Reducing Disparities in Early Intervention Use: The Opening Doors to Early Intervention Study

减少早期干预使用的差异：早期干预研究的大门

基本信息

批准号：
10058848
负责人：
JAMES P GUEVARA
金额：
$ 76.14万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
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：
2018-04-01 至 2022-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10058848
关键词：
Address Affect Age-Months Caring Characteristics Child Child Development Childhood Clinic Control Groups County Development Developmental Delay Disorders Disabled Persons Early Intervention Education Family Fostering Funding Goals Health Services Accessibility Home Income Intention Intervention Intervention Studies Knowledge Life Logistics Measures Mediating Modeling Motivation Outcome Parents Participant Patients Philadelphia Pilot Projects Poverty Primary Health Care Procedures Program Effectiveness Public Health Randomized Research Risk Risk Factors Schedule Services Testing Training Urban Community Visit Work base child services community based participatory research comparative effectiveness study disparity reduction dosage early childhood educational atmosphere effectiveness evaluation effectiveness testing experience health belief health disparity health disparity populations health literacy improved intervention effect intervention program minority children programs randomized trial recruit referral services screening service intervention service utilization therapy design treatment as usual trial design urban minority

项目摘要

Project Summary Developmental delays are frequently encountered among young children and disproportionately affect impoverished minority children leading to disparities in early child development. To promote healthy child development, the Individuals with Disabilities Education Act (IDEA) mandated early intervention (EI) services be made available to young children with delays, but only half of at-risk children initiate and complete EI services. As a result, many at-risk children may not receive needed services to improve their development. To foster initiation and completion of EI services, we developed the Opening Doors to Early Intervention Program, a patient navigation intervention based on the Health Belief Model and targeted to at-risk urban minority children. An initial pilot study among at-risk children demonstrated feasibility and generated promising results. Therefore, this Community-Based Participatory Research application proposes to test the effectiveness of this program in a single urban county using a randomized trial design. The specific aims are to 1) determine the effectiveness of the Opening Doors to early Intervention Program on child developmental status and EI referral and services use, 2) assess whether parent engagement in early intervention mediates the effects of the program, and 3) explore whether the home learning environment, parental health literacy, and poverty moderate the effects of the program. This application addresses health disparities in early childhood by testing an intervention designed to improve participation rates in EI among urban minority children and their families on measures of early child development and EI services use. Three to four primary care pediatric clinics that provide care to this diverse urban community will be recruited to participate. Three hundred sixty children who are less than 30 months of age and have been identified as developmentally at-risk and referred for EI services at participating clinics will be randomized to receive the Opening Doors to Early Intervention Program or usual care. Urban minority parents who have previously participated in EI services will be trained as patient navigators to provide education, motivation, and assistance for families with initiation and completion of EI referrals and services. Clinicians and Child Find staff will provide usual care consisting of developmental screening and referrals without assistance. Information on participant demographic characteristics, health literacy, and the home learning environment at baseline; parent engagement and EI referral and services completion at 3, 6, 9, and 12 months; and child development at 12 months will be collected during scheduled study visits. Differences in outcomes between intervention and control participants will be compared using intention-to-treat analysis. Findings from this comparative effectiveness study can be disseminated to similar large urban counties across the U.S. to inform Child Find and EI procedures and address disparities in early child development.

项目摘要在幼儿中经常遇到发展延迟，并不成比例地影响贫困的少数族裔儿童导致早期儿童发展的差异。促进健康的孩子发展，《残疾人教育法》（IDEA）强制性干预（EI）服务可以向有延迟的幼儿提供，但只有一半的高危儿童开始并完成EI 服务。结果，许多高危儿童可能没有获得所需的服务来改善他们的发展。到促进EI服务的启动和完成，我们开发了早期干预计划的开头，基于健康信念模型的患者导航干预措施，目标是危险的城市少数民族孩子们。高危儿童的初步试点研究表明可行性并产生了令人鼓舞的结果。因此，这项基于社区的参与性研究申请提出了测试此功能的有效性使用随机试验设计在一个城市县的单个城市县进行了计划。具体目的是1）确定早期干预计划的开头大门关于儿童发育状况的有效性和EI推荐和服务使用，2）评估父母参与早期干预是否介导计划，以及3）探索家庭学习环境，父母健康素养和贫困是否调节程序的效果。该申请通过测试解决儿童早期的健康差异旨在提高城市少数民族儿童及其家人的EI参与率的干预措施关于早期儿童发展和EI服务使用的措施。三到四个初级保健小儿诊所将招募为这个多样化的城市社区提供照顾。三百六十个孩子年龄少于30个月，已被确定为发育型高风险，并被转介到EI服务在参与的诊所将被随机接收到早期干预计划或往常的开门门关心。以前曾参加EI服务的城市少数族裔父母将接受培训导航员为启动和完成EI的家庭提供教育，动力和援助推荐和服务。临床医生和儿童发现员工将提供由发育组成的常规护理在没有帮助的情况下进行筛查和推荐。有关参与者人口特征，健康的信息扫盲和基线的家庭学习环境；家长参与以及EI推荐和服务在3、6、9和12个月完成；在计划期间将收集12个月的儿童发展研究访问。将使用干预参与者和控制参与者之间的结果差异意向性治疗分析。这项比较有效性研究的发现可以分散到类似美国各地的大型城市县，以告知儿童发现和EI程序，并解决早期的差异儿童发展。