Improving Transition Outcomes for Youth with Autism Spectrum Disorder from within a Medicaid Accountable Care Organization

项目总结 尽管患有自闭症谱系障碍(ASD)的美国儿童数量不断增加，但 整个儿童和成人服务系统导致#年教育、就业和健康结果差 处于过渡期的青年。虽然在患有自闭症的幼儿中进行了许多研究，但有 解决老年青年护理过渡问题的工作较少。这份K18职业生涯的目的 增强奖是为经验丰富的临床试验研究员迈克尔·西尔弗斯坦，医学博士，公共卫生硕士，配备 在ASD过渡研究领域的新技能和知识，以便他可以扩大他的研究组合 往这个方向走。到目前为止，西尔弗斯坦博士已经在差异中进行了心理健康服务研究 主要是在抑郁症预防领域。这份K18概述了一个两年计划，在这个计划中，Dr。 Silverstein将与新的导师合作，以增强他的内容和方法专业知识，扩大他的 指导ASD过渡研究的能力，并进行随机试点研究以优化问题- 基于解决的过渡干预，支持青年的自主性，但解决变量功能 通过将其他家庭成员纳入干预参与者来提高ASD人群的能力。 K18研究计划的前提是ASD人群成功过渡到成年期 这取决于系统和家庭层面的战略的混合。因此，拟议的干预措施将是 嵌入到一系列更广泛的系统级过渡战略中，目前正在大规模部署 医疗补助责任护理组织。试点试验的主要目的是优化原型问题。 解决干预模式。模型的改进将侧重于专门针对患有ASD的青年和 不同功能青少年干预中父母最佳参与程度的确定 超能力。同时进行的定性工作旨在生成关于可测试干预目标的假设 问题解决策略如何影响ASD过渡结果。为了支持这项研究，Dr。 Silverstein的K18职业发展活动包括强调学习的结构化导师会议 针对自闭症青少年的干预设计并熟悉教育、职业教育和服务体系 培训和住房。其他活动包括在Riverview School(专门从事 对于患有自闭症的儿童)学习可纳入干预设计的教育策略；以及 团体辅导经验，为有意研究自闭症服务的初级调查人员提供职业发展 为过渡年龄的年轻人准备的。K18旨在为一种新的干预模式的临床试验奠定基础 促进成功的护理过渡和西尔弗斯坦博士研究重点的持续转移。

PROJECT SUMMARY Despite an increasing number of American children with autism spectrum disorder (ASD), fragmentation across child and adult service systems results in poor education, employment and health outcomes for transition-age youth. Whereas much research is being conducted among young children with ASD, there has been less work that addresses the topic of care transitions for older youth. The purpose of this K18 Career Enhancement Award is to equip an experienced clinical trial investigator, Michael Silverstein, MD, MPH, with new skills and knowledge in the area of ASD transition research, so that he can expand his research portfolio in this direction. To date, Dr. Silverstein has conducted mental health services research among disparity populations, primarily in the field of depression prevention. This K18 outlines a two-year plan, whereby Dr. Silverstein will work with new mentors to augment his content and methodologic expertise, expand his mentoring capacity in ASD transitions research, and conduct a randomized pilot study to optimize a problem- solving based transition intervention that supports youth's autonomy, but addresses the variable functional abilities of the ASD population by including other family members as intervention participants. The premise of the K18 research plan is that successful transition to adulthood for the ASD population depends on a mixture of systems- and family-level strategies. The proposed intervention, therefore, will be embedded in a series of broader, systems-level transition strategies currently being deployed in a large Medicaid accountable care organization. The primary aim of the pilot trial is to optimize a prototype problem solving intervention model. Model refinements will focus on new components specific to youth with ASD and on determining the optimal degree of parental involvement in the intervention for youth with varying functional abilities. Concurrent qualitative work aims to generate hypotheses concerning testable intervention targets for how problem solving strategies could impact ASD transition outcomes. To support this research, Dr. Silverstein's K18 career development activities include structured mentor meetings that emphasize learning intervention design for youth with ASD and becoming familiar with service systems in education, vocational training and housing. Other activities include a 2-month internship at the Riverview School (which specializes in children with ASD) to learn educational strategies that could be incorporated into intervention design; and group mentoring experiences to develop the careers of junior investigators interested in studying ASD services for transition-age youth. The K18 is designed to set the stage for a clinical trial of a new intervention model to promote successful care transition and for a sustained shift in Dr. Silverstein's research focus.