44 Chapter 2 The final barrier, an external factor, in early detection of ASD and adherence to the guideline is availability of healthcare services to refer to once children are identified as being at risk. PCPs mentioned that there is no easy access available to healthcare services, due to long waiting lists or limited offer. This is alarming, since it is expected that early detection leads to improved outcomes, as a result of an early referral to adequate treatment (Zwaigenbaum et al., 2019). In addition, screening at an early age (< 24 months) is also likely to identify other developmental delays and disorders then ASD (Chlebowsiki et al., 2013) that require early and appropriate intervention. Overall, improvement in the accessibility and availability of healthcare services is a priority and will be further addressed in the section below. Proposed improvement strategies by PCPs. In order to reach guideline adherence and overcome barriers, PCPs express their need of a) knowledge about the content and subject of the guideline and b) closer collaboration between healthcare organizations. Additional training in order to improve PCPs’ knowledge and professional attitude is highly likely to enhance the overall quality of care for children at risk of ASD and is therefore been frequently recommended in the current study and in previous studies (Fenikilé et al., 2015; Mazurek et al., 2020; Pinto-Martin et al., 2005). Indeed, availability of easy access information about ASD in infants and toddlers has increased in recent years. Examples are the development of new and accessible state-of-the-art websites, online learning modules and the 'Learn the Signs: Act Early' initiative by the Centers for Disease Control and Prevention. Specifically to the Dutch guideline, additional training has been provided to PCP and an accessible website has been developed for healthcare professionals and parents. Thus, there has already been an increased offer and availability of additional training and information. Therefore, we argue that the need for additional training does not come from a lack of information resources, but due to insufficient compensation leading to the absence of active investment. In order to uphold positive effects of additional training, previous research has established that active investment and maintenance are demanded (Pijl et al., 2017). In order to fulfill PCPs needs for additional training, improve early detection of ASD and obtain guideline adherence, the importance of early detection of ASD should be brought to the attention of policymakers (i.e. governments/municipalities) and preventive care organizations, as reimbursement (in the form of additional training, more time and sufficient human resources) of these activities are an important condition. A second strategy to improve early detection of ASD and guideline adherence is a closer collaboration between healthcare organizations. Recognizing this, Dutch researchers and clinicians formed a national, interdisciplinary network with the goal of exchanging knowledge and translating scientific results into tools for the clinical field. As an example, this network is currently developing and studying a new and innovative intervention program, called the BEAR parent training for young children at risk of ASD. The program demonstrates a close collaboration
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