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提高自闭症患者的生活。早期自闭症干预至关重要，因为它可以显着改善儿童和家庭成果，但世界范围内存在实施差距。这些差距在非洲最为明显，到 2050 年，由于非洲缺乏专家，早期自闭症患者的任务转移对非专家的干预将是一项关键的实施策略。自然发展行为干预（NDBI）是一类早期自闭症干预方法，可以通过照顾者。通过杜克大学和开普敦大学之间的合作，我们的团队奠定了为自闭症儿童创新且可扩展的辅导干预奠定了基础。我们系统地针对南非的情况改编了看护者辅导 NDBI，其中辅导由以下人员有效提供：教育部雇用的非专业儿童早期发展从业人员。在拟议的研究，我们将通过实施 1 类混合有效性实施来建立我们的基础工作在南非现有的护理系统内试验由非专家提供的辅导干预。我们的目标是通过开展研究在非洲实施可行、可扩展的早期自闭症干预模式在以社区为基础的环境中与具有文化和语言多样性的参与者合作，即包容不同的人利益相关者的观点并纳入任务转移。在拟议的研究中，我们将在目前的基础上与家庭、从业者和政策制定者的关系，通过将这些关系正式化并包括其他主要利益攸关方团体，例如南非自闭症患者通过社区学术界进行自我倡导伙伴关系是 EPIS 实施框架中的一个关键桥梁因素。拟议项目有三个主要内容目标。首先，评估非专业提供的 NDBI 护理人员指导的现实效果改善照顾者与儿童互动的模式和儿童发展成果，并评估成本这种方法的有效性。其次，确定实施决定因素，为扩大规模提供信息。三、至扩大非洲自闭症研究能力以增强可扩展性。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，我们将评估其程度对干预的反应受到照顾者和儿童维度特征的调节。此外，使用创新数字评估方法，自闭症相关维度定量测量的变化行为将受到审查。最后，维度自闭症相关行为的跨文化差异将被通过与美国研究中收集的现有定量表型数据进行比较进行评估。这个研究很及时具有创新性，将为扩大非洲自闭症早期干预提供信息。评估可扩展的影响在像南非这样面临重大背景挑战的环境中进行干预，会增加世界上许多面临类似挑战的地区的研究结果的生态有效性和相关性。