Factors that influence clinical decisions about offering parent coaching for autistic youth served within the Medicaid system.
Factors that influence clinical decisions about offering parent coaching for autistic youth served within the Medicaid system.
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DOI：
10.1177/26334895231153631
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发表时间：
2023-01
影响因子：
--
通讯作者：
Ingersoll, Brooke
中科院分区：
文献类型：
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作者：
Straiton, Diondra;Frost, Kyle;Ingersoll, Brooke
家长辅导是一种针对自闭症儿童的循证实践，但在医疗补助系统等资源较低的社区环境中，这种做法没有得到充分利用。临床医生往往很难实施家长辅导与低收入和边缘化的家庭，但很少有人知道哪些因素影响临床医生的决策过程中提供家长辅导，这一人群。定性分析采用了框架法和主题分析法。我们使用了探索，准备，实施和维持（EPIS）框架，以确定社区提供者在为参加医疗补助的自闭症儿童家庭提供家长辅导时使用的临床决策过程中的因素。与13个供应商和一个焦点小组与13个供应商的访谈进行了分析。出现了以下主题：1）政策驱动提供者任务优先级并影响竞争需求; 2）当机构领导监控父母指导基准时，提供者更有可能使用父母指导，尽管这很少这样做; 3）时间安排和治疗地点等逻辑因素影响使用父母指导的感知可行性; 4）以前在父母辅导和/或家庭系统的经验或课程支持父母辅导实施的质量; 5）提供者对“父母准备”的看法最初是由父母利益的公开表达来表示的。在缺乏外部环境和内部环境政策的情况下，提供者有更多的决策权，可以根据自己的判断和偏好提供家长辅导，这可能导致向家长辅导提供服务的家庭减少，并增加与向哪些家庭提供这种服务有关的偏见。国家，机构和临床医生的建议，提供了增加公平提供这种基于证据的做法自闭症。我们探讨了医疗机构如何在为参加医疗补助的自闭症儿童提供家长指导时做出临床决策。数据来自13个单独访谈和一个由13个供应商组成的焦点小组。我们发现，提供者讨论了5个主要主题：1）提供者优先考虑使用他们的时间来遵循国家或机构政策的要求，并且不太可能优先考虑这些政策不要求的其他事情; 2）如果他们的机构领导人监控他们做父母辅导的频率，提供者更有可能提供和使用父母辅导; 3）时间安排和治疗地点等逻辑因素影响提供者与家庭一起使用父母指导的可能性; 4）具有关于父母指导和/或与家庭一起工作的先前经验或课堂工作的提供者更愿意与家庭一起使用父母指导; 5）提供者认为，如果父母表现出他们对具体行动感兴趣，比如直接向提供者征求如何与孩子合作的建议，父母就更“准备好”进行父母辅导。这些结果表明，政策必须优先考虑这种基于证据的做法，以确保供应商公平地实施它对所有适合父母辅导的家庭。我们为临床医生和机构领导人/管理人员提供建议，以改善在资源较低的环境中实施家长辅导。
Parent coaching is an evidence-based practice for young autistic children, but it is underutilized in lower-resourced community settings like the Medicaid system. Clinicians often struggle to implement parent coaching with low-income and marginalized families, but little is known about which factors influence clinician decision making processes about providing parent coaching to this population. This qualitative analysis used the framework method and thematic analysis. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to identify factors in the clinical decision-making process that community providers use when offering parent coaching to families of Medicaid-enrolled autistic children. Interviews with 13 providers and a focus group with 13 providers were analyzed. The following themes emerged: 1) Policies drive provider task priorities and affect competing demands; 2) Providers are more likely to use parent coaching when agency leaders monitor parent coaching benchmarks, though this is rarely done; 3) Logistical factors like scheduling and treatment location affect perceived feasibility of using parent coaching; 4) Previous experience or coursework in parent coaching and/or family systems supports the quality of parent coaching implementation; 5) Provider perceptions of “parent readiness” are initially indicated by overt expressions of parent interest. In the absence of outer-context and inner-context policies, providers have more decision-making power to offer parent coaching based on their own judgements and preferences, which may result in fewer families being offered parent coaching and increased bias related to which families are offered this service. State-, agency-, and clinician-level recommendations are provided for increasing equitable provision of this evidence-based practice for autism. We explored how providers make clinical decisions when offering parent coaching to Medicaid-enrolled autistic children. The data came from 13 individual interviews and a focus group with 13 providers. We found that there were 5 main themes that providers discussed: 1) Providers prioritize using their time to follow requirements made by state or agency policies, and are less likely to prioritize other things that are not required by these policies; 2) Providers are more likely to offer and use parent coaching if their agency leaders monitor how often they do parent coaching; 3) Logistical factors like scheduling and treatment location affect how likely the provider is to use parent coaching with a family; 4) Providers with previous experience or classwork about parent coaching and/or working with families feel more comfortable to use parent coaching with families; 5) Providers think parents are more “ready” to do parent coaching sessions if parents show they are interested with specific actions such as directly asking providers for advice about how to work with their child. These results suggest that policies must prioritize this evidence-based practice in order to ensure that providers are implementing it equitably to all families who are appropriate for parent coaching. We provide recommendations for clinicians and agency leaders/administrators to improve the implementation parent coaching in lower-resourced settings.
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影响因子：
5.2
作者：
Straiton, Diondra;Groom, Barb;Ingersoll, Brooke
通讯作者：
Ingersoll, Brooke
影响因子：
4
作者：
Gale NK;Heath G;Cameron E;Rashid S;Redwood S
通讯作者：
Redwood S
影响因子：
2.4
作者：
Cross, Christina J.
通讯作者：
Cross, Christina J.
影响因子：
2.1
作者：
Buchanan, NiCole T.
通讯作者：
Buchanan, NiCole T.
影响因子：
--
作者：
Jamtvedt, Gro;Young, Jane M.;Oxman, Andrew D.
通讯作者：
Oxman, Andrew D.