Examining the Effectiveness of the Early Start Denver Model in Community Programs serving Young Autistic Children

项目摘要 越来越多的儿童被确定为自闭症，导致以营利为目的的应用程序呈指数增长 行为分析（ABA）机构为他们服务，使用高度结构化的方法， 适合幼儿发展1，而且在不同环境和时间内对所学技能的使用有限， 以及对有限的有效性数据和服务成本的日益增长的公共卫生担忧。 功效测试促进了循证自闭症干预措施（EBI）的发展，尤其是自然主义干预措施 发展行为干预（NDBI），得到多项临床试验的支持。NDBI整合了理论和 ABA和发展科学的策略，被认为是自闭症儿童的最佳实践。 缺乏关于NDBI在社区机构（CBAs）中使用的有效性数据， 作为付款方的供资更有可能承认较旧的结构化方法。丹佛早期模式 （ESDM）是一项全面的NDBI，旨在改善年轻人的社会沟通和语言成果 自闭症儿童在多个控制的功效研究。ESDM将社会动机作为一种机制， 增加儿童在环境中参与社会学习的机会， 儿童学习。ESDM包括满足资助者要求的评估和数据收集方法， 测试社区培训模式。了解ESDM是否有效，以及相同的治疗是否有效 在功效试验中运行的机制也在具有不同样本的社区实施中运行 是确定NDBIs（如ESDM）满足以下公共卫生目标的潜力的关键科学问题： 改善广大自闭症儿童获得高质量、适合发展的护理的机会 和他们的家人。为了促进规模扩大，我们与自闭症CBAs合作，这项研究将确定因素 影响社区实施ESDM的因素。该项目将使用混合1型随机 受控设计，以检查ESDM在社区中的有效性，并收集实施数据 决定因素主要的儿童成果包括语言和社会沟通。次要结局 包括自适应行为、ESDM策略的父代使用以及提供程序对模型的忠诚度。社会动机 和照顾者忠诚度将被测量为中介变量。母亲教育的调节作用， 将检查儿童种族/民族和提供者ESDM忠诚度。ESDM实施的决定因素将是 探讨了了解像ESDM这样的干预措施的有效性，中介变量， 适度的儿童成果，以及社区使用其行动机制的参与，有可能 增加所有自闭症儿童获得高质量干预的机会， 那些来自不同背景，依赖公共服务的人。理解执行决定因素 将支持在整个社区推广有效的模式。

PROJECT SUMMARY The rising number of children being identified as autistic has led to exponential growth in for-profit applied behavior analysis (ABA) agencies serving them, the use of highly structured approaches that may not be developmentally appropriate for young children1 and that limit use of learned skills across settings and time, and growing public health concerns regarding limited effectiveness data combined with the cost of services. Efficacy testing has led to growth in evidence-based autism interventions (EBI), especially naturalistic developmental behavior interventions (NDBIs), supported by multiple clinical trials. NDBIs integrate theory and strategies from ABA and developmental science and are considered best practice for young autistic children. The lack of effectiveness data regarding NDBI use in community-based agencies (CBAs) contributes to limited funding as payors are more likely to recognize older, structured methods. The Early Start Denver Model (ESDM) is a comprehensive NDBI shown to improve social communication and language outcomes for young autistic children in multiple controlled efficacy studies. ESDM engages social motivation as a mechanism to increase child engagement in social learning opportunities in the environment resulting in increased rate of child learning. ESDM includes assessment and data collection methods that meet funder requirements and a tested community training model. Understanding whether ESDM is effective and whether the same treatment mechanisms operating in efficacy trials are also operating in community implementation with diverse samples are critical scientific questions to determine the potential of NDBIs like ESDM to meet the public health goals of improving access to high quality, developmentally appropriate care for a broad range of young autistic children and their families. To facilitate scale up, we have partnered with autism CBAs and this study will identify factors that affect implementation of ESDM in the community. This project will use a hybrid type 1 randomized controlled design to examine ESDM effectiveness in the community and to gather data on implementation determinants. Primary child outcomes include language and social communication. Secondary outcomes include adaptive behavior, parent use of ESDM strategies, and provider fidelity to the model. Social motivation and caregiver fidelity will be measured as mediating variables. The moderating effects of maternal education, child race/ethnicity, and provider ESDM fidelity will be examined. ESDM implementation determinants will be explored. Understanding the effectiveness of an intervention like ESDM, the variables that mediate and moderate child outcomes, and engagement of its mechanisms of action in community use, has the potential to increase availability, and therefore, access to high quality intervention for all young autistic children, especially those from diverse backgrounds who depend on public services. Understanding implementation determinants will support scale-up of effective models throughout communities.