Optimizing a Paraprofessional, Family Partner Navigation Model for Children

项目总结 二十年的证据支持家庭导航(FN)作为一种护理管理方法的有效性 致力于缩小障碍患者获得医疗服务的差距；尽管有很大的希望，但普遍存在 国民阵线的传播仍然面临重大挑战。FN是一种复杂的、多成分的干预 通常包括激励性访谈、解决问题的策略、患者教育和护理 协调。这些组件中的每一个都可以通过一系列策略交付，包括面对面 会议、远程医疗、家访和/或基于Web的技术。我们团队的研究有力地支持了FN 整体有效性；然而，仍然存在三个问题：1)最有效的交付战略是什么 对于FN；2)FN的哪些成分是“有效成分”；以及3)FN如何传播到广泛的 人口。在目前的计划中，FN将由一名家庭合作伙伴交付并部署以改进 3-12岁儿童获得行为健康服务的机会。我们的研究将大规模地进行。 在一个新成立的责任关怀组织内拥有联邦合格的卫生中心。对于这个项目，我们 建议优化FN，以便规模化传播。首先，使用多阶段优化策略 (MOST)，它依赖于随机、多因素设计，我们将同时测试 提供FN组成部分的三项新战略：(A)技术辅助的护理协调提供 使用创新的基于网络的平台；(B)基于社区；以及(C)使用 循证筛查工具(与标准的儿科监测相比)。第二，使用路径 分析，我们将测试FN结果的调解人和调解人。第三，使用混合方法，我们 将研究影响执行的因素。我们三个目标的整合将产生一个FN模式，即 针对效率、效果和更广泛的实施进行了优化。我们的具体目标是：(1)评估 交付国民阵线组成部分的三种战略的有效性。我们将使用2x2x2阶乘实验 设计以测试三种交付FN组件的策略。家庭(n=304)将被随机分配到八个家庭之一 条件。我们将估计三个实验因素的主效应和加性效应 影响研究主要结果的因素组合--参与适当的心理健康服务。(2) 评估FN的有效机制以及对谁最有效。(3)将FN优化为 传播和评估实施战略。遵循Aarons的横向扩展框架，我们将 使用混合方法通过评估保真度(干预)来探索实施的障碍和促进者 和实施)、覆盖范围和成本。然后，与我们的利益相关者团队合作，我们将整合这些 使用来自目标1和目标2的数据的结果，以基于有效性、确定的介体和 主持人，以及实施的成功。

PROJECT SUMMARY Two decades of evidence support the effectiveness of family navigation (FN) as a care-management approach to reducing disparities in access to health services for disorders; despite substantial promise, widespread dissemination of FN still faces significant challenges. FN is a complex, multi-component intervention that generally incorporates motivational interviewing, problem-solving strategies, patient education, and care coordination. Each of these components can be delivered through a range of strategies including in-person meetings, telehealth, home visits, and/or web-based technologies. Our team’s research strongly supports FN’s effectiveness as a whole; however, three questions remain: 1) what are the most effective delivery strategies for FN; 2) which FN components are the “active ingredients;” and 3) how can FN be disseminated to a broad population. In the current proposal, FN will be will be delivered by a Family Partner and deployed to improve access to behavioral health services among children ages 3-12 years. Our study will be carried out at a large federally qualified health center within a newly formed Accountable Care Organization. For this project, we propose to optimize FN for dissemination at scale. First, using the Multiphase Optimization Strategy (MOST), which relies on a randomized, multi-factorial design, we will simultaneously test the effectiveness of three novel strategies for delivering FN components: (A) technology-assisted delivery of care coordination using an innovative, web-based platform; (B) community-based; and (C) enhanced symptom tracking using evidence-based screening instruments (compared to standard pediatric surveillance). Second, using path analysis, we will test mediators and moderators of FN outcomes. Third, using a mixed-methods approach, we will study factors that influence implementation. Integration of our three aims will yield a FN model that is optimized for efficiency, effectiveness, and wider implementation. Our specific aims are: (1) To evaluate the effectiveness of three strategies to deliver FN components. We will use a 2 x 2 x 2 factorial experimental design to test three strategies to deliver FN components. Families (n=304) will be randomized to one of eight conditions. We will estimate main effects of the three experimental factors and the additive effects of combinations of factors on the study’s primary outcome – engagement in appropriate mental health services. (2) To evaluate mechanisms of FN effectiveness and for whom it is most effective. (3) To Optimize FN for dissemination and evaluate implementation strategies. Following Aarons’ scaling-out framework, we will use mixed methods to explore barriers and facilitators to implementation by evaluating fidelity (to intervention and implementation), reach, and cost. Then, working with our team of stakeholders, we will integrate these findings with data from Aim 1 and 2 to optimize FN based on effectiveness, identified mediators and moderators, and implementation success.