Refining and Implementing Technology-Enhanced Family Navigation to Promote Early Access and Engagement with Mental Health Services for Youth with Autism

完善和实施技术增强的家庭导航，以促进自闭症青少年早期获得和参与心理健康服务

• 批准号: 9976304
• 负责人: Nicole A Stadnick
• 金额: $ 19.69万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9976304
• 关键词: Address; Age; Anxiety; Behavior; Caregivers; Case Management; Child; Child health care; Childhood; Clinic; Clinical; Communities; Computerized Medical Record; Diagnostic Services; Early Intervention; Educational workshop; Effectiveness; Enhancement Technology; Family; Focus Groups; Funding; Health Technology; Healthcare; Hybrids; Infant; Intervention; Mental Health; Mental Health Services; Methods; Modeling; National Institute of Mental Health; Needs Assessment; Outcome; Phase; Population; Primary Health Care; Public Health; Randomized; Research Priority; Risk; School-Age Population; Series; Service delivery model; Services; Step Tests; Strategic Planning; Technology; Testing; Toddler; Training; Youth; autism spectrum disorder; autistic children; base; care providers; comorbidity; design; digital; effectiveness implementation trial; effectiveness testing; evidence base; health information technology; implementation science; innovation; medical specialties; phase II trial; primary care setting; prototype; response; service coordination; technology validation; tool; treatment services; user centered design

12. Project Summary In response to PAR-18-429, we propose to refine and test implementation of technology-enabled family navigation to promote early access to, and engagement between, primary and mental health (MH) care for children (ages 5-13 years) with autism spectrum disorder plus MH comorbidity (ASD+). Unmet MH needs (e.g., anxiety, disruptive behaviors) are a common and principal concern, associated with deleterious public health effects for children with ASD. While evidence-based MH interventions for ASD+ are available (e.g., AIM HI5,6), there are multi-level challenges limiting access to such treatment. Family navigation, a model of lay case management designed to mitigate barriers to specialty healthcare, is a promising solution to overcome these challenges for children with ASD+. Family navigation is an established model to facilitate engagement in diagnostic and treatment services including early intervention for infants and toddlers at risk for ASD. However, family navigation has not been tested with children with ASD+. Health information technologies have not been systematically tested as a component of family navigation. Integrating these technologies is a critical next step in increasing the effectiveness and implementation of family navigation. This proposal addresses this next step by testing the effectiveness and implementation of family navigation with systematically designed navigator implementation technology enhancements for children (5-13 years) with ASD+. The Accelerated Creation-to-Sustainment (ACTS) model will be used to guide the design and trial of technology enhancement to family navigation. The ACTS model, based on user-centered design principles and implementation science, provides systematic guidance in rapidly moving from design (Phase 1: Create) of a technology-enabled service to implementation (Phase 2: Trial) and sustainment (Phase 3: Sustain). We propose to use a community- partnered approach guided by the ACTS model to refine and test technology-enhanced family navigation to promote early and ongoing integrated MH care for children with ASD+. This proposal is highly responsive to research priorities in the NIMH Strategic Plan, in digital health technology to advance MH service delivery models and the HHS Interagency Autism Coordinating Committee Strategic Plan. Further, this proposal capitalizes on existing NIMH-funded initiatives to build capacity to treat children with ASD+ in MH settings. The specific aims are: Aim 1: Adapt family navigation (FN) content and training for school-age children with ASD+. Aim 2: Develop FN technology tools to enhance navigator implementation of FN for ASD+. Aim 3: Examine the implementation, service and clinical impacts of technology-enhanced FN for ASD+ through a hybrid type I effectiveness-implementation trial in primary care. A randomized stepped wedge design in primary care will be conducted with five clinics, 30 PCPs and 160 families to examine mechanisms of change and outcomes. Based on successful execution of these aims, we will have a technology-enhanced FN for ASD+ that is ready for large-scale R01 implementation and sustainment testing within diverse primary care settings.

12.项目摘要 作为对PAR-18-429的回应，我们建议完善和测试技术支持的家庭 导航，以促进抢先体验，并参与初级和精神卫生（MH）护理， 患有自闭症谱系障碍加MH合并症（ASD+）的儿童（年龄5-13岁）。未满足的卫生保健需求（例如， 焦虑，破坏性行为）是一个共同的和主要的关注，与有害的公共卫生 对ASD儿童的影响虽然ASD+的循证MH干预措施是可用的（例如，AIM HI5，6）， 有多层次的挑战限制了获得这种治疗的机会。家庭导航，一个奠定案例的模型 旨在减轻专业医疗保健障碍的管理，是克服这些障碍的一个有前途的解决方案。 ASD+儿童面临的挑战家庭导航是一个既定的模式，以促进参与 诊断和治疗服务，包括对有ASD风险的婴幼儿进行早期干预。然而，在这方面， 家庭导航尚未在ASD+儿童中进行测试。卫生信息技术尚未 作为家庭导航的一部分进行系统测试。整合这些技术是关键的下一步 提高家庭导航的有效性和实施。本提案接下来将解决这一问题 通过测试家庭导航的有效性和实施步骤， 针对患有ASD+的儿童（5-13岁）的导航器实施技术增强。加速 将采用“从创造到维持”模式指导技术改进的设计和试验， 家庭导航基于以用户为中心的设计原则和实现科学的可持续发展模型， 提供了从设计（第1阶段：创建）到技术支持服务的快速转变的系统指导 执行（第2阶段：试验）和维持（第3阶段：维持）。我们建议使用一个社区- 在物联网模型的指导下，采用合作方式完善和测试技术增强型家庭导航， 促进ASD+儿童的早期和持续综合MH护理。这一建议高度响应了 NIMH战略计划中的研究优先事项，数字健康技术，以推进MH服务提供模式 和HHS机构间自闭症协调委员会战略计划。此外，该提案利用了 现有的NIMH资助的倡议，以建立在MH环境中治疗ASD+儿童的能力。具体目标 目标1：调整家庭导航（FN）的内容和培训，为学龄儿童ASD+。目标二： 开发FN技术工具，以增强ASD+的FN导航器实施。目标3：检查 通过混合型技术增强型FN治疗ASD+的实施、服务和临床影响 初级保健中的有效性实施试验。初级保健中的随机阶梯式楔形设计 将与五个诊所，30个PCP和160个家庭进行，以检查变化和结果的机制。 在成功实现这些目标的基础上，我们将为ASD+提供一种技术增强型FN， 用于在不同的初级保健环境中进行大规模R 01实施和维持测试。