Embedded Autism Evaluations in Pediatric Primary Care Clinics: Perspectives on Provider and Caregiver Experiences, Implementation, and Sustainment.

introductionThe Autism in Primary Care Program (APC) was developed to train embedded psychologists in urban community primary care settings to provide autism diagnostic evaluations and to engage care coordinators in supporting families navigating autism services. The objective of this study was to understand provider and caregiver experiences and clarify implementation and sustainment factors of APC. Primary care providers (PCPs) and caregivers shared their experiences of APC services through interviews and focus groups. Grounded in the Exploration, Preparation, Implementation, Sustainment (EPIS) implementation science framework, feedback on implementation and sustainment factors of the program was collected from the implementation team (embedded psychologists and care coordinators) through periodic reflection procedures. Caregivers and PCPs reported positive experiences with APC including evaluation timeliness, care coordination support, and the program's integration within primary care. They also described ongoing supports families needed following the evaluation. The implementation team identified factors impacting the implementation and sustainment of the program, many of which aligned with qualitative findings from caregivers and PCPs. Identifying multiple perspectives on APC can inform our field on a promising model which can improve earlier diagnosis and treatment access for families and reduce inequities in care.