The effectiveness of an autistic-delivered peer-support intervention for autistic adults: Community Autism Peer Specialist (CAPS) program

自闭症成人同伴支持干预的有效性：社区自闭症同伴专家 (CAPS) 计划

• 批准号: 10683383
• 负责人: Mark S. Salzer
• 金额: $ 22.91万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-12 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683383
• 关键词: Address; Adoption; Adult; Age; Area; Certification; Childhood; Cities; Clinical; Clinical Trials; Communication impairment; Communities; Community Participation; Development; Disease; Education; Effectiveness; Effectiveness of Interventions; Employment; Evaluation; Evidence based intervention; Evidence based practice; Family Relationship; Feedback; Friendships; Funding; Future; Goals; Health; Health Services Accessibility; Housing; Hybrids; Individual; Infrastructure; Intervention; Intervention Studies; Knowledge; Life; Loneliness; Manuals; Medicaid; Mental Health; Mental disorders; Modality; Motivation; Nature; Occupations; Outcome; Participant; Personal Satisfaction; Persons; Phase; Philadelphia; Population; Population Heterogeneity; Positioning Attribute; Preparation; Prevalence; Procedures; Process; Provider; Public Health; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Resources; Role; Self Determination; Self Efficacy; Services; Signal Transduction; Social Interaction; Social Network; Social Values; Social support; Specialist; Structure; Supervision; Surveys; System; Testing; Training; Training Support; Transportation; United States; Work; acceptability and feasibility; adolescent with autism spectrum disorder; adult with autism spectrum disorder; aged; autism community; autism spectrum disorder; autistic; comparison intervention; cost; disability; effectiveness evaluation; effectiveness-implementation RCT; effectiveness/implementation study; effectiveness/implementation trial; empowerment; evidence base; experience; feasibility testing; health determinants; high school; implementation facilitators; individuals with autism spectrum disorder; inpatient service; interest; novel; peer; peer support; poor communities; programs; recruit; resilience; retention rate; satisfaction; severe mental illness; social; social engagement; social relationships; success; systematic review; therapeutic development; tool; treatment as usual; young adult with autism spectrum disorder

Abstract Approximately 5.4 million adults in the United States (1 in 45) are believed to have autism spectrum disorder (ASD), but there is a lack of services available to support them in reaching their full potential. Although typically conceptualized as a childhood disorder, ASD-related service needs persist into adulthood. The core social and communication impairments of ASD, reported difficulties with change, and a high rate of co-occurring mental health conditions often result in limited participation in major life areas that are determinants of health, including social and community participation, employment, housing, and transportation. The transition to adulthood is not only associated with developmental challenges, but also a “services cliff” whereby supports and services that were previously available through the education system are no longer available. Peer- delivered interventions have emerged as a potent, evidence-based modality for enhancing outcomes among other clinical populations, such as adults with serious mental illnesses, with effectiveness in enhancing social networks, empowering participants, reducing the use of inpatient services, and increasing life satisfaction. At present, there is limited research on the effectiveness of autistic-led peer support interventions, especially those that target broad aspects of community functioning. The proposed study seeks to refine, manualize, and test a pilot autistic peer support program aimed at supporting community participation among autistic young adults, with the goal of preparing it for large-scale testing and future dissemination and sustainability. The first aim of this proposal is to enhance the structure of a pilot autistic-peer delivered intervention (Community Autism Peer Specialists, or CAPS) that is currently in use as a Medicaid-reimbursed service in Philadelphia. This will include developing a manual and fidelity tool to facilitate evaluation and systematic implementation. The second and third aims are to conduct a hybrid type 1 effectiveness-implementation randomized controlled trial with 40 young autistic adults to test the feasibility and acceptability of the intervention and research procedures, while also examining proposed target mechanisms of action (e.g., self-efficacy, working alliance, perceived social support) and clinical outcomes such as community participation, loneliness, and resilience. This work will gather additional evidence and implementation information to support a fully-powered R01- funded clinical trial. The proposed efforts will involve substantial engagement of a diverse group of autistic adults in all phases along with multiple community partners, including a Medicaid payer. The project has tremendous potential to expand service options for autistic adults and is uniquely poised to have broad, scalable impact.

抽象的 美国大约有 540 万成年人（每 45 人中就有 1 人）被认为患有自闭症谱系障碍 （ASD），但缺乏可用的服务来支持他们充分发挥潜力，尽管通常如此。 与自闭症谱系障碍相关的服务需求被概念化为一种儿童期障碍，一直持续到成年期。 自闭症谱系障碍（ASD）的沟通障碍、改变的困难以及同时发生的精神障碍的比例很高 健康状况往往导致对作为健康决定因素的主要生活领域的参与有限， 包括社会和社区参与、就业、住房和交通。 成年期不仅与发展挑战相关，而且还存在“服务悬崖”，从而支持 以前通过教育系统提供的服务也不再提供。 所提供的干预措施已成为一种有效的、基于证据的方式，可提高患者的结果 其他临床人群，例如患有严重精神疾病的成年人，可有效增强社交能力 网络，赋予参与者权力，减少住院服务的使用，并提高生活满意度。 目前，关于自闭症主导的同伴支持干预措施的有效性的研究有限，特别是 拟议的研究旨在对社区功能的广泛方面进行完善、手动化和改进。 测试一项试点自闭症同伴支持计划，旨在支持自闭症青少年的社区参与 成人，其目标是为大规模测试以及未来的传播和可持续性做好准备。 该提案的目的是加强自闭症同伴提供的试点干预的结构（社区 自闭症同伴专家 (CAPS) 目前在费城用作医疗补助报销服务。 这将开发一个手动和保真度工具，以促进评估和系统实施。 第二个和第三个目标是进行混合型 1 型有效性实施随机对照试验 对 40 名年轻自闭症成人进行的试验，以测试干预和研究的可行性和可接受性 程序，同时还审查拟议的目标行动机制（例如自我效能、工作联盟、 感知的社会支持）和临床结果，例如社区参与、孤独感和复原力。 这项工作将收集额外的证据和实施信息，以支持功能齐全的 R01- 资助的临床试验将涉及不同自闭症群体的大量参与。 各个阶段的成年人以及多个社区合作伙伴，包括医疗补助付款人。 扩大自闭症成人服务选择的巨大潜力，并且具有独特的优势，具有广泛的、 可扩展的影响。