Developing a Pediatrics-based Social Needs Intervention to Reduce Disparities in ADHD Outcomes for Low-income Children

制定基于儿科的社会需求干预措施，以减少低收入儿童多动症结果的差异

基本信息

批准号：
9789941
负责人：
Andrea Spencer
金额：
$ 16.41万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-21 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9789941
关键词：
Academy Address Affect Age American Arvin Attention deficit hyperactivity disorder Caring Child Child Care Child Health Childhood Chronic Chronic Disease Clinical Clinical Trials Design Communities Development Diagnosis Disease Early Intervention Education Enrollment Environment Equation Family Food Foundations Future Goals Health Services Healthcare Heritability Hyperactive behavior Impairment Individual Infant Inferior Intervention Intervention Trial Interview Learning Life Cycle Stages Logistics Low income Measurement Mediator of activation protein Mental Health Mentored Patient-Oriented Research Career Development Award Mentors Methods Modeling Modernization Morbidity - disease rate National Institute of Mental Health Nursery Schools Onset of illness Outcome Outcome Measure Parents Pediatrics Positioning Attribute Prevalence Primary Health Care Procedures Psychiatric Social Work Psychiatrist Psychosocial Assessment and Care Randomized Randomized Controlled Trials Reporting Research Research Personnel Resources Risk Factors School Enrollments Series Special Education Statistical Models Strategic Planning Stress Structure Surveys Symptoms Target Populations Testing Training Transportation Visit age group base bilingualism collaborative care critical developmental period disorder risk disparity reduction experience field study food insecurity health disparity housing instability improved inattention lower income families modifiable risk novel pilot trial preference primary outcome programs recruit screening service intervention side effect social socioeconomic disadvantage socioeconomic disparity socioeconomics therapy development treatment response

项目摘要

PROJECT SUMMARY. Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common chronic conditions in childhood, with significantly higher rates and worse outcomes among socioeconomically disadvantaged children. Social adversities including unmet basic needs such as food insecurity, housing instability, and lack of quality child care emerge as potent risk factors for ADHD symptoms as early as the preschool years. The development of early intervention strategies for young children with both ADHD and socioeconomic disadvantage is critical for mitigating future impairment. New research demonstrates that a low intensity, family-centered screening and referral program (WE CARE) at well infant visits is feasible and can increase receipt of resources for unmet social needs (e.g. food, transportation, and parent education). Adapting this strategy to target preschoolers with emerging ADHD, who are typically first identified in primary care, could significantly impact clinical symptoms and disease trajectory during a critical developmental period. Therefore, the objective of this project is develop an early intervention strategy, adapted from the WE CARE program, targeting unmet social needs for low-income families of preschool-age children with emerging ADHD. The WE CARE intervention will be adapted on 3 key domains (for a new target population, content, and primary outcomes) through the pursuit of 3 interrelated studies. These are: 1) Examine the association between specific unmet social needs and ADHD symptoms in 7,565 nationally representative children age 3-5 from the National Survey for Children's Health (NSCH) and explore potential mediators of this association (including parental stress, activation, and unmet need for care) via structural equation modeling (SEM); 2) Identify parent-reported mechanisms by which unmet social needs exacerbate ADHD symptoms in preschool age children and how an intervention addressing these needs could improve clinical outcomes by conducting semi-structured interviews with 25 parents of preschoolers with ADHD symptoms; and 3) Conduct an adaptive, randomized pilot trial of a novel treatment model addressing unmet social needs with parents of 60 low-income children age 3-5 with ADHD symptoms. This research plan reflects Objective 3.2 of the NIMH Strategic Plan, to develop ways to tailor existing and new interventions to optimize outcomes, and addresses an urgent need to reduce socioeconomic disparities in pediatric mental health outcomes by targeting modifiable risk factors in vulnerable young children. These research aims will also serve as vehicles for pragmatic learning of the following training goals: 1) Learn advanced statistical modeling and measurement methods for social determinants research; 2) Gain expertise in intervention development to reduce mental health disparities; and 3) Obtain training in modern clinical trial design for the study of psychosocial and health services interventions. This mentored K23 award will facilitate Dr. Spencer's long-term goal of becoming an independent investigator developing novel interventions to reduce socioeconomic inequities in pediatric psychiatric outcomes.

项目摘要。注意力缺陷/多动障碍（ADHD）是最常见的慢性疾病之一儿童时期的状况，在社会经济方面的比率明显更高，但结果更差弱势儿童。社会逆境包括未满足的基本需求，例如粮食不安全、住房不稳定和缺乏优质的儿童保育早在儿童时期就成为 ADHD 症状的潜在危险因素。学龄前时期。针对患有 ADHD 和 ADHD 的幼儿的早期干预策略的制定社会经济劣势对于减轻未来的损害至关重要。新的研究表明，低在健康婴儿就诊中开展以家庭为中心的筛查和转诊计划（WE CARE）是可行的，并且可以增加对未满足的社会需求的资源接收（例如食品、交通和家长教育）。调整这一策略以针对患有新出现的多动症的学龄前儿童，他们通常首先在小学被发现护理可能会显着影响关键发育时期的临床症状和疾病轨迹。因此，该项目的目标是制定一项早期干预策略，改编自 WE CARE 计划，针对患有新出现的多动症的学龄前儿童的低收入家庭未满足的社会需求。 WE CARE 干预措施将在 3 个关键领域进行调整（针对新的目标人群、内容和主要结果）通过进行 3 项相互关联的研究来实现。这些是： 1) 检查关联 7,565 名具有全国代表性的 3-5 岁儿童的特定未满足的社会需求与 ADHD 症状之间的关系来自全国儿童健康调查 (NSCH) 的数据并探索该关联的潜在调节因素（包括父母的压力、激活和未满足的护理需求）通过结构方程模型（SEM）； 2）确定家长报告的未满足的社会需求加剧学龄前多动症症状的机制年龄儿童以及解决这些需求的干预措施如何通过进行对 25 名患有 ADHD 症状的学龄前儿童家长进行半结构化访谈； 3) 进行适应性调整，针对 60 名低收入父母未满足的社会需求的新型治疗模式的随机试点试验患有 ADHD 症状的 3-5 岁儿童。该研究计划反映了 NIMH 战略计划的目标 3.2，制定方法来调整现有和新的干预措施以优化结果，并解决迫切需要通过针对可改变的风险因素，减少儿科心理健康结果的社会经济差异弱势幼儿。这些研究目标也将作为实用学习的工具培训目标如下： 1）学习先进的社会统计建模和测量方法决定因素研究； 2) 获得干预措施开发方面的专业知识，以减少心理健康差异；和 3) 获得现代临床试验设计方面的培训，以研究心理社会和卫生服务干预措施。这项 K23 指导奖将有助于 Spencer 博士实现成为独立研究者的长期目标制定新的干预措施，以减少儿科精神病结果中的社会经济不平等。