Autism Caregiver Coaching in Africa

非洲自闭症护理人员辅导

基本信息

批准号：
10685489
负责人：
Lauren Franz
金额：
$ 59.86万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-17 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10685489
关键词：
Acceleration Adaptive Behaviors Address Adopted Advocate Africa African Age Behavior Behavior Therapy Caregivers Characteristics Child Communication Communities Computer software Cost Analysis Data Development Dimensions Distal Early Intervention Education Effectiveness Environment Europe Evidence based intervention Face Family Future Goals Home Income Individual Intervention Intervention Trial Language Learning Linguistics Measures Medical center Methods Modeling North America Outcome Participant Patterns of Care Persons Policy Maker Population Quality of Care Quality of life Randomized Research Research Personnel Research Training Resolution Services South Africa South African Specialist System Tanzania Testing Universities Work Workforce Development World Health autism spectrum disorder autistic autistic children care systems career caregiver interventions community based service cost cost effectiveness design digital assessment early childhood effectiveness evaluation effectiveness/implementation trial evidence base experience implementation barriers implementation determinants implementation framework implementation strategy improved improved outcome innovation insight low and middle-income countries member mindfulness neural phenomenological models phenotypic data programs response scale up service intervention skills social social engagement social learning stakeholder perspectives treatment as usual

项目摘要

ABSTRACT Globally there is a growing need to implement community-based services that support improvements in quality of life of autistic people. Early autism intervention is critical because it can significantly improve both child and family outcomes, but implementation gaps exist worldwide. These gaps are starkest in Africa, where by 2050, iven the lack of specialists in Africa, task shifting early autism intervention to non-specialists will be a key implementation strategy. Naturalistic Developmental Behavioral Interventions (NDBI), are a class of early autism intervention approaches, that can be effectively delivered by caregivers. Through a partnership between Duke University and the University of Cape Town, our team laid the groundwork for an innovative and scalable coaching intervention for young autistic children . We systematically adapted a caregiver coaching NDBI for the South African context in which coaching is effectively delivered by non-specialist Early Childhood Development practitioners employed by the Education Department. In the proposed study we will build on our foundational work by conducting a type 1 hybrid effectiveness implementation trial of the coaching intervention, delivered by non-specialists, within an existing system of care in South Africa. Our goal is to implement a feasible, scalable early autism intervention model in Africa by conducting research with culturally and linguistically diverse participants in community-based settings, that is inclusive of diverse stakeholder perspectives and incorporates task-shifting. In the proposed study, we will build on our current relationships with families, practitioners, and policy makers by formalizing these relationships and including other key stakeholder groups such as South African autistic self-advocates through a community-academic partnership, a key bridging factor in the EPIS implementation framework. The proposed project has three main objectives. First, to evaluate the real-world effectiveness of non-specialist delivered NDBI caregiver coaching for improving patterns of caregiver-child interaction and child developmental outcomes, and assess the cost- effectiveness of this approach. Second, to identify implementation determinants to inform scale-up. Third, to expand African autism research capacity to enhance scalability. This project also offers a unique opportunity to study variability in autism-related behaviors and phenomenology. We will therefore assess the degree to which response to intervention is moderated by caregiver and dimensional child characteristics. In addition, using an innovative digital assessment method, changes in dimensional quantitative measures of autism-related behaviors will be examined. Finally, cross-cultural differences in dimensional autism-related behaviors will be evaluated via comparison with existing quantitative phenotypic data gathered in U.S. studies. This study is timely and innovative and will inform scale-up of autism early intervention in Africa. Assessing the impact of a scalable intervention in an environment like South Africa which faces significant contextual challenges, increases the ecological validity and relevance of findings for many regions of the world that face with similar challenges.

抽象的在全球范围内，越来越需要实施基于社区的服务来支持质量的改善自闭症患者的生活。早期自闭症干预至关重要，因为它可以显着改善孩子和家庭成果，但在全球范围内存在实施差距。这些差距在非洲是最明显的，到2050年，在非洲缺乏专家，任务转移早期自闭症对非专家的干预将是关键的实施策略。自然发展行为干预措施（NDBI）是一类早期自闭症干预方法，可以有效地提供照顾者。通过杜克大学和开普敦大学之间的合作伙伴关系，我们的团队奠定了为年轻自闭症儿童进行创新且可扩展的教练干预的基础。我们系统地改编了一名护理人员教练NDBI的南非背景，其中教练有效地由教育部门雇用的非专业幼儿发展从业人员。在拟议的研究我们将通过进行1型混合有效性实施来基于我们的基础工作非专业人士在南非现有的护理体系中对教练干预的审判。我们的目标是通过进行研究在非洲实施可行的，可扩展的早期自闭症干预模型在基于社区环境中的文化和语言上不同的参与者，其中包括多样化利益相关者的观点并结合了任务转换。在拟议的研究中，我们将基于当前通过形式化这些关系并包括其他人，与家庭，从业者和政策制定者的关系南非自闭症等主要利益相关者群体通过社区学术进行自我倡导合作伙伴关系，是EPIC实施框架中的关键桥接因素。拟议的项目有三个主要目标。首先，要评估非专业人士的现实有效性改善照顾者 - 孩子互动和儿童发育成果的模式，并评估成本 - 这种方法的有效性。第二，确定实施确定因素以告知规模。第三，到扩大非洲自闭症研究能力以提高可扩展性。该项目还提供了一个独特的机会研究自闭症相关行为和现象学的变异性。因此，我们将评估哪个程度护理人员和维度儿童特征调节了对干预的反应。另外，使用创新的数字评估方法，自闭症相关的维度定量度量的变化将检查行为。最后，与自闭症相关行为的跨文化差异将是通过与美国研究中收集的现有定量表型数据进行比较。这项研究是及时的和创新性，并将为非洲的自闭症早期干预提供范围。评估可扩展的影响干预像南非这样的环境，面临重大背景挑战，增加了生态有效性和研究结果对面临类似挑战的世界许多地区的相关性。