Adapting and Implementing an Integrated Care Model for Youth with Autism Spectrum Disorder and Psychiatric Comorbidity

适应和实施针对患有自闭症谱系障碍和精神共病的青少年的综合护理模式

• 批准号: 9313473
• 负责人: Nicole A Stadnick
• 金额: $ 20.33万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9313473
• 关键词: Attention; Autistic Disorder; Caregivers; Caring; Child; Child Care; Child health care; Childhood; Chronic; Clinical; Communities; Community Services; Comorbidity; Complex; Consultations; Custom; Data; Development; Diagnostic; Doctor of Philosophy; Early identification; Effectiveness; Electronic Health Record; Expenditure; Goals; Grant; Health Care Costs; Health Services Accessibility; Health Services Research; Health system; Healthcare; Impairment; Improve Access; Influentials; Knowledge; Lead; Link; Mental Health; Mental Health Services; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; National Institute of Mental Health; Needs Assessment; Outcome; Participant; Patients; Population; Positioning Attribute; Preparation; Prevalence; Primary Health Care; Procedures; Process; Provider; Public Health; Randomized; Reporting; Research; Research Activity; Research Priority; Risk; School-Age Population; Services; Strategic Planning; Structure; Technology; Testing; Training; Training Activity; Translating; United States National Institutes of Health; Youth; autism spectrum disorder; career; clinical practice; community partnership; cost; design; evidence base; experience; functional disability; health care service; high risk population; implementation research; implementation science; improved; medical specialties; meetings; member; personalized approach; primary care setting; screening; skills; systems research; theories

Project Summary. The purpose of this revised K23 Mentored Patient-Oriented Research Career Development Award is to assist the applicant in acquiring the skills needed for an independent research career in implementation and sustainment of pediatric integrated mental health care for children with Autism Spectrum Disorder (ASD). Children with ASD represent a rapidly growing, high-priority clinical population with multiple service needs including access to effective mental health treatment given high rates of psychiatric comorbidity when using structured research assessments. Pediatric primary care is a critical and ongoing point of health care access for children with ASD and thus represents an ideal setting for services linkage and identification of additional service needs. However, children with ASD have high unmet mental health needs due, in part, because identifying MH problems in these children is complex, under-identified, and subject to diagnostic overshadowing in which comorbid mental health problems are overlooked due to a more pronounced condition like ASD. Given this, efforts to improve integrated primary-mental health care with specific focus on mental health screening and linkage to mental health care requires a tailored approach for children with ASD. Under the mentorship of Gregory Aarons, Ph.D. (primary sponsor and mentor) and expert implementation and services research consultants, the applicant will pursue training in: 1) implementation science theory and methodology to apply to pediatric integrated health care service delivery models for children with ASD, 2) pediatric cross-systems research for children with ASD, 3) electronic health record technology in pediatric primary care to facilitate improved integrated care for children with ASD, and 4) adaptive randomized designs for large-scale effectiveness and implementation services research. These training goals will facilitate pursuit of the following research aims: 1) identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD, 2) adapt integrated care procedures into “Access To Tailored Autism INtegrated Care,” ATTAIN, to facilitate identification of mental health problems and linkage to evidence-based care for youth with ASD, and 3) conduct an open trial feasibility pilot test in pediatric primary care with providers and caregivers of children with ASD. This proposal strongly aligns with Objective 4.1 of the NIMH Strategic Plan “improve the efficiency and effectiveness of existing mental health services” and research priorities identified by the HHS Interagency Autism Coordinating Committee through its targeted focus on the urgent need to improve mental health services access and coordination for children with ASD. The strong training and research experience will effectively position the applicant for an independent research career that intersects implementation science and pediatric integrated services research for children with ASD and additional psychiatric comorbidities.

项目摘要。本修订版K23指导的以患者为导向的研究生涯的目的 发展奖旨在帮助申请人获得独立研究生涯所需的技能 实施和维持自闭症儿童的儿科综合精神卫生保健 自闭症（ASD）。ASD儿童代表了一个快速增长的高优先级临床人群， 服务需求，包括获得有效的精神卫生治疗，因为精神科合并症的发生率很高 使用结构化研究评估时。儿科初级保健是一个关键和持续的健康点 为ASD儿童提供护理，因此代表了服务联系和识别的理想环境， 额外的服务需求。然而，ASD儿童有很高的未满足的心理健康需求，部分原因是， 因为在这些儿童中识别MH问题是复杂的，识别不足，并且需要诊断 阴影，其中共病的心理健康问题被忽视，由于更明显的条件 比如自闭症有鉴于此，改善综合初级精神卫生保健，特别是精神卫生保健， 健康筛查和与精神卫生保健的联系需要为自闭症儿童量身定制的方法。下 Gregory Aarons博士的指导（主要发起人和导师）和专家实施， 服务研究顾问，申请人将追求培训：1）实施科学理论和 适用于ASD儿童的儿科综合保健服务提供模式的方法，2） 针对自闭症谱系障碍儿童的儿科跨系统研究，3）儿科电子健康记录技术 初级保健，以促进改善ASD儿童的综合护理，以及4）适应性随机设计 进行大规模的有效性和实施服务研究。这些训练目标将有助于追求 （1）确定改善精神健康筛查的目标， ASD儿童初级保健中的卫生服务，2）将综合护理程序纳入“获得 定制自闭症综合护理，”ATTAIN，以促进精神健康问题的识别和联系， 对患有ASD的青少年进行循证护理，以及3）在儿科初级 与ASD儿童的提供者和照顾者一起照顾。这一建议与《联合国千年宣言》的目标4.1非常一致。 NIMH战略计划“提高现有精神卫生服务的效率和有效性”和研究 HHS机构间自闭症协调委员会通过有针对性地关注 迫切需要改善ASD儿童的心理健康服务获得和协调。坚强 培训和研究经验将有效地定位申请人的独立研究生涯， 交叉实施科学和儿科综合服务研究与自闭症儿童， 其他精神病合并症。