Enhancing autism diagnostic capacity in Bolivia using an Extension for Community Healthcare Outcomes model

In low- and middle-income countries like Bolivia, the pathway from recognizing early symptoms of autism spectrum disorder (ASD) to receiving a diagnosis is often hindered by limited public awareness, financial constraints, and a shortage of trained professionals. This study explores the impact of the ECHO (Extension for Community Healthcare Outcomes) framework as a virtual professional development strategy to enhance diagnostic capacity for ASD in Bolivia.

The project involved 9 credentialed diagnosticians who participated in a 3-day preparatory workshop and 10 monthly ECHO sessions, which included community building, didactic presentations, and case discussions. Additionally, individuals who can serve to refer families for evaluations attended live webinars to learn ASD screening strategies.

Pre- and post-surveys indicated significant increases in diagnosticians' competence and confidence in ASD evaluations, as well as a reduction in perceived barriers and an expansion of professional networks. Diagnosticians reported increased use of ASD screening tools and more frequent referrals for intervention supports. Qualitative interviews suggested improvements in evaluation procedures and referral rates, though systemic and financial barriers remain.

The findings suggest that the ECHO methodology holds promise for enhancing ASD diagnostic capacity in low- and middle-income countries.