Developing the Autism Model of Implementation for ASD Community Providers

为 ASD 社区提供者开发自闭症实施模型

• 批准号: 8240881
• 负责人: Amy Drahota
• 金额: $ 18.53万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8240881
• 关键词: Address; Adopted; Adoption; Affect; Anxiety Disorders; Autistic Disorder; Behavior; Budgets; California; Characteristics; Child; Childhood; Client; Clinical; Collaborations; Communication; Communities; Consultations; Data; Data Analyses; Development; Diagnosis; Disease; Effectiveness; Evidence based practice; Family; Feedback; Focus Groups; Geographic Locations; Goals; Impairment; Individual; Intervention; Interview; Lead; Life; Literature; Manuscripts; Measures; Mental disorders; Mentored Research Scientist Development Award; Mentors; Methods; Modeling; Outcome; Participant; Phase; Pilot Projects; Platelet Factor 4; Play; Population; Procedures; Process; Professional Organizations; Provider; Readiness; Reporting; Research; Research Methodology; Role; School-Age Population; Services; Severities; Structure; Surveys; Symptoms; System; Testing; Training; Training Activity; Training Support; Wood material; Work; Writing; autism spectrum disorder; career; clinically significant; cost; executive function; experience; implementation research; implementation science; improved; meetings; programs; response; skills; skills training; social communication; social skills; statistics; symposium; theories; tool

DESCRIPTION (provided by applicant): This Mentored Research Scientist Development Award (K01) will provide the applicant with the advanced training and skills necessary to meet immediate career goals; specifically, developing an independent program of research focusing on improving the services received by children with autism spectrum disorders (ASD) and their families in community contexts by increasing the implementation of evidence-based practices delivered by ASD community providers. Longer term, the experience and data generated by this project are expected to lead to larger scale studies focusing on refining the AMI, including specific aspects of the AMI Process Materials, as well as studies to test the implementation effectiveness, generalizability, and sustainability of the AMI across various ASD agencies and geographic locations. Background and Significance. Currently, 1 out of 110 children are diagnosed with an ASD, and the annual estimate of costs for services is $35 billion. Typically, ASD Community Providers (ASD-CPs) provide services to children with any severity of ASD symptoms using various treatment paradigms with few treatments considered efficacious or probably efficacious. When evidence-based practices (EBPs) are successfully implemented by ASD-CPs, they result in positive outcomes. Despite this promise, EBPs are often implemented unsuccessfully and other treatments used by ASD-CPs lack supportive evidence, especially for school age children with ASD. While it is not well understood why ASD-CPs are not implementing EBPs, organizational and individual ASD-CP characteristics likely play a role in hindering implementation. As a response to this need, and to improve the lives of children with ASD and their families, the proposed study aims to develop and test the feasibility and acceptability of the Autism Model of Implementation (AMI) and AMI Process Materials to support the implementation of EBPs by ASD-CPs. Moreover, the proposed study will positively impact the field of implementation science by providing an empirically-supported and tested model of implementation to facilitate the identification, adoption, and use of EBPs by ASD-CPs, specifically. Research Plan. The specific aims of the proposed research include: Aim 1. Assess agency antecedents and readiness factors, individual ASD-CP characteristics, and methods of implementing EBPs by ASD Leaders, to identify factors that facilitate or hinder adoption and use of EBPs by ASD-CPs. This will be done through a mixed methods approach involving ASD-CPs participating in focus groups and completing quantitative surveys to provide information about the needs of clients with ASD and ASD-CPs; EBPs in general; agency and ASD-CP factors that might facilitate or inhibit EBP implementation; and their current process used to implement EBPs (if any). Data will be integrated using recommended procedures in consultation with study mentors and consultants. Results will be presented to academic- community collaborative (ACC) partners who will provide additional interpretation and feedback. Aim 2. Develop the Autism Model of Implementation (AMI) with the focus on identification, adoption, and use of EBPs within agencies serving children with ASD. Using a collaborative, iterative approach, the PI will develop the AMI with approximately 10 ACC partners (ASD-CPs who have agreed to collaborate with the PI to accomplish the research aims). Interpretation of data, and feedback from ACC partners are expected to increase external validity, feasibility, and acceptability of the AMI and AMI Process Materials. Aim 3. Examine the feasibility and acceptability of the AMI through a small-scale pilot study. Aim 3 involves the implementation of the AMI and AMI Process Materials (developed in Aim 2) in ASD Community Agencies as an organizational intervention (participants include ASD organizational leaders), and will use a specific EBP-a manualized CBT to treat anxiety disorders in children with ASD (a highly prevalent disorder in the ASD childhood population and stated concern by ASD-CPs in the community). The focus of this Aim is to evaluate the AMI and AMI Process Materials in terms of feasibility within ASD agencies; perceived fit, relevance, utility, and compatibility within ASD agencies and among ASD-CPs; training and support in use of AMI and AMI Process Materials, and observed fidelity. A mixed methods research approach will be used to assess post- implementation data in consultation with study mentor/consultants. Training Goals. In order to accomplish these research aims, the applicant requires the following training: 1) Acquire expertise in the theory and application of implementation research, including tailoring implementation models for specific community providers and contexts; 2) Gain expertise in academic-community collaboration (ACC); and 3) Acquire skills in mixed qualitative and quantitative methods. Training activities will include: a) consultation with Drs. Aarons (expertise: implementation science), Stahmer (expertise: ASD and collaborative models), Palinkas (mixed methods), Roesch (quantitative methods), and Wood (ASD and co-occurring disorders); b) synthesizing literature of implementation science and collaborative models; c) application to the IRI; d) coursework (i.e., UW CCPH online models of collaboration course, SDSU statistical classes in advanced statistics); e) applied training activities (i.e., mixed methods and quantitative data analyses), f) participating in professional organizations and conference (IMFAR, AOM, CCPH Consultancy Network), g) actively participating in structured training activities (i.e., IRI, VA QUERI Cyber Seminars, attend and lead UCSD Research Groups, attend and lead community collaborative groups); and h) manuscript writing. PUBLIC HEALTH RELEVANCE: Currently, 1 out of 110 children have an autism spectrum disorder (ASD), costing an estimated $35 billion in services, including treatments that are most often provided by ASD Community Providers (ASD-CPs). Research indicates that evidence-based practices (EBPs) are not routinely used by ASD-CPs, especially for school age children with ASD and co-occurring psychiatric disorders (e.g., anxiety disorders, which affects upwards of 80% of this population), and few ASD-CPs use a systematic process for adopting and implementing EBPs. Academic-community collaboration to partner with ASD-CPs will facilitate the development of the Autism Model of Implementation (AMI) specific for ASD community agencies. The AMI will help to provide school age children with ASD the best and most effective services in their own community, especially for those with co-occurring anxiety disorders for which very limited services are currently available. The aims of this study are to 1) assess agency and individual factors likely to facilitate implementing EBPs in this setting, 2) develop the Autism Model of Implementation (AMI) to address identified barriers and facilitators, and 3) pilot test the AMI to examine its feasibility and acceptability using a specific EBP to treat anxiety disorders in school age children with ASD.

描述（由申请人提供）：该导师研究科学家发展奖（K01）将为申请人提供实现近期职业目标所需的高级培训和技能；具体来说，制定一项独立的研究计划，重点是通过加强自闭症谱系障碍 (ASD) 社区提供者提供的循证实践的实施，改善自闭症谱系障碍 (ASD) 儿童及其家人在社区环境中获得的服务。从长远来看，该项目产生的经验和数据预计将导致更大规模的研究，重点是完善 AMI，包括 AMI 流程材料的具体方面，以及测试实施有效性、普遍性和可持续性的研究。跨各个 ASD 机构和地理位置的 AMI。背景和意义。目前，每 110 名儿童中就有 1 名被诊断患有 ASD，每年的服务成本估计为 350 亿美元。通常，自闭症谱系障碍社区提供者 (ASD-CP) 使用各种治疗模式为患有任何严重自闭症谱系障碍症状的儿童提供服务，但很少有治疗被认为有效或可能有效。当 ASD-CP 成功实施循证实践 (EBP) 时，就会产生积极的结果。尽管有这样的承诺，EBP 常常实施不成功，并且 ASD-CP 使用的其他治疗缺乏支持证据，特别是对于患有 ASD 的学龄儿童。虽然尚不清楚为什么 ASD-CP 不实施 EBP，但组织和个人 ASD-CP 的特征可能会阻碍实施。为了满足这一需求，并改善自闭症儿童及其家庭的生活，拟议的研究旨在开发和测试自闭症实施模型（AMI）和 AMI 流程材料的可行性和可接受性，以支持自闭症儿童及其家庭的实施ASD-CP 的 EBP。此外，拟议的研究将通过提供经验支持和测试的实施模型来促进 ASD-CP 识别、采用和使用 EBP，从而对实施科学领域产生积极影响。研究计划。拟议研究的具体目标包括： 目标 1. 评估机构前因和准备因素、个人 ASD-CP 特征以及 ASD 领导者实施 EBP 的方法，以确定促进或阻碍 ASD-CP 采用和使用 EBP 的因素。这将通过混合方法来完成，其中 ASD-CP 参与焦点小组并完成定量调查，以提供有关 ASD 和 ASD-CP 客户需求的信息； EBP 一般情况；可能促进或抑制 EBP 实施的机构和 ASD-CP 因素；以及他们当前用于实施 EBP 的流程（如果有）。将与研究导师和顾问协商，使用推荐的程序整合数据。结果将提交给学术界合作 (ACC) 合作伙伴，他们将提供额外的解释和反馈。目标 2. 开发自闭症实施模式 (AMI)，重点是在为自闭症谱系障碍儿童服务的机构内识别、采用和使用 EBP。使用协作、迭代的方法，PI 将与大约 10 个 ACC 合作伙伴（同意与 PI 合作实现研究目标的 ASD-CP）一起开发 AMI。数据解释和 ACC 合作伙伴的反馈预计将提高 AMI 和 AMI 流程材料的外部有效性、可行性和可接受性。目标 3. 通过小规模试点研究检验 AMI 的可行性和可接受性。目标 3 涉及在 ASD 社区机构中实施 AMI 和 AMI 流程材料（在目标 2 中开发）作为组织干预（参与者包括 ASD 组织领导），并将使用特定的 EBP（一种手动 CBT）来治疗儿童焦虑症患有自闭症谱系障碍（自闭症谱系障碍儿童群体中一种非常普遍的疾病，并受到社区中自闭症谱系障碍人士的关注）。该目标的重点是评估 AMI 和 AMI 流程材料在 ASD 机构内的可行性； ASD 机构内部和 ASD-CP 之间的感知适合性、相关性、实用性和兼容性；使用 AMI 和 AMI 流程材料的培训和支持，以及观察到的保真度。将与研究导师/顾问协商，采用混合方法研究方法来评估实施后数据。培训目标。为了实现这些研究目标，申请人需要接受以下培训： 1）获得实施研究的理论和应用方面的专业知识，包括针对特定社区提供者和环境定制实施模型； 2）获得学术界合作（ACC）方面的专业知识； 3) 获得混合定性和定量方法的技能。培训活动将包括： a) 与 Drs. 进行咨询。 Aarons（专业知识：实施科学）、Stahmer（专业知识：ASD 和协作模型）、Palinkas（混合方法）、Roesch（定量方法）和 Wood（ASD 和并发疾病）； b) 综合实施科学和协作模型的文献； c) 向 IRI 提出申请； d) 课程作业（即 UW CCPH 在线合作模型课程、SDSU 高级统计统计课程）； e) 应用培训活动（即混合方法和定量数据分析）， f) 参加专业组织和会议（IMFAR、AOM、CCPH 咨询网络）， g) 积极参与结构化培训活动（即 IRI、VA QUERI Cyber​​）研讨会、参加并领导 UCSD 研究小组、参加并领导社区协作小组）； h) 手稿写作。 公共健康相关性：目前，每 110 名儿童中就有 1 名患有自闭症谱系障碍 (ASD)，估计花费了 350 亿美元的服务费用，其中包括通常由 ASD 社区提供者 (ASD-CP) 提供的治疗。研究表明，ASD-CP 并不常规使用循证实践 (EBP)，特别是对于患有 ASD 和并发精神疾病（例如焦虑症，影响该人群 80% 以上）的学龄儿童，以及很少有 ASD-CP 使用系统流程来采用和实施 EBP。与 ASD-CP 合作的学术界合作将促进针对 ASD 社区机构的自闭症实施模型 (AMI) 的开发。 AMI 将帮助为患有自闭症谱系障碍 (ASD) 的学龄儿童提供其所在社区中最好、最有效的服务，特别是对于那些同时患有焦虑症（目前可获得的服务非常有限）的儿童。本研究的目的是 1) 评估可能促进在这种情况下实施 EBP 的机构和个人因素，2) 开发自闭症实施模型 (AMI) 以解决已识别的障碍和促进因素，以及 3) 对 AMI 进行试点测试以检查使用特定的 EBP 治疗学龄 ASD 儿童的焦虑症的可行性和可接受性。