Educational-Clinical Linkage to Improve Health Equity for Children with Developmental Delays and Disabilities from Marginalized Communities

教育与临床联系可改善边缘化社区发育迟缓和残疾儿童的健康公平

• 批准号: 10835586
• 负责人: Reshma Shah
• 金额: $ 73.48万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10835586
• 关键词: 5 year old; Acceleration; Address; Black race; Brain; Caregivers; Caring; Characteristics; Child; Child Care; Child Rearing; Child health equity; Childhood; Chronic Care; Cities; Clinic; Clinical; Communities; Data Collection; Development; Developmental Delay Disorders; Developmental Disabilities; Documentation; Economics; Education; Effectiveness; Eligibility Determination; Evaluation; Failure; Family; Fostering; Guidelines; Health; Health Insurance; Health Services; Hispanic; Improve Access; Income; Inequity; Intervention; Interview; Knowledge; Low income; Measures; Mediating; Mediator; Medical Education; Mental Health; Methods; Modeling; Morbidity - disease rate; Not Hispanic or Latino; Nursery Schools; Outcome; Parents; Participant; Preventive care; Quality of life; Randomized; Recommendation; Research; School Health Services; School-Age Population; Scientific Advances and Accomplishments; Services; Stress; Structural Racism; Surveys; System; Testing; Therapeutic; United States Agency for Healthcare Research and Quality; Waiting Lists; arm; care systems; child services; clinical care; critical period; design; early childhood; education access; effectiveness evaluation; effectiveness testing; effectiveness/implementation hybrid; evidence base; group intervention; health care disparity; health equity promotion; implementation evaluation; implementation measures; implementation outcomes; improved; innovation; intervention effect; lower income families; marginalized community; neighborhood safety; novel; patient centered medical home; peer; pilot test; primary outcome; resilience; secondary outcome; service delivery; skills; social; social health determinants; success; treatment as usual; virtual

ABSTRACT Societal and structural inequities have resulted in longstanding health care disparities among Black, Hispanic, and low-income preschool-age children with developmental delays and disabilities (PCw/DD) depriving them of educational and therapeutic services which foster development and improve later academic, economic, and health outcomes. Studies also indicate when children receive these needed services, their parents benefit with improvements in mental health, stress, and quality of life. The scientific objectives of this proposal are to 1) test effective strategies to increase access to ECSE services among PCw/DD from historically marginalized communities; and 2) characterize potential mechanisms by which such strategies may lead to improved multilevel health outcomes. Preschool and Me (PreM) is a novel community clinical linkage (CCL) designed for clinical settings serving historically marginalized communities. Combining key components of CCLs with a personalized medical-education care plan and remote navigator support, PreM targets different levels of influence impacting therapeutic access identified in our prior research. In pilot testing, PreM was feasible to deliver, acceptable to parents, and demonstrated preliminary efficacy on completed ECSE evaluations among families attending a pediatric clinic serving largely Black and Hispanic families from low-income communities. Thus, this R01 application proposes to utilize a hybrid effectiveness-implementation approach to test PreM in two models of real-world service delivery conditions. Participants (n=320) will be randomized to either: 1) 6 months of PreM (intervention group) or 2) a waitlist control arm beginning the intervention after a 6-month delay. We will follow all participants for 12 months with data collection occurring at 4 timepoints (baseline, 3-, 6- and 12-months). Our specific aims are to test effectiveness of PreM on indicators of ECSE access (primary) and child-, parent-, family- and health service outcomes (secondary); examine theoretically derived mediators of intervention effects using a mixed methods approach; and explore social determinants of health as potential moderators. We will also simultaneously conduct a mixed methods implementation evaluation focusing on implementation outcomes to serve as indicators for implementation success; measures of implementation quality; and intermediate outcomes to understand and address successes and failures in relation to clinical outcomes. The results of this project have the potential to: 1) advance scientific knowledge about how gaps and delays in educational and therapeutic services impact health outcomes among PCw/DD and their families; 2) identify mechanisms to increase access to ECSE services and address longstanding health care disparities; and 3) support effective implementation of educational-clinical linkage models within pediatric clinical settings serving historically marginalized communities which can be utilized to improve health outcomes for families and their children with a range of health conditions.

摘要 社会和结构性的不平等导致了黑人、西班牙裔、 和低收入学龄前儿童发育迟缓和残疾(PCW/DD)，剥夺了他们 教育和治疗服务，促进发展并改善以后的学术、经济和 健康结果。研究还表明，当孩子们获得这些所需的服务时，他们的父母将受益于 改善精神健康、压力和生活质量。这项提议的科学目标是：1)测试 从历史上被边缘化的PCW/DD增加获得ECSE服务的有效战略 社区；以及2)描述这些战略可能导致改进的潜在机制 多层次的健康结果。学前班和我(PREM)是一种新的社区临床联系(CCL)，专为 为历史上被边缘化的社区服务的临床环境。将CCLS的关键组件与 个性化医疗教育护理计划和远程导航器支持，PREM针对不同级别的 在我们之前的研究中确定的影响治疗获得的影响。在试点测试中，Prem是可行的 交付，家长可以接受，并在完成的ECSE评估中展示了初步效果 在儿科诊所就诊的家庭主要为来自低收入社区的黑人和西班牙裔家庭服务。 因此，此R01应用程序建议使用混合有效性实现方法来测试Prem 两个真实世界服务交付条件的模型。参与者(n=320)将随机分为以下两组：1)6 前6个月(干预组)或2)等待控制组在6个月后开始干预 延迟。我们将跟踪所有参与者12个月，在4个时间点进行数据收集(基线，3-， 6个月和12个月)。我们的具体目标是测试PREM在ECSE准入指标上的有效性(主要) 和儿童、父母、家庭和健康服务结果(次要)；审查理论上衍生的中介因素 使用混合方法评估干预效果；探索潜在的健康社会决定因素 版主。我们还将同时进行混合方法实施评估，重点是 执行成果，作为执行成功的指标；执行措施 质量；和中间结果，以了解和解决与临床相关的成功和失败 结果。该项目的成果有可能：1)促进有关差距如何的科学知识 教育和治疗服务的延误影响了儿童和儿童及其家人的健康结果； 2)确定各种机制，以增加获得ECSE服务的机会，并解决长期存在的卫生保健差距； 3)支持在儿科临床环境中有效实施教育-临床联动模式 服务于历史上被边缘化的社区，可用于改善家庭的健康状况 和他们的孩子有一系列的健康状况。