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.

抽象的 社会和结构不平等导致黑人，西班牙裔，长期以来的医疗保健差异 以及低收入的学龄前儿童发育延迟与残疾儿童（PCW/DD）剥夺了他们 教育和治疗服务促进发展并改善后来的学术，经济和 健康结果。研究还表明，何时孩子获得这些需要的服务，他们的父母受益 改善心理健康，压力和生活质量。该提议的科学目标是1）测试 从历史上边缘化的PCW/DD中增加PCW/DD之间获得ECSE服务的有效策略 社区； 2）表征这种策略可能会改善的潜在机制 多级健康结果。幼儿园和我（PREM）是一个新颖的社区临床联系（CCL） 为历史上边缘化社区提供服务的临床环境。将CCL的关键组件与 个性化的医学教育护理计划和远程导航员支持，PREM针对不同的水平 影响我们先前研究中确定的治疗访问的影响。在飞行员测试中，PERS是可行的 交付，可供父母接受，并在完成的ECSE评估中表现出初步疗效 在一家小儿诊所参加的家庭，在很大程度上为黑人和来自低收入社区的西班牙裔家庭服务。 因此，此R01应用建议利用混合有效性实施方法来测试PERM 实际服务交付条件的两种型号。参与者（n = 320）将被随机分为：1）6 PERM的月份（干预组）或2）6个月后开始干预的候补控制臂 延迟。我们将跟随所有参与者12个月，在4个时间点上进行数据收集（基线，3-，， 6个月和12个月）。我们的具体目的是测试PREM对ECSE访问指标（主要）的有效性 以及儿童，家长，家庭和健康服务成果（中学）；审查理论派生的调解人 采用混合方法方法的干预效果；并探索健康的社会决定因素作为潜力 主持人。我们还将同时进行重点的混合方法实施评估 实施成果是作为实施成功指标的指标；实施度量 质量;以及中级结果以了解和解决与临床有关的成功和失败 结果。该项目的结果有可能：1）提高有关差距的科学知识 教育和治疗服务的延迟会影响PCW/DD及其家人的健康状况； 2）确定增加获得ECSE服务并解决长期保健差异的机制； 3）支持在儿科临床环境中有效实施教育 - 临床连锁模型 为历史上边缘化的社区提供服务，可用于改善家庭的健康状况 和他们的孩子有一系列健康状况。