Social Determinants for Early Intervention Participation and Efficacy

早期干预参与和有效性的社会决定因素

• 批准号: 7483512
• 负责人: Beth Marie McManus
• 金额: $ 2.92万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-15 至 2009-05-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7483512
• 关键词: Social; Determinants; Early; Intervention; Participation; Social; Determinants; Early; Intervention; Participation

DESCRIPTION (provided by applicant): The 2001 Survey of Children with Special Health Care Needs (CSHCN) shows that, among children less than 3 years of age, the prevalence of health and developmental impairments significant enough to warrant increased medical or therapeutic services or to impact daily living is 6.5% (Data Resource Center, CSHCN). However, this data underestimates children at risk for developmental difficulties. In a similar nationally representative survey, the National Survey of Children's Health, 40% of parents of children less than 5 reported concern that their child was at risk for neurodevelopmental difficulties including delayed language acquisition, poor social skills, and limited mobility (The Health and Well-Being of Children: A Portrait of States and the Nation, 2005). Early childhood social policy, the Individuals with Disabilities Education Act Part C, was promulgated to create state Early Intervention (EI) programs in order to ameliorate neurodevelopmental risk among infants and toddlers. Qualitative studies reveal that there exists extreme variation across states in many facets of Part C programming including eligibility requirements (Spiker, 2001), models of service coordination (Scarborough, 2004) while quantitative studies suggest mixed effect of EI in small samples (Shonkoff, 1986; Hebbeler, 2007). What is unknown are the social determinants of variability of EI participation, the degree to which health and developmental services are coordinated and seamless, and whether EI is associated with improved neurodevelopmental outcomes at the population level. The purpose of this research is to examine, among a cohort of young children at risk for neurodevelopmental difficulties, 1) the social determinants in participation In Early Intervention services and the extent to which these might be explained by relevant sociopolitical, contextual factors (Paper 1), 2) the social determinants in satisfaction with care coordination and the extent to which these might be explained by relevant sociopolitical, contextual factors (Paper 2), and 3) the relationship between changes in neurodevelopment over time and participation in Early Intervention (Paper 3). This research will be completed to fulfill my doctoral dissertation requirement of three publishable quality manuscripts. It will entail secondary data analyses using two nationally representative surveys, the 2005 National Survey of Children with Special Healthcare Needs and the Early Childhood Longitudinal Study Birth Cohort. For the first two papers, multi-level modeling will be used, which allows for investigation of individual and contextual level variables simultaneously while appropriately addressing the clustering of individuals within states. The third paper will entail a longitudinal analysis which will allow for an investigation of the relationship between EI participation and neurodevelopmental outcomes over time. This research will contribute to the field of public health as it directly relates to not only social policy and programmatic initiatives aimed at addressing social disparities in access to health and developmental services for vulnerable populations, but also is consonant with the CDC's objective of promoting "Healthy People at Every Stage of Life." Early Intervention (EI) is a federally mandated, state-based program to reduce developmental risk in infants and toddlers. This study will explore social determinants of access to, satisfaction with, and effectiveness of EI programming among a nationally representative sample of children at risk for developmental difficulties.

描述（由申请人提供）：2001年对具有特殊卫生保健需求的儿童的调查（CSHCN）表明，在不到3岁以下的儿童中，健康和发育障碍的患病率足以保证增加医疗或治疗服务或影响日常生活，或影响日常生活（数据资源中心，CSHCN）。但是，这些数据低估了有发育困难的风险的儿童。在一项类似的全国代表性调查中，全国对儿童健康的调查，有40％的儿童父母少于5个报告，他们担心孩子面临神经发育困难的风险，包括延迟语言获取，社交技能差和流动性有限（儿童的健康和福祉：国家和国家的肖像肖像和国家，2005年）。儿童早期的社会政策，《残疾人教育法》第C部分，颁布了制定国家早期干预（EI）计划，以减轻婴儿和幼儿的神经发育风险。定性研究表明，C部分编程的许多方面之间存在极大的变化，包括资格要求（Spiker，2001），服务协调模型（Scarborough，2004年），而定量研究表明EI在小样本中的混合效应（Shonkoff，Shonkoff，1986; Hebbeler，2007）。未知的是EI参与变异性的社会决定因素，健康和发展服务的协调和无缝的程度，以及EI是否与人口层面的神经发育结果改善相关。这项研究的目的是在遇到神经发育困难风险的一群幼儿中，1）社会决定因素参与早期干预服务的参与以及这些可以通过相关的社会政治，上下文因素（论文1）来解释的程度（纸1），2）与护理协调的社会确定性相关的社会和相关性的范围，以及3个相关的社会，3）是相关的，3）是构成了3个相关性的关系，这是3个相关性的关系，这是相关性的，这是相关性的，这是相关性的，这是相关性的）随着时间的流逝和参与早期干预的参与（论文3）。这项研究将完成，以满足我三个可发布质量手稿的博士学位论文要求。它将使用两项全国代表性调查进行二级数据分析，即2005年对具有特殊医疗保健需求的儿童的全国调查以及幼儿纵向研究出生队列。对于前两篇论文，将使用多层次建模，该建模允许同时研究个体和上下文级别变量，同时适当地解决了各州范围内个体的聚类。第三篇论文将需要进行纵向分析，这将允许对EI参与与神经发育结果之间的关系进行研究。这项研究将有助于公共卫生领域，因为它不仅与旨在解决易受伤害人群的健康和发展服务方面的社会差异有关的社会政策和计划倡议，而且还符合疾病预防控制中心（CDC）在每个阶段促进健康人的目标的目标。早期干预（EI）是一项基于州的联邦授权计划，可降低婴儿和幼儿的发育风险。这项研究将探讨社会决定因素，即在有发育困难风险的国家代表性的儿童样本中获得EI编程的机会，满意和有效性。