1/2 Effectiveness of a Multi-Level Implementation Strategy for ASD Interventions

1/2 ASD 干预措施多层次实施策略的有效性

• 批准号: 9223411
• 负责人: LAUREN BROOKMAN-FRAZEE
• 金额: $ 76.26万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9223411
• 关键词: Adoption; Attention; Attitude; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Child Behavior; Child Care; Climate; Clinical; Collaborations; Community Services; Consultations; Data; Education; Educational Intervention; Educational process of instructing; Effectiveness; Ensure; Evidence based intervention; Funding; Hybrids; Individual; Intervention; Leadership; Link; Mediating; Mediator of activation protein; Mental Health; Mental Health Services; Methods; Modeling; Motivation; Organizational Change; Outcome; Participant; Patients; Population; Process; Provider; Public Health; Quality of Care; Randomized; Recording of previous events; Research; Research Project Grants; Role; Sample Size; Schools; Services; Site; Symptoms; System; Target Populations; Testing; Training; Translating; autism spectrum disorder; behavior change; care systems; cost; design; implementation science; improved; mental health education; organizational climate; organizational structure; programs; provider intervention; response; routine care; scale up; school district; teacher; treatment as usual

12. PROJECT SUMMARY The Centers for Disease Control (CDC) estimates that 1 in 68 children have autism spectrum disorder (CDC, 2014) and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. We propose to conduct two, coordinated studies testing the effectiveness of the “Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy” (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes – provider training completion and ASD EBI fidelity, and subsequent child outcomes. The TEAMS– LEAD module applies the LOCI (“Leadership and Organizational Change for Implementation”)1 strategies, and the TEAMS-PROV module applies MI (Motivational Interviewing) strategies to facilitate individual provider and organizational behavior change. These studies will use a randomized implementation/effectiveness Hybrid, Type 3, trial. Study #1 will test the TEAMS model with the AIM HI intervention (“An Individualized Mental Health Intervention for ASD”) in publicly-funded mental health services. Study #2 will test TEAMS with the CPRT intervention (“Classroom Pivotal Response Teaching”) in education settings. AIM HI and CPRT data indicate that (1) provider attitudes towards EBI and (2) implementation leadership are promising targets of implementation interventions. TEAMS will target these specific mechanisms of change. This study will randomize 37 MH programs and 37 school districts to one of four groups (TEAMS PROV+LEAD; TEAMS- LEAD; TEAMS-PROV; EBI training only) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. A dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Implementation outcomes including provider training completion, fidelity and child behavior change will be examined for 295 MH providers, 295 teachers and 590 children (combined across studies). This implementation intervention has the potential to increase quality of care for ASD in publicly-funded settings by improving effectiveness of EBI implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services.

12。项目摘要 疾病控制中心（CDC）估计，有68名儿童患有自闭症谱系障碍（CDC， 2014年）和美国ASD的年成本 估计为2360亿美元。基于证据的干预措施 已经开发并证明了改善儿童结局的有效性。但是，研究 在关怀这些孩子的多个服务系统中扩展这些实践的可概括方法 我们有限，对于满足日益增长的公共卫生需求至关重要。 我们建议进行两个协调 研究测试“翻译基于证据的干预措施（EBI）的ASD：多级别的有效性 实施策略（团队）模型。团队专注于改善实施领导力， 组织环境和提供商参加和动力，以改善两个关键的实施 成果 - 提供者培训完成和ASD EBI Fidelity以及随后的儿童成果。团队 - LEAD模块应用基因座（“实施领导和组织变革”）1策略， 团队支持模块采用MI（动机访谈）策略来促进个人提供商和 组织行为改变。这些研究将使用随机实施/有效性混合， 3型，试验。研究＃1将通过AIM HI干预测试团队模型（“个性化的心理 在公共资助的心理健康服务中，ASD的健康干预。研究＃2将与 教育环境中的CPRT干预（“教室关键响应教学”）。 AIM HI和CPRT数据 表明（1）提供者参加EBI，（2）实施领导是承诺的目标。 实施干预措施。团队将针对这些特定的变革机制。这项研究会 将37个MH计划和37个学区随机分为四个小组之一（团队Prov+Lead; Teams- 带领;团队支持；仅EBI培训）测试结合标准，特定于EBI的培训的有效性 两支团队单独并共同进行多个实施成果。拆除 设计将用于了解团队的有效性和跨环境的变化机制 和参与者。实施成果，包括提供者培训完成，忠诚和儿童行为 将检查295个MH提供者，295名教师和590名儿童（在研究中合并）的变更。这 实施干预措施有可能提高在公开资助的环境中的ASD的护理质量 提高EBI实施的有效性。该过程和模块可以推广到多个 服务系统，提供商和干预措施，对社区服务产生广泛的影响。