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Optimizing a Paraprofessional, Family Partner Navigation Model for Children

优化儿童辅助专业人员、家庭合作伙伴导航模型

基本信息

批准号：
10409572
负责人：
EMILY FEINBERG
金额：
$ 70.38万
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：
2018-08-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10409572
关键词：
Adopted Age Attention deficit hyperactivity disorder Attitude Caring Child Childhood Clinic Collaborations Communities Community Health Complex Computerized Medical Record Consumption Data Disease Dissemination and Implementation Effectiveness Enhancement Technology Ethnic Origin Experimental Designs Face Family Federally Qualified Health Center Future HIV Health Services Health Services Accessibility Home Home visitation Improve Access Individual Information Networks Insurance Intervention Language Low income Malignant Neoplasms Measures Mediator of activation protein Mental Health Mental Health Services Mental disorders Methods Modeling Monitor Motivation Online Systems Oregon Outcome Outcome Study Patient Education Persons Population Primary Health Care Problem Solving Protocols documentation Race Randomized Research Resources Schools Severities Symptoms System Technology Testing Time Transportation autism spectrum disorder base behavioral health care coordination care delivery care systems chronic care model cost cost effective design disparity reduction effectiveness evaluation effectiveness testing evidence base family support health knowledge implementation evaluation implementation facilitators implementation strategy innovation instrument meetings motivational enhancement therapy multi-component intervention multiphase optimization strategy novel strategies patient portal primary outcome public health intervention response screening social stigma success telehealth theories

项目摘要

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.

项目概要二十年的证据支持家庭导航（FN）作为护理管理方法的有效性减少获得疾病卫生服务方面的差距；尽管有很大的希望，但广泛 FN的传播仍然面临重大挑战。 FN 是一种复杂的、多成分的干预措施，通常包括动机性访谈、问题解决策略、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来交付，包括面对面的策略会议、远程医疗、家访和/或基于网络的技术。我们团队的研究有力支持了 FN 整体有效性；然而，仍然存在三个问题：1）什么是最有效的交付策略对于 FN； 2) 哪些 FN 成分是“活性成分”； 3）如何将FN传播到更广泛的范围人口。在当前的提案中，FN 将由家庭合作伙伴交付并部署以改善 3-12 岁儿童获得行为健康服务的机会。我们的研究将在大范围内进行新成立的责任医疗组织内的联邦合格健康中心。对于这个项目，我们建议优化 FN 以进行大规模传播。一、使用多阶段优化策略（MOST），它依赖于随机、多因素设计，我们将同时测试以下方法的有效性：提供 FN 组成部分的三种新策略：(A) 技术辅助的护理协调提供使用创新的网络平台； (B) 以社区为基础； (C) 使用增强的症状跟踪基于证据的筛查工具（与标准儿科监测相比）。二、使用路径分析中，我们将测试 FN 结果的中介变量和调节变量。第三，我们采用混合方法将研究影响实施的因素。整合我们的三个目标将产生一个 FN 模型，即针对效率、有效性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 FN 组件的三种策略的有效性。我们将使用 2 x 2 x 2 阶乘实验旨在测试三种交付 FN 组件的策略。家庭 (n=304) 将被随机分配到八个家庭之一状况。我们将估计三个实验因素的主效应和相加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 有效性机制及其对谁最有效。 (3) 优化FN 传播并评估实施策略。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（干预措施）来探索实施的障碍和促进因素和实施）、覆盖范围和成本。然后，与我们的利益相关者团队合作，我们将整合这些根据目标 1 和 2 的数据得出结论，根据有效性、确定的中介因素和确定的因素来优化 FN 版主和实施成功。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Operationalizing Primary Outcomes to Achieve Reach, Effectiveness, and Equity in Multilevel Interventions.

落实主要成果，以实现多层次干预措施的覆盖面、有效性和公平性。

DOI：
10.1007/s11121-023-01613-2
发表时间：
2023
期刊：
Prevention science : the official journal of the Society for Prevention Research
影响因子：
0
作者：
Guastaferro,Kate;Sheldrick,RChristopher;Strayhorn,JillianC;Feinberg,Emily
通讯作者：
Feinberg,Emily

Adapting Community Health Worker Care Models to Advance Mental Health Services Among LGBTQ Youth.

DOI：
10.1007/s10488-023-01268-9
发表时间：
2023-07
期刊：
ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH
影响因子：
2.6
作者：
Barnett, Miya L.;Salem, Hanan;Rosas, Yessica Green;Feinberg, Emily;Nunez-Pepen, Rocio;Chu, Andrea;Belmont-Ryu, Hana;Matsuno, Em;Broder-Fingert, Sarabeth
通讯作者：
Broder-Fingert, Sarabeth