Autism Adaptive Community-based Treatment to Improve Outcomes using Navigators (ACTION) Network

项目摘要 研究表明，通过训练可以对自闭症谱系障碍(Asd)做出稳定的诊断。 专业人士18-24个月，而美国确诊的中位年龄是4-5岁。更低的位置 收入、少数民族和农村家庭最多在1.5年后得到诊断，更有可能错过窗口 早期干预机会(EI)。尽管科学进步，但我们面临的最大挑战之一 和投资，是如何弥合医疗保健科学与服务之间的差距，并解决 ASD儿童获得循证EI的机会。这样做将是改善终身生活的最佳解决方案 结果，降低社会成本，改变自闭症的面貌。针对RFA-MH-17-008， 自闭症行动网络-一个由8个机构组成的新的跨学科网络-将结合临床有效性和 实施研究旨在研究2种循证干预措施的单独和联合影响 真实世界环境：1)当家庭第一次了解到他们的孩子有 使用基于证据的干预措施的自闭症的迹象，该干预方法结合了动机访谈和问题- 解决教育(MI PSE)；以及2)指导家庭嵌入循证干预策略 患有自闭症的学步儿童在日常活动中使用早期社交互动(ESI)模型。在现有基础上构建 基础设施，我们将使用基于Web的课程集合Autis Navigator®注入移动技术 和工具。家庭将通过在3个不同的社区初级保健和EI系统中进行筛选来招募 两个州的地区：佛罗里达州和马萨诸塞州。在第一阶段，我们将比较自适应的有效性 在两阶段序贯多重分配随机试验中使用MI PSE的干预措施 关于家庭参与精神分裂症、父母在日常活动中使用干预策略的(SMART)设计 和儿童的社交结果、积极参与、自闭症症状、发展水平和 适应性行为。在第二阶段，我们将构建一个适应性干预，以优化MI PSE的效果 并研究了基于SMART的ESI在两个新业务系统中实施的可行性 加州--Kaiser Permanente Healthcare System和国家黑人教会倡议。这个网络 带来了一支独特的跨学科团队，其专业知识涵盖早期检测、孕产妇心理健康、临床 试验、健康差距、实施科学和政策。我们的动态技术平台雄心勃勃 传播的目的是向致力于在人口层面产生影响的变革推动者群体提供信息。 这一研究网络可以为社区基础系统的建设提供更早和更广泛的能力 获得成本效益高、社区可行的治疗，并准备好立即和快速实施 在美国各地。这些发现将通过为研究人员提供一种快速部署的方法来推进科学 以证据为基础的实践，使研究更年轻-加速遗传、神经科学和 干预研究-并导致劳动力发展和医疗保健提供的变革性变化。

PROJECT ABSTRACT Research shows that a stable diagnosis of autism spectrum disorder (ASD) can be made by trained professionals at 18-24 months and yet the median age of diagnosis in the US is 4-5 years of age. Lower income, minority, and rural families receive a diagnosis up to 1.5 years later and more likely miss the window of opportunity for early intervention (EI). One of the greatest challenges we face, in spite of scientific advances and investments, is how to bridge the healthcare science-to-service gap and address health disparities in access to evidence-based EI for children with ASD. Doing this would be the best solution to improve lifelong outcomes, reduce costs to society, and change the landscape of autism. In response to RFA-MH-17-008, the Autism ACTION Network—a new interdisciplinary network of 8 institutions—will blend clinical effectiveness and implementation research designs to study individual and combined effects of 2 evidence-based interventions in real world settings: 1) engage families to access resources and support when they first learn their child has signs of ASD using an evidence-based intervention that integrates motivational interviewing and problem- solving education (MI+PSE); and 2) coach families to embed evidence-based intervention strategies for toddlers with ASD in everyday activities using the Early Social Interaction (ESI) model. Building on existing infrastructure, we will infuse mobile technology using the Autism Navigator® collection of web-based courses and tools. Families will be recruited by screening in community-based primary care and EI systems in 3 diverse regions in 2 states: Florida and Massachusetts. In Phase 1, we will compare the effectiveness of adaptive interventions that use MI+PSE with and without ESI in a 2-stage Sequential Multiple Assignment Randomized Trial (SMART) design on family engagement in EI, parent use of intervention strategies in everyday activities, and child outcomes of social communication, active engagement, autism symptoms, developmental level, and adaptive behavior. In Phase 2, we will construct an adaptive intervention to optimize the effects of MI+PSE with ESI based on the SMART and study the feasibility of implementation in two new service systems in California--Kaiser Permanente Healthcare System and the National Black Church Initiative. This network brings a unique interdisciplinary team with expertise spanning early detection, maternal mental health, clinical trials, health disparities, implementation science, and policy. Our dynamic technology platform has ambitious dissemination aims of informing a community of change agents committed to impact at the population level. This research network can build the capacity of community-based systems to provide earlier and widespread access to cost-efficient, community-viable treatment and be ready for immediate and rapid implementation across the US. Findings will advance science by providing researchers with a method for rapidly deploying evidence-based practices, enabling research at younger ages—accelerating genetic, neuroscience, and intervention research—and lead to transformative changes in workforce development and healthcare delivery.