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

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 年有特殊医疗保健需要的儿童调查 (CSHCN) 显示，在 3 岁以下的儿童中，健康和发育障碍的普遍存在，足以需要增加医疗或治疗服务，或对日常生活的影响为 6.5%（数据资源中心，CSHCN）。然而，这一数据低估了面临发育困难风险的儿童。在一项类似的全国代表性调查“全国儿童健康调查”中，40% 的 5 岁以下儿童家长表示担心他们的孩子面临神经发育困难的风险，包括语言习得迟缓、社交技能差和活动能力受限（健康和儿童的福祉：国家和民族的肖像，2005 年）。颁布了幼儿社会政策，即《残疾人教育法》C 部分，以创建州早期干预 (EI) 计划，以改善婴儿和幼儿的神经发育风险。定性研究表明，各州在 C 部分规划的许多方面存在极大差异，包括资格要求（Spiker，2001 年）、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，1986 年）赫伯勒，2007）。目前尚不清楚的是 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程度，以及 EI 是否与人口水平神经发育结果的改善相关。本研究的目的是在一群面临神经发育困难风险的幼儿中检验：1) 参与早期干预服务的社会决定因素，以及这些因素在多大程度上可以通过相关的社会政治、背景因素来解释（论文 1） ），2）对护理协调满意度的社会决定因素，以及这些因素在多大程度上可以通过相关的社会政治、背景因素来解释（论文 2），以及 3）神经发育随时间的变化与参与护理之间的关系早期干预（论文 3）。这项研究将完成以满足我的博士论文要求，即三篇可发表的高质量手稿。它将需要使用两项具有全国代表性的调查（2005 年全国有特殊医疗保健需求的儿童调查和早期儿童纵向研究出生队列）进行二次数据分析。对于前两篇论文，将使用多级建模，它允许同时调查个体和上下文层面的变量，同时适当地解决州内个体的聚类问题。第三篇论文将进行纵向分析，以便调查 EI 参与与神经发育结果之间随时间变化的关系。这项研究将为公共卫生领域做出贡献，因为它不仅直接涉及旨在解决弱势群体在获得健康和发展服务方面的社会差异的社会政策和计划举措，而且也符合疾病预防控制中心促进“健康”的目标。处于人生各个阶段的人们。”早期干预 (EI) 是一项联邦政府授权、州级计划，旨在降低婴幼儿的发育风险。本研究将在具有发展困难风险的全国代表性儿童样本中，探讨影响 EI 项目获得、满意度和有效性的社会决定因素。