Kaiser Health News -- The Biden administration finalized nursing home staffing rules Monday that will require thousands of them to hire more nurses and aides — while giving them years to do so.
The new rules from the Centers for Medicare & Medicaid Services (CMS) are the most substantial changes to federal oversight of the nation’s roughly 15,000 nursing homes in more than 3 decades. But they are less stringent than what patient advocates said was needed to provide high-quality care.
Spurred by disproportionate deaths from COVID-19 in long-term care facilities, the rules aim to address perennially sparse staffing that can be a root cause of missed diagnoses, severe bedsores, and frequent falls.
“For residents, this will mean more staff, which means fewer ER visits potentially, more independence,” Vice President Kamala Harris said while meeting with nursing home workers in La Crosse, Wisconsin. “For families, it’s going to mean peace of mind in terms of your loved one being taken care of.”
"
CMS estimated the rules will ultimately cost $6 billion annually, but the plan omits any more payments from Medicare or Medicaid.
When the regulations are fully enacted, 4 in 5 homes will need to augment their payrolls, CMS estimated. But the new standards are likely to require slight if any improvements for many of the 1.2 million residents in facilities that are already quite close to or meet the minimum levels.
“Historically, this is a big deal, and we’re glad we have now established a floor,” Blanca Castro, California’s long-term care ombudsman, said in an interview. “From here we can go upward, recognizing there will be a lot of complaints about where we are going to get more people to fill these positions.”
The rules primarily address staffing levels for 3 types of nursing home workers. Registered nurses, or RNs, are the most skilled and responsible for guiding overall care and setting treatment plans. Licensed practical nurses, sometimes called licensed vocational nurses, work under the direction of RNs and perform routine medical care such as taking vital signs. Certified nursing assistants are supposed to be the most plentiful and help residents with daily activities like going to the bathroom, getting dressed, and eating.
While the industry has increased wages by 27% since February 2020, homes say they are still struggling to compete against better-paying work for nurses at hospitals and at retail shops and restaurants for aides. On average, nursing home RNs earn $40 an hour, licensed practical nurses make $31 an hour, and nursing assistants are paid $19 an hour, according to the most recent data from the Bureau of Labor Statistics.
CMS estimated the rules will ultimately cost $6 billion annually, but the plan omits any more payments from Medicare or Medicaid, the public insurers that cover most residents’ stays — meaning additional wages would have to come out of owners’ pockets or existing facility budgets.
The American Health Care Association, which represents the nursing home industry, called the regulation “an unreasonable standard” that “creates an impossible task for providers” amid a persistent worker shortage nationwide.
“This unfunded mandate doesn’t magically solve the nursing crisis,” the association’s CEO, Mark Parkinson, said in a statement. Parkinson said the industry will keep pressing Congress to overturn the regulation.
Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based advocacy nonprofit, said “it is hard to call this a win for nursing home residents and families” given that the minimum levels were below what studies have found to be ideal.
The plan was welcomed by labor unions that represent nurses — and whom President Joe Biden is counting on for support in his reelection campaign. Service Employees International Union President Mary Kay Henry called it a “long-overdue sea change.” This political bond was underscored by the administration’s decision to have Harris announce the rule with SEIU members in Wisconsin, a swing state.
The new rules supplant the vague federal mandate that has been in place since the 1980s requiring nursing homes to have “sufficient” staffing to meet residents’ needs. In practice, inspectors rarely categorized inadequate staffing as a serious infraction resulting in possible penalties, federal records show.
Starting in 2 years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, a KFF analysis found.
The rules give homes breathing room before they must comply with more specific requirements. Within 3 years, most nursing homes will need to provide daily RN care of at least 0.55 hours per resident and 2.45 hours from aides.
CMS also mandated that within 2 years an RN must be on duty at all times in case of a patient crisis on weekends or overnight. Currently, CMS requires at least 8 consecutive hours of RN presence each day and a licensed nurse of any level on duty around the clock. An inspector general report found that nearly a 1000 nursing homes didn’t meet those basic requirements.
Nursing homes in rural areas will have longer to staff up. Within 3 years, they must meet the overall staffing numbers and the round-the-clock RN requirement. CMS’ rule said rural homes have four years to achieve the RN and nurse aide thresholds, although there was some confusion within CMS, as its press materials said rural homes would have 5 years.
Under the new rules, the average nursing home, which has around 100 residents, would need to have at least 2 RNs working each day, and at least 10 or 11 nurse aides, the administration said. Homes could meet the overall requirements through 2 more workers, who could be RNs, vocational nurses, or aides.
Homes can get a hardship exemption from the minimums if they are in regions with low populations of nurses or aides and demonstrate good-faith efforts to recruit.
Democrats praised the rules, though some said the administration did not go nearly far enough. Rep. Lloyd Doggett (D-Texas), the ranking member of the House Ways and Means Health Subcommittee, said the changes were “modest improvements” but that “much more is needed to ensure sufficient care and resident safety.” A Republican senator from Nebraska, Deb Fischer, said the rule would “devastate nursing homes across the country and worsen the staffing shortages we are already facing.”
Advocates for nursing home residents have been pressing CMS for years to adopt a higher standard than what it ultimately settled on. A CMS-commissioned study in 2001 found that the quality of care improved with increases of staff up to a level of 4.1 hours per resident per day — nearly a fifth higher than what CMS will require. The consultants CMS hired in preparing its new rules did not incorporate the earlier findings in their evaluation of options.
CMS said the levels it endorsed were more financially feasible for homes, but that assertion didn’t quiet the ongoing battle about how many people are willing to work in homes at current wages and how financially strained homes owners actually are.
“If states do not increase Medicaid payments to nursing homes, facilities are going to close,” said John Bowblis, PhD, an economics professor and research fellow with the Scripps Gerontology Center at Miami University. “There aren’t enough workers and there are shortages everywhere. When you have a 3% to 4% unemployment rate, where are you going to get people to work in nursing homes?”
Researchers, however, have been skeptical that all nursing homes are as broke as the industry claims or as their books show. A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors.
Charlene Harrington, a professor emeritus at the nursing school of the University of California-San Francisco, said: “In their unchecked quest for profits, the nursing home industry has created its own problems by not paying adequate wages and benefits and setting heavy nursing workloads that cause neglect and harm to residents and create an unsatisfactory and stressful work environment.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Consistent evidence supports a link between exposure to wildfire smoke and increased pulmonary morbidity, with multiple studies showing associations between levels of particulate matter 2.5 (PM2.5) from wildfires and rates of hospitalization and emergency department (ED) visits for respiratory illnesses such as acute bronchitis, asthma, and chronic obstructive pulmonary disease.1-3 Additionally, some studies have demonstrated associations between exposure to wildfire smoke and an increased risk for cardiovascular disease (CVD).
“Emerging data suggests that wildfire smoke exposure increases cardiovascular events such as heart attacks and cardiovascular hospitalizations, and elderly patients and patients with underlying comorbidities such as cardiovascular disease and respiratory conditions seem to be more susceptible,” explained American Heart Association (AHA) volunteer Sanjay Rajagopalan, MD, FACC, FAHA, chief of cardiovascular medicine and chief academic and scientific officer at University Hospitals Harrington Heart and Vascular Institute in Cleveland, Ohio. “The chemical composition of wildfire smoke suggests that it may be even more toxic than traditional fossil fuel-based emissions.”4
Findings on Wildfire Smoke and CVD Risk
In a study published in 2022 in Geohealth, stratified analyses showed an increase in unscheduled hospital visits in California for all CVDs, ischemic heart disease, and heart failure among non‐Hispanic White patients and patients older than 65 years on days with the highest concentrations of PM2.5 from wildfires. The study authors also reported that higher temperatures may interact with wildfire-derived PM2.5 and further increase hospital visits for CVD among individuals with pre-existing heart disease.1
Another California-based study observed higher rates of ED visits for various CV events, including myocardial infarction (RR, 1.42; 95% CI, 1.09-1.84), ischemic heart disease (RR, 1.22; 95% CI, 1.01-1.47), and heart failure (RR, 1.22; 95% CI, 1.10-1.35) on days with dense smoke, with the highest rates found among adults aged 65 years and older.5
In other studies, the risk for out‐of‐hospital cardiac arrest increased on days with heavy smoke due to California wildfires, and elevated levels of PM2.5 from Colorado wildfires were associated with increased rates of CVD hospitalization and CV mortality (OR, 1.478; 95% CI, 1.12–1.94).6,2
In a study published in 2022, post-wildfire physician visits among older adults increased by 11% (95% CI, 3%-21%) for congestive heart failure and 19% (95% CI, 7%-33%) for ischemic heart disease, and patients with diabetes demonstrated a higher risk for CV morbidity (relative risk [RR], 1.22; 95% CI, 1.01-1.46) and respiratory morbidity (RR , 1.35; 95% CI, 1.09-1.67) following wildfires in Calgary, Canada.7
Other recent research suggests a slight increase in the risk of CV mortality associated with wildfire smoke, with 2 studies showing that 0.55 and 0.56 of CV deaths were attributable to wildfire-related PM2.5 exposure during each study period.8,9
Overall, however, findings regarding the connection between wildfire smoke and CV outcomes are mixed.2 “While some studies have indicated an uptick in emergency room admissions for CVD post-wildfire, others have not,” noted Julio Lamprea Montealegre, MD, PhD, MPH, clinical instructor in the division of cardiology at the University of California San Francisco. “The specific types of cardiovascular events that are most likely affected by wildfire exposure also remain unclear.”
Clinical Implications and Next Steps
Although further research is needed to elucidate the relationship between CVD and wildfire smoke exposure, wildfire-related CV events may become more prevalent with the potential intensification of wildfires in the coming years, according to Dr Rajagopalan and Dr Montealegre. This possibility highlights the need for increased awareness and preparation among patients, providers, and health systems.
“Awareness is the first prerequisite for appropriate intervention, and the association between cardiovascular events and wildfire smoke needs to be widely promulgated amongst health care personnel,” Dr Rajagopalan said. Patient awareness of neighborhood air pollution levels during wildfire episodes is also important. Higher-risk patients, such as the elderly and those with prior CV or respiratory conditions, should be educated about protective measures, he advised.
“The US Environmental Protection Agency (EPA) has set forth recommendations to mitigate exposure to particle pollution, particularly for vulnerable groups including those with pre-existing cardiovascular diseases,” Dr Montealegre stated. “Recommendations encompass both indoor and outdoor measures, such as employing portable air cleaners and limiting outdoor activities during times when the Air Quality Index (AQI) indicates unhealthy levels.”10 Patients and providers can check AirNow.gov to monitor daily AQI forecasts.
As roughly 67% of exposure to PM2.5 from outdoor origins occurs inside the home due to infiltration of outdoor pollutants, efforts to improve indoor air quality are essential in reducing wildfire smoke exposure and related health risks.11
In a review published in 2022 in Circulation, Hadley et al recommended various measures to reduce wildfire smoke exposure and the associated CV impact in affected areas.12 On the individual level, for example, they recommend the use of particle respirators such as N95 masks among vulnerable patients.12
In the health care setting, they recommend that clinicians ensure the aggressive management of traditional CVD risk factors and optimization of medical therapy among at-risk patients prior to the start of each fire season.12
More broadly, they recommend that health care facilities strive for cleaner indoor air and that health systems “make preparations for wildfire season to protect their susceptible patients and avoid shortfalls in beds, supplies, human resources, and key partnerships,” as described in the paper.12
Dr Montealegre emphasized the crucial need for a deeper dive into research aimed at elucidating the CV consequences of wildfire smoke. “Priorities include enhanced exposure science that offers a precise evaluation of individual exposure levels, rigorous mechanistic studies elucidating the connection between pollutants from wildfire smoke and cardiovascular repercussions, and clinical trials assessing the efficacy of mitigation techniques such as air filters in curtailing cardiovascular events,” he said.
Beyond efforts to mitigate the adverse health effects of wildfire smoke in high-risk individuals, the most important broader measures needed in this area are “steps to prevent climate change, which include ongoing efforts at decarbonizing our economy and uncoupling CO2 emissions from economic activity,” Dr Rajagopalan stated. “In this regard, movement to a fossil fuel-free future is not only eminently possible, but may also be associated with better health, better economies, and hopefully better climate in the not-too-distant future.”
"
["post_title"]=>
string(80) "Wildfire Smoke, Health Effects, and the Relationship With Cardiovascular Disease"
["post_excerpt"]=>
string(124) "Wildfire smoke health effects, including cardiovascular disease, are in need of further study as climate change intensifies."
["post_status"]=>
string(7) "publish"
["comment_status"]=>
string(6) "closed"
["ping_status"]=>
string(0) ""
["post_password"]=>
string(0) ""
["post_name"]=>
string(65) "wildfire-smoke-health-effects-relationship-cardiovascular-disease"
["to_ping"]=>
string(0) ""
["pinged"]=>
string(0) ""
["post_modified"]=>
string(19) "2024-04-23 09:47:22"
["post_modified_gmt"]=>
string(19) "2024-04-23 13:47:22"
["post_content_filtered"]=>
string(0) ""
["post_parent"]=>
int(0)
["guid"]=>
string(41) "https://www.clinicaladvisor.com/?p=183381"
["menu_order"]=>
int(0)
["post_type"]=>
string(4) "post"
["post_mime_type"]=>
string(0) ""
["comment_count"]=>
string(1) "0"
["filter"]=>
string(3) "raw"
}
[2]=>
object(WP_Post)#7043 (24) {
["ID"]=>
int(183367)
["post_author"]=>
string(5) "45391"
["post_date"]=>
string(19) "2024-04-23 09:05:51"
["post_date_gmt"]=>
string(19) "2024-04-23 13:05:51"
["post_content"]=>
string(1037) "
A 43-year-old soldier presents with a 10-year history of neck pain. The patient believes that carrying heavy objects and wearing helmets for 20 years while in service may have played a role in his worsening neck pain. He describes intermittent headaches and neck pain over the center of his cervical spine that is made worse with range of motion and prolonged positioning such as when driving. He has no pain radiating down the arms or weakness in the upper extremities. To help with pain, the patient has tried massage therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxers for temporary relief. He rates his neck pain as 8 out of 10 on the numeric pain scale and notes that it affects his range of motion, which impacts activities of daily living. Imaging tests are performed (Figures 1-2) on the cervical spine that shows mild facet arthritis. Magnetic resonance imaging (Figure 3) of the neck shows mild facet inflammation but no evidence of nerve impingement.
"
["post_title"]=>
string(28) "OrthoDx: Long-term Neck Pain"
["post_excerpt"]=>
string(200) "A 43-year-old soldier presents with a 10-year history of neck pain. The patient believes that carrying heavy objects and wearing helmets for 20 years may have played a role in his worsening neck pain."
["post_status"]=>
string(7) "publish"
["comment_status"]=>
string(6) "closed"
["ping_status"]=>
string(6) "closed"
["post_password"]=>
string(0) ""
["post_name"]=>
string(27) "orthodx-long-term-neck-pain"
["to_ping"]=>
string(0) ""
["pinged"]=>
string(0) ""
["post_modified"]=>
string(19) "2024-04-23 09:05:53"
["post_modified_gmt"]=>
string(19) "2024-04-23 13:05:53"
["post_content_filtered"]=>
string(0) ""
["post_parent"]=>
int(0)
["guid"]=>
string(69) "https://www.clinicaladvisor.com/?post_type=hm-slideshow&p=183367"
["menu_order"]=>
int(0)
["post_type"]=>
string(12) "hm-slideshow"
["post_mime_type"]=>
string(0) ""
["comment_count"]=>
string(1) "0"
["filter"]=>
string(3) "raw"
}
[3]=>
object(WP_Post)#7030 (24) {
["ID"]=>
int(183028)
["post_author"]=>
string(5) "45510"
["post_date"]=>
string(19) "2024-04-22 10:51:00"
["post_date_gmt"]=>
string(19) "2024-04-22 14:51:00"
["post_content"]=>
string(15905) "
Autism spectrum disorder (ASD) is a developmental disorder characterized by ongoing problems with social communication, social interaction, and restricted, repetitive behaviors, interests, and activities.1,2 While an experienced clinician can reliably identify ASD in children as young as age 2 years, many children do not receive the diagnosis until they are much older, which delays effective treatment.3 Parents may be able to spot signs and symptoms of ASD very early in their child's life, which can lead to earlier evaluation and treatment. This article describes what you should do to prepare for the initial evaluation if you suspect your child may have ASD, or if you think you might have ASD.
Prevalence of Autism Spectrum Disorder
In the United States, approximately 1 in every 36 children aged 8 years is estimated to have ASD.4 Boys are approximately 4 times as likely to be diagnosed with ASD than girls.4 Because ASD is a lifelong condition, an estimated 2.2% of U.S. adults (approximately 5.4 million people aged 18 years and older) are living with ASD.5
Early Signs of Autism Spectrum Disorder
Autism spectrum disorder can be diagnosed at any age.6 Symptoms of ASD are generally identified when a child is aged 12 to 24 months, though they may appear earlier than 12 months if severe, or later than 24 months if subtle.1 Parents or caregivers may be able to notice early signs of ASD before their child is 1 year old.2
Typical early symptoms of ASD include1:
A delay in language development;
A lack of social interest or unusual social interactions (such as pulling someone by the hand without trying to look at them);
Abnormal patterns of play (such as carrying toys around but not actually playing with them); and
Atypical communication (such as knowing the alphabet but not responding to their own name).
The 2 types of symptoms of ASD are difficulties with social communication/interactions and restricted, repetitive behavior, interests, or activities.1
Specific social communication/interactions problems include avoiding eye contact, having difficulty using nonverbal gestures, using stilted or scripted speech, interpreting abstract ideas literally, having trouble recognizing one's own emotions as well as the emotions of other people, and having difficulty making or keeping friends.2
A child who shows restricted interests is extremely focused on a specific subject to the exclusion of other subjects and expects others to be just as interested in that subject.2 A child with ASD has inflexible behavior and extreme difficulty dealing with change, particularly changes in routine or participating in new experiences.2 Repetitive behaviors might include movements such as hand flapping, rocking, or spinning, being hypersensitive to stimuli such as loud noises, and arranging toys or other items in a very particular pattern.1,2
Studies have shown that, with rare exceptions, a child with ASD will experience deterioration in their social and communication behaviors over the first 2 years of life. During the second year of life (aged 12 to 24 months) repetitive behaviors and abnormal play typically become more obvious. A small number of patients with ASD experience these behavioral declines in adolescence. Some people with ASD may not seek an evaluation for ASD until they are an adult, possibly prompted by an ASD diagnosis in a child in their family.1,2
Autism Spectrum Disorder Screening: Resources and Tools
While parents can informally assess their child for signs and symptoms of ASD, they also can use tools designed for that purpose. While these tools generally are intended to be used by clinicians, they rely at least in part on input from parents, so parents may find it helpful to explore them before their child is evaluated by a specialist.
The Modified Checklist for Autism in Toddlers (M-CHAT-R; available at www.mchatscreen.com) is a screening tool intended to be used by primary care providers, specialists, or other professionals to determine a child’s risk for ASD.7 It consists of 2 parts: the M-CHAT-R and the M-CHAT-R Follow-up (M-CHAT-R/F).
The M-CHAT-R consists of 20 yes/no questions about how a child usually behaves. Scoring of the M-CHAT-R is interpreted as follows7:
Total score 0 to 2: Low risk. Repeat screen after second birthday for children under 24 months of age.
Total score 3 to 7: Medium risk. A clinician should administer the M-CHAT-R/F to obtain further details about at-risk responses. If the score is still 2 or higher, the child has screened positive.
Total score 8 to 20: High risk. The child should receive immediate diagnostic assessment and early intervention evaluation from a clinician.
If a child screens positive on the M-CHAT-R, a clinician should administer the M-CHAT-R/F, which consists of 20 pass/fail questions and detailed instructions for how to interpret the results.7 Because the goal of the M-CHAT-R is to detect as many cases of ASD as possible, it has a high rate of false positives, which means that not every child whose M-CHAT-R results suggest they are at risk for ASD will be diagnosed with the disorder.7 However, children who screen positive on the M-CHAT-R are at risk for other developmental disorders and should be evaluated by an experienced clinician.7
In addition to M-CHAT, several other tools that include input from parents can be used to screen children for development delays that might suggest a diagnosis of ASD3:
Ages and Stages Questionnaires (https://agesandstages.com) is a general developmental screening tool to be completed by a parent or caregiver. It features 19 age-specific questionnaires that address communication, gross motor, fine motor, problem-solving, and individual adaptive skills.
Parents’ Evaluation of Developmental Status (https://pedstest.com) is a general developmental screening tool. It is a parent-interview form used to screen for developmental or behavioral problems that warrant further evaluation.
Communication and Symbolic Behavior Scales (https://brookespublishing.com/product/csbs) is a standardized tool to screen for communication and symbolic abilities in children up to age 24 months.
Screening Tool for Autism in Toddlers and Young Children (https://vkc.vumc.org/vkc/triad/stat) is an interactive screening tool for children with suspected developmental delays. It features 12 activities that evaluate play, communication, and imitation skills.
Screening tools such as these are used to help identify a child who might have a neurodevelopmental delay such as ASD, but they do not provide conclusive evidence of a delay and they do not establish a diagnosis.3 Parents who thinks their child might have ASD should express their concerns to their child's pediatrician. The American Academy of Pediatrics recommends that pediatricians conduct general developmental screening of all children at 9, 18, and 30 months of age, and screening specifically for symptoms of ASD at 18 and 24 months.8 If necessary, the pediatrician will refer parents to a specialist who will conduct a thorough evaluation using the appropriate diagnostic criteria.
Autism Spectrum Disorder Diagnostic Criteria
In order to receive a diagnosis of ASD, a child needs to meet the criteria established by the American Psychiatric Association and published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision.1 Those criteria can be summarized as follows1:
A. Persistent deficits in social communication and social interaction as manifested by all of the following:
Deficiencies in social-emotional reciprocity (such as an inability to engage in normal back-and-forth conversation);
Deficiencies in nonverbal gestures used in social interaction (such as problems with eye contact, body language, or understanding or using gestures); and
Deficiencies in developing, maintaining, and understanding relationships (such as a lack of interest in peers).
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following:
Repetitive motor movements, use of objects, or speech (such as body rocking, arm or hand flapping, lining up toys, repeating words just spoken by another person);
Insistence on sameness, inflexible adherence to routine, or ritualized patterns of behavior (such as difficulty with transitions, rigid thinking patterns, need to eat the same food each day);
Highly restricted, fixated interests that are abnormal in intensity or focus (such as a strong attachment to peculiar objects); and
Hypersensitivity or hyporeactivity to sensory input or abnormal interest in sensory aspects of the environment (such as indifference to pain or temperature, adverse response to specific sounds or textures).
To meet these criteria, a child must not only have the required number of symptoms but the symptoms must have been apparent early in the child's developmental period and must cause significant impairment in functioning.1 These symptoms must not be better explained by an intellectual disability or global developmental delay.1
Autism Spectrum Disorder Checklist for Parents
To best help a child who they suspect might have ASD, parents can be better informed about the condition and diagnosis. Some checklist items for parents to address include:
Keep track of your child’s developmental milestones through the Centers for Disease Control and Prevention (CDC) milestone tracker app (https://www.cdc.gov/ncbddd/actearly/milestones-app.html), which outlines incremental milestones for children from age 2 months to 5 years.9
Research the initial signs/symptoms and diagnostic criteria of ASD.1
Use a developmental screening tool, such as the M-CHAT-R or Ages and Stages Questionnaire, to prepare for your child's initial diagnostic evaluation with their pediatrician.3
Seek out an evaluation from a specialist such as a psychiatrist or psychologist.2
Autism Spectrum Disorder Checklist for Patients
An adolescent or adult who suspects they may have ASD can follow a similar checklist:
Research the symptoms and diagnostic criteria of ASD.
Express your concerns to your primary care provider.
Seek out a specialized evaluation from a specialist.
"
["post_title"]=>
string(69) "Autism Checklist: How to Prepare for Your First Diagnostic Evaluation"
["post_excerpt"]=>
string(155) "This article describes what you should do to prepare for the initial evaluation if you suspect your child may have ASD, or if you think you might have ASD."
["post_status"]=>
string(7) "publish"
["comment_status"]=>
string(6) "closed"
["ping_status"]=>
string(6) "closed"
["post_password"]=>
string(0) ""
["post_name"]=>
string(16) "autism-checklist"
["to_ping"]=>
string(0) ""
["pinged"]=>
string(0) ""
["post_modified"]=>
string(19) "2024-04-22 10:51:10"
["post_modified_gmt"]=>
string(19) "2024-04-22 14:51:10"
["post_content_filtered"]=>
string(0) ""
["post_parent"]=>
int(0)
["guid"]=>
string(41) "https://www.clinicaladvisor.com/?p=183028"
["menu_order"]=>
int(0)
["post_type"]=>
string(4) "post"
["post_mime_type"]=>
string(0) ""
["comment_count"]=>
string(1) "0"
["filter"]=>
string(3) "raw"
}
}
You’ve read {{metering-count}} of {{metering-total}} articles this month.
We want you to take advantage of everything Clinical Advisor has to offer. To view unlimited content, log in or register for free.
{{login-button}} {{register-button}}
Want to view more content from Clinical Advisor?
Register now at no charge to access unlimited clinical news with personalized daily picks for you, full-length features, case studies, conference coverage, and more.
{{login-button}} {{register-button}}
Want to read more?
Please login or register first to view this content.
