Optimizing a Paraprofessional, Family Partner Navigation Model for Children

优化儿童辅助专业人员、家庭合作伙伴导航模型

基本信息

批准号：
10210234
负责人：
EMILY FEINBERG
金额：
$ 82.44万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10210234
关键词：
Adopted Age Attention deficit hyperactivity disorder Attitude Caring Child Childhood Clinic Collaborations Communities Community Health Complex Computerized Medical Record Consumption Data Disease Effectiveness Enhancement Technology Ethnic Origin Experimental Designs Face Family Federally Qualified Health Center Future HIV Health Services Health Services Accessibility Home Home visitation Improve Access Individual Information Networks Insurance Intervention Language Low income Malignant Neoplasms Measures Mediator of activation protein Mental Health Mental Health Services Mental disorders Methods Modeling Monitor Motivation Online Systems Oregon Outcome Outcome Study Patient Education Persons Population Primary Health Care Problem Solving Protocols documentation Race Randomized Research Resources Schools Severities Structure Symptoms System Technology Testing Time Transportation autism spectrum disorder base behavioral health care coordination care delivery care systems chronic care model cost cost effective design disparity reduction effectiveness evaluation effectiveness testing evidence base family support health knowledge implementation strategy innovation instrument meetings motivational enhancement therapy multi-component intervention multiphase optimization strategy novel strategies patient portal primary outcome public health intervention response screening social stigma success telehealth theories

项目摘要

PROJECT SUMMARY Two decades of evidence support the effectiveness of family navigation (FN) as a care-management approach to reducing disparities in access to health services for disorders; despite substantial promise, widespread dissemination of FN still faces significant challenges. FN is a complex, multi-component intervention that generally incorporates motivational interviewing, problem-solving strategies, patient education, and care coordination. Each of these components can be delivered through a range of strategies including in-person meetings, telehealth, home visits, and/or web-based technologies. Our team’s research strongly supports FN’s effectiveness as a whole; however, three questions remain: 1) what are the most effective delivery strategies for FN; 2) which FN components are the “active ingredients;” and 3) how can FN be disseminated to a broad population. In the current proposal, FN will be will be delivered by a Family Partner and deployed to improve access to behavioral health services among children ages 3-12 years. Our study will be carried out at a large federally qualified health center within a newly formed Accountable Care Organization. For this project, we propose to optimize FN for dissemination at scale. First, using the Multiphase Optimization Strategy (MOST), which relies on a randomized, multi-factorial design, we will simultaneously test the effectiveness of three novel strategies for delivering FN components: (A) technology-assisted delivery of care coordination using an innovative, web-based platform; (B) community-based; and (C) enhanced symptom tracking using evidence-based screening instruments (compared to standard pediatric surveillance). Second, using path analysis, we will test mediators and moderators of FN outcomes. Third, using a mixed-methods approach, we will study factors that influence implementation. Integration of our three aims will yield a FN model that is optimized for efficiency, effectiveness, and wider implementation. Our specific aims are: (1) To evaluate the effectiveness of three strategies to deliver FN components. We will use a 2 x 2 x 2 factorial experimental design to test three strategies to deliver FN components. Families (n=304) will be randomized to one of eight conditions. We will estimate main effects of the three experimental factors and the additive effects of combinations of factors on the study’s primary outcome – engagement in appropriate mental health services. (2) To evaluate mechanisms of FN effectiveness and for whom it is most effective. (3) To Optimize FN for dissemination and evaluate implementation strategies. Following Aarons’ scaling-out framework, we will use mixed methods to explore barriers and facilitators to implementation by evaluating fidelity (to intervention and implementation), reach, and cost. Then, working with our team of stakeholders, we will integrate these findings with data from Aim 1 and 2 to optimize FN based on effectiveness, identified mediators and moderators, and implementation success.

项目概要二十年的证据支持家庭导航（FN）作为护理管理方法的有效性尽管有很大希望，但普遍存在减少获得疾病卫生服务的差距； FN 的传播仍然面临重大挑战。 FN 是一项复杂的、多方面的干预措施。通常包括动机性访谈、问题解决策略、患者教育和护理这些组成部分中的每一个都可以通过一系列策略来实现，包括面对面的策略。我们团队的研究强烈支持 FN 的会议、远程医疗、家访和/或基于网络的技术。整体有效性；然而，仍然存在三个问题：1）什么是最有效的交付策略对于 FN；2) 哪些 FN 成分是“活性成分”；以及 3) 如何将 FN 传播到更广泛的范围在当前的提案中，FN 将由家庭合作伙伴提供并部署以改善人口。我们的研究将在 3-12 岁儿童中进行大规模的行为健康服务。对于这个项目，我们在新成立的责任医疗组织内拥有联邦资格的健康中心。建议优化 FN 以进行大规模传播。首先，使用多阶段优化策略。（MOST），它依赖于随机、多因素设计，我们将同时测试以下方法的有效性：提供 FN 组成部分的三种新策略： (A) 技术辅助的护理协调提供使用基于网络的创新平台；(B) 基于社区；以及 (C) 使用增强的症状跟踪；基于证据的筛查工具（与标准儿科监测相比）其次，使用路径。分析中，我们将测试 FN 结果的中介变量和调节变量。第三，我们使用混合方法。将研究影响实施的因素整合我们的三个目标将产生一个 FN 模型：我们的具体目标是： (1) 评估提供 FN 组件的三种策略的有效性我们将使用 2 x 2 x 2 阶乘实验。旨在测试三种提供 FN 组件的策略的设计将被随机分配到八个家庭之一。我们将估计三个实验因素的主效应和附加效应。影响研究主要结果的因素组合——参与适当的心理健康服务 (2)。 (3) 优化FN 遵循 Aarons 的扩展框架，我们将进行传播和评估策略的实施。使用混合方法通过评估保真度（干预措施）来探索实施的障碍和促进因素然后，与我们的利益相关者团队合作，我们将整合这些。根据目标 1 和 2 的数据得出结果，根据有效性、确定的中介因素和确定的因素来优化 FN 主持人，并成功实施。