2. Primary Care Physician (PCP) is notified ASAP about the evaluation result and service plans in order to have a follow-up with the family. PCP shares results of Audiological Evaluation and other referrals (if any) with the CDSA as soon as results are reported. Notes: Autism specific evaluations and/or confirmation of an autism diagnosis are influenced by the age of the child and findings; younger children and those with less significant symptoms are more difficult to diagnose. MCHAT is Positive (+) OR Autism Surveillance yields 2 or more + risk factors If Global Developmental Delay, Intellectual Disability is present, or Genetic or Neurologic disorder is suspected CDSA Audiology Evaluation Consider referral to D & B Pediatrician Geneticist Neurologist Eligibility evaluation If developmental delay or established condition found IFSP Further Autism-specific evaluation as needed Continued Case Management, IFSP Continued Direct Services as indicated No ASD or Developmental Delay found CSC or other community services (if renewed concern re- refer) Primary Care Autism Screening Referral Process for Infants and Toddlers

3. Referral Flow Chart Legend & Notes Questions of autism for a specific infant or toddler: The AAP recommends simultaneous referral for ASD evaluation, EI services, and Audiology evaluation. –leads to a referral to your Children’s Developmental Services Agency (CDSA) –leads to a referral for an audiology evaluation –may lead to a referral to a D&B pediatrician, geneticist, or neurologist for assistance with an etiologic workup and/or a search for coexisting conditions if indicated. When referring, include: –Diagnosis of autism if you have made it –Copies of child’s MCHAT –Additional information as appropriate –Copies of family’s release of information for communication from and to pediatrician/CDSA ACTION STEPS As Primary Care Practices begin screening for autism per AAP recommendations: –PCP’s: Discuss CDSA resources with CDSA staff Discuss other community resources with community partners, including CDSA Facilitate communication between primary practice, other diagnostic referrals, and CDSA - CDSAs: Discuss CDSA resources with community PCP’s (e.g., possibility of audiological evaluation) Assure feedback to referring PCP’s regarding eligibility of child. (Complete ROI if it has not been obtained at the primary care practice.) Continue communication regarding additional assessment as needed CCNC

5. North Carolina Physician to Preschool Exceptional Children Program Notification Process Chart For Children 3 to Pre-Kindergarten 5 Years of Age e.g., Developmental Delays, MCHAT is Positive (+) OR Autism Surveillance yields 2 or more + risk factors; ASQ or PEDs scores are raised Physician informs family of LEA services, Physician provides family with Child Find information from school system Referral for child service coordination via health department (if appropriate) Direct contact made between school system & family Interview parents about child development concerns School system obtains existing screenings, observations, etc. Suggested Interventions offered to family School system or parent may initiate a referral Eligibility determination & IEP developed, if eligible parental consent for services obtained, if eligible Services begin School system sends follow- up information to physician With consent for release of confidential information School system conducts assessment or proceeds to eligibility determination Process stopped- NO EVALUATION Parent denies consent to make written referral School system may utilize procedural safeguards to pursue evaluation. No educational concerns identified Process stopped Parent denies consent for services Assessments reveal no educational concerns Not eligible for special education NO Physician sends notification and parental release of information form Contact information Signed release of information Health screening; including vision and hearing Developmental screening Behavioral health screening Evaluation(s) in process School system or parent initiates referral If school system rejects referral, parent may make a written request Parent signs informed consent to evaluate 90 day timeline begins YES