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，自闭症谱系障碍（ASD）的稳定诊断可以通过训练 专业人士在18 - 24个月，但在美国的诊断年龄中位数是4 - 5岁。低 收入，少数民族和农村家庭在1.5年后得到诊断，更有可能错过窗口期 早期干预（EI）。我们面临的最大挑战之一，尽管科学进步， 和投资，是如何弥合医疗保健科学与服务的差距，并解决健康差距， 为ASD儿童提供基于证据的EI。这样做将是最好的解决方案，以改善终身 结果，降低社会成本，改变自闭症的景观。根据RFA-MH-17 - 008， 自闭症行动网络-一个新的跨学科网络的8个机构-将融合临床效果， 实施研究旨在研究2种循证干预措施的单独和综合效果， 真实的世界环境：1）当家庭第一次得知他们的孩子有 ASD的迹象，使用基于证据的干预，整合动机访谈和问题， 解决教育（MI + PSE）; 2）指导家庭嵌入基于证据的干预策略， ASD幼儿在日常活动中使用早期社会互动（ESI）模型。利用现有 基础设施，我们将注入移动的技术使用自闭症导航®收集基于网络的课程 和工具.家庭将通过在3个不同的社区初级保健和EI系统中进行筛选来招募。 两个州的地区：佛罗里达和马萨诸塞州。在第一阶段，我们将比较自适应 在2阶段序贯多重随机分配中使用MI + PSE（有和无ESI）的干预措施 关于家庭参与EI的试验（SMART）设计，父母在日常活动中使用干预策略， 和儿童的社会交往结果，积极参与，自闭症症状，发展水平， 适应行为在第2阶段，我们将构建适应性干预，以优化MI + PSE的效果 与ESI基于SMART和研究在两个新的服务系统中实施的可行性， 加州--凯撒永久医疗保健系统和国家黑人教会倡议。这个网络 带来了一个独特的跨学科团队，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。我们的动态技术平台雄心勃勃， 传播的目的是向致力于在人口一级产生影响的变革推动者社区提供信息。 这一研究网络可以建设社区系统的能力，以便更早和更广泛地提供 获得具有成本效益、社区可行的治疗，并准备立即和迅速实施 在美国各地。这些发现将为研究人员提供一种快速部署 以证据为基础的做法，使研究在年轻的年龄-加速遗传，神经科学， 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.