Funded through the Maternal Child Health Bureau at the Health Resources and Services Administration in the Department of Health and Human Services and administered by the Association of University Centers on Disabilities, the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) grants provide interdisciplinary training to enhance the clinical expertise and leadership skills of professionals dedicated to caring for children with neurodevelopmental and other related disabilities and special health care needs. The Combating Autism Act of 2006 Public Law 109-416 brought additional funds to the LEND program to promote education, early detection, and intervention in autism and related developmental disabilities.
LEND embodied values I had promoted throughout my career: multidisciplinary teamwork, parent engagement, community-based programs, and the need to build both awareness and expertise. I was recruited to CHOP just as a new emphasis on (and funding for) autism was helping to re-shape LEND. This gave me the opportunity to shape new programs of training and research from the ground up (to my knowledge, all of the programs I initiated within LEND continue to thrive). I served as Autism Training Director for the LEND program for graduate and post-graduate level fellows from Audiology, Dentistry, Developmental and Behavioral Pediatrics, Family Fellowship, Genetic Counseling, Health Care Administration, Nursing, Nutrition, Occupational Therapy, Physical Therapy, Psychology, Social Work, Special Education, and Speech-Language Pathology.
Leadership and Education in Neurodevelopmental and Related Disabilities
The multidisciplinary approach was central to the ASD LEND Training Clinic I created within the Regional Autism Center (RAC) at CHOP, in collaboration with Dr Susan Levy. The Training Clinic was a multidisciplinary assessment team for young children referred for an ASD diagnosis, operating one day each week for 11 months of the LEND annual cycle. Over the LEND year, ASD LEND Fellows assumed more and more responsibility for all aspects of assessment: within 6 months, they were responsible for assessment, report-writing, and family feedback for one case, and by the end of the year assumed this responsibility for up to 3 cases each week. The weekly clinic helped to reduce the waiting list for assessments at RAC (as long as 18 months prior to my tenure) and provided an opportunity for other LEND trainees to observe diagnostic assessments from start to finish.
I created an intensive, Autism II cycle for 4 ASD LEND Fellows who focused their LEND experience on ASD to include: 45 hours of advanced training in assessment, intervention, research, and policy; Supervision from myself and from their discipline advisor for their work in the LEND ASD Training Clinic described earlier, and; Participation in the NextSteps workshops to prepare them to provide such training in the future (Doehring, 2011). Over the course of their LEND training, they gradually assumed a greater role until the final workshop during which they assumed full responsibility for delivering content and answering questions pertaining to their discipline. The development of this advanced training served as the base for the addition of a new position at CHOP, a specialized predoctoral psychology internship. This advanced training also served as the base for the creation of a new role for Practicing Nurse Practitioners (PNPs), who began to play a more active role in the diagnosis of ASD in certain types of cases (Ott, Levy, & Doehring, 2010).
A program to offer ASD screening within the Homeless Health Initiative. The Homeless Health Initiative (HHI) is a volunteer outreach program providing medical and dental services to children in area shelters and assist families in accessing important health care services including health insurance, primary care and specialty care. I created a program to offer ASD screening within HHI. LEND fellows participated in regular visits with of CHOP professionals in the homeless shelters of West Philadelphia. They conducted ASD screening for young children using the Modified Checklist for Autism in Toddlers (M-CHAT) and the Social Communication Questionnaire (SCQ).