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.项目总结 疾病控制中心(CDC)估计，每68名儿童中就有一名患有自闭症谱系障碍(CDC， 2014)，以及美国自闭症的年成本。 估计为2,360亿美元。循证干预 已经制定并证明了在改善儿童结果方面的有效性。然而，对 在照顾这些儿童的多个服务系统中扩大这些做法的普遍方法有 这是有限的，对满足日益增长的公共卫生需求至关重要。 我们建议进行两次协调 测试自闭症翻译循证干预措施(EBI)有效性的研究：多层次 实施战略“(团队)模式。团队专注于提高实施领导力， 组织氛围以及提供商的态度和动机，以改进两个关键实施 结果-提供者培训完成率和ASD EBI保真度，以及随后的儿童结果。两支队伍- 领导单元采用LOCI(“实施领导和组织变革”)1战略，以及 团队-Prov模块应用MI(激励性访谈)策略来促进个人提供者和 组织行为改变。这些研究将使用随机实施/有效性混合， 类型3，试验。研究1将通过AIM HI干预测试团队模型(个体化心理 自闭症的健康干预“)在公共资助的精神卫生服务中。研究2将测试团队使用 教育环境中的CPRT干预(“课堂枢轴反应教学”)。AIM HI和CPRT数据 指出(1)提供商对EBI的态度和(2)实施领导力是有希望的目标 实施干预措施。团队将针对这些特定的变化机制。这项研究将 将37个MH项目和37个学区随机分为四组(团队PROV+LEAD；团队- 领导；团队-Prov；仅限EBI培训)，以测试结合标准和EBI特定培训的有效性 与两个小组就多个执行成果单独和共同编写单元。一次拆解 设计将被用来理解团队的有效性和跨环境的变化机制 和参与者。实施结果包括提供者培训完成率、忠诚度和儿童行为 将检查295名卫生保健提供者、295名教师和590名儿童(结合不同研究)的变化。这 实施干预措施有可能通过以下方式提高公共资助环境中ASD的护理质量 提高EBI实施的有效性。该过程和模块将可概括为多个 服务系统、提供者和干预措施，对社区服务产生广泛影响。