Addition of Social Needs to a Telephone-Based Developmental Care Coordination Randomized Controlled Trial in the Era of COVID

在新冠病毒时代，将社会需求添加到基于电话的发育护理协调随机对照试验中

• 批准号: 10242405
• 负责人: PAUL J CHUNG
• 金额: $ 15.5万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242405
• 关键词: 3 year old; Academy; Address; Administrative Supplement; Advisory Committees; Affect; Age; American; Behavioral; COVID-19; COVID-19 pandemic; Caring; Child; Child Behavior Checklist; Child Care; Child Development; Child Health; Childhood; Clinic; Control Groups; County; Data; Development; Developmental Delay Disorders; Disasters; Disease; Early Intervention; Economics; Effectiveness; Elderly; Eligibility Determination; Emergency Situation; Enrollment; Evaluation; Family; Financial Hardship; Funding; Future; Goals; Health; Health Personnel; Healthcare Systems; Human; Intervention; Language; Language Delays; Link; Long-Term Effects; Los Angeles; Measures; Medical Records; Mental Health; Modeling; Morbidity - disease rate; National Institute of Child Health and Human Development; Nursery Schools; Online Systems; Outcome; Outcome Measure; Parents; Participant; Pathogenicity; Pediatrics; Persons; Population; Positioning Attribute; Preventive healthcare; Preventive service; Primary Health Care; Process; Provider; Psychological Stress; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Project Grants; Resources; Risk; Schools; Services; Site; Social Distance; Social Work; Speech Delay; Stress; System; Telephone; Testing; Time; Unemployment; Vaccination; Visit; autism spectrum disorder; base; behavior measurement; behavioral outcome; care coordination; care systems; child services; community clinic; coronavirus disease; cost estimate; early childhood; effectiveness testing; experience; externalizing behavior; food insecurity; food security; group intervention; health care service; high risk; improved; kindergarten; mortality; novel coronavirus; pandemic disease; primary outcome; program costs; programs; psychologic; psychosocial; research study; response; screening; service intervention; social; socioeconomics; stressor; treatment as usual

PROJECT SUMMARY/ ABSTRACT Although universal early childhood developmental screening is recommended by the American Academy of Pediatrics, ample evidence suggests that child health providers are not meeting those recommendations, and many early developmental delays are being missed. Additional evidence suggests that both providers and parents struggle to navigate the early childhood developmental system of care, with few high-risk children actually getting referred, and fewer still ultimately receiving services. The gaps in care processes have created gaps in evidence linking developmental screening to developmental outcomes, leading the US Preventive Services Task Force to state that there is not enough evidence to recommend for or against universal screening for speech and language delays or Autism Spectrum Disorders. The proposed project is a randomized controlled trial of a telephone-based early childhood developmental care coordination system, in partnership with 2-1-1 Los Angeles County (211LA), part of a national network of 2-1-1 call centers covering 93% of the US population. We will test the effectiveness of 211LA in increasing referrals for developmental evaluation, increasing the numbers of children deemed eligible for services, and increasing the number of children actually receiving interventions. The trial will enroll 662 children ages 1-3 years who receive well- childcare at one of 10 partner clinic sites. We will conduct developmental screening on all children using the Parental Evaluation of Developmental Status (PEDS) Online system, and randomize children 1:1 into intervention (connection to 211LA for developmental care coordination + usual care) or control (usual care alone, with developmental care coordination conducted by clinic staff). Primary outcomes will include referrals to early intervention evaluations, eligibility for intervention services, and receipt of services. We will measure these outcomes through parent report, medical record review, and 211LA data, at 6 months after enrollment. For children with elevated developmental risk based on the PEDS Online results, we will assess development using the PEDS: Developmental Milestones – Assessment Level (PEDS:DM-AL), conducted at baseline and 12 and 24 months after enrollment. For all children, we will administer the language subscale of the PEDS:DM- AL at baseline, 12 months and 24 months, to evaluate development over time in the two groups. We will measure behavioral outcomes for all children using the externalizing behavior subscale of the Child Behavior Checklist. Expected findings include higher rates of referrals, eligibility, and receipt of intervention services among intervention group participants, and greater developmental gains among children in the intervention group. We will also examine the costs of the program in relation to these outcomes, to estimate the costs and potential long-term benefits of this model. If effective, the model has the potential to disseminate rapidly throughout the 2-1-1 network and transform developmental care coordination in the US.

项目概要/摘要 尽管美国科学院建议普遍进行儿童早期发育筛查 儿科、充足的证据表明儿童保健提供者没有达到这些建议，以及 其他证据表明，许多早期发育迟缓都被忽视了。 父母很难驾驭儿童早期发展护理系统，高危儿童很少 实际上得到转诊的人越来越少，最终接受服务的人越来越少。 护理流程中的差距造成了这种情况。 将发育筛查与发育结果联系起来的证据存在差距，导致美国预防性 服务工作组声明没有足够的证据支持或反对普遍 筛查言语和语言发育迟缓或自闭症谱系障碍 拟议项目是一个。 基于电话的幼儿发展护理协调系统的随机对照试验 与 2-1-1 洛杉矶县 (211LA) 建立合作伙伴关系，这是 2-1-1 呼叫中心全国网络的一部分，覆盖范围 我们将测试 93% 的美国人口在增加发展转介方面的有效性。 评估，增加被认为有资格获得服务的儿童数量，并增加 该试验将招募 662 名接受良好干预的 1-3 岁儿童。 我们将在 10 个合作诊所之一对所有使用该设施的儿童进行发育筛查。 家长发育状况评估 (PEDS) 在线系统，将儿童按 1:1 随机分组 干预（连接211LA进行发育护理协调+常规护理）或控制（常规护理 主要结果将包括转诊。 我们将衡量早期干预评估、干预服务的资格以及服务的接受情况。 这些结果来自入组后 6 个月的家长报告、病历审查和 211LA 数据。 对于根据 PEDS Online 结果发育风险较高的儿童，我们将评估发育情况 使用 PEDS：发展里程碑 – 评估级别 (PEDS:DM-AL)，在基线和 入学后 12 个月和 24 个月，我们将执行 PEDS:DM- 的语言分量表。 我们将在基线、12 个月和 24 个月进行 AL，以评估两组的发展情况。 使用儿童行为的外化行为分量表来衡量所有儿童的行为结果 预期结果包括更高的转介率、资格和接受干预服务。 干预组中儿童的发展进步更大 我们还将检查与这些结果相关的计划成本，以估计成本和 该模型的潜在长期效益 如果有效，该模型有可能迅速传播。 整个 2-1-1 网络并改变美国的发育护理协调。