Refining and Implementing Technology-Enhanced Family Navigation to Promote Early Access and Engagement with Mental Health Services for Youth with Autism

完善和实施技术增强的家庭导航，以促进自闭症青少年早期获得和参与心理健康服务

• 批准号: 10459425
• 负责人: Nicole A Stadnick
• 金额: $ 23.7万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10459425
• 关键词: Address; Age; Anxiety; Behavior; Caregivers; Case Management; Child; Child health care; Childhood; Clinic; Clinical; Communities; Computerized Medical Record; Diagnostic Services; Early Intervention; Educational workshop; Effectiveness; Enhancement Technology; Family; Focus Groups; Funding; Health Technology; Healthcare; Hybrids; Infant; Intervention; Mental Health; Mental Health Services; Methods; Modeling; National Institute of Mental Health; Needs Assessment; Outcome; Phase; Population; Primary Health Care; Public Health; Randomized; Research Priority; Risk; School-Age Population; Series; Service delivery model; Services; Step Tests; Strategic Planning; Technology; Testing; Toddler; Training; adolescent with autism spectrum disorder; autism spectrum disorder; autistic children; base; care providers; comorbidity; design; digital health; effectiveness implementation trial; effectiveness testing; evidence base; health information technology; implementation science; innovation; medical specialties; phase II trial; primary care setting; prototype; response; service coordination; technology validation; tool; treatment services; user centered design

12. Project Summary In response to PAR-18-429, we propose to refine and test implementation of technology-enabled family navigation to promote early access to, and engagement between, primary and mental health (MH) care for children (ages 5-13 years) with autism spectrum disorder plus MH comorbidity (ASD+). Unmet MH needs (e.g., anxiety, disruptive behaviors) are a common and principal concern, associated with deleterious public health effects for children with ASD. While evidence-based MH interventions for ASD+ are available (e.g., AIM HI5,6), there are multi-level challenges limiting access to such treatment. Family navigation, a model of lay case management designed to mitigate barriers to specialty healthcare, is a promising solution to overcome these challenges for children with ASD+. Family navigation is an established model to facilitate engagement in diagnostic and treatment services including early intervention for infants and toddlers at risk for ASD. However, family navigation has not been tested with children with ASD+. Health information technologies have not been systematically tested as a component of family navigation. Integrating these technologies is a critical next step in increasing the effectiveness and implementation of family navigation. This proposal addresses this next step by testing the effectiveness and implementation of family navigation with systematically designed navigator implementation technology enhancements for children (5-13 years) with ASD+. The Accelerated Creation-to-Sustainment (ACTS) model will be used to guide the design and trial of technology enhancement to family navigation. The ACTS model, based on user-centered design principles and implementation science, provides systematic guidance in rapidly moving from design (Phase 1: Create) of a technology-enabled service to implementation (Phase 2: Trial) and sustainment (Phase 3: Sustain). We propose to use a community- partnered approach guided by the ACTS model to refine and test technology-enhanced family navigation to promote early and ongoing integrated MH care for children with ASD+. This proposal is highly responsive to research priorities in the NIMH Strategic Plan, in digital health technology to advance MH service delivery models and the HHS Interagency Autism Coordinating Committee Strategic Plan. Further, this proposal capitalizes on existing NIMH-funded initiatives to build capacity to treat children with ASD+ in MH settings. The specific aims are: Aim 1: Adapt family navigation (FN) content and training for school-age children with ASD+. Aim 2: Develop FN technology tools to enhance navigator implementation of FN for ASD+. Aim 3: Examine the implementation, service and clinical impacts of technology-enhanced FN for ASD+ through a hybrid type I effectiveness-implementation trial in primary care. A randomized stepped wedge design in primary care will be conducted with five clinics, 30 PCPs and 160 families to examine mechanisms of change and outcomes. Based on successful execution of these aims, we will have a technology-enhanced FN for ASD+ that is ready for large-scale R01 implementation and sustainment testing within diverse primary care settings.

十二、项目概要 为了响应 PAR-18-429，我们建议完善和测试技术支持系列的实施 导航以促进初级保健和心理健康 (MH) 护理的早期获得和参与 患有自闭症谱系障碍加上 MH 合并症 (ASD+) 的儿童（5-13 岁）。未满足的 MH 需求（例如， 焦虑、破坏性行为）是一个常见且主要的问题，与有害的公共健康有关 对 ASD 儿童的影响。虽然针对 ASD+ 的循证 MH 干预措施是可用的（例如 AIM HI5,6）， 存在多层次的挑战限制获得此类治疗。家庭导航，外行案例典范 旨在减轻专业医疗保健障碍的管理是克服这些障碍的一个有前途的解决方案 ASD+ 儿童面临的挑战。家庭导航是促进参与的既定模式 诊断和治疗服务，包括对有 ASD 风险的婴幼儿进行早期干预。然而， 家庭导航尚未针对 ASD+ 儿童进行测试。卫生信息技术尚未 作为家庭导航的一个组成部分进行了系统测试。集成这些技术是下一步关键 提高家庭导航的有效性和实施。该提案接下来解决这个问题 通过系统设计测试家庭导航的有效性和实施情况 针对 ASD+ 儿童（5-13 岁）的导航器实施技术增强。加速的 创建到维持（ACTS）模型将用于指导技术增强的设计和试验 家庭导航。 ACTS模型，基于以用户为中心的设计原则和实现科学， 提供系统化指导，帮助您快速完成技术支持服务的设计（第一阶段：创建） 实施（第 2 阶段：试验）和维持（第 3 阶段：维持）。我们建议使用社区- 以 ACTS 模型为指导的合作方法，以完善和测试技术增强型家庭导航 促进对 ASD+ 儿童进行早期和持续的综合 MH 护理。该提案得到了高度响应 NIMH 战略计划中的研究重点是数字医疗技术，以推进 MH 服务提供模式 和 HHS 机构间自闭症协调委员会战略计划。此外，该提案还利用了 NIMH 资助的现有举措旨在建设在 MH 环境中治疗 ASD+ 儿童的能力。具体目标 目标 1：调整家庭导航 (FN) 内容并为患有 ASD+ 的学龄儿童提供培训。目标 2： 开发 FN 技术工具以增强 ASD+ 的 FN 导航器实施。目标 3：检查 通过混合类型技术增强的 FN 对 ASD+ 的实施、服务和临床影响 I 初级保健的有效性实施试验。初级保健中的随机阶梯楔形设计 将与 5 个诊所、30 个 PCP 和 160 个家庭一起进行，以检查变化和结果的机制。 基于成功执行这些目标，我们将为 ASD+ 准备好技术增强型 FN 用于在不同的初级保健环境中进行大规模 R01 实施和维持测试。

项目成果

Sero-prevalence and determinants of Hepatitis B among a cohort of HIV-infected women of reproductive age in Nigeria.

尼日利亚一群感染艾滋病毒的育龄妇女中乙型肝炎的血清流行率和决定因素。

• DOI: 10.1371/journal.pone.0236456
• 发表时间: 2020
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Adeyemi,OlusegunAdewale;Itanyi,IjeomaUchenna;Ozigbu,ChamberlineEkene;Stadnick,Nicole;Tsuyuki,Kiyomi;Olayiwola,Olanrewaju;Ogidi,AmakaGrace;Eze,Chuka;Aarons,GregoryAlan;Onoka,ChimaAriel;Ezeanolue,EchezonaEdozie
• 通讯作者: Ezeanolue,EchezonaEdozie

Psychometric Assessment of the Eyberg Child Behavior Inventory in Children with Autism in Community Settings.

• DOI: 10.1007/s10803-022-05427-z
• 发表时间: 2023-04
• 期刊: JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
• 影响因子: 3.9
• 作者: Martinez, Kassandra;Chlebowski, Colby;Roesch, Scott;Stadnick, Nicole A.;Villodas, Miguel;Brookman-Frazee, Lauren
• 通讯作者: Brookman-Frazee, Lauren

Strengthening capacity for implementation of evidence-based practices for autism in schools: The roles of implementation climate, school leadership, and fidelity.

• DOI: 10.1037/amp0000649
• 发表时间: 2020-11
• 期刊: The American psychologist
• 作者: Melgarejo M;Lind T;Stadnick NA;Helm JL;Locke J
• 通讯作者: Locke J

Pediatric Primary Care Perspectives on Integrated Mental Health Care for Autism.

• DOI: 10.1016/j.acap.2020.03.006
• 发表时间: 2020-11
• 期刊: Academic pediatrics
• 影响因子: 3.1
• 作者: Stadnick NA;Martinez K;Aarons GA;Lee DA;Van Cleave J;Brookman-Frazee L
• 通讯作者: Brookman-Frazee L

Pre-Implementation Organizational Environment Associated with Pediatric Integrated Care Readiness in Primary Care.

• DOI: 10.1080/23794925.2021.1875344
• 发表时间: 2022
• 期刊: Evidence-based practice in child and adolescent mental health
• 作者: Stadnick NA;Penalosa MG;Martinez K;Brookman-Frazee L;Gizzo DP;Sahms T;Kuelbs CL;Aarons GA
• 通讯作者: Aarons GA