Healthy People 2020 At Work in the Community: Autism Spectrum Quotient Screening Access
Funding from the Office of Disease Prevention and Health Promotion (ODPHP), through the Healthy People 2020 Community Innovations Project, enabled the Minnesota Academy of Pediatrics Foundation (MAPF) to partner with two Minnesota clinics and Somali parents to increase earlier developmental screening of Somali children ages 1 to 3 years using an audio form of the Autism Spectrum Quotient (ASQ) screening tool in the Somali language.
MAPF provides education and service projects for children and families in Minnesota and the pediatricians who serve them. MAPF partnered with two clinics, one in rural St. Cloud and the other in urban Minneapolis, serving a large percentage of the Somali families who have resettled in the state.
In 2005, 40% of all Minnesota immigrants came from Africa. Minnesota has the highest population of Somali people outside of Somalia. Parents, physicians, school personnel, and the state health department have identified increasing concerns about high rates of autism among Somali children.
For this project, MAPF convened community meetings and focus groups in the St. Cloud, MN community in partnership with the CentraCare Clinic, the St. Cloud Area Somali Women's Association, and St. Cloud State University.
MAPF also held community meetings and focus groups in the Minneapolis area in partnership with parents in the Somali community to improve preventive pediatric services.
Autism Spectrum Quotient Screening Access
One of the current quality improvement initiatives of MAPF is to improve the process and access to early behavioral and developmental screening for all Minnesotans.
The purpose of the focus groups was to gain the Somali community's acceptance of autism screening and to identify the barriers and concerns associated with screening. In addition, MAPF wanted to understand successful strategies for conducting the screening. The focus groups included Somali parents with children age 5 and under. Twenty-five Somali men and women participated from the St. Cloud and Minneapolis areas.
For most Somalis, English is their second language, and parents are not fluent in English. In the past, the ASQ screening was available in paper form in English. Even if an interpreter was available to help translate the form, this method did not generally work well with Somalis due to a lack of trust and/or lack of understanding of the purpose of the screening. Therefore, parents who may have been asked by an interpreter to complete an ASQ screening may have answered "No," either because the parents misunderstood the question or the purpose of the screening.
MAPF partnered with a technology company to design an ASQ software program to communicate with Somalis in their own language. The videos featured Somalis explaining the purpose of the screening. The two clinics that volunteered for the project installed computer kiosks in their waiting rooms for people to use before and after doctor appointments. The kiosks provided families the opportunity to do the screening on their own without interrupting their visits with the doctor. The computers were also loaded with videos on a variety of other health topics in addition to autism. Pairing related short videos in their native language with native actors and actresses before or after screening was important for Somali parents to feel more comfortable with the information being delivered.
Some of the videos were uploaded onto YouTube and were viewed by people in other parts of Minnesota, the United States, and also in other countries. The YouTube videos have received over 15,000 views from people around the world. People in England, where Somalis have also resettled, have viewed the videos and contacted MAPF for additional information and content.
Ms. Katherine Cairns, the Executive Director of the Minnesota Chapter of American Academy of Pediatrics, said the project was successful in increasing awareness among Somali people about developmental and behavioral screenings. The project also increased access to health education through videos and provided educational screening tools in clinics in audio format all in the Somali language. Also, since the ASQ software program and the educational videos are transferable to other computers, the possibility exists to easily implement the program at other clinics.
Ms. Cairns felt that engaging the Somali community beforehand through the focus groups, before the design and implementation of a new ASQ screening method, was critical to the success of this project. In addition, the focus group process also served a dual purpose of educating Somali parents on how to access health care services, including medical homes, while soliciting input on the intervention intended to increase developmental and behavioral screenings. This project increased access to developmental screening for Somali children in rural and urban areas of Minnesota.
"Getting people connected to medical homes for preventive health and trying to increase screening is a goal statewide, not just for Somalis." Although the project period is over, the computer kiosks are still in the waiting rooms providing access to ASQ screening and health education videos not only for Somalis, but also for English-speaking and Spanish-speaking families. Ms. Cairns looks forward to acquiring funding to expand the kiosks at five other Minnesota clinics.
Autism Spectrum Quotient Screening Access
The Office of Disease Prevention and Health Promotion (ODPHP) challenged America’s health organizations to come up with new and innovative projects that could tackle some of today’s most pressing public health issues.
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