Reducing Disparities in Early Intervention Use: The Opening Doors to Early Intervention Study

项目摘要 发育迟缓在幼儿中经常遇到，对儿童的影响不成比例 贫困的少数族裔儿童导致儿童早期发展的差距。促进儿童健康 发展，《残疾人教育法》(IDEA)规定了早期干预(EI)服务 向有延迟的幼儿提供，但只有一半的高危儿童开始并完成EI 服务。因此，许多高危儿童可能得不到改善其发展所需的服务。至 为了促进EI服务的启动和完成，我们制定了开放门户早期干预计划， 基于健康信念模型的针对高危城市少数民族的患者导航干预 孩子们。在高危儿童中进行的初步初步研究证明了可行性，并产生了令人振奋的结果。 因此，这个基于社区的参与式研究应用程序建议测试此应用程序的有效性 计划在单个城市县使用随机试验设计。具体目标是：1)确定 门户开放早期干预方案对儿童发育状况和早期精神分裂症转诊的影响 和服务使用，2)评估父母在早期干预中的参与是否中介了 计划，以及3)探索家庭学习环境、父母健康素养和贫困 缓和该计划的效果。这个应用程序通过测试解决儿童早期的健康差距 旨在提高城市少数民族儿童及其家庭参与教育的干预措施 关于儿童早期发展和精神卫生服务使用的措施。三到四家初级保健儿科诊所 为这个多元化的城市社区提供关爱将被招募参与。三百六十个孩子 年龄不到30个月，并已被确定为发育风险，并被转介到精神分裂症服务 在参与的诊所将随机接受开放的早期干预计划或通常 关心。以前参加过EI服务的城市少数民族家长将接受患者培训 导航员为家庭提供教育、激励和帮助，帮助他们开始和完成EI 推荐和服务。临床医生和儿童发现工作人员将提供常规护理，包括 在没有协助的情况下进行筛选和转介。关于参与者的人口统计特征、健康状况的信息 识字率和基线的家庭学习环境；家长参与和EI转介和服务 在3个月、6个月、9个月和12个月完成；12个月的儿童发育将在预定时间内收集 参观考察。干预和对照参与者之间的结果差异将使用以下方法进行比较 意向治疗分析。这项比较有效性研究的结果可以传播给类似的人 全美大城市县通知儿童发现和EI程序并解决早期差异 儿童发展。

Project Summary Developmental delays are frequently encountered among young children and disproportionately affect impoverished minority children leading to disparities in early child development. To promote healthy child development, the Individuals with Disabilities Education Act (IDEA) mandated early intervention (EI) services be made available to young children with delays, but only half of at-risk children initiate and complete EI services. As a result, many at-risk children may not receive needed services to improve their development. To foster initiation and completion of EI services, we developed the Opening Doors to Early Intervention Program, a patient navigation intervention based on the Health Belief Model and targeted to at-risk urban minority children. An initial pilot study among at-risk children demonstrated feasibility and generated promising results. Therefore, this Community-Based Participatory Research application proposes to test the effectiveness of this program in a single urban county using a randomized trial design. The specific aims are to 1) determine the effectiveness of the Opening Doors to early Intervention Program on child developmental status and EI referral and services use, 2) assess whether parent engagement in early intervention mediates the effects of the program, and 3) explore whether the home learning environment, parental health literacy, and poverty moderate the effects of the program. This application addresses health disparities in early childhood by testing an intervention designed to improve participation rates in EI among urban minority children and their families on measures of early child development and EI services use. Three to four primary care pediatric clinics that provide care to this diverse urban community will be recruited to participate. Three hundred sixty children who are less than 30 months of age and have been identified as developmentally at-risk and referred for EI services at participating clinics will be randomized to receive the Opening Doors to Early Intervention Program or usual care. Urban minority parents who have previously participated in EI services will be trained as patient navigators to provide education, motivation, and assistance for families with initiation and completion of EI referrals and services. Clinicians and Child Find staff will provide usual care consisting of developmental screening and referrals without assistance. Information on participant demographic characteristics, health literacy, and the home learning environment at baseline; parent engagement and EI referral and services completion at 3, 6, 9, and 12 months; and child development at 12 months will be collected during scheduled study visits. Differences in outcomes between intervention and control participants will be compared using intention-to-treat analysis. Findings from this comparative effectiveness study can be disseminated to similar large urban counties across the U.S. to inform Child Find and EI procedures and address disparities in early child development.