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: 10242405
• 负责人: PAUL J CHUNG
• 金额: $ 15.5万
• 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 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242405
• 关键词: 3 year old; Academy; Address; Administrative Supplement; Advisory Committees; Affect; Age; American; Behavioral; COVID-19; COVID-19 pandemic; Caring; Child; Child Behavior Checklist; Child Care; Child Development; Child Health; Childhood; Clinic; Control Groups; County; Data; Development; Developmental Delay Disorders; Disasters; Disease; Early Intervention; Economics; Effectiveness; Elderly; Eligibility Determination; Emergency Situation; Enrollment; Evaluation; Family; Financial Hardship; Funding; Future; Goals; Health; Health Personnel; Healthcare Systems; Human; Intervention; Language; Language Delays; Link; Long-Term Effects; Los Angeles; Measures; Medical Records; Mental Health; Modeling; Morbidity - disease rate; National Institute of Child Health and Human Development; Nursery Schools; Online Systems; Outcome; Outcome Measure; Parents; Participant; Pathogenicity; Pediatrics; Persons; Population; Positioning Attribute; Preventive healthcare; Preventive service; Primary Health Care; Process; Provider; Psychological Stress; Randomized; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Project Grants; Resources; Risk; Schools; Services; Site; Social Distance; Social Work; Speech Delay; Stress; System; Telephone; Testing; Time; Unemployment; Vaccination; Visit; autism spectrum disorder; base; behavior measurement; behavioral outcome; care coordination; care systems; child services; community clinic; coronavirus disease; cost estimate; early childhood; effectiveness testing; experience; externalizing behavior; food insecurity; food security; group intervention; health care service; high risk; improved; kindergarten; mortality; novel coronavirus; pandemic disease; primary outcome; program costs; programs; psychologic; psychosocial; research study; response; screening; service intervention; social; socioeconomics; stressor; treatment as usual

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.

项目摘要/摘要 尽管普遍的儿童早期发育筛查是由美国儿科学会推荐的 儿科，充分的证据表明，儿童保健提供者没有满足这些建议，并且 许多早期的发育迟缓被忽略了。更多证据表明，供应商和 父母努力适应早期儿童发育系统的照顾，很少有高危儿童 实际上得到了推荐，最终接受服务的人更少。护理过程中的差距已经造成 在将发育筛查与发育结果联系起来的证据方面的差距，导致美国预防性 服务工作组表示，没有足够的证据建议或反对全能 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 基于电话的早期儿童发展护理协调系统的随机对照试验 与2-1-1洛杉矶县(211LA)合作，这是2-1-1呼叫中心全国网络的一部分，覆盖 占美国人口的93%。我们将测试211LA在增加发展中的转介方面的有效性 评估，增加被认为有资格获得服务的儿童人数，并增加 实际接受干预的儿童。这项试验将招募662名1-3岁的儿童，他们获得了良好的- 在10个合作伙伴诊所中的一个提供托儿服务。我们将对所有儿童进行发育筛查， 父母发育状况评估(PEDS)在线系统，并将儿童1：1随机分为 干预(连接到211LA以进行发育护理协调+常规护理)或对照(常规护理 仅由诊所工作人员进行发展护理协调)。主要结果将包括转诊 到早期干预评估、干预服务的资格和接受服务。我们将衡量 这些结果是在登记后6个月通过父母报告、病历审查和211LA数据得出的。 对于基于儿科在线结果的发育风险升高的儿童，我们将评估发育 使用PEDS：发展里程碑-评估水平(PEDS：DM-AL)，在基线和 注册后12个月和24个月。对于所有的儿童，我们将管理儿科的语言分量表：DM- 在基线、12个月和24个月时，评估两组随时间的发展情况。我们会 使用儿童行为的外化行为子量表测量所有儿童的行为结果 核对表。预期的结果包括更高的转诊率、资格和接受干预服务 在干预组参与者中，在干预中儿童获得了更大的发展收益 一群人。我们还将检查与这些结果相关的计划成本，以估计成本和 这一模式的潜在长期好处。如果有效，该模型有可能迅速传播。 通过2-1-1网络，并改变美国的发展护理协调。