2/2 Effectiveness of a Multi-Level Implementation Strategy for ASD Interventions

2/2 ASD 干预措施多层次实施策略的有效性

• 批准号: 9419943
• 负责人: Aubyn C. Stahmer
• 金额: $ 71.3万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9419943
• 关键词: Adoption; Attention; Attitude; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Child Behavior; Child Care; Climate; Clinical; Collaborations; Community Services; Consultations; Data; Education; Educational Intervention; Educational process of instructing; Effectiveness; Ensure; Evidence based intervention; Funding; Hybrids; Individual; Intervention; Leadership; Link; Mediating; Mediator of activation protein; Mental Health; Mental Health Services; Methods; Modeling; Motivation; Organizational Change; Outcome; Participant; Patients; Population; Process; Provider; Public Health; Quality of Care; Randomized; Recording of previous events; Research; Research Project Grants; Role; Sample Size; Schools; Services; Site; Symptoms; System; Target Populations; Testing; Training; Translating; autism spectrum disorder; behavior change; care systems; cost; design; implementation science; implementation strategy; improved; mental health education; motivational enhancement therapy; organizational climate; organizational structure; programs; provider intervention; response; routine care; scale up; school district; teacher; treatment as usual

12. PROJECT SUMMARY The Centers for Disease Control (CDC) estimates that 1 in 68 children have autism spectrum disorder (CDC, 2014) and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. We propose to conduct two, coordinated studies testing the effectiveness of the “Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy” (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes – provider training completion and ASD EBI fidelity, and subsequent child outcomes. The TEAMS– LEAD module applies the LOCI (“Leadership and Organizational Change for Implementation”)1 strategies, and the TEAMS-PROV module applies MI (Motivational Interviewing) strategies to facilitate individual provider and organizational behavior change. These studies will use a randomized implementation/effectiveness Hybrid, Type 3, trial. Study #1 will test the TEAMS model with the AIM HI intervention (“An Individualized Mental Health Intervention for ASD”) in publicly-funded mental health services. Study #2 will test TEAMS with the CPRT intervention (“Classroom Pivotal Response Teaching”) in education settings. AIM HI and CPRT data indicate that (1) provider attitudes towards EBI and (2) implementation leadership are promising targets of implementation interventions. TEAMS will target these specific mechanisms of change. This study will randomize 37 MH programs and 37 school districts to one of four groups (TEAMS PROV+LEAD; TEAMS- LEAD; TEAMS-PROV; EBI training only) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. A dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Implementation outcomes including provider training completion, fidelity and child behavior change will be examined for 295 MH providers, 295 teachers and 590 children (combined across studies). This implementation intervention has the potential to increase quality of care for ASD in publicly-funded settings by improving effectiveness of EBI implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services.

12. 项目概要 美国疾病控制中心 (CDC) 估计，每 68 名儿童中就有 1 名患有自闭症谱系障碍 (CDC, 2014）以及美国 ASD 的年度费用 估计为2360亿美元。循证干预措施 已被开发并证明在改善儿童结局方面有效。然而，研究 在照顾这些儿童的多个服务系统中扩大这些做法的通用方法已经 是有限的，但对于满足这一日益增长的公共卫生需求至关重要。 我们建议开展两项协调一致的工作 研究测试了“将循证干预措施 (EBI) 转化为自闭症谱系障碍 (ASD) 的有效性：多层次 实施战略”（TEAMS）模型。TEAMS 专注于提高实施领导力， 组织氛围、提供者的态度和动机，以改进两个关键的实施 结果 – 提供者培训完成情况和 ASD EBI 保真度，以及随后的儿童结果。团队—— LEAD 模块应用 LOCI（“领导力和组织变革实施”）1 策略，以及 TEAMS-PROV 模块应用 MI（动机访谈）策略来促进个体提供者和 组织行为的改变。这些研究将使用随机实施/有效性混合， 类型3，试用。研究 #1 将通过 AIM HI 干预测试 TEAMS 模型（“个体化心理治疗”） 自闭症谱系障碍 (ASD) 的健康干预”）在公共资助的心理健康服务中。研究 #2 将测试齐思 (TEAMS) 与 教育环境中的 CPRT 干预（“课堂关键反应教学”）。 AIM HI 和 CPRT 数据 表明 (1) 提供商对 EBI 的态度和 (2) 实施领导力是有希望的目标 实施干预措施。 TEAMS 齐思将针对这些具体的变革机制。这项研究将 将 37 个 MH 项目和 37 个学区随机分配到四组之一（TEAMS PROV+LEAD；TEAMS- 带领; TEAM-PROV；仅 EBI 培训）以测试标准、EBI 特定培训相结合的有效性 两个团队模块单独或一起实现多个实施结果。一个拆解 设计将用于了解 TEAMS 的有效性以及跨环境的变化机制 和参与者。实施成果包括提供者培训完成情况、忠诚度和儿童行为 将对 295 名 MH 提供者、295 名教师和 590 名儿童（跨研究合并）进行检查。这 实施干预有可能通过以下方式提高公共资助环境中自闭症谱系障碍 (ASD) 的护理质量： 提高 EBI 实施的有效性。该流程和模块将可推广到多个 服务系统、提供者和干预措施，对社区服务产生广泛影响。