CARE FOR CHILDREN/ADOLESCENTS WITH AUTISM SPECTRUM DISORDER IN SECONDARY HEALTH SERVICES

Abstract

Flows of care are essential for health services, especially for individuals with Autism Spectrum Disorder. This study aimed to analyze strategies for organizing service flows in secondary health care settings for children and adolescents with autism, focusing on care management. A qualitative exploratory study was conducted between March 2020 and September 2022 in four secondary health units and the Municipal Health Department. Data collection involved analyzing physical environments and operational processes through technical visits and a field diary. Approved by the ethics committee (approval no. 5.615.537), the study employed Inductive Thematic Analysis. A total of 14 visits were conducted, engaging 11 professionals from three Specialized Rehabilitation Centers, one autism-specific institution, and the Municipal Health Department. The field diary comprised 22 pages. Institutions had multidisciplinary teams; three provided screening, diagnosis, and rehabilitation services, while one focused solely on rehabilitation. Many children and adolescents with ASD were registered in multiple services to increase therapy frequency or address gaps, limiting the inclusion of new users. Walk-in services facilitated access but varied in structure, with some services using initial consultations to manage waitlists. Nonetheless, the number of available slots was insufficient. Clinical observation and behavioral assessments were used for diagnosis, as no specific tests for autism exist. While some services accepted external diagnostic reports, others re-evaluated and occasionally rejected them. The study concluded that improving the organization of autism care services is vital to optimizing service flow and delivery. Limited availability of slots amid high demand creates a challenging and isolating experience for families seeking support.