Examining co-production as an implemntation strategy for autism early intervention delivered in Part C service systems

项目总结/摘要 这个K23职业发展奖的目的是支持申请人获得知识， 作为一个独立的研究生涯所需的技能实施科学家谁评估战略， 加强早期干预对自闭症谱系障碍（ASD）儿童的影响， 多样化的服务体系。它将通过补充候选人的社区背景来实现这一点 在干预保真度和适应性，临床决策方面与专家指导进行研究， 临床试验设计和评估，以及[代表性不足的儿童中的自闭症服务不平等]。 获得早期干预的持续差异损害了自闭症儿童的生活质量， 家庭，并可以通过翻译循证治疗，如父母介导的干预措施， （PMIs）纳入服务系统，这是照顾幼儿的一个接入点。虽然翻译工作 正在进行中，高损耗已经损害了PMI的影响，当交付的胜利被边缘化时， 社区.这一差距可能反映了对以保持保真度的方式实施PMI的重视， 有时也与PMI中不可避免地出现的代表性不足的家庭的复杂需求相冲突。这 K23提案将通过评估联合制作或忠诚与家庭之间的平衡来解决这一差距- 中心护理，在ASD的循证PMI中，项目ImPACT，在国家资助的早期 干预系统。主要利益攸关方将使用第一个研究目标的混合方法结果， 制定和评估一项实施战略，以理想的共同生产为目标，以提高护理人员的能力 在项目ImPACT中。在劳伦斯·斯卡希尔博士的主要指导下，的专家 ASD的临床试验，以及Aubyn Stahmer博士的共同指导，Chris Sheldrick博士，[and詹妮弗 Singh，PhD.]，申请人将接受以下方面的培训：1）早期干预的保真度和适应性; 2）临床和 共同决策; 3）临床试验的设计和执行;以及[4]文化多样性和系统性 不平等]。这些领域的培训将提高申请人对以下研究目标的追求： 评估ImPACT项目内的联合生产; 2）制定一项实施战略，以实现理想的联合生产。 通过教授忠诚和以家庭为中心的护理之间的平衡，在ImPACT项目中进行生产;以及3）行为 一项试点随机试验，以评估评估项目ImPACT培训的可行性时，与合作， 生产实施战略（项目ImPACT-C）与通常的项目ImPACT培训相比 （项目ImPACT-TAU）。该提案与NIMH的战略目标[4.3a]相一致， 采取干预措施，考虑到调节因素，包括健康的社会决定因素， 代表性不足的群体]。此外，K23中嵌入的强大的培训和研究计划 提案将有效地定位申请人的独立研究生涯评估战略， 当在不同的服务系统中实施时，提高ASD干预的服务成果。

PROJECT SUMMARY/ABSTRACT The purpose of this K23 Career Development Award is to support the applicant in acquiring the knowledge and skills needed for an independent research career as an implementation scientist who evaluates strategies that enhance the impact of early intervention for children with Autism Spectrum Disorder (ASD) when delivered in diverse service systems. It will achieve this by complementing the candidate’s background in community engaged research with expert mentorship in intervention fidelity and adaptation, clinical decision making, clinical trial design and evaluation, and [autism service inequities among underrepresented children]. Persistent disparities accessing early intervention compromise the quality of life of autistic children and their families and can be addressed by translating evidence-based treatments, such parent-mediated interventions (PMIs), into service systems that are an access point to care for young children. Although translation efforts are under way, high attrition has compromised the impact of PMIs when delivered win marginalized communities. This gap may reflect an emphasis on implementing PMIs in a manner that maintains fidelity while also at times conflicting with the complex needs of underrepresented families that inevitably arise in PMI. This K23 proposal will address this gap by evaluating co-production, or the balance between fidelity and family- centered care, within an evidence-based PMI for ASD, Project ImPACT, delivered in a state-funded Early Intervention system. Mixed-methods findings from the first research aim will be used by key stakeholders to develop and evaluate an implementation strategy that targets ideal co-production to enhance caregiver engagement within Project ImPACT. Under the primary mentorship of Lawrence Scahill, Ph.D., an expert in clinical trials for ASD, and co-mentorship from Aubyn Stahmer, Ph.D., Chris Sheldrick, Ph.D., [and Jennifer Singh, PhD.], the applicant will pursue training in: 1) early intervention fidelity and adaptation; 2) clinical and shared decision making; 3) the design and execution of clinical trials; and [4) cultural diversity and systemic inequities]. Training in these areas will enhance the applicant’s pursuit of the following research aims: 1) Evaluate co-production within Project ImPACT; 2) Develop an implementation strategy that targets ideal co- production within Project ImPACT by teaching the balance of fidelity and family-centered care; and 3) Conduct a pilot randomized trial to assess the feasibility of evaluating Project ImPACT training when paired with the co- production implementation strategy (Project ImPACT-C) in comparison to Project ImPACT training as usual (Project ImPACT-TAU). This proposal is aligned with NIMH’s strategic objective [4.3a to adapt evidence-based intervention to account for moderators, including social determinants of health, that impact effectiveness among underrepresented groups]. Further, the strong training and research plans embedded within this K23 proposal will effectively position the applicant for an independent research career evaluating strategies that enhance the service outcomes of ASD interventions when implemented within diverse service systems.