On Fridays, children coming to Duke Children’s Primary Care in North Durham for their well visit might see a clinical psychology doctoral intern from the Duke Center for Autism and Brain Development on rotation with their pediatrician.
This collaboration between the center and Duke Health’s primary care pediatric clinics began in 2016. The center is uniquely positioned to integrate these services because Gary Maslow, MD, MPH, Medical Director of the Duke Center for Autism and Brain Development, is also a practicing child and adolescent psychiatrist and primary care pediatrician at Duke.
Maslow sees fewer patients on these days, allowing for longer visits, and the appointments are not necessarily for autistic children. Over the last two years, the “Friday clinic” has become a formal rotation, offering a Duke Center for Autism and Brain Development intern a unique opportunity for training in primary care that complements their learning experience in the Duke Autism Clinic.
An Interdisciplinary Rotation
Anna Laakman, MEd, a clinical psychology intern with a focus in autism, started on the Friday clinic rotation in July 2024 and will continue through June 2025. “I love being in the primary care clinic. The clinic atmosphere is fantastic,” says Laakman, a clinical psychology PhD student at the University of Houston who is completing her doctoral internship at Duke. “The collaboration between psychiatry and pediatrics puts a family’s care team on the same page to get them what they need,” she noted.
In addition to rotating in the pediatric primary care clinic, Laakman also rotates in the Duke Autism Clinic, Duke’s Psychosocial Treatment Clinic, and the Duke ADHD Clinic. The Duke Autism Clinic is where comprehensive autism evaluations and more intensive interventions happen. Families are referred here after developmental differences are seen in primary care, such as social or language delays, or if they are actively seeking out information about autism.
“In the autism clinic, patients find their way to us. In primary care, it’s all kids coming in for well visits. It’s a way for us to lend expertise to families who wouldn’t otherwise find their way to the autism clinic.” - Jill Howard, PhD, director of the Duke Autism Clinic.
For patients and families, a visit with an embedded "autism intern" is not necessarily a fast-track to a diagnostic evaluation, but it certainly helps with getting a referral or other resources. Primary care is the first touchpoint for developmental differences when a family is looking for a diagnosis or recommendation.
Barriers and Bridges
Being able to provide specialty-level expertise in a well-child visit reduces barriers to specialty care. Typically, medical specializations work in separate silos. A patient may bring up a concern with their primary care physician and get sent to one specialist after another who does not have a relationship with the patient or have a complete picture of their history. Not only does the Friday clinic psychology intern have a more direct route to a referral, but they can follow up with the same children they see in the autism clinic at their primary care visits and develop that relationship.
Parents can ask autism-related questions in the moment, and the providers can send information and resources without a referral, as an extension of the same visit.
“These families are already juggling a lot. The Friday clinic integration can take one small thing – making another appointment with another specialist – off their plate.” - Nicole Heilbron, PhD, associate director of the Duke Center for Autism and Brain Development
With some autism services placing new applicants on years-long waitlists, getting connected as early as possible helps. “There’s often a gap between the services a patient needs and the documentation required to access those services. Bringing autism and psychology expertise into primary care is critical to getting the right assessments and bridging that gap,” Maslow says.
“It’s important that when kids come in, if there are resources that would be helpful to them, they can get connected.” - Gary Maslow, MD, MPH
The Friday clinic is a bridge between the Duke Center for Autism and the primary care clinics that serve the Durham community. Families have access to autism expertise that they may not otherwise have found, and the interns benefit from the learning experience. “The patients love Dr. Maslow. That’s evident to the interns when they observe that connection,” says Howard.
The providers are able to work hands-on with patients and learn more about how neurodivergent patients and those with intellectual and developmental disabilities may present in a clinical setting. The intern can bring this knowledge back to the autism clinic and beyond, as they go on to professional careers in other health care settings.
“Gary is amazing to watch. You can tell how much families appreciate having him as their provider. Being in the same room is a guarantee that you’ll learn something. He intentionally makes sure each patient interaction is a training experience for the interns.” - Anna Laakman, MEd
The team hopes to expand the program in the future, reaching more clinics and getting general pediatric practices up to speed on our current understanding of autism.