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

项目总结

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.