Developing the Autism Model of Implementation for ASD Community Providers

为 ASD 社区提供者开发自闭症实施模型

• 批准号: 8240881
• 负责人: Amy Drahota
• 金额: $ 18.53万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8240881
• 关键词: Address; Adopted; Adoption; Affect; Anxiety Disorders; Autistic Disorder; Behavior; Budgets; California; Characteristics; Child; Childhood; Client; Clinical; Collaborations; Communication; Communities; Consultations; Data; Data Analyses; Development; Diagnosis; Disease; Effectiveness; Evidence based practice; Family; Feedback; Focus Groups; Geographic Locations; Goals; Impairment; Individual; Intervention; Interview; Lead; Life; Literature; Manuscripts; Measures; Mental disorders; Mentored Research Scientist Development Award; Mentors; Methods; Modeling; Outcome; Participant; Phase; Pilot Projects; Platelet Factor 4; Play; Population; Procedures; Process; Professional Organizations; Provider; Readiness; Reporting; Research; Research Methodology; Role; School-Age Population; Services; Severities; Structure; Surveys; Symptoms; System; Testing; Training; Training Activity; Training Support; Wood material; Work; Writing; autism spectrum disorder; career; clinically significant; cost; executive function; experience; implementation research; implementation science; improved; meetings; programs; response; skills; skills training; social communication; social skills; statistics; symposium; theories; tool

DESCRIPTION (provided by applicant): This Mentored Research Scientist Development Award (K01) will provide the applicant with the advanced training and skills necessary to meet immediate career goals; specifically, developing an independent program of research focusing on improving the services received by children with autism spectrum disorders (ASD) and their families in community contexts by increasing the implementation of evidence-based practices delivered by ASD community providers. Longer term, the experience and data generated by this project are expected to lead to larger scale studies focusing on refining the AMI, including specific aspects of the AMI Process Materials, as well as studies to test the implementation effectiveness, generalizability, and sustainability of the AMI across various ASD agencies and geographic locations. Background and Significance. Currently, 1 out of 110 children are diagnosed with an ASD, and the annual estimate of costs for services is $35 billion. Typically, ASD Community Providers (ASD-CPs) provide services to children with any severity of ASD symptoms using various treatment paradigms with few treatments considered efficacious or probably efficacious. When evidence-based practices (EBPs) are successfully implemented by ASD-CPs, they result in positive outcomes. Despite this promise, EBPs are often implemented unsuccessfully and other treatments used by ASD-CPs lack supportive evidence, especially for school age children with ASD. While it is not well understood why ASD-CPs are not implementing EBPs, organizational and individual ASD-CP characteristics likely play a role in hindering implementation. As a response to this need, and to improve the lives of children with ASD and their families, the proposed study aims to develop and test the feasibility and acceptability of the Autism Model of Implementation (AMI) and AMI Process Materials to support the implementation of EBPs by ASD-CPs. Moreover, the proposed study will positively impact the field of implementation science by providing an empirically-supported and tested model of implementation to facilitate the identification, adoption, and use of EBPs by ASD-CPs, specifically. Research Plan. The specific aims of the proposed research include: Aim 1. Assess agency antecedents and readiness factors, individual ASD-CP characteristics, and methods of implementing EBPs by ASD Leaders, to identify factors that facilitate or hinder adoption and use of EBPs by ASD-CPs. This will be done through a mixed methods approach involving ASD-CPs participating in focus groups and completing quantitative surveys to provide information about the needs of clients with ASD and ASD-CPs; EBPs in general; agency and ASD-CP factors that might facilitate or inhibit EBP implementation; and their current process used to implement EBPs (if any). Data will be integrated using recommended procedures in consultation with study mentors and consultants. Results will be presented to academic- community collaborative (ACC) partners who will provide additional interpretation and feedback. Aim 2. Develop the Autism Model of Implementation (AMI) with the focus on identification, adoption, and use of EBPs within agencies serving children with ASD. Using a collaborative, iterative approach, the PI will develop the AMI with approximately 10 ACC partners (ASD-CPs who have agreed to collaborate with the PI to accomplish the research aims). Interpretation of data, and feedback from ACC partners are expected to increase external validity, feasibility, and acceptability of the AMI and AMI Process Materials. Aim 3. Examine the feasibility and acceptability of the AMI through a small-scale pilot study. Aim 3 involves the implementation of the AMI and AMI Process Materials (developed in Aim 2) in ASD Community Agencies as an organizational intervention (participants include ASD organizational leaders), and will use a specific EBP-a manualized CBT to treat anxiety disorders in children with ASD (a highly prevalent disorder in the ASD childhood population and stated concern by ASD-CPs in the community). The focus of this Aim is to evaluate the AMI and AMI Process Materials in terms of feasibility within ASD agencies; perceived fit, relevance, utility, and compatibility within ASD agencies and among ASD-CPs; training and support in use of AMI and AMI Process Materials, and observed fidelity. A mixed methods research approach will be used to assess post- implementation data in consultation with study mentor/consultants. Training Goals. In order to accomplish these research aims, the applicant requires the following training: 1) Acquire expertise in the theory and application of implementation research, including tailoring implementation models for specific community providers and contexts; 2) Gain expertise in academic-community collaboration (ACC); and 3) Acquire skills in mixed qualitative and quantitative methods. Training activities will include: a) consultation with Drs. Aarons (expertise: implementation science), Stahmer (expertise: ASD and collaborative models), Palinkas (mixed methods), Roesch (quantitative methods), and Wood (ASD and co-occurring disorders); b) synthesizing literature of implementation science and collaborative models; c) application to the IRI; d) coursework (i.e., UW CCPH online models of collaboration course, SDSU statistical classes in advanced statistics); e) applied training activities (i.e., mixed methods and quantitative data analyses), f) participating in professional organizations and conference (IMFAR, AOM, CCPH Consultancy Network), g) actively participating in structured training activities (i.e., IRI, VA QUERI Cyber Seminars, attend and lead UCSD Research Groups, attend and lead community collaborative groups); and h) manuscript writing. PUBLIC HEALTH RELEVANCE: Currently, 1 out of 110 children have an autism spectrum disorder (ASD), costing an estimated $35 billion in services, including treatments that are most often provided by ASD Community Providers (ASD-CPs). Research indicates that evidence-based practices (EBPs) are not routinely used by ASD-CPs, especially for school age children with ASD and co-occurring psychiatric disorders (e.g., anxiety disorders, which affects upwards of 80% of this population), and few ASD-CPs use a systematic process for adopting and implementing EBPs. Academic-community collaboration to partner with ASD-CPs will facilitate the development of the Autism Model of Implementation (AMI) specific for ASD community agencies. The AMI will help to provide school age children with ASD the best and most effective services in their own community, especially for those with co-occurring anxiety disorders for which very limited services are currently available. The aims of this study are to 1) assess agency and individual factors likely to facilitate implementing EBPs in this setting, 2) develop the Autism Model of Implementation (AMI) to address identified barriers and facilitators, and 3) pilot test the AMI to examine its feasibility and acceptability using a specific EBP to treat anxiety disorders in school age children with ASD.

描述（由申请人提供）：这一指导的研究科学家发展奖（K01）将为申请人提供实现直接职业目标所必需的高级培训和技能；具体而言，开发了一项独立的研究计划，重点是改善自闭症谱系障碍儿童（ASD）在社区环境中获得的服务，通过增加ASD社区提供者提供的基于证据的实践的实施。从长远来看，该项目产生的经验和数据有望导致大规模研究，重点是精炼AMI，包括AMI过程材料的特定方面，以及测试AMI在各个ASD机构和地理位置的实施效率，概括性和可持续性的研究。背景和意义。目前，110名儿童中有1人被诊断出患有ASD，服务费用的年度估计为350亿美元。通常，ASD社区提供者（ASD-CPS）使用各种治疗范式为具有ASD症状的儿童提供服务，而很少有被认为有效或可能有效的治疗方法。当ASD-CP成功实施基于证据的实践（EBP）时，它们会带来积极的结果。尽管有这样的承诺，但EBP通常会未能成功实施，而ASD-CPS使用的其他治疗则缺乏支持证据，尤其是对于ASD的学龄儿童。虽然尚不清楚为什么ASD-CPS不实施EBP，但组织和个人ASD-CP特征可能在阻碍实施中起作用。为了应对这一需求，并改善了ASD及其家人的生活，拟议的研究旨在开发和测试自闭症实施模型（AMI）和AMI过程材料的可行性和可接受性，以支持ASD-CPS实施EBP。此外，拟议的研究将通过提供经验支持和经过测试的实施模型来积极影响实施科学领域，以促进ASD-CPS（特别是ASD CPS）促进识别，采用和使用EBP。研究计划。拟议研究的具体目的包括：目标1。评估机构的前因和准备因素，个体ASD-CP特征以及ASD领导者实施EBP的方法，以识别促进或阻碍ASD-CPS采用和使用EBP的因素。这将通过涉及参与焦点小组的ASD-CP的混合方法方法来完成，并完成定量调查，以提供有关ASD和ASD-CPS客户需求的信息；一般而言EBP；可能有助于或抑制EBP实施的代理和ASD-CP因素；以及他们当前的过程用于实施EBP（如果有）。数据将使用建议的程序与研究导师和顾问进行协商。结果将介绍给学术社区合作（ACC）合作伙伴，他们将提供其他解释和反馈。 AIM 2。开发实施自闭症模型（AMI），重点是在为ASD儿童提供服务的机构中的识别，采用和使用EBP。使用协作，迭代方法，PI将与大约10个ACC合作伙伴（ASD-CPS同意与PI合作以完成研究目标的ASD-CPS）开发AMI。预计数据的解释以及ACC合作伙伴的反馈将增加AMI和AMI过程材料的外部有效性，可行性和可接受性。目标3。通过一项小型试点研究检查AMI的可行性和可接受性。 AIM 3涉及在ASD社区机构中实施AMI和AMI过程材料（在AIM 2中开发）作为组织干预（参与者包括ASD组织领导者），并将使用特定的EBP-A手动CBT来治疗ASD儿童的ASD（ASD儿童中极为普遍的障碍）（ASD儿童人群和社区中的ASD Compersed Compersed Compersed Compersect中的一种非常普遍的障碍）。该目标的重点是根据ASD机构内的可行性评估AMI和AMI过程材料； ASD机构和ASD-CP中的感知拟合，相关性，实用性和兼容性；使用AMI和AMI过程材料的培训和支持，并观察到保真度。混合方法研究方法将用于与研究导师/顾问协商时评估实施后数据。培训目标。为了实现这些研究目的，申请人需要以下培训：1）获得实施研究理论和应用方面的专业知识，包括针对特定社区提供者和环境的实施模型； 2）获得学术社区合作（ACC）方面的专业知识； 3）获得混合定性和定量方法的技能。培训活动将包括：a）与Drs的咨询。 Aarons（专业知识：实施科学），Stahmer（专业知识：ASD和协作模型），Palinkas（混合方法），Roesch（定量方法）和Wood（ASD和COSCRECRAINDERS）； b）综合实施科学和协作模型的文献； c）申请IRI； d）课程工作（即，UW CCPH在线协作课程，高级统计中的SDSU统计课程）； e）应用培训活动（即混合方法和定量数据分析），f）参加专业组织和会议（IMFAR，AOM，AOM，CCPH咨询网络），g）积极参与结构化培训活动（即IRI，VA Queri网络研讨会，参加并领导UCSD研究小组，UCSD研究小组，参加UCSD研究小组，参加和领导社区）；和h）手稿写作。 公共卫生相关性：目前，110名儿童中有1人患有自闭症谱系障碍（ASD），估计耗资350亿美元的服务，包括ASD社区提供者（ASD-CPS）最常提供的治疗方法。研究表明，ASD-CPS并未常规使用基于证据的实践（EBP），特别是对于患有ASD和同时发生的精神疾病的学龄儿童（例如，焦虑症（例如焦虑症），影响该人群的80％以上），而ASD-CP则使用了采用和实施EBP的系统过程。与ASD-CPS合作的学术社区合作将有助于开发针对ASD社区机构特有的自闭症实施模型（AMI）。 AMI将帮助学龄儿童为自己社区中最好，最有效的服务提供ASD，尤其是对于患有焦虑症的焦虑症患者目前提供非常有限的焦虑症的人。这项研究的目的是对1）评估机构和可能促进在这种情况下实施EBP的个人因素； 2）开发实施自闭症模型（AMI）以解决已确定的障碍和促进者，以及3）试验AMI测试AMI以检查其可行性和可接受性，使用特定的EBP来治疗ASD儿童的特定EBP。