Examining the Effectiveness of the Early Start Denver Model in Community Programs serving Young Autistic Children

检查早期开始丹佛模式在为自闭症儿童服务的社区项目中的有效性

• 批准号: 10725999
• 负责人: Aubyn C. Stahmer
• 金额: $ 93.83万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10725999
• 关键词: Acceleration; Adaptive Behaviors; Address; Affect; Behavior Therapy; Caregivers; Caring; Child; Child Rearing; Clinical Trials; Clinical effectiveness; Communities; Community Practice; Community Trial; Competence; Data; Data Collection; Development; Drug Prescriptions; Education; Effectiveness; Effectiveness of Interventions; Ensure; Environment; Ethnic Origin; Family; Funding; Geographic Locations; Goals; Growth; Hybrids; Improve Access; Insurance; Intervention; Language; Learning; Learning Skill; Manuals; Measures; Mediating; Meta-Analysis; Methods; Modeling; Motivation; Outcome; Parents; Participant; Pilot Projects; Provider; Public Health; Quality of Care; Race; Randomized, Controlled Trials; Regulation; Research; Sampling; Science; Services; Structure; Symptoms; System; Testing; Time; Training; acceptability and feasibility; applied behavior analysis; autism community; autism spectrum disorder; autistic; autistic children; caregiver education; community setting; cost; effective intervention; effectiveness evaluation; effectiveness testing; effectiveness/implementation design; efficacy study; efficacy testing; efficacy trial; ethnic diversity; evidence base; health goals; implementation barriers; implementation determinants; implementation outcomes; improved; language outcome; programs; provider adherence; randomized controlled design; satisfaction; scale up; secondary outcome; service delivery; social; social communication; social engagement; social learning; systematic review; theories; treatment as usual; treatment effect; treatment group; usability

PROJECT SUMMARY The rising number of children being identified as autistic has led to exponential growth in for-profit applied behavior analysis (ABA) agencies serving them, the use of highly structured approaches that may not be developmentally appropriate for young children1 and that limit use of learned skills across settings and time, and growing public health concerns regarding limited effectiveness data combined with the cost of services. Efficacy testing has led to growth in evidence-based autism interventions (EBI), especially naturalistic developmental behavior interventions (NDBIs), supported by multiple clinical trials. NDBIs integrate theory and strategies from ABA and developmental science and are considered best practice for young autistic children. The lack of effectiveness data regarding NDBI use in community-based agencies (CBAs) contributes to limited funding as payors are more likely to recognize older, structured methods. The Early Start Denver Model (ESDM) is a comprehensive NDBI shown to improve social communication and language outcomes for young autistic children in multiple controlled efficacy studies. ESDM engages social motivation as a mechanism to increase child engagement in social learning opportunities in the environment resulting in increased rate of child learning. ESDM includes assessment and data collection methods that meet funder requirements and a tested community training model. Understanding whether ESDM is effective and whether the same treatment mechanisms operating in efficacy trials are also operating in community implementation with diverse samples are critical scientific questions to determine the potential of NDBIs like ESDM to meet the public health goals of improving access to high quality, developmentally appropriate care for a broad range of young autistic children and their families. To facilitate scale up, we have partnered with autism CBAs and this study will identify factors that affect implementation of ESDM in the community. This project will use a hybrid type 1 randomized controlled design to examine ESDM effectiveness in the community and to gather data on implementation determinants. Primary child outcomes include language and social communication. Secondary outcomes include adaptive behavior, parent use of ESDM strategies, and provider fidelity to the model. Social motivation and caregiver fidelity will be measured as mediating variables. The moderating effects of maternal education, child race/ethnicity, and provider ESDM fidelity will be examined. ESDM implementation determinants will be explored. Understanding the effectiveness of an intervention like ESDM, the variables that mediate and moderate child outcomes, and engagement of its mechanisms of action in community use, has the potential to increase availability, and therefore, access to high quality intervention for all young autistic children, especially those from diverse backgrounds who depend on public services. Understanding implementation determinants will support scale-up of effective models throughout communities.

项目摘要 被确定为自闭症的儿童数量的增加导致了应用营利性的指数增长 行为分析（ABA）为他们服务的机构，使用可能不是的高度结构化方法 在开发上适合年轻儿童1，以及限制在环境和时间跨越学习技能的使用， 以及越来越多的公共卫生问题对有限的有效数据以及服务成本相结合。 功效测试导致基于证据的自闭症干预措施（EBI），尤其是自然主义 发育行为干预（NDBIS），由多个临床试验支持。 NDBIS整合理论和 ABA和发展科学的策略被认为是年轻自闭症儿童的最佳实践。 缺乏有关基于社区机构（CBA）的NDBI使用的有效性数据有限 作为付款人的资金更有可能认识到较旧的结构化方法。早期的丹佛模型 （ESDM）是一个综合的NDBI 自闭症儿童在多个受控疗效研究中。 ESDM将社会动机作为一种机制 增加儿童参与环境中社会学习机会，从而增加 儿童学习。 ESDM包括满足资助人要求的评估和数据收集方法 经过测试的社区培训模型。了解ESDM是否有效以及是否使用相同的治疗 在效力试验中运行的机制也在社区实施中运行，并具有不同的样本 是确定NDBIS之类的ESDM的潜力来满足公共卫生目标的关键科学问题 改善对各种年轻自闭症儿童获得高质量的，发育适当的护理 和他们的家人。为了促进扩大规模，我们已经与自闭症CBAS合作，这项研究将确定因素 这会影响社区中ESDM的实施。该项目将使用混合类型1随机分组 受控设计以检查社区中的ESDM有效性并收集有关实施的数据 决定因素。主要儿童结果包括语言和社交交流。次要结果 包括自适应行为，父母对ESDM策略的使用以及对模型的提供商的保真度。社会动机 和看护者的保真度将被衡量为中介变量。孕产妇教育的调节作用， 将检查儿童种族/种族和提供者ESDM保真度。 ESDM实施确定因素将是 探索。了解像ESDM这样的干预措施的有效性，介导的变量和 适度的儿童结果，以及其在社区使用中的行动机制的参与，有可能 增加可用性，因此，可以为所有年轻的自闭症儿童提供高质量的干预措施 那些依赖公共服务的不同背景的人。了解实施决定因素 将支持整个社区中有效模型的规模扩展。