Access Challenges Research Articles

Expert Opinions on the Management of Hemophilia A in India: The Role of Emicizumab.

Hemophilia A (HA) is a genetic disorder of hemostasis associated with a deficiency or reduced activity of clotting factor VIII (FVIII). This disorder remains unacceptably underdiagnosed in India. Early diagnosis and appropriate management of HA can substantially prevent morbidity and mortality. Currently, HA is managed with regular replacement therapy using standard or extended half-life FVIII concentrates or non-factor drug products. The challenges associated with FVIII concentrates include plateauing of drug effect, issues with its administration and adherence to treatment, breakthrough bleeds, and the development of inhibiting antibodies against administered clotting factors. Emicizumab is a bispecific antibody, launched in India in April 2019, for managing patients with HA. To investigate the role of emicizumab in Indian patients with HA, opinions were sought from 13 eminent hematologists and experts from India on the effectiveness of emicizumab in preventing all bleeds, spontaneous bleeds, perioperative bleeds, and intracranial hemorrhage; resolving target joints; and reducing the rate of hospitalizations and fatality associated with HA in children and adults, with or without inhibitors. The benefits of emicizumab over traditional FVIII concentrates include the subcutaneous route of delivery, less frequent dosing, and a lack of inhibitor development, in addition to providing sustained hemostasis without in-depth monitoring. It is a safe and effective management option for all HA patients, especially for patients with certain archetypes, such as those with inhibitors, those with high annualized bleed rates, those living far away from hemophilia care centers, pediatric patients and infants with intravenous access challenges, and those with a history of life-threatening bleeding events.

Examining the Use of Intelligent Conversational Voice-Assistants for Improved Mobility Behavior of Older Adults in Smart Cities

Intelligent Conversational Voice-assistants (ICV) can interpret the speech of human and respond back using synthesized voices and are increasingly employed for interacting with different applications. ICV offers promising tool to address the increasing mobility accessibility challenge faced by older people. Yet, irrespective of the increased ageing population, studies that employed ICV to improve the mobility, walkability, and wayfinding of older people are scarce. This is because the development of ICV in the mobility domain presents several designs, technical, and linguistic challenges. A systematic literature review was adopted grounded on secondary data from the literature and descriptive analysis was employed. Grounded on user-centred design perspective based on the “ability-based design framework” and “ISO 9241-110 framework for ergonomics of human-system interaction.” Therefore, this study describes the requirement specifications needed to design an ICV suitable for supporting the mobility behavior of older people. Findings from this paper identifies the perceived factors that influences the use of ICV by older people. Additionally, findings from this study discusses how ICV that simulates human-like behavior can provide personalized mobility, walkability, and wayfinding guide when older people walk in cities. This study provides recommendations for the implementation of a user-centred ICV for safe, independent, accessible mobility for older people in urban environment.

Astronomy’s Photographic Glass Plates: Demonstrating Value Through Use Cases

Astronomy's extensive collections of photographic glass plates contain historical images and spectra of celestial objects, documenting more than a century of the observable cosmos. Many reveal changes, both sudden (explosive), periodic, or gradual (evolutionary), which is material of immense interest for time-domain studies because of the long time-base they cover. Those early photographic observations also furnished all the basic data which supported our early understanding of the universe, and from which modern stellar classifications have been derived. Once the ubiquitous workhorse detector, plates or film are now replaced by electronic detectors, and systems are modified to take advantage of advances in telescope technology. This change poses challenges of preservation and accessibility for the plates, leading administrators to question the usefulness of the older materials in relation to the cost of their care and preservation. The following paper details many examples of reusing or re-purposing those plates, demonstrates their unique value to modern astronomy and the history of science, and makes a strong case for committing resources towards their long-term preservation and ultimately their comprehensive digitization.

Managing the co-creation of accessible and inclusive family recreation retail encounters: A critical incident analysis

Entertainment and recreation are pull factors for retail shopping malls and supercentres. For families in particular, recreation is a relevant part of their retail visits. However, families with children with disabilities (FCwD) continue to face access challenges in retail service environments. In this paper, we empirically explore how a value co-creation process undertaken with FCwD can enhance their perception of an accessible and inclusive family recreation retail visit. Our findings are based on a collaborative research project conducted in 2019 with a major shopping mall in the city of Barcelona, Spain. The methodology consisted of focus groups with stakeholders, ethnographic techniques and interviews with 20 FCwD using a constant comparative technique. The research design included two studies: Study 1, on the design of accessible and inclusive recreation retail encounters for FCwD, and Study 2, on the design of accessible and inclusive recreation retail encounters with FCwD. Using critical incident techniques (CIT), we found that the families perceived the recreation retail encounters in Study 2 to be more inclusive and accessible. From this research, we provide retail managers with recommendations for the successful design of inclusive family recreation retail opportunities in shopping malls.

A Machine Learning System to Indicate Diagnosis of Idiopathic Pulmonary Fibrosis Non-Invasively in Challenging Cases.

Radiologic usual interstitial pneumonia (UIP) patterns and concordant clinical characteristics define a diagnosis of idiopathic pulmonary fibrosis (IPF). However, limited expert access and high inter-clinician variability challenge early and pre-invasive diagnostic sensitivity and differentiation of IPF from other interstitial lung diseases (ILDs). We investigated a machine learning-driven software system, Fibresolve, to indicate IPF diagnosis in a heterogeneous group of 300 patients with interstitial lung disease work-up in a retrospective analysis of previously and prospectively collected registry data from two US clinical sites. Fibresolve analyzed cases at the initial pre-invasive assessment. An Expert Clinical Panel (ECP) and three panels of clinicians with varying experience analyzed the cases for comparison. Ground Truth was defined by separate multi-disciplinary discussion (MDD) with the benefit of surgical pathology results and follow-up. Fibresolve met both pre-specified co-primary endpoints of sensitivity superior to ECP and significantly greater specificity (p = 0.0007) than the non-inferior boundary of 80.0%. In the key subgroup of cases with thin-slice CT and atypical UIP patterns (n = 124), Fibresolve's diagnostic yield was 53.1% [CI: 41.3-64.9] (versus 0% pre-invasive clinician diagnostic yield in this group), and its specificity was 85.9% [CI: 76.7-92.6%]. Overall, Fibresolve was found to increase the sensitivity and diagnostic yield for IPF among cases of patients undergoing ILD work-up. These results demonstrate that in combination with standard clinical assessment, Fibresolve may serve as an adjunct in the diagnosis of IPF in a pre-invasive setting.

Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda

IntroductionNeonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings...

No Country for Young Refugees: Barriers and Opportunities for Inclusive Refugee Education Practices

The recent refugee crises in Ukraine (2022) and Syria (2011) have created millions of refugees, 40% of whom are children. The education systems of countries hosting refugees struggle to integrate such large populations. In addition, language barriers and the stigma associated with refugees hamper inclusive and equitable education opportunities for these children. There is thus a risk of “lost generations” distanced from education, who may eventually depend on social security systems and monetary aid in the long term. This study considers the following research question: How can a host country improve the inclusion of refugee children in the education system without overburdening its infrastructure? First, we document the availability and accessibility challenges and opportunities that refugee children face during the Syrian refugee crisis. We then develop an inclusive planning strategy aligned with existing capacity and resources and formulate two adaptations of the maximum covering problem (MCP): cooperative capacitated MCP with heterogeneity constraints (CCMCP-HC) to improve the current schooling access in Türkiye and Modular CCMCP-HC to guide early planning in the case of a future crisis. Our computational analyses illustrate that the proposed approach yields higher schooling rates and capacity utilization than existing approaches. Our results emphasize the importance of having a planning strategy in the initial phases of a crisis that considers future integration possibilities. This study analyzes Türkiye’s experience and lessons learned to provide a road map for other ongoing and future refugee crises.

Exploring alternative preschool education methods in Georgia: Enhancing accessibility

This study is relevant as it examines public-private partnerships in early childhood education in Georgia, seeking solutions to the significant educational challenges common to post-Soviet regions. It assesses the suitability of alternative educational models in a society that is still struggling with the infrastructural legacy of the Soviet past, providing valuable recommendations for policy reforms needed to expand access to and improve the quality of preschool education. The purpose of the study was to assess the readiness of Georgian society to implement alternative educational practices. Drawing upon the experiences of post-Soviet nations, alongside international insights and local perspectives, the study aims to provide comprehensive insights into the feasibility and effectiveness of alternative models in Georgia. Employing a mixed-methods approach encompassing qualitative interviews, surveys, and data analysis, the research examines the strengths, challenges, and implementation prospects of various alternative models within the unique socio-economic and cultural context of post-Soviet Georgia. Early childhood education in post-Soviet and similar countries confronts common challenges in access and quality, despite varied policies, with efforts such as legislation and public-private partnerships aimed at addressing financial and geographical barriers. Persistent disparities in preschool systems across the region, as illustrated by reform initiatives and staffing issues in Georgia, highlight the need for continuous reforms. These factors underscore the importance of sustained policy efforts to support comprehensive and effective early learning environments. The results underscore a compelling need for alternative education avenues in Georgia, particularly in regions facing infrastructural and geographical barriers similar to those experienced in other post-Soviet nations. While highlighting the potential benefits of public-private partnerships models, the study also identifies key challenges that need to be addressed to ensure their successful implementation within the post-Soviet context. The practical value of this study extends to policymakers, educators, and communities across post-Soviet countries with similar educational challenges. By advocating for legislative reforms to incorporate alternative approaches, this research contributes to ongoing efforts to strengthen preschool education and promote inclusivity in post-Soviet Georgia and beyond

Creating culturally-informed protocols for a stunting intervention using a situated values-based approach (WeValue InSitu): a double case study in Indonesia and Senegal

International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing ‘cultural protocols’ to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which ‘crystallize’ their envelope of local shared values, making them communicable to outsiders.Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.

Exploring Small and Medium Enterprises Access to Finance: A Bibliometric Analysis

This study conducts a bibliometric investigation into the access of small and medium enterprises (SMEs) to finance. Access to finance significantly impacts SME success and growth, yet understanding this intricate matter still needs to be completed. Bibliometric analysis aims to uncover significant trends, research gaps, and influential contributors. The methodology involves extensively searching and assessing scholarly articles, journals, and publications related to SMEs' finance access. A systematic approach identifies relevant studies, extracts bibliographic data, and analyzes citation patterns, co-authorship networks, and thematic clusters. This detailed process maps the research landscape's structure, showcasing trends and new research areas. Results of the bibliometric analysis provide vital insights dominant themes like alternative financing methods, government policies, financial inclusion initiatives, and entrepreneurial finance. Influential authors, institutions, and journals contributing to SMEs' finance access knowledge are also identified. This research offers a comprehensive understanding of existing knowledge and addresses critical research gaps. Analyzing scholarly literature provides valuable insights for researchers, policymakers, and practitioners. Identified gaps and emerging areas guide future research, shaping agendas and prompting further investigations. Furthermore, the bibliometric analysis encourages interdisciplinary collaboration and knowledge exchange among scholars and practitioners. Identifying key authors and institutions supports collaborations and knowledge sharing. Ultimately, this research aims to aid evidence-based decision-making and policy formulation for improved SME finance access. By understanding the research's current state, identifying gaps, and noting emerging trends, this study strives to enhance SME growth and development by fostering a better understanding of finance access challenges and possibilities.

ANALYSIS OF THE ADVANTAGES AND CHALLENGES OF INFORMATION COMMUNICATION TECHNOLOGY-BASED LEARNING IN ELEMENTARY SCHOOLS

This study aims to examine in depth the advantages of Information and Communication Technology (ICT)-based learning at the elementary school level. ICT-based learning in elementary schools refers to the integration of information and communication technology in the learning process. The government has adopted initiatives to bring ICT into the basic education curriculum. The population in this study consisted of teachers, students and related parties at Sekolah Dasar Negeri Maguwoharjo 1, Sleman Regency, Yogyakarta. The use of ICT allows wider access to distance learning, increases student learning motivation, makes it easier to understand material, and facilitates independent learning. Apart from that, teachers also find it easy to convey lesson material and minimize their shortcomings in coordinating the class. The use of ICT also provides easier access to learning resources, enriches learning, and facilitates the creation of important documents.Teachers need to address the challenges of technical preparation, device and internet accessibility, and changes in teaching methods. Schools must face the challenges of investment in ICT infrastructure, staff and teacher training, as well as unstable electricity issues. In facing these challenges, support from schools, teachers and other interested parties is very important to ensure the successful implementation of ICT-based learning.Keywords: Advantages, challenges, ICT, elementary school

‘I created my own access:’ understanding mental healthcare access experiences among LGTBQ + youth who use cannabis in Canada

In North America, LGBTQ+ youth have high rates of cannabis use and face mental health issues. We conducted a photovoice study to describe the perspectives, needs, and motivations of forty-six LGBTQ+ youth who use cannabis as they access mental healthcare services. Participants’ photographs were discussed in individual semi-structured interviews conducted by peer researchers. Following a thematic analysis of the interview transcripts, we first found that, beyond medication, LGBTQ+ youth sought mental health services facilitating introspection to better understand their sexual and gender identities and mental health. Second, participants sought affirming health professionals but often felt judged by providers. Third, access to desired services was often described as uncertain and taxing, which impacted their mental health. Fourth, participants’ agency was determined by their experience with mental health services, which translated into resilience to tackle access challenges and cannabis use to mitigate their mental health struggles. Our findings point to the need for mental healthcare delivery that goes beyond medication provision but which in addition foster therapeutic processes based on a holistic understanding of mental health. A trusting dynamic between health professionals and LGBTQ+ youth is imperative to counteract the feelings of stigma experienced by LGBTQ+ youth using cannabis in Canada.

Comparative Study of Inclusive Education Programs for Women in Indonesia and Malaysia

Education constitutes a fundamental right for all individuals, irrespective of gender. Despite this, gender-based educational disparities persist globally. This study conducts a comparative analysis of inclusive education programs for women in Indonesia and Malaysia, aiming to elucidate gender challenges in educational access and participation. Employing a qualitative methodology and comparative analysis, this research scrutinizes inclusive policies and initiatives within these nations, delineating their distinctions and commonalities. Data were collected through document reviews, observations, and interviews and subsequently subjected to comparative descriptive analysis. The findings reveal both countries' dedication to enhancing female educational participation. Nonetheless, obstacles such as restricted rural educational access, prevalent gender stereotypes in certain academic disciplines, discrepancies in STEM proficiency, and economic constraints continue to impede progress. To surmount these gender challenges in education, it is imperative to eradicate gender stereotypes, fortify gender-specific policies, broaden educational access, and provide tailored support for women with unique needs. Through collaborative efforts across multiple stakeholders, this study advocates for the establishment of an inclusive, equitable, and gender-fair educational milieu.

Not All Who Wander Are Lost: Redefining Career Exploration and Indecision in Undergraduate Students

Inspired by a Tolkien quote, “Not All Who Wander Are Lost,” the authors introduce the concept of career wandering in the context of undergraduate student development. Proposing an alternative to traditional linear career trajectories, we conceptualize a dynamic approach that embraces nonlinear paths, indecision, and adaptability in a rapidly changing labor market. Drawing from our experience as educators, we define career wandering by integrating principles of lifelong learning, flexibility, chance events, and openness to diverse experiences. We explore the implications of career wandering for student affairs professionals, emphasizing the need for supportive, inclusive environments that encourage exploration and holistic student development. Addressing potential critiques, we acknowledge the challenges of equity and accessibility, and the need for intentional institutional support. Ultimately, the career wandering approach aligns with the evolving nature of work and promotes a more inclusive and adaptable model of career development in higher education.

510 Addressing the Regulatory Needs and Challenges of Academic Researchers by Creating a One-Stop Shop Web Portal

OBJECTIVES/GOALS: To identify challenges faced by academic researchers in accessing online regulatory information and/or tools to advance their research work to develop a free, publicly accessible, interactive web portal that provides regulatory support. METHODS/STUDY POPULATION: The Regulatory Knowledge and Support core of the Southern California Clinical and Translational Science Institute interviewed five local research professionals. These interviews guided the development of a Qualtrics survey, consisting of multiple responses and open-ended questions, submitted to our local institutional review board (IRB). After receiving IRB approval, the survey was disseminated via email, newsletters, flyers, and presentations targeting researchers at academic institutions and members of clinical and translational science hubs. Survey data will be used to identify the challenges academic researchers face in finding regulatory resources and to compile the types of regulatory information or tools they would find helpful for their research. RESULTS/ANTICIPATED RESULTS: According to the interviews, researchers with extensive involvement in clinical trials found regulatory resources easily accessible compared to those with less experience. Additionally, they all stated having a colleague or regulatory specialist whom they can consult about regulatory requirements. Insights from these initial interviews confirmed the need to obtain a comprehensive view across research professionals. Anticipated results will show the challenges in accessibility, source, and type of regulatory resources researchers typically encounter. It is also anticipated that researchers will share what kinds of resources they would find most useful for their work. Ultimately, the information and tools identified as essential by survey takers will be collected and incorporated into the web portal. DISCUSSION/SIGNIFICANCE: Academic researchers find navigating through regulatory hurdles persistently challenging when translating their work from bench to clinic, especially since academia is typically resource-constrained. Findings from this study will allow the creation of a web portal for researchers that is broadly accessible and meets their regulatory needs.

IJCM_422A : Artificial Intelligence & Sustainable Development Goals in Health Care

Background: The intersection of Artificial Intelligence and Sustainable Development Goal (SDG) 3 presents both opportunities and challenges. AI has the potential to enhance healthcare delivery by improving diagnostic accuracy, enabling personalized treatment approaches, and facilitating remote healthcare services through telemedicine. AI-driven technologies can also streamline administrative tasks, optimize resource allocation, and support evidence-based decision-making in healthcare settings. Objective: This study seeks to identify challenges and opportunities for utilizing AI to advance global health objectives to support Sustainable Development Goal 3 Methodology: A review of existing literature was carried out to evaluate the current landscape of AI applications in healthcare and its potential implications for SDG achievement. We identified constraints such as data bias, ethical considerations, and accessibility barriers, and looked at the potential remedies and strategies for maximizing the positive impact of AI in healthcare. Conclusion: There exists significant hurdles into the integration of AI into healthcare however there are promising prospects for enhancing healthcare delivery, disease prevention, and drug discovery processes. By addressing issues such as data bias, ethical dilemmas, and accessibility challenges, AI holds the potential to revolutionize healthcare systems on a global scale. Embracing AI technologies can contribute significantly to realizing SDGs pertaining to health and well-being, thereby fostering more sustainable and equitable healthcare practices.

Creating inequality in access to public transit? Densification, gentrification, and displacement

Densification is a key concept in contemporary urban planning. Yet, there are widespread concerns about densification causing displacement and gentrification. This paper examines densification around train stations—a prevalent form of transit-oriented development (TOD) in cities with established public transit systems—in the Canton of Zurich, Switzerland. We assess the effects of densification around train stations on the socioeconomic population composition in these areas and investigate three different potential displacement effects. Leveraging 1.8 million linked person-housing unit observations for all individuals within our study perimeter, we provide a more nuanced understanding of densification’s effects on the population composition and displacement than prior research. Our findings reveal that even though densification increases the absolute number of low-income residents, it primarily benefits middle- and high-income households. Specifically, there is a decline in the share of low-income residents, attributed to the influx of younger high-income individuals. Moreover, incumbent low-income residents experience an increased risk of direct displacement due to housing demolitions. These outcomes highlight the limitations of TOD strategies in mitigating persistent socioeconomic disparities in public transit access, emphasizing the need for more comprehensive measures to address the challenges of equitable housing and public transit accessibility.

The challenges of universal access to water: some contributions to the sustainable management of water resources in rural areas

The United Nations 2030 Agenda for Sustainable Development, highlighted as Sustainable Development Goal (SDG) 6, related to access to safe drinking water and sanitation for all, including vulnerable groups, considers water a human right and advocates for its universalization. Thus, the article aims to o point out, in the field of public, social and governmental policies, assumptions for the sustainable management of water resources in rural areas or for territorially vulnerable populations. The article is based on a qualitative and descriptive methodology, using bibliographic and documentary data to analyze socioeconomic practices and public policies in water resources management. It explores the conceptual framework of the Social and Solidarity Economy and its link with sustainable territorial development, highlighting the importance of community participation and collaboration in water management. The authors suggest that shared or cooperative management of water resources is one way to address environmental, economic, and social challenges. In conclusion, shared management of water resources can solve environmental, economic, and social challenges in rural areas and vulnerable populations, promoting sustainable territorial development.

Challenges Faced by Rural Health Care Providers Caring for Parkinson's Disease Patients in Neighbor Islands of Hawai'i.

When compared to their urban counterparts, rural regions have worse health outcomes and more challenges in health care access. As the only island state in the US, Hawai'i's unique geographic layout may magnify these disparities. However, there are limited publications on the impact of urban-rural disparities in health care in Hawai'i. The study team aimed to identify the challenges rural health care providers face when managing treatment of Parkinson's disease (PD), a complex disease. A self-administered survey was sent to 247 eligible providers who practiced in Hawai'i and prescribed PD medications from 2017-2019. The survey assessed: provider's comfort level in PD management; utilization and accessibility of health care services; perspective on barriers to PD care; and perspective on telemedicine. Providers were categorized into O'ahu providers (OP, urban) and neighbor island (Hawai'i, Kaua'i, and Maui) providers (NIP, rural). The final sample size was 44 providers (18% response rate). NIP were significantly less likely than OP to report access to social workers (P=.025), geriatric services (P=.001), and psychologist/psychiatrist/mental health professionals (P=.009). There were no statistical differences in: criteria used for PD diagnosis, resources utilized for PD education, and comfort in prescribing PD medications. The findings show that NIP are just as engaged and capable in providing PD care as OP. However, NIP encounter more limitations to accessibility, which can affect the quality of PD care that their rural patients receive. Further research is needed to understand how these limitations affect health-related outcomes in PD as well as other chronic diseases.

143 Training & Sustaining: Training and learning collaborative outcomes across a statewide network for early diagnosis of children with autism

OBJECTIVES/GOALS: Community-based primary care autism diagnostic models are one promising solution to delays in autism diagnosis. Our objective is to describe the development and report on outcomes related to primary care professional (PCP) training and sustained engagement in a longitudinal learning collaborative across a statewide network for autism diagnosis. METHODS/STUDY POPULATION: We developed ADAPT (i.e., Accelerating the Diagnosis of Autism with Primary care Training), a training program to prepare PCPs to develop independent competency in evaluation of autism in children ages 14-48 months. ADAPT includes didactic and case-based modules and expert practice-based coaching delivered by a diagnostic specialist; following training PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected. RESULTS/ANTICIPATED RESULTS: To date, 13 PCPs have completed ADAPT didactic and practicum training reaching competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge following didactic training (p=.02). There was an overall trend toward increased scoring agreement on an autism observational assessment over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert trainers. Following training, PCPs attended 57% of monthly learning collaborative sessions. DISCUSSION/SIGNIFICANCE: Training PCPs to deliver autism evaluations as part of community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standard PCP training model which results in achievement of independent competency and sustained engagement in in autism evaluation.