Autism: New Course Helps Underserved Families in Washington

The number of children who have been diagnosed with Autism has increased sharply in recent years—at least for some children.

White children in the U.S. are tested for Autism Spectrum Disorder (ASD) as a part of regular care. This means they can be diagnosed earlier and go down a road for intervention and services that tremendously helps both them and their families reach their fullest potential.

Hispanic or Latino and Black children, on the other hand, are less likely to be diagnosed with ASD than white kids. Hispanic children are 65% less likely to be diagnosed, and Black children 19% less likely, according to a study in the American Journal of Public Health.

A new project from the Washington State Department of Health aims to reduce those disparities and add support to vulnerable families in the state. They plan to use the help of community health workers (CHWs) through an online course called Understanding Autism Spectrum Disorder.

Understanding Autism Spectrum Disorder

“This project is really exciting! It gives CHWs a better understanding of what autism is and helps them build their network of resources to share with families going through diagnosis and afterwards. That will be fundamental in helping families in Washington State,” says Nikki Dyer, Family Engagement Coordinator in the office of Prevention and Community Health at the Washington State Department of Health.

Understanding Autism Spectrum Disorder was built by online training agency Talance, Inc., and is offered for no cost as part of Washington’s Community Health Worker Training Program. More than 2000 people from around the state have participated in the 10-week online blended learning program. It is designed to strengthen the common skills, knowledge, and abilities of community health workers. Past participants are eligible to enroll in any of the free Continuing Education Health Specific Modules, including Understanding Autism Spectrum Disorder.

Understanding Autism Spectrum Disorder “lets CHWs get a grasp of what kind of resources they have locally around diagnosis, referral, and how to navigate a family,” says Dyer. It also exposes CHWs to services for kids with Autism who have already been diagnosed through to transitioning to adulthood services.

“Transition’s a huge issue that has been largely unexplored and leaves a big gap for autistic youth and their families when making that leap to adult services,” Dyer says.

Early Autism Diagnosis

One of the main goals of the course is to encourage earlier and more equitable access to diagnosis. This is especially important for families who face health disparities because of race, ethnicity, and cultural needs.

“Pre-diagnosis is a chaotic time in a family’s life,” says Dyer.

Families might:

  • Not be able to recognize the early signs.
  • Feel confused and isolated when their child is diagnosed with ASD and immediately after.
  • Suspect their child has autism but wait to get a diagnosis. Or, they may feel too overwhelmed by the reality of the diagnosis to know where to find services and supports.

Diagnosing ASD early can help families cope. Early interventions are also critically important to helping children with ASD develop social skills and improve their quality of life.

“Early diagnosis provides the best possibility to be proactive and provide the child with services to reach their fullest potential development,” says Dyer.

Health Disparities and ASD

Here’s where many Black and Hispanic or Latino families are left behind. If their children are never diagnosed, or diagnosed later in life, they miss out on these important support mechanisms and adjustments to help families and youth. Outreach campaigns to have all children screened for ASD can catch some of the people who fall through.

The number of white children diagnosed with ASD compared to Black and Hispanic children is much higher. Source: CDC.

Some communities have a cultural stigma or other expectations of childhood development. That can prevent early diagnosis and put a stop to families seeking a diagnosis even when their provider or child’s teacher may encourage it.

Working Across Washington

Dyer and her colleagues in the Children and Youth with Special Health Care Needs program knew of the challenges of supporting families in Washington.

“They turned their eyes toward CHWs and began investigating collaborative opportunities with the Department of Health’s CHW Training Program for developing training resources,” says Scott Carlson, Community Health Worker Training System Supervisor at the Washington State Department of Health.

CHWs work in the homes of families all around the state, and—importantly–in the most underserved areas. With the right kind of training, CHWs can make referrals to ASD specialists and provide other resources.

Family Navigators and Community Health Workers

“Family navigators” are healthcare workers who regularly support families with an ASD diagnosis. But—like CHWs—they don’t have a clear definition. It’s a catch-all term for someone who provides families with extra care coordination. There are no training requirements or standard services provided by family navigators.

The upshot: CHWs can be family navigators. They can use the skills provided through the Washington CHW program and through this training to serve families in a culturally and linguistically competent and relevant way.

“We would like to promote the CHW program by creating this course and making it open to partners who are doing peer mentoring and navigation for people with special health care needs, even if they are not trained CHWs,” says Dyer.

Doing so opens up employment possibilities for participants who want to be CHWs but might not know about the number of available jobs labeled as “family navigation.”

“We would also like to promote the program as a whole and encourage our partners who may receive access to this module without being a CHW to take the initial training in those basic skills.”

CHW Family Navigation Skills

People who participate in Understanding Autism Spectrum Disorder will gain skills that support families in many areas, including:

  • Understanding what ASD is and its stages of severity
  • Advocating for early testing and diagnosis through referring clients and providers
  • Care coordination for connecting families to needed services, supports, and therapies. This is the case even outside of the healthcare field, specifically through a customized resource directory

So far, learner feedback has been overwhelmingly positive for the course. In a survey, 92% found it interesting and easy to follow. Another 95% were able to find ASD resources that were local and relevant to their jobs.

“This information will be applied immediately,” says Najja Brown, who recently completed the training. Brown works with ASD clients as part of her work through DSHS/DDA. “We will understand our clients better, be able to recommend resources/support groups, and make appropriate suggestions based on the information learned. We will also use the proper language when references to ASD.

“I know so much more than before. When I resume providing services, I will have a better understanding of my clients, whom are all ASD.”

Additional Training

Anyone interested in taking Understanding Autism Spectrum Disorder can learn more at Washington’s Community Health Worker Training website.

Dyer suggests participating in these courses as a “Family Navigation track”:

  • Providing Social Support
  • Immunizations Across the Lifespan
  • Navigating Health Insurance
  • Health Advocacy
  • Social Determinants of Health & Disparities
  • Depression, Anxiety, & Stress

How to Write Survey Quiz Questions: A Guide

By Gabrielle Carrero
Feedback is one of the best ways you can enhance your program, whether it’s an assessment in a training program or a survey aimed at your community members as part of user research.

When you ask your learners to complete a survey or assessment, you can learn the opinions, perspectives, and judgements of your practices and programs directly from the people who use them.

You should have clear objectives of what you want to learn from participants before deciding what types of questions you want to use. When you can define those goals, you can begin to choose what types of questions will yield appropriate data.

This article will introduce you to the most common types of questions used in assessments and surveys and help you decide which will get you the feedback you want. We’ve included examples and suggestions to help you create your own.

Types of questions

In the question hierarchy, there are two types:

  1. Close-ended questions that produce quantitative data. These can be answered with a “yes” or “no” or have a limited set of answers, as in a multiple-choice quiz.
  2. Open-ended questions that produce qualitative data. These allow someone to give freeform responses, usually in a sentence, paragraph, or longer.

Open-ended questions are helpful when you don’t want to influence the kind of response you’re looking to collect. You might use these when doing research into a community’s needs or asking for suggestions.

When testing learners in assessments, prioritize close-ended survey questions. They produce the most manageable results. You will also learn where open-ended questions fit in the design of your survey.

Close-ended survey questions

Close-ended survey questions provide a fixed set of options. Data from close-ended questions is quantitative and can be calculated into figures like percentages, statistics, or scores.

Common close-ended questions include:

  • multiple-choice questions
  • rating scale questions
  • Likert scale questions
  • semantic differential questions
  • ranking questions
  • dichotomous questions

Read on for more information about each type of question and examples.

Multiple-choice questions

Multiple-choice questions are questions with a pool of answers. They produce clean data for you to analyze and are easiest for participants to complete. Here’s an example from a behavioral health course:

When creating multiple-choice questions, it is important to create a direct and simple question with a comprehensive set of answers. Do your best to create answers that cover all options but do not overlap with one another.

One way to avoid biased results and limitations in your answer set is to give the respondent an “Other” option. Although adding an option for “Other” may not allow the data to be as neat, participants can offer a perspective you have not considered.

Another consideration to make when developing multiple-choice questions is to decide whether you want a single answer or allow multiple answers.

Multiple choice = only one correct option

Multiple answer = more than one correct option

Use single-answer questions when you want the respondent to make one choice. You may only want a single-answer because you want the participant to make a decision or because there is only one answer to choose like age. In general, multiple-choice questions are effective for collecting demographic information.

Use multiple-answer questions when you want participants to select all answers that apply. For instance, participants can select more than one service or product they use.

The example above could be rephrased as a multiple-answer question this way:

Choose all of the examples of items that can make someone more at risk of a behavioral health disorder.

Rating scales

Rating scale questions allow participants to rate or assign weight to an answer choice. Use rating scale questions when you want to learn what a respondent thinks or feels across a scale.

An example of this is a confidence scale about health self-management:

Source: Howsyourhealth.org

When using a rating scale question, you are asking the respondent to measure where their response lies a scale like 0 to 10, 1 to 5, or 0 to 100. You might ask the participant to rate their happiness, satisfaction, likeliness to do something, and experience with your organization.

Rating scale questions can be an effective tool to evaluate change, growth, or progress over time.

For example, if you utilize them as an assessment tool at the beginning of a new program, you can use the same question later or at a final stage of a program to measure changes in sentiment among participants.

When designing the rating scale question, the scale must clearly label the difference in relationship between the numbers.  If you choose a rating scale between 0 and 10, what will 0 represent and what will 10 represent?

Likert scales

A Likert scale measures a participant’s agreement with a question or statement. They are useful for measuring attitudes and behaviors because they ask the respondent to select how much they agree or disagree.

Here’s an example from a quantitative patient survey:

A Likert scale question is a type of rating scale question, but it specifically labels each answer with a level of agreement or likelihood from “strongly disagree” to “strongly agree” or “not at all likely” to “highly likely.”

Use Likert scale questions to measure participant attitudes, opinions, and beliefs and use the 5- or 7-point scale with clear labels.

Semantic differential questions

A semantic differential question is another tool for rating and understanding opinion and attitudes. It asks participants to rate something on a scale between two opposing statements, and emphasizes two opposite adjectives at each end.

You see these questions in customer satisfaction surveys, as in the Net Promoter Score:

Semantic differential questions help you gather multiple impressions about one subject area.

For instance, you would define polar opposite statements like strong-weak, love-hate, exceptional-terrible, expensive-cheap, likely to return-unlikely to return, or satisfied-unsatisfied and include multi-point options in between.

You can acquire multiple attitudes about a service like “What is your impression of Service A?” and have options rate between “Hard to Use” to “Easy to Use,” “Weak” to “Strong,” and “Cheap” to “High Quality,” all to learn more about Service A.

Use semantic differential questions when you want to collect many opinions in one question.

Ranking

Ranking questions lets participants compare list items with another and assign an order of preference to them.

Ranking question data will show the level of priority or importance multiple items has to them, but will not offer insight into “why.”

If you want to look closely at individual respondent preference, then a ranking question is appropriate because it shows the relationship of how much they prefer one option to another. This can be more difficult when analyzing large sets of data because instead of learning how much more an item is preferred to another, the data would offer insight into what item is generally preferred.

Use ranking scale questions to learn what your participant values and prioritizes most.

Dichotomous questions

Dichotomous survey questions gives respondents two answers to choose from such as Yes/No and True/False.

These questions are simple and quick for respondents to answer, and they offer you clean data to analyze. The weakness of dichotomous questions is there is no room for preference, and leaves you little to interpret.

Use a dichotomous question if you want a participant to make a strict decision.

Open-ended questions

Instead of giving participants a set of answers to choose from, open-ended questions allow participants to respond in their own words in a text box. We use these in evaluation surveys often.

The data from open-ended questions is qualitative and less focused on measurement.

Open-ended question responses offer insight into learner impressions, opinions, motivations, challenges, and attitudes. They do take a level of interpretation on your end, and it may help to put their answer in context with any information provided about themselves and their other survey selections.

Although open-ended questions and qualitative data require more attention, they can fill gaps in the story of what your survey wants to learn. You can pair an open-ended question with a close-ended question to understand more about their decision: “What is the reason for your selection/score/ranking?” You may also include them independently: “How do you think you can improve as a business?”

The general advice is to use open-ended questions sparingly and strategically.

Like creating any kind of educational or survey content, coming up with effective and clear assessments takes practice. Great training content is always a work in progress.