The Screening and Linkage to Services for Autism pragmatic trial examined the effect of family navigation on referral and evaluation for autism spectrum disorder in an urban healthcare system serving low-income families. Children aged 16-30 months with initial scores [greater than or equal to]3 on the Modified Checklist for Autism in Toddlers--Revised with Follow-up (M-CHAT-R/F) were randomized to usual care (n = 133) or navigation if indicated (n = 142). Bilingual, bicultural autism family navigators offered navigation to intervention-group families if the completed M-CHAT-R/F indicated the need for autism spectrum disorder diagnostic evaluation. Autism family navigators also assisted families to arrange for completion of the M-CHAT-R/F interview if not done, and then offered navigation if indicated. Of 49 families for whom navigation was indicated, 45% received navigation, including care coordination, education, and practical support. In intention-to-treat analyses, the intervention did not increase referrals for evaluation but more than doubled completed autism spectrum disorder diagnostic evaluations. Intervention children were also more likely to complete the M-CHAT-R/F interview with fidelity. Research is needed to identify effective methods to improve uptake of family navigation. Family navigation may be an important tool for reducing systemic inequalities in the early identification and treatment of young children with autism spectrum disorder (ClinicalTrials.gov, https://clinicaltrials.gov/; NCT02374541). [This study was presented at the International Society for Autism Research (INSAR) 2019 Annual Meeting, Montreal, Canada, May 1-4, 2019.]