Addressing systemic health disparities in early ASD identification and treatment

描述（由申请人提供）：拟议工作的目标是实施系统级干预，以(a)改善自闭症谱系障碍（ASD）的早期发现，(b)增加早期获得自闭症特定早期干预服务的机会，特别是对于那些通常没有得到已知早期干预服务益处的儿童。拟议的研究建立在一项资助的多阶段筛选研究的基础上，该研究目前正在3个早期干预项目中实施，这些项目服务于波士顿地区“希望之圈”的儿童，该地区社会/经济风险高，儿童中有很大比例来自种族/少数民族人口、英语学习者或生活贫困的儿童。美国的自闭症发病率正在上升，最近的估计表明每88名儿童中就有1名患有自闭症。早期诊断和干预对于确保最佳的长期结果至关重要；然而，在诊断率和诊断年龄方面存在显著差异。上述群体的儿童被诊断的可能性较小，并且比白人，非贫困，说英语的儿童晚1-2年。这种延迟限制了获得针对自闭症的早期治疗。及时识别和治疗至少需要两个步骤：1)了解和识别ASD的早期迹象，2)及早采取行动。儿科医生、家长和EI提供者必须决定孩子是否表现出足够的迹象来证明进一步的评估或治疗是合理的，或者孩子的风险是否足够低，可以放弃立即采取行动。因此，尽早采取行动要求志愿者小组评估早期症状，并选择一个是/否的行动方案，我们将其称为临床阈值。我们相信，通过提高对ASD早期症状的认识，以及通过影响筛查、评估和参考ASD特异性干预措施的决策阈值，可以改善早期识别和获得护理的机会。此外，获得服务需要这些决策者之间的协议和合作。在我们之前的理论工作以及与儿科医生和EI提供者的接触的指导下，我们将通过提供：(1)对所有参与EI的14-24个月的儿童进行多阶段ASD筛查，(2)对符合ASD服务条件的儿童的父母进行动机性访谈，以及(3)对EI站点的儿科医生进行系统的外展，从而改善ASD儿童获得所需服务的机会和接受情况。这种系统级的方法包括改变儿科医生、EI提供者和家长评估ASD迹象并采取行动的环境，以减少在获得ASD诊断和服务方面的差异。本研究将检验以下假设：1)暴露于自闭症谱系障碍的儿童将更有可能被识别、转诊和接受自闭症谱系障碍服务，无论种族/民族、语言或贫困状况如何；2)暴露的儿科医生和EI提供者会识别出更多的自闭症儿童，并以更高的比例进行评估和服务；3)接触过自闭症儿童的父母会更认同并更有可能跟进自闭症特定评估和服务转介。

DESCRIPTION (provided by applicant): The goal of the proposed work is to implement a system-level intervention to (a) improve early detection of autism spectrum disorders (ASD) and (b) increase early access to autism specific early intervention services, especially for children who often are not given the known benefits of early intervention services. The proposed study builds on a funded multi-stage screening study that is currently being implemented in 3 Early Intervention programs serving children in the Circle of Promise, a Boston region with high social/economic risk and comprised of a high percentage of children from racial/ethnic minority populations, English language learners, or living in poverty. ASD Rates are increasing in the U.S., with recent estimates indicating that 1 in 88 children have ASD. Early diagnosis and intervention are crucial to ensuring optimal long-term outcomes; yet significant disparities exist in rates and age of diagnosis. Children in the above groups are less likely to be diagnosed and are diagnosed 1-2 years later than White, non-poor, English speaking children. This delay limits access to autism-specific early treatments. Timely identification and treatment requires at least two steps: 1) knowing and identifying the early signs of ASD, and 2) acting early. Pediatricians, parents, and EI providers must decide whether a child is showing enough signs to justify further assessment or treatment, or whether the child is at low enough risk to forego immediate action. Thus, acting early requires the about groups to evaluate the early signs and choose a yes/no course of action, which we refer to as a clinical threshold. We believe that early identification and access to care can be improved both by increasing knowledge of the early signs of ASD and by influencing these decision thresholds regarding when to screen, assess, and refer to ASD-specific interventions. Moreover, access to services requires agreement and cooperation among these decision-makers. Guided by our prior theoretical work and engagement with pediatricians and EI providers, we will influence improved access and receipt of needed services for children with ASD by offering: (1) multistage ASD screening to all EI-enrolled children ages 14-24 months, (2) motivational interviewing to parents whose children qualify for ASD services, and (3) systematic outreach to pediatricians from EI sites. This system- level approach involves altering the context in which pediatricians, EI providers, and parents assess and act on signs of ASD to reduce disparities in access to ASD diagnosis and services. This study will test the following hypotheses: 1) Exposed children with ASD will be more likely to be identified, referred, and receive ASD services, regardless of race/ethnicity, language or poverty status; 2) Exposed pediatricians and EI providers will identify more children with ASDs and refer to assessment and services at higher rates; and 3) Exposed parents of children with ASD will report greater agreement with and will be more likely to follow through on ASD-specific assessment and service referrals.