Addition of Social Needs to a Telephone-Based Developmental Care Coordination Randomized Controlled Trial in the Era of COVID

在新冠病毒时代，将社会需求添加到基于电话的发育护理协调随机对照试验中

• 批准号: 10575018
• 负责人: PAUL J CHUNG
• 金额: $ 13.25万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10575018
• 关键词: 5 year old; Academy; Address; Advisory Committees; Age; American; Appointment; Birth; Caring; Child; Child Behavior Checklist; Child Care; Child Health; Clinic; Clinical; Cognitive; Collaborations; Community Services; Control Groups; Costs and Benefits; Country; County; Data; Development; Developmental Delay Disorders; Drops; Early Intervention; Effectiveness; Eligibility Determination; Employment; Enrollment; Ensure; Equipment and supply inventories; Evaluation; Extravasation; Failure; Family; Federally Qualified Health Center; Gold; Health; Health Personnel; Human; Infrastructure; Intervention; Investigation; Language; Language Delays; Lead; Link; Location; Los Angeles; Measures; Medical Records; Modeling; Online Systems; Outcome; Outcome Measure; Parents; Participant; Pediatrics; Population; Preventive service; Process; Provider; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Risk; Series; Services; Site; Speech Delay; Structure; System; Systems Development; Telephone; Testing; Time; Training; Uncertainty; Visit; Well Child Visits; Work; autism spectrum disorder; base; behavior measurement; behavioral outcome; care coordination; care providers; care systems; child services; cost; cost estimate; early childhood; early screening; effectiveness testing; externalizing behavior; follow-up; group intervention; high risk; improved; improved outcome; innovation; intervention program; kindergarten; member; pediatrician; prevent; primary outcome; program costs; programs; randomized controlled study; screening; service intervention; service organization; telephone-based; tool; treatment as usual; voltage; vulnerable community

PROJECT SUMMARY/ ABSTRACT Although universal early childhood developmental screening is recommended by the American Academy of Pediatrics, ample evidence suggests that child health providers are not meeting those recommendations, and many early developmental delays are being missed. Additional evidence suggests that both providers and parents struggle to navigate the early childhood developmental system of care, with few high-risk children actually getting referred, and fewer still ultimately receiving services. The gaps in care processes have created gaps in evidence linking developmental screening to developmental outcomes, leading the US Preventive Services Task Force to state that there is not enough evidence to recommend for or against universal screening for speech and language delays or Autism Spectrum Disorders. The proposed project is a randomized controlled trial of a telephone-based early childhood developmental care coordination system, in partnership with 2-1-1 Los Angeles County (211LA), part of a national network of 2-1-1 call centers covering 93% of the US population. We will test the effectiveness of 211LA in increasing referrals for developmental evaluation, increasing the numbers of children deemed eligible for services, and increasing the number of children actually receiving interventions. The trial will enroll 662 children ages 1-3 years who receive well- childcare at one of 10 partner clinic sites. We will conduct developmental screening on all children using the Parental Evaluation of Developmental Status (PEDS) Online system, and randomize children 1:1 into intervention (connection to 211LA for developmental care coordination + usual care) or control (usual care alone, with developmental care coordination conducted by clinic staff). Primary outcomes will include referrals to early intervention evaluations, eligibility for intervention services, and receipt of services. We will measure these outcomes through parent report, medical record review, and 211LA data, at 6 months after enrollment. For children with elevated developmental risk based on the PEDS Online results, we will assess development using the PEDS: Developmental Milestones – Assessment Level (PEDS:DM-AL), conducted at baseline and 12 and 24 months after enrollment. For all children, we will administer the language subscale of the PEDS:DM- AL at baseline, 12 months and 24 months, to evaluate development over time in the two groups. We will measure behavioral outcomes for all children using the externalizing behavior subscale of the Child Behavior Checklist. Expected findings include higher rates of referrals, eligibility, and receipt of intervention services among intervention group participants, and greater developmental gains among children in the intervention group. We will also examine the costs of the program in relation to these outcomes, to estimate the costs and potential long-term benefits of this model. If effective, the model has the potential to disseminate rapidly throughout the 2-1-1 network and transform developmental care coordination in the US.

项目总结/摘要 尽管美国儿科学会建议进行普遍的儿童早期发育筛查， 儿科，充分的证据表明，儿童健康提供者没有达到这些建议， 许多早期发育迟缓被忽略了。其他证据表明，供应商和 父母们努力在幼儿发展护理系统中导航，几乎没有高危儿童 实际上得到推荐，最终接受服务的人更少。护理过程中的差距造成了 将发育筛查与发育结果联系起来的证据存在差距，导致美国预防 服务工作队指出，没有足够的证据来建议或反对普遍 筛查言语和语言延迟或自闭症谱系障碍。拟议的项目是一个 一项基于电话的儿童早期发育护理协调系统的随机对照试验， 与2-1-1洛杉矶县（2 - 1 - 1 LA）合作，该公司是2-1-1呼叫中心全国网络的一部分， 占美国人口的93%。我们将测试211 LA在增加发展转诊方面的有效性。 评估，增加被认为有资格获得服务的儿童人数， 孩子们实际上得到了干预。该试验将招募662名1-3岁的儿童，他们接受了良好的- 在10个合作伙伴诊所之一提供托儿服务。我们会使用 父母发育状况评估（PEDS）在线系统，并将儿童1：1随机分配到 干预（连接到211 LA，用于发育护理协调+常规护理）或控制（常规护理 单独使用，由诊所工作人员进行发育护理协调）。主要结果将包括转诊 早期干预评估、干预服务的资格和接受服务。我们将测量 这些结果通过父母报告、病历审查和211 LA数据，在入组后6个月。 对于根据PEDS在线结果具有较高发育风险的儿童，我们将评估其发育 使用基线时进行的PEDS：发育里程碑-评估水平（PEDS：DM-AL）， 入组后12和24个月。对于所有儿童，我们将管理PEDS的语言分量表：DM- 基线、12个月和24个月时的AL，以评价两组随时间的发展。我们将 使用儿童行为的外化行为分量表测量所有儿童的行为结果 清单。预期结果包括更高的转诊率、合格率和接受干预服务的比率 在干预组参与者中， 组我们还将检查与这些结果相关的计划成本，以估计成本， 这种模式的潜在长期好处。如果有效，该模式有可能迅速传播 在整个2-1-1网络中，并改变美国的发育护理协调。