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

检查早期开始丹佛模式在为自闭症儿童服务的社区项目中的有效性

• 批准号: 10725999
• 负责人: Aubyn C. Stahmer
• 金额: $ 93.83万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10725999
• 关键词: Acceleration; Adaptive Behaviors; Address; Affect; Behavior Therapy; Caregivers; Caring; Child; Child Rearing; Clinical Trials; Clinical effectiveness; Communities; Community Practice; Community Trial; Competence; Data; Data Collection; Development; Drug Prescriptions; Education; Effectiveness; Effectiveness of Interventions; Ensure; Environment; Ethnic Origin; Family; Funding; Geographic Locations; Goals; Growth; Hybrids; Improve Access; Insurance; Intervention; Language; Learning; Learning Skill; Manuals; Measures; Mediating; Meta-Analysis; Methods; Modeling; Motivation; Outcome; Parents; Participant; Pilot Projects; Provider; Public Health; Quality of Care; Race; Randomized, Controlled Trials; Regulation; Research; Sampling; Science; Services; Structure; Symptoms; System; Testing; Time; Training; acceptability and feasibility; applied behavior analysis; autism community; autism spectrum disorder; autistic; autistic children; caregiver education; community setting; cost; effective intervention; effectiveness evaluation; effectiveness testing; effectiveness/implementation design; efficacy study; efficacy testing; efficacy trial; ethnic diversity; evidence base; health goals; implementation barriers; implementation determinants; implementation outcomes; improved; language outcome; programs; provider adherence; randomized controlled design; satisfaction; scale up; secondary outcome; service delivery; social; social communication; social engagement; social learning; systematic review; theories; treatment as usual; treatment effect; treatment group; usability

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.

项目概要 被认定患有自闭症的儿童数量不断增加，导致营利性应用呈指数级增长 为他们服务的行为分析 (ABA) 机构，使用可能不常见的高度结构化的方法 适合幼儿1的发展，并且限制了在不同环境和时间范围内使用学到的技能， 公众对有限的有效性数据和服务成本的日益关注。 功效测试导致了基于证据的自闭症干预措施（EBI）的增长，特别是自然主义干预措施 发育行为干预（NDBI），得到多项临床试验的支持。 NDBI 整合了理论和 来自 ABA 和发展科学的策略被认为是自闭症儿童的最佳实践。 缺乏关于社区机构 (CBA) 中 NDBI 使用的有效性数据导致有限 作为付款人的资助更有可能认可较旧的结构化方法。丹佛早期模式 (ESDM) 是一项综合性 NDBI，旨在改善年轻人的社交沟通和语言成果 多项对照功效研究中的自闭症儿童。 ESDM 将社会动机作为一种机制 增加儿童参与环境中的社会学习机会，从而提高 孩子学习。 ESDM 包括满足资助者要求的评估和数据收集方法以及 测试了社区培训模型。了解 ESDM 是否有效以及是否相同的治疗方法 在功效试验中运作的机制也在不同样本的社区实施中运作 是确定 NDBI（如 ESDM）实现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。为了扩大规模，我们与自闭症 CBA 合作，这项研究将确定因素 影响 ESDM 在社区中的实施。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。儿童的主要成果包括语言和社交沟通。次要结果 包括适应性行为、家长对 ESDM 策略的使用以及提供者对模型的忠诚度。社会动机 护理人员的忠诚度将作为中介变量进行衡量。母亲教育的调节作用 将检查儿童种族/民族和提供商 ESDM 保真度。 ESDM 实施的决定因素将是 探索过。了解 ESDM 等干预措施的有效性、调节和调节的变量 适度的儿童成果以及将其行动机制纳入社区使用，有可能 增加可用性，从而为所有自闭症儿童，特别是自闭症儿童提供高质量干预的机会 那些来自不同背景、依赖公共服务的人。了解实施决定因素 将支持在整个社区推广有效模式。