United States

Social Determinants, Health Care Access and Utilization in Detroit, Michigan LatinX Community

Background - The Amigos Médicos Clinic is a Wayne State School of Medicine Latino Medical Student Association (LMSA) project started formally in June of 2021, that aims to bridge the healthcare gap faced by the uninsured/underinsured Latinx community of Detroit by providing free medical screenings and education to this community. According to a 2018 survey conducted by the University of Michigan’s Detroit Metro Area Community Study (DMACS), 22% of Latinx residents reported lacking insurance, and 14.2% of Latinx residents utilize hospital emergency rooms as their usual place of medical care when they are sick. Along with providing blood glucose and blood pressure readings, refilling prescriptions, and providing person-to-person education along with educational resources, the clinic will conduct a survey to further assess the existing disparities facing this population. Objective(s) - Assess social determinants contributing to health disparities among the LatinX community in Detroit, Michigan. Identify and facilitate utilization of existing local resources that address the lack of social support to combat health disparities among the Detroit LatinX community Method - A survey assessing social determinants of health is completed by each patient with the assistance of the clinic staff and is offered in English and Spanish. The questions cover determinants such as transportation, ethnicity, language, health insurance, health status, and health accessibility. Data was collected from June to September 2021. In total, the English survey had 4 respondents and the Spanish survey had 16 respondents. The survey is anonymous and does not include any identifying information. Data was compiled on a Microsoft Excel file for analysis. Results - The findings from the English survey include 25% of respondents not having health insurance, none had a primary care provider (PCP), and 50% believed that Hispanics receive a lower quality of care compared to their non-Hispanic counterparts. There were only 4 respondents for the English survey however so the sample size is too small to be representative. The Spanish survey (n=16) found that 56.3% of patients do not have health insurance or a PCP. The majority of respondents said they seek care at a community clinic when they are ill with very few seeking care from a private physician. Additionally, it had been over a year since 50% of patients had seen a physician in any capacity. The most common health conditions were hypertension (50%), high cholesterol (68.8%), and type 2 diabetes (37.5%). Seventy-five percent of respondents to the Spanish survey were unemployed with 43.8% having difficulty affording food in the past year and difficulty affording medication previously. Respondents said that the biggest issue they had when seeking care was cost (52.17%). Fifty-six percent believe that Hispanics receive a lower quality of care while the rest believe Hispanics receive the same quality as non-Hispanics. Twenty-five percent have felt discriminated against by a healthcare provider before. Over half of patients claimed they needed assistance in understanding medical materials and over 80% have difficulty understanding written materials about their condition. Less than a third (31.3%) of patients said they are very confident filling out medical forms on their own. Conclusions & Impact - Our study was able to better elucidate the social determinants of health and access to health in Southwest Detroit, which is known for its LatinX community. We found that community members were often hesitant to seek medical care due to barriers arising from disenfranchisement, mostly cost. Upon seeking treatment, another salient barrier to treatment and confidence in treatment was language difference. Participants reported feeling discriminated against. This state of affairs can lead to tragic discrepancies in public health. We believe that the LatinX community is strong and capable of overcoming historical disenfranchisement if they are empowered by the health care infrastructure. Our findings highlight the importance of communication and outreach, especially in Spanish. On a practical level, we feel there is certainly a need for community-based health interventions. We will continue to do our part as the Amigos Medicos Clinic at the Wayne State University School of Medicine to serve these needs and encourage similar initiatives that will help build a stronger, healthier, more just Detroit