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）的早期发现和（B）增加对自闭症特定早期干预服务的抢先体验，特别是对那些通常没有获得早期干预服务的已知好处的儿童。这项拟议的研究建立在一项受资助的多阶段筛查研究的基础上，该研究目前正在3个早期干预项目中实施，这些项目为承诺圈的儿童提供服务，该承诺圈是一个具有高社会/经济风险的波士顿地区，其中包括高比例的少数种族/民族人口，英语学习者或贫困儿童。美国的ASD发病率正在上升，最近的估计表明，88个儿童中就有1个患有ASD。早期诊断和干预对于确保最佳长期结果至关重要;但在诊断率和年龄方面存在显著差异。上述群体中的儿童被诊断的可能性较小，并且比白色、非贫困、讲英语的儿童晚1-2年被诊断。这种延迟限制了获得自闭症特异性早期治疗的机会。及时识别和治疗至少需要两个步骤：1）了解和识别ASD的早期症状，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，及早采取行动要求有关群体评估早期迹象，并选择是/否的行动方案，我们称之为临床阈值。我们认为，早期识别和获得护理可以通过增加对ASD早期体征的了解以及影响这些关于何时筛查，评估和参考ASD特定干预措施的决策阈值来改善。此外，获得服务需要这些决策者之间达成协议与合作。在我们之前的理论工作以及与儿科医生和EI提供者的合作的指导下，我们将通过提供以下服务来改善ASD儿童所需服务的获得和接受：（1）对所有14-24个月的EI登记儿童进行多阶段ASD筛查，（2）对有资格获得ASD服务的儿童的父母进行动机访谈，以及（3）对EI站点的儿科医生进行系统的外展。这种系统级方法涉及改变儿科医生、EI提供者和家长评估ASD迹象并对其采取行动的背景，以减少获得ASD诊断和服务的差异。本研究将检验以下假设：1）无论种族/民族、语言或贫困状况如何，接触自闭症的儿童将更有可能被识别、转诊和接受自闭症服务; 2）接触儿科医生和EI提供者将识别更多的自闭症儿童，并以更高的比率转诊评估和服务;和3）自闭症儿童的暴露父母将报告更大的协议，并将更有可能遵循自闭症特定的评估和服务转介。

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.