Identifying Effective Organizational Climate Embedding Mechanisms for Autism Interventions

确定自闭症干预的有效组织氛围嵌入机制

• 批准号: 10825089
• 负责人: Elizabeth Rangel
• 金额: $ 4.04万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-06 至 2025-09-05
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10825089
• 关键词: Caring; Centers for Disease Control and Prevention (U.S.); Child; Climate; Clinical; Community Services; Complement; Data; Development; Education; Educational process of instructing; Evidence based intervention; Evidence based practice; Exploration, Preparation, Implementation, and Sustainment; Fostering; Funding; Goals; Health; Health Services Research; Hybrids; Individual; Intervention; Interview; Investigational Therapies; Leadership; Link; Literature; Measures; Mediating; Mental Health; Mentors; Methods; Modeling; National Institute of Mental Health; National Research Service Awards; Organizational Change; Organizational Culture; Outcome; Parents; Perception; Provider; Randomized, Controlled Trials; Reporting; Research; Role; Schools; Scientist; Service setting; Services; Source; Strategic Planning; Structure; System; Testing; Time; Training; Translating; United States; autism spectrum disorder; autistic children; career; child mental health service; community setting; effective intervention; effectiveness testing; implementation determinants; implementation facilitation; implementation intervention; implementation outcomes; implementation science; implementation strategy; improved; medical specialties; meetings; organizational climate; programs; prospective; routine care; school district; telephone coaching; tool; training opportunity

PROJECT SUMMARY /ABSTRACT The Centers for Disease Control and Prevention estimates that 1 in 44 children have autism. Implementing evidence-based practices (EBPs) is crucial for their meeting their needs. However, there are challenges to delivering EBPs for autistic children in routine services. This proposal leverages data from the TEAMS (Translating Evidence-based Interventions for Autism: A Multi-Level Implementation Strategy) Hybrid Type III trials. TEAMS aimed to improve implementation of EBPs by testing multi-level implementation strategies in children’s mental health services (Study 1 PI: Brookman-Frazee, R01-MH111950) and schools (Study 2 PI: Stahmer, R01-MH111981). Specifically, the TEAMS trials applied the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and utilized the Leadership and Organizational Change for Implementation (LOCI) strategy to test the effectiveness of two multi-component implementation strategies. TEAMS targeted organizational and provider level mechanisms. The organization level implementation strategy (TEAMS Leadership Institute, TLI), an adapted version of the Leadership and Organizational Change for Implementation (LOCI) strategy, targeted organizational implementation leadership and climate as mechanisms. The proposed study will supplement the primary study aims by exploring a new potential mechanism of TLI – climate embedding mechanisms (CEM). The construct of CEM refers to tools that leaders utilize to teach their organizations how to perceive, think, feel, and behave. This study aims to identify which individual CEM are most impactful to promote successful implementation and whether use of specific CEM mediates the associations between TLI and implementation and child outcomes. The objective of this NRSA application is to foster my development as an implementation scientist with a focus on organizational implementation factors and autism services research. The proposed project will examine climate embedding mechanisms as potential mechanisms of action of an organizational implementation strategy within two linked randomized controlled trials. Specifically, Aim 1 will identify individual climate embedding mechanisms associated with implementation (provider) and clinical (child) outcomes. Aim 2 will utilize quantitative methods to examine whether the individual climate embedding mechanisms identified in Aim 1 mediate the effects of TLI on implementation and clinical outcomes. Lastly, Aim 3 will use qualitative and mixed methods to complement and expand quantitative findings on additional climate embedding mechanisms and explain how individual mechanisms facilitated implementation of autism EBPs. The present proposal represents an important step in further understanding mechanisms of organizational implementation strategies. With support of my mentoring team, this proposal will launch my development toward a career as an independent implementation scientist focusing on organizational level strategies and mechanisms to improve EBP implementation in autism services settings.

项目概要/摘要 美国疾病控制与预防中心估计，每 44 名儿童中就有 1 名患有自闭症。 实施循证实践（EBP）对于满足他们的需求至关重要，但是，也存在一些问题。 在日常服务中为自闭症儿童提供 EBP 面临的挑战 该提案利用了来自自闭症儿童的数据。 TEAMS（转化自闭症循证干预措施：多层次实施策略）混合 III 类试验旨在通过测试多级实施来改进 EBP 的实施。 儿童心理健康服务策略（研究 1 PI：Brookman-Frazee，R01-MH111950）和学校 （研究 2 PI：Stahmer，R01-MH111981）具体而言，TEAMS 试验应用了探索、准备、 实施、维持 (EPIS) 框架并利用领导力和组织变革 实施 (LOCI) 策略用于测试两个多组件实施策略的有效性。 TEAMS 针对组织和提供商级别的机制。 战略（TEAMS 领导力研究所，TLI），领导力和组织变革的改编版本 实施 (LOCI) 战略、有针对性的组织实施领导力和氛围 拟议的研究将通过探索新的潜力来补充主要研究目标。 TLI 的机制——气候嵌入机制（CEM） CEM 的构造是指领导者的工具。 本研究旨在确定哪些 个别 CEM 对促进成功实施最有影响力，以及是否使用特定的 CEM 调节 TLI 与实施和儿童结果之间的关联。 此 NRSA 应用程序的目标是促进我作为一名具有以下能力的实施科学家的发展： 拟议项目将重点关注组织实施因素和自闭症服务研究。 检查气候嵌入机制作为组织的潜在行动机制 具体来说，目标 1 将确定个体的实施策略。 与目标 2 的实施（提供者）和临床（儿童）结果相关的气候嵌入机制。 将利用定量方法来检查中确定的个体气候嵌入机制是否 目标 1 调节 TLI 对实施和临床结果的影响最后，目标 3 将使用定性和临床结果。 混合方法来补充和扩展额外气候嵌入机制的定量发现 并解释各个机制如何促进自闭症 EBP 的实施。 这是进一步理解组织实施战略机制的重要一步。 在我的导师团队的支持下，这个提案将启动我的职业生涯发展 独立的实施科学家专注于组织层面的战略和机制的改进 自闭症服务机构中 EBP 的实施。