Chloe White

H&S 490
Dr. Brown
April 19, 2023
Intervention Assignment

1. Intervention Website Review

Developmental screenings are standardized assessments used by medical professionals to

identify developmental, intellectual, and learning concerns and delays. Developmental
screenings are a method of early intervention because they can catch early warning signs of
disability. This allows families to prepare and plan for a lifetime of disability services and
resources. Developmental screenings are typically conducted in a healthcare setting but can
also be performed at home. It is recommended that children receive developmental
screenings before they enroll in pre-K education to ensure they receive an enriching and
appropriate education. Unfortunately, it is becoming increasingly common for children to
enter school without being monitored for developmental concerns. The populations most
impacted by this issue are single mothers, parents with incomes below the federal poverty
level, parents with limited education levels, and culturally diverse families. Rurality can also
impact access to health care and the availability of services. For this project, most research
will be focused on intervention strategies that work with culturally diverse families of low
socioeconomic status.

Website: “Learn the Signs. Act Early” https://www.cdc.gov/ncbddd/actearly/index.html

General Purpose of the Website:

“Learn the Signs. Act Early” provides numerous resources and supports to improve the early
identification of intellectual and developmental disabilities. This webpage includes
resources that parents, healthcare providers, and early childhood educators can use
independently. Parents can find a list of important milestones at each age from two months
to five years. Milestones include the typical social/emotional, language/communication,
cognitive, and movement/physical development at each age. The milestone checklist has
also been translated into different languages for culturally diverse families and can also be
accessed through a mobile app. Healthcare providers are given numerous resources on how
they can incorporate CDC checklists and developmental surveillance techniques into their
practice. Six specific steps for developmental screening are listed accompanied by advice
and suggestions from the American Academy of Pediatrics. For early childhood educators,
there is a 1-hour module on why developmental monitoring is important and how to talk to
families about their child’s development. This is an accredited course developed by the
Centers for Disease Control and Prevention in partnership with many other child
development organizations. All of these resources are free and printable for individual use.
It is noted on the website that these materials should not be substituted for standardized
developmental screening assessments. These resources act as a preventative measure to
help identify the warning signs and what to do if concerns arise.

Effective Interventions:

https://www.cdc.gov/ncbddd/wicguide/pdf/336220-A_WIC_Implementation-Guide_V7-
2.1.23-FINAL_508.pdf

After looking into the specific materials on the CDC website, I found an example of these
resources being successfully implemented by Women, Infants, and Children (WIC) clinics in
Missouri. The PDF document contains an entire guide for implementing a developmental
milestone checklist program. The intervention is focused on what is called the “Missouri
Model”. The University of Missouri received a grant from the CDC to expand “Learn the
Signs. Act Early” resources and distribute them to WIC services in the area. Their mission
was to help parents “(1) learn the signs of healthy childhood development; (2) act early if
there is a concern; and (3) talk to [their] child’s doctor”. The intervention includes 5 main
components: Recruit clinics and train staff, design environmental graphics, administer
milestone checklists, make referrals, and track success. After implementing these resources
in 11 different WIC clinics, the results were significant showing that “97% of parents learned
new information about childhood development” and “61% of children were seen by their
doctor because of a WIC referral.”

Critical Thinking in Relation to my Health Topic:

1) The WIC Developmental Monitoring Implementation Guide is most applicable to my

project. WIC clinics commonly encounter children with developmental disabilities.
Nutrition and disability go hand-in-hand and nutritional needs can often increase one’s
risk for developmental delays. If WIC staff are trained to assess important milestones,
they can make referrals if they notice any concerns. I am focusing on educating families
and healthcare providers on the importance of disability screening so educating WIC
staff on monitoring child growth and development is a good place to start. WIC staff can
easily communicate information and concerns with parents because they are already in
close contact. This essentially eliminates the barrier of physician access because WIC is a
service that families already receive. In addition, my primary population of interest is
single mothers and families in poverty. This is the main demographic of WIC, so the
intervention is already focused on my selected audience.
 2) Even without the implementation of the WIC intervention, the printable nature of the
CDC milestone checklists makes them readily accessible for parents and other
benefactors to use. These checklists could be displayed in doctors’ offices, schools,
childcare sections of grocery stores, bulletin boards, libraries, and anywhere else new
parents are likely to go.
3) https://healthandwelfare.idaho.gov/services-programs/children-families/about-infant-
toddler-program The Idaho Infant and Toddler Program assists families in finding early
intervention services for children below the age of 3 who have developmental delays.

https://researchautism.org/families/guidebook-series/ The Organization for Autism

Research contains a parent’s guide to autism assessment throughout their child’s
lifetime.

2. Intervention Research Reading

The first three levels of prevention are the most important for my topic. I want to focus
on educating parents and a lot of this education will come from medical providers.
Strengthening Individual Knowledge and Skills (1) is most related to parent knowledge of
developmental monitoring and assessment practices. Parents are the main indicator of whether
or not a child will receive a disability diagnosis and the appropriate services. Unless parents are
given the tools to notice early warning signs, a lack of developmental screenings will continue
to occur. Educating providers (3) is what will make this parent education and understanding
happen. Medical providers and other child-health services are in charge of transmitting
information to parents so they can make educated decisions. If providers are not briefed on the
importance of developmental screenings and how to conduct them, then parents are less likely
to complete similar assessments on their own.
In regards to predisposing factors, Self et al. (2014) found that many doctors were
unconfident in their developmental monitoring abilities which resulted in a lack of screenings
altogether. If providers are not completing developmental screenings, this can put children at
risk for unnoticed developmental delays. Enabling factors can include law and policy. The
Individuals with Disabilities Education Act of 2004 Part C has done a lot to provide financial
assistance to states so they can develop comprehensive early intervention services and
programs (Early Childhood Technical Assistance Center, 2022). Unless parents are aware of
these programs, the lack of screenings may continue. When early intervention programs are
mobilized into more low-income or rural communities, then there will be a greater outreach for
families in need.
Lastly, reinforcing factors provide an incentive to engage in a certain behavior. For
example, the Idaho Center on Disabilities and Human Development (CDHD) assists individuals
with disabilities in finding opportunities around the community. CDHD can educate families on
the types of resources available for home screening tests. CDHD, doctors, and teachers can also
refer families to developmental screening tests and milestone checkpoints that can be
completed in 15 minutes or less at home. Parents can screen their children themselves and take
their children to a physician for an official diagnosis if the results indicate a developmental or
intellectual delay.

3. Research Articles

Developmental and Autism Screening Through 2-1-1: Reaching Underserved Families (1 of 3)

Roux, A. M., Herrera, P., Wold, C. M., Dunkle, M. C., Glascoe, F. P., & Shattuck, P. T. (2012).

Developmental and autism screening through 2-1-1: reaching underserved

families. American Journal of Preventive Medicine, 43(6 Suppl 5), S457–S463.

https://doi.org/10.1016/j.amepre.2012.08.011

Population/Participants:

The population for this intervention is families in Los Angeles County who are low-income
and/or racially diverse. More than half of the participants have a monthly income of fewer than
$1,000 dollars, 80% qualify for Medicaid services, and 45% do not have access to a car.

Describe the Intervention and its effectiveness:

Research shows that the most prominent barriers to universal screenings are
inconsistent access to primary care, lack of testing from providers, frequent use of non-
standardized assessments, and unprocessed referrals. Due to these barriers, the 2-1-1 LA
project was established to provide developmental and autism screening services by phone.
When a parent calls the phone line, they are directed to a questionnaire that asks them
questions about their child’s development. If a parent notes an area of concern, they are
automatically referred to a specialist for screening. After parental consent is documented, a
“trained care coordinator” will administer either the “Parent’s Evaluation of Developmental
Status (PEDS online)” for children under 5 years old or the “modified checklist for Autism in
Toddlers (M-CHAT)” for children between 16 and 48 months. Results are then immediately
shared with the family and explained in a way that makes sense. If results indicate that the child
is at risk for a developmental disability, the care coordinator will refer the family to public
services and medical care. Children were also referred to early intervention programs such as
Early Head Start. The most unique part about this intervention is how an action plan is
developed for every family that receives a referral. One of the biggest challenges for parents is
knowing what to do once they receive a diagnosis. This service eliminates that barrier because
it automatically directs families to the services that will best fit their specific needs.
Overall, this intervention was extremely successful and showed an increase in screening
access and referral numbers for at-risk families in Los Angeles Country. Due to the service being
delivered over the phone, many children who never received screenings in a primary care
setting were evaluated. About 56% of children who were screened had a moderate to high risk
for developmental delays. This statistic shows the necessity of screenings. Without it, these
children would likely never receive early intervention services. Furthermore, the intervention
added a standardized screening tool and regulated system for tracking data and outcomes
which was a previously documented barrier.
Many families care about their children’s development, they just do not know where to
start. 2-1-1 LA gave socially disadvantaged families the chance to receive the care they might
not otherwise get. In general, the authors determined that this early intervention model is
replicable, but there are many factors to consider. First, due to the confidential nature of the
topic, there needs to be a secure software program that can manage the action plans and
referrals of large numbers of people. The main limitation is finding enough staff who are trained
in childhood development and have experience working with individuals with disabilities. It is
also important that team members are bilingual or have translation skills. The inherent nature
of call centers can overwhelm staff members if there is an uneven ratio of patients to “care
coordinators”.

Critical Thinking and relation to your project:

The main thing I learned was the accessibility of screening services. Screenings do not
only have to be completed at a doctor’s office. I am looking into ways that parents can
complete developmental screenings at home, free of cost, and this practice would fit those
standards. When analyzing the demographic information of Latah County, over 95% of families
had access to a phone. Because of this, a call center could be easily accessed by most
individuals in the county. I also learned about two new types of screening instruments. The
PEDS and M-CHAT are easy to administer by telephone and immediately identify whether the
patient is exhibiting developmental concerns. The automatic nature of these tests can give
families the results they need and want right away.
I would need to adapt to the scale of the program to fit my intended population. This
model was designed for Los Angeles which has a population 200 times larger than Latah
County. Because of this, there would not need to be as many care coordinators actively on call.
One way to reduce the scale is by partnering with an organization in Latah County that already
has experience with disability services. For example, the Center on Disabilities and Human
Development (CDHD) already has staff members trained to work with protected populations. A
call system could be integrated into one of the services that CDHD already provides. The call
center could also gain certified employees by contracting school psychologists or other service
workers from around the state.

Improving Autism and Developmental Screening and Referral in US Primary Care Practices
serving Latinos (2 of 3)

Zuckerman, K. E., Chavez, A. E., Wilson, L., Unger, K., Reuland, C., Ramsey, K., King, M., Scholz,

J., & Fombonne, E. (2021). Improving autism and developmental screening and referral

in US primary care practices serving Latinos. Autism : the International Journal of

Research and Practice, 25(1), 288–299. https://doi.org/10.1177/1362361320957461

Population/Participants:

This intervention is focused on increasing primary care provider guideline adherence at Latino
clinics in Oregon State. The participants in the study include clinical staff, providers, front office
staff, nurses, medical assistants, and referral specialists. Latino children are screened less often
and their families typically face literacy, language, and geographic barriers. Medical providers
have an important role in helping families manage these barriers, but a lack of training on the
end of providers can create an even greater barrier.

Describe the Intervention and its effectiveness:

The primary goals of the Risk Evaluation of Autism in Latinos – Screening Tools and
Referral Training (REAL-START) intervention were to increase adherence to developmental and
Autism screening guidelines, increase the number of early intervention referrals, and improve
billing practices by primary care providers. Clinics eligible for the study had the demographics of
greater than 50% of patients using Medicaid and greater than 25% being Latino. REAL-START is
a 12-month intervention filled with four catered lunch meetings that care providers were
required to attend. Each meeting was led by a certified pediatrician via webinar or in person.
The first part of the program discussed how to administer and score the Ages and Stages
Questionnaire (ASQ-3) and M-CHAT assessments. Hospital coordinators then discussed billing
processes and cultural responsiveness to language barriers. In the following months, 3 follow-
up sessions were conducted to address the language development of children in diverse
households, culturally responsive screening tactics, and Autism and developmental disability
management for parents in the home.
 I was most interested in how the program tracked the progress of how providers
implemented the information they learned during the sessions. The site advisor of the study
helped each clinic create a specific plan to improve adherence to screening guidelines and then
tracked the number of referrals that came out of each clinic. Overall, this program was very
successful. Autism screening rates increased by 24% with adherence to developmental
screening guidelines increasing from 46% to 91%. The number of children who gained access to
early intervention services remained the same, however, the age range and total number of
referrals increased by a significant amount. More research is needed on the eligibility
requirements for early intervention services as a referral alone may not be enough evidence
that the child has developmental concerns.

Critical Thinking and relation to your project:

The main thing I learned was how to incorporate effective and informative education
classes that people will actually go to. Gritman Medical Center is the primary provider for all of
Latah County. This makes it much simpler to communicate with each clinic because they are all
run under the same organization. Faculty at Gritman are already required to attend staff
meetings, so adding a professional development component would not be out of the ordinary. I
like how the meetings took place over a catered lunch because this provided an incentive for
people to attend. One way Gritman could implement developmental screening courses is by
making them available online, or by holding them in person with an incentive of a stipend or
overtime pay.
The Latinx population only makes up a small portion of Latah County. Due to its rural
location in Idaho, physicians may not have a lot of experience working with culturally diverse
families. Instead of only focusing on the Latinx population, my project could focus on all diverse
groups. Part of this would mean educating physicians on cultural responsiveness and making
sure they do not make referral decisions based on cultural factors alone. It is important that
language barriers not be misconstrued for developmental delays, resulting in biased or faulty
referrals. In addition, the study was only focused on increasing the number of referrals for the
Latinx community. It may be more appropriate to monitor the intervention success and referral
rates for children of all backgrounds in Latah County.

Developmental Stages of Developmental Screenings: Steps to Implementation of a Successful

Program (3 of 3)
Pinto-Martin, J. A., Dunkle, M., Earls, M., Fliedner, D., & Landes, C. (2005). Developmental

Stages of Developmental Screening: Steps to Implementation of a Successful

 Program. American Journal of Public Health (1971), 95(11), 1928–1932.

https://doi.org/10.2105/AJPH.2004.052167

Population/Participants:

This study believes that all children, not just those with suspected signs of disability or delay,
should receive developmental screenings. There are two interventions mentioned in the study.
The first intervention is a community-based approach that takes place in WIC clinics, providing
resources to single mothers and parents of low-income status. The second intervention
discusses increasing developmental screenings at well-child checks in the pediatric setting.

Describe the Intervention and its effectiveness:

These interventions were implemented because only one-fifth of all providers use
standardized screening tools to effectively assess children for developmental disabilities. The
main goal of both interventions was to increase the number of developmental screenings and
physician knowledge of why screenings are so important to a child’s development. In the
community-based intervention, the “Early Advantage Program (EAP)” went into WIC clinics
around Los Angeles County and trained WIC staff in early childhood development, and taught
them how to administer and score screenings. If screening results came back positive, a
representative from EAP met with the family and connected them with resources in the area. It
was incredibly effective for EAP to partner with WIC. Parents already see WIC as a non-
threatening environment where they can take their children to receive education on both
nutrition and childhood development. Despite the effectiveness of this intervention, there are
limitations. Client confidentiality needs to be the utmost priority because they are working with
a protected population of people. Sharing data and referral information between the child’s
primary care provider and WIC staff can be a concern if it is not secure. Furthermore,
administering developmental screenings is not WIC’s sole purpose. Outside funding may be
needed to keep the clinics staffed and cover the added costs of screening tools and referral
measures.
The second intervention took a pediatric physician’s approach. The intervention was
first introduced in North Carolina through the Commonwealth Fund. The two major
components of the initiative include introducing and integrating standardized and valid
screening tools, and collaboration with state or local agencies that work with families to identify
children in need. The intervention is “Physician driven” but also worked with a state advisory
group to make the needed policy changes. The first step of the intervention was to assess the
clinics’ current developmental screenings. The next step was finding a physician in each clinic
who would endorse the intervention and be a voice for change. After this, each clinic would
select the screening tool they wanted to adopt and analyze their existing plan for referral if a
child demonstrated developmental delays. The final step was briefing staff on the changes. A
curriculum based on these changes was developed for physicians, nurse practitioners, early
intervention providers, families, and therapy services to follow.
As a result of the intervention, over 16,000 developmental screenings were conducted
and the overall rate of developmental screenings in North Carolina increased to 75%. In
addition, the number of referrals has gone up and the average age of referral has gone down.
The most surprising and significant change from the intervention was seen in North Carolinas
Medicaid policies. Since 2005, it has been mandated that children receive screenings at 6, 12,
18, and 24 months as well as 3, 4, and 5, years. This goes to show that policy change plays a big
part in increasing the frequency of screenings and physician adherence to the rules. The main
consideration noted in the study was the appropriate time and place to administer screenings.
Depending on the current office flow, accommodations for developmental screening
appointments may need to occur.

Critical Thinking and relation to your project:

In order to educate parents and providers, an integral place to start is partnering with
other organizations in the community. The first intervention partnered with WIC clinics whose
main clientele is parents and children. This helped me realize that services can be provided in
places whose main resource is not developmental screenings. Many different types of people
can be educated on how to deliver screenings and it is not only up to physicians and parents.
Anyone who works with young children should be aware of the importance of developmental
screenings and how to administer them. Even if a staff member is not eligible to administer
screenings, they can still advise parents on where to go for support and resources for general
welfare or concerns.
When looking at the second intervention, they took a more systematic and policy-
oriented approach. I am mainly focused on increasing the knowledge of providers and parents,
but a lot of the intervention is still applicable. Latah Country has a considerably smaller
population than North Carolina. The main thing I would need to adapt is the stakeholders who
can make the change happen. As most of Latah County’s medical services are directed by
Gritman, this organization could be a good place to start for endorsements and policy change.
Gritman is a large organization and there are likely many people who would be willing to go
into the clinics and asses their current developmental screening practices. If Gritman can
provide one person who is passionate about creating change and evaluating the effectiveness
of their services, they can determine what pediatric services are doing well and where they can
improve. Once an analysis is completed on the types and frequency of screenings used, Gritman
can provide the funding and resources needed to implement a standardized screening measure
and professional development opportunities for providers and other healthcare professionals.

Intervention Plan

1. In order to increase the proportion of children who receive developmental screenings,

my project will focus on reaching families in the home and healthcare setting and
educating providers on how to improve their screening practice. This project is a
combination of both primary and secondary prevention. Developmental screenings are
a measure of early detection for developmental and intellectual disabilities. Families and
providers will need one-on-one or group education to understand the importance of
developmental screenings, how to receive/conduct developmental screenings, and thus
prevent the progression of disability by administering developmental screenings to all
children.

2. Intervention Types and Strategies

Selected interventions to increase the proportion of children who receive

developmental screenings: 1) Environmental and Systems Change, 2) Educational
Activities, and 3) Communication and Marketing.

*For many environmental and systems changes to happen, they need to be followed
up by educational activities and communication/marketing. Corresponding systems
changes, educational activities, and communication initiatives are labeled by number.

Environmental and Systems Change

 (1) A representative from a local hospital will go into pediatric clinics and evaluate their
adherence to developmental screening practices using a guided checklist. The checklist will
assess the types of standardized screening tools used (if there are any), how often they are
used, and their referral process. Once the strengths and weaknesses are documented, the
representative will work with the clinic manager to determine a plan for what screening
tools all physicians will use and to whom referrals will be processed. Creating partnerships
with local agencies is critical for this step to ensure that parents have access to early
intervention services if a referral for their child is processed (Pinto-Martin et al., 2005).
 (2) Eliminate the barrier of provider access by implementing developmental screening
practices in WIC clinics (CDC Missouri Model, 2022).
 (3) A local disability agency will establish a developmental screening call center hotline.
Parents can call the number 7-1-1LC and be given immediate attention. They will receive an
over-the-phone developmental milestone questionnaire, and if any concerns are noted,
they will be automatically directed to a specialist for an official assessment. Assessment
results are then explained to the family and the agency will help the family create a plan so
the child can receive the appropriate resources (Roux et al., 2012).

Educational Activities

 (1) Brief staff on the changes being made to their clinics’ current developmental screening
practice. Provide a curriculum that displays a step-by-step procedure of the implementation
process and how staff should be interacting with patients (Pinto-Martin et al., 2005).
 (2) Provide training to WIC clinic staff on disability early warning sign detection, how to
administer developmental screenings, and how to make referrals if concerns are detected
(Pinto-Martin et al., 2005).
 Require clinic staff to attend incentivized professional development opportunities that
discuss the importance of developmental screenings, cultural responsiveness, how to
administer a specific screening tool, and the referral process. There will be four hour-long
sessions with each session covering one topic (Zuckerman et al., 2021).

Communication and Marketing

 Display printed versions of the CDC “developmental milestone checklists” in doctors’ offices,
schools, childcare sections of grocery stores, bulletin boards, libraries, and anywhere else
new parents are likely to go (CDC Learn the Signs, 2022).
 Create developmental monitoring “tool-kits” that include CDC resources and contact
information for early-childcare services. Distribute these toolkits to new parents in the
hospital setting (CDC Learn the Signs, 2022).
 (3) Display developmental screening call center phone numbers on bulletin boards in the
community. Families may rip off one of the phone number slips and call the hotline
whenever it is convenient (Roux et al., 2012).

3. Potential for Success

a. The main predisposing factor is doctor adherence to developmental screening

mandates. Having a representative physically go into clinics and evaluate their
adherence to developmental screening guidelines can show providers what areas they
need to improve on (Pinto-Martin et al., 2005). This also sets the stage for professional
development opportunities. Providers will not know how to improve their practice if
 they are not given the tools to do so. Requiring providers to learn about the steps of a
successful developmental screening practice will not only improve their own practice
but show families they are dedicated to the well-being of their children (Zuckerman et
al., 2021). When providers are more educated on the issue, they can provide more
comprehensive advice to parents in need.
Furthermore, it is essential that parents have the resources to take developmental
screenings into their own hands. Many parents do not understand the importance of
developmental screenings let alone where to receive the services. By providing parents
with toolkits, brochures, milestone checklists, and a hotline, parents will at least have a
place to start (CDC Learn the Signs, 2022). Parents should feel empowered to get their
children the support they need.

b. For this project, sustainability can be evaluated at the family and provider levels. Just
providing families with tools to help them receive developmental screenings is not
enough. If a screening documents a concern, the family needs to have a plan for how
they will support their child. After a disability is formally documented the agency that
diagnosed the disability will work with the family to create a timely plan for the services
and resources the child will receive. Creating a plan will not only connect parents with
the appropriate services right away but help them stay connected as they move through
this new journey of life.
In terms of provider sustainability, it is important that they are frequently evaluated on
their developmental screening practices. After the problems are identified and changes
are made, someone has to make sure those changes stay in place. Routine annual
evaluations will make sure providers are adhering to the developmental screening
guidelines and mandates. In addition, educating providers and health care staff on
developmental monitoring is with the purpose of creating lifelong learners. Medical
workers can take the information they learn and implement it in their own practice and
lives, no matter where they go in their careers. Hopefully, these professional
development sessions encourage healthcare workers to make the change, be the
change, develop a curiosity for learning, and better themselves along the way.
 References

Center for Disease Control and Prevention. (2022). Developmental Milestone Checklist Program

for WIC. PDF. https://www.cdc.gov/ncbddd/wicguide/pdf/336220-

A_WIC_Implementation-Guide_V7-2.1.23-FINAL_508.pdf

Early Childhood Technical Assistance Center. (2022, October 6). Part C of IDEA. FPG Child

Development Institute. https://ectacenter.org/partc/partc.asp

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control

and Prevention. (2022, September 19). "Learn the Signs. Act Early.". Centers for Disease

Control and Prevention. Retrieved April 16, 2023, from

https://www.cdc.gov/ncbddd/actearly/index.html

Pinto-Martin, J. A., Dunkle, M., Earls, M., Fliedner, D., & Landes, C. (2005). Developmental

Stages of Developmental Screening: Steps to Implementation of a Successful

Program. American Journal of Public Health (1971), 95(11), 1928–1932.

https://doi.org/10.2105/AJPH.2004.052167

Roux, A. M., Herrera, P., Wold, C. M., Dunkle, M. C., Glascoe, F. P., & Shattuck, P. T. (2012).

Developmental and autism screening through 2-1-1: reaching underserved

families. American Journal of Preventive Medicine, 43(6 Suppl 5), S457–S463.

https://doi.org/10.1016/j.amepre.2012.08.011

Self, T. L., Parham, D. F., & Rajagopalan, J. (2015). Autism Spectrum Disorder Early Screening

Practices: A Survey of Physicians. Communication Disorders Quarterly, 36(4), 195–207.

https://doi-org.uidaho.idm.oclc.org/10.1177/1525740114560060
Zuckerman, K. E., Chavez, A. E., Wilson, L., Unger, K., Reuland, C., Ramsey, K., King, M., Scholz,

J., & Fombonne, E. (2021). Improving autism and developmental screening and referral

in US primary care practices serving Latinos. Autism : the International Journal of

Research and Practice, 25(1), 288–299. https://doi.org/10.1177/1362361320957461