Alicia Brewer Curran works at the University of Missouri, where she is the director of operations for the Extension for Community Healthcare Outcomes (ECHO) Autism Program, and serves as a parent panelist on three expert hub teams. Additionally, she is the family faculty member for the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program, program manager and quality improvement lead for the Autism Learning Health Network (AHLN), and the CDC’s Learn the Signs. Act Early. ambassador for Missouri. 

ED: How did you begin your career in early childhood?

My interest in early childhood began after my son was diagnosed with autism spectrum disorder. Due to lack of knowledge, I didn’t realize how concerned I should be about the differences I observed in his development, and I didn’t recognize that these differences were the early symptoms of autism. That resulted in my son losing out on two years of early intervention services.

After finally getting connected to services, it was clear that early intervention was making a difference. That inspired me to seek a career that allowed me to empower families with information and resources about developmental disabilities, specifically autism. Knowledge is power, and I did not want other families to end up in the “unknown zone” like I did. It was a very painful place for me because I felt so helpless. The more I learned about autism, the less scary it became, and I developed a sense of empowerment. I was not sure what type of career would allow me to be part of making the autism journey easier for other families, but I have been blessed with several positions that allow me to do just that.

ED: What efforts have you been involved in to improve the quality of early childhood programs and services?

Although I have several roles at the University of Missouri, early childhood initiatives are integrated into every part of my professional work. One example is my role with the Extension for Community Healthcare Outcomes (ECHO) Autism Program, where I serve as the director of operations and as a family advocate on a number of expert teams. Through both roles, I leverage my expertise of lived experience to help build programs as well as mentor and coach a variety of autism professionals with a goal of ensuring children and families receive high-quality autism care.

The mission of the ECHO Autism Program is to equip all communities to care and support individuals with autism and their families through best practices, regardless of geographic location. We recognize that early childhood is the most critical window for intervention success, yet many families face long waitlists and extensive travel to access a diagnostic evaluation. Additionally, access to interventionists with autism expertise is scarce. To address these issues, we developed two ECHO Autism programs that focus, specifically, on young children receiving the support they need.

The ECHO Autism: STAT Program trains primary care physicians and nurse practitioners to evaluate and diagnose, with the guidance and verification of a panel of autism experts, children ages 14 to 48 months who are exhibiting unambiguous signs of autism. After studying our 2016 cohort of trained ECHO Autism STAT Providers, we found that families were able to access early intervention services two to six months sooner, and on average they saved approximately 173 miles of travel. Additionally, we were able to significantly increase the use of autism specific screening measures at both 18- and 24-month well-child visits. Our providers have developed their expertise and have become local experts.

In late 2019, we launched ECHO Autism: Early Intervention. This program aims to increase access to evidence-based, autism-focused early intervention for children with autism. Led by an occupational therapist and a speech-language pathologist, the expert team shares evidence-based standards for the assessment and intervention of children with autism. Additionally, the program highlights the importance of facilitating communication across systems and the value of partnering with families. A variety of therapists and educators participate in this dynamic program. We are excited about continuing to build capacity in the intervention space.

Due to the ECHO Autism Program, children and families in Missouri are more likely to receive the high-quality services, supports and resources they need sooner, and be served closer to home. ECHO Autism providers are dedicated to serving this population and delivering whole care for the whole family. They invest in families by partnering with them to ensure every child they serve reaches their greatest potential. This program has radically changed the landscape of care for children with autism and their families. Being part of that work is incredibly rewarding for me on a professional and personal level.

ED: What are some of the challenges you have experienced in your work and what strategies have you tried to overcome them?

Aligning with the mission of providing families with high-quality services, supports and resources, we were quick to respond to the COVID-19 crisis. We knew that the pandemic would be especially difficult for people with autism and their families. Therefore, we developed a robust resource page on our ECHO Autism website with educational, behavioral, mental health, therapeutic, and parent training resources from around the world to help struggling families during this crisis. Additionally, we leveraged our ECHO Autism Facebook page to disseminate resources to a broader audience. A number of our ECHO Autism programs held sessions specifically focused on helping families during this time of crisis. During our program sessions, we have rich problem-solving conversations where ECHO Autism content experts and other network members share multiple strategies and resources to address the barriers and challenges families are facing.

ED: What suggestions do you have for others interested in improving early childhood services and programs?

It is all about thinking strategically and building relationships with key stakeholders to be successful. Additionally, involving families through every part of the process is critical. After identifying the goal you want to achieve, map out your plan. There are many tools, (e.g., logic models, action plans, causal loop diagrams, focus groups, system support mapping, process maps, hexagon tool, etc.) to help you stay goal focused, identify challenges, and stay on your timeline. When implementing your plan, it is essential to achieve and sustain high-quality. Evaluating your services and programs through quality improvement practices is key. There are many helpful tools (e.g., driver diagrams, cause and effect diagrams, failure modes and effects analysis (FEMA) tool, pareto charts, run charts, control charts, plan do study act (PDSA) cycles, etc.) that work together to help you understand how your services and programs are performing and identify areas of improvement. Continuous improvement leads to high-quality outcomes.