Addressing systemic health disparities in early ASD identification and treatment

解决自闭症谱系障碍早期识别和治疗中的系统性健康差异

• 批准号: 9493766
• 负责人: Alice S. Carter
• 金额: $ 14.18万
• 依托单位: UNIVERSITY OF MASSACHUSETTS BOSTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-25 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9493766
• 关键词: Address; Adult; Affect; Age; Agreement; Autistic Disorder; Awareness; Behavioral; Boston; Caring; Centers for Disease Control and Prevention (U.S.); Child; Child Health; Childhood; Cities; Clinical; Collaborations; Data; Development; Developmental Disabilities; Diagnosis; Diagnostic Services; Early Diagnosis; Early Intervention; Early identification; Early treatment; Economics; Engineering; English Learner; Enrollment; Ensure; Ethnic Origin; Evaluation; Experimental Designs; Exposure to; Family; Feedback; Focus Groups; Funding; Future; Goals; Health Services Accessibility; Healthcare Systems; High Prevalence; Improve Access; Individual; Intervention; Knowledge; Language; Learning; Massachusetts; Outcome; Parents; Participant; Pediatrics; Phase; Poverty; Psychology; Public Health; Qualitative Methods; Quality of life; Race; Reporting; Research; Risk; Risk Assessment; Services; Site; Special Education; Surveys; Symptoms; System; Testing; Theoretical model; Time; Underserved Population; United States Health Resources and Services Administration; Universities; Visit; Work; autism spectrum disorder; care coordination; child services; collaborative care; cost; court; design; disparity reduction; ethnic minority population; experience; health disparity; improved; inferential statistics; intervention cost; intervention effect; intervention program; models and simulation; motivational enhancement therapy; novel; outreach; pediatrician; primary outcome; provider intervention; public health relevance; racial and ethnic; referral services; screening; service intervention; service programs; shared decision making; social

DESCRIPTION (provided by applicant): The goal of the proposed work is to implement a system-level intervention to (a) improve early detection of autism spectrum disorders (ASD) and (b) increase early access to autism specific early intervention services, especially for children who often are not given the known benefits of early intervention services. The proposed study builds on a funded multi-stage screening study that is currently being implemented in 3 Early Intervention programs serving children in the Circle of Promise, a Boston region with high social/economic risk and comprised of a high percentage of children from racial/ethnic minority populations, English language learners, or living in poverty. ASD Rates are increasing in the U.S., with recent estimates indicating that 1 in 88 children have ASD. Early diagnosis and intervention are crucial to ensuring optimal long-term outcomes; yet significant disparities exist in rates and age of diagnosis. Children in the above groups are less likely to be diagnosed and are diagnosed 1-2 years later than White, non-poor, English speaking children. This delay limits access to autism-specific early treatments. Timely identification and treatment requires at least two steps: 1) knowing and identifying the early signs of ASD, and 2) acting early. Pediatricians, parents, and EI providers must decide whether a child is showing enough signs to justify further assessment or treatment, or whether the child is at low enough risk to forego immediate action. Thus, acting early requires the about groups to evaluate the early signs and choose a yes/no course of action, which we refer to as a clinical threshold. We believe that early identification and access to care can be improved both by increasing knowledge of the early signs of ASD and by influencing these decision thresholds regarding when to screen, assess, and refer to ASD-specific interventions. Moreover, access to services requires agreement and cooperation among these decision-makers. Guided by our prior theoretical work and engagement with pediatricians and EI providers, we will influence improved access and receipt of needed services for children with ASD by offering: (1) multistage ASD screening to all EI-enrolled children ages 14-24 months, (2) motivational interviewing to parents whose children qualify for ASD services, and (3) systematic outreach to pediatricians from EI sites. This system- level approach involves altering the context in which pediatricians, EI providers, and parents assess and act on signs of ASD to reduce disparities in access to ASD diagnosis and services. This study will test the following hypotheses: 1) Exposed children with ASD will be more likely to be identified, referred, and receive ASD services, regardless of race/ethnicity, language or poverty status; 2) Exposed pediatricians and EI providers will identify more children with ASDs and refer to assessment and services at higher rates; and 3) Exposed parents of children with ASD will report greater agreement with and will be more likely to follow through on ASD-specific assessment and service referrals.

描述（由申请人提供）：拟议工作的目的是实施系统级干预措施，以（a）改善对自闭症谱系障碍（ASD）（ASD）和（b）提高自闭症特定早期干预服务的早期发现，尤其是对于经常没有得到早期干预服务的孩子的儿童。拟议的研究以一项资助的多阶段筛查研究为基础，该研究目前正在为诺言中的儿童提供服务的3个早期干预计划，这是一个具有较高社会/经济风险的波士顿地区，由种族/族裔少数民族人群，英语学习者，英语学习者或生活在贫困中的儿童组成。美国的ASD率在增加，最近的估计表明，有88名儿童中有1人患有ASD。早期诊断和干预对于确保最佳的长期结局至关重要。然而，诊断率和年龄存在很大的差异。上述小组中的儿童被诊断出来的可能性较小，比白人，不贫穷的英语儿童晚1-2年。这种延迟限制了对自闭症特定早期治疗的访问。及时的识别和治疗需要至少两个步骤：1）了解和识别ASD的早期迹象，以及2）早期行动。儿科医生，父母和EI提供者必须决定孩子是否表现出足够的迹象以证明进一步的评估或治疗是合理的，或者孩子是否有足够的风险来放弃立即采取行动。因此，提早行动需要大约小组评估早期迹象，并选择“是/否”行动，我们将其称为临床阈值。我们认为，可以通过提高对ASD的早期迹象的知识以及影响有关何时筛查，评估和参考ASD特定的干预措施的这些决策阈值来改善早期识别和获得护理的机会。此外，获得服务需要这些决策者之间的协议和合作。在我们先前的理论工作以及与儿科医生和EI提供者的参与下，我们将通过发行来改善和接收ASD儿童所需的服务：（1）对所有14-24个月的EI-EI-Ei-En摄取儿童的多阶段筛查，（2）对父母进行ASD Service Service Serecriant and（3）Systeatic Systeatic Satericatiic and（3）的动机访谈。这种系统级别的方法涉及改变儿科医生，EI提供者和父母评估并采取ASD迹象的情况，以减少获得ASD诊断和服务的差异。这项研究将检验以下假设：1）不论种族/族裔，语言或贫困状况如何，都将更有可能识别，推荐和接收ASD服务的ASD儿童； 2）裸露的儿科医生和EI提供者将确定更多患有ASD的儿童，并以更高的速度参考评估和服务； 3）ASD儿童的暴露父母将报告更大的同意，并且更有可能遵循特定于ASD的评估和服务推荐。