Autism Adaptive Community-based Treatment to Improve Outcomes using Navigators (ACTION) Network

使用导航器（ACTION）网络改善自闭症适应性社区治疗结果

• 批准号: 10237197
• 负责人: AMY M WETHERBY
• 金额: $ 186.44万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-07 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237197
• 关键词: 5 year old; Adaptive Behaviors; Address; Adoption; Age; Age-Months; California; Caring; Child; Church; Clinical; Clinical Research; Clinical Trials; Clinical effectiveness; Collection; Communities; Community Health Aides; Detection; Development; Diagnosis; Dose; Early Diagnosis; Early Intervention; Education; Educational Curriculum; Evaluation; Evidence based intervention; Evidence based practice; Face; Family; Feasibility Studies; Florida; Genetic Research; Geography; Growth; Health Services Accessibility; Healthcare; Healthcare Systems; Home; Individual; Industry; Infant; Infrastructure; Institution; Intervention; Intervention Studies; Investments; Lead; Learning; Linguistics; Low income; Massachusetts; Measures; Mental Health; Methods; Minority; Modeling; Neuronal Plasticity; Neurosciences Research; Online Systems; Outcome; Outcome Measure; Parents; Phase; Policies; Population; Primary Health Care; Problem Solving; Process; Process Measure; Public Health; Research; Research Personnel; Resources; Science; Science Policy; Scientific Advances and Accomplishments; Sequential Multiple Assignment Randomized Trial; Services; Site; Social Interaction; Social outcome; Societies; Students; Symptoms; System; Technology; Testing; Toddler; Training; Workforce Development; acceptability and feasibility; adaptive intervention; autism community; autism spectrum disorder; autistic children; base; community based treatment; compare effectiveness; comparison intervention; cost; cost efficient; digital media; effectiveness research; evidence base; feasibility testing; field study; follow-up; health care delivery; health disparity; hybrid type 1 design; implementation design; implementation science; implementation strategy; improved; improved outcome; mobile computing; motivational enhancement therapy; novel; outreach; rapid technique; recruit; research to practice; response; rural families; scale up; screening; screening guidelines; screening program; service gap; skills; social communication; societal costs; socioeconomics; success; tool; trial design; uptake; workforce needs

PROJECT ABSTRACT Research shows that a stable diagnosis of autism spectrum disorder (ASD) can be made by trained professionals at 18-24 months and yet the median age of diagnosis in the US is 4-5 years of age. Lower income, minority, and rural families receive a diagnosis up to 1.5 years later and more likely miss the window of opportunity for early intervention (EI). One of the greatest challenges we face, in spite of scientific advances and investments, is how to bridge the healthcare science-to-service gap and address health disparities in access to evidence-based EI for children with ASD. Doing this would be the best solution to improve lifelong outcomes, reduce costs to society, and change the landscape of autism. In response to RFA-MH-17-008, the Autism ACTION Network—a new interdisciplinary network of 8 institutions—will blend clinical effectiveness and implementation research designs to study individual and combined effects of 2 evidence-based interventions in real world settings: 1) engage families to access resources and support when they first learn their child has signs of ASD using an evidence-based intervention that integrates motivational interviewing and problem- solving education (MI+PSE); and 2) coach families to embed evidence-based intervention strategies for toddlers with ASD in everyday activities using the Early Social Interaction (ESI) model. Building on existing infrastructure, we will infuse mobile technology using the Autism Navigator® collection of web-based courses and tools. Families will be recruited by screening in community-based primary care and EI systems in 3 diverse regions in 2 states: Florida and Massachusetts. In Phase 1, we will compare the effectiveness of adaptive interventions that use MI+PSE with and without ESI in a 2-stage Sequential Multiple Assignment Randomized Trial (SMART) design on family engagement in EI, parent use of intervention strategies in everyday activities, and child outcomes of social communication, active engagement, autism symptoms, developmental level, and adaptive behavior. In Phase 2, we will construct an adaptive intervention to optimize the effects of MI+PSE with ESI based on the SMART and study the feasibility of implementation in two new service systems in California--Kaiser Permanente Healthcare System and the National Black Church Initiative. This network brings a unique interdisciplinary team with expertise spanning early detection, maternal mental health, clinical trials, health disparities, implementation science, and policy. Our dynamic technology platform has ambitious dissemination aims of informing a community of change agents committed to impact at the population level. This research network can build the capacity of community-based systems to provide earlier and widespread access to cost-efficient, community-viable treatment and be ready for immediate and rapid implementation across the US. Findings will advance science by providing researchers with a method for rapidly deploying evidence-based practices, enabling research at younger ages—accelerating genetic, neuroscience, and intervention research—and lead to transformative changes in workforce development and healthcare delivery.

项目摘要 研究表明，经过培训的人员可以对自闭症谱系障碍 (ASD) 做出稳定的诊断 专业人士的诊断年龄为 18-24 个月，但美国的诊断年龄中位数为 4-5 岁。降低 收入、少数民族和农村家庭最多 1.5 年后才得到诊断，更有可能错过窗口期 早期干预（EI）的机会。尽管科学进步，但我们面临的最大挑战之一 和投资，是如何弥合医疗保健科学与服务之间的差距并解决各地区的健康差距 为患有自闭症谱系障碍 (ASD) 的儿童提供基于证据的 EI。这样做将是改善终身的最佳解决方案 成果，降低社会成本，并改变自闭症的面貌。为了回应 RFA-MH-17-008， 自闭症行动网络——一个由 8 个机构组成的新的跨学科网络——将结合临床有效性和 实施研究旨在研究两种循证干预措施的单独和综合效果 现实世界环境：1）当家庭第一次得知孩子有问题时，让他们获取资源和支持 使用基于证据的干预措施来识别自闭症谱系障碍的迹象，该干预措施结合了动机访谈和问题- 解决教育（MI+PSE）； 2）指导家庭嵌入基于证据的干预策略 使用早期社交互动 (ESI) 模型对患有自闭症谱系障碍 (ASD) 的幼儿进行日常活动。建立在现有的基础上 基础设施中，我们将使用 Autism Navigator® 网络课程集合注入移动技术 和工具。将通过在 3 个不同的社区初级保健和 EI 系统中进行筛选来招募家庭 2 个州的地区：佛罗里达州和马萨诸塞州。在第一阶段，我们将比较自适应的有效性 在 2 阶段序贯多重分配随机中使用 MI+PSE（有或没有 ESI）的干预措施 关于家庭参与 EI 的试验 (SMART) 设计、家长在日常活动中使用干预策略、 以及儿童的社交沟通、积极参与、自闭症症状、发育水平和 适应性行为。在第二阶段，我们将构建适应性干预措施来优化 MI+PSE 的效果 结合基于SMART的ESI，研究在两个新的服务系统中实施的可行性 加利福尼亚州——凯撒永久医疗保健系统和全国黑人教会倡议。这个网络 带来了一支独特的跨学科团队，其专业知识涵盖早期检测、孕产妇心理健康、临床 试验、健康差异、实施科学和政策。我们充满活力的技术平台雄心勃勃 传播的目的是让社区了解致力于在人口层面产生影响的变革推动者。 该研究网络可以建立基于社区的系统的能力，以提供更早和更广泛的服务 获得具有成本效益、社区可行的治疗，并做好立即、快速实施的准备 遍布美国。研究结果将通过为研究人员提供快速部署的方法来推动科学发展 基于证据的实践，使研究能够在更年轻的时候进行——加速遗传学、神经科学和 干预研究——并导致劳动力发展和医疗保健服务的变革。

项目成果

The influence of loss to follow-up in autism screening research: Taking stock and moving forward.

自闭症筛查研究中失访对随访的影响：盘点并前进。

• DOI: 10.1111/jcpp.13867
• 发表时间: 2024
• 期刊: Journal of child psychology and psychiatry, and allied disciplines
• 作者: Sheldrick,RChristopher;Hooker,JessicaL;Carter,AliceS;Feinberg,Emily;Croen,LisaA;Kuhn,Jocelyn;Slate,Elizabeth;Wetherby,AmyM
• 通讯作者: Wetherby,AmyM

The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum.

• DOI: 10.1177/13623613231159153
• 发表时间: 2023-03-15
• 期刊: AUTISM
• 影响因子: 5.2
• 作者: Guthrie, Whitney;Wetherby, Amy M.;Woods, Juliann;Schatschneider, Christopher;Holland, Renee D.;Morgan, Lindee;Lord, Catherine E.
• 通讯作者: Lord, Catherine E.