Examining the active ingredients of consultation to improve implementation of a parent-mediated intervention for children with autism in the community mental health system.

项目摘要/摘要 自闭症谱系障碍(ASD)是一种终生神经发育障碍，每54名儿童中就有1名受到影响 美国。已经开发了许多基于证据的干预措施，以改善儿童的预后 患有自闭症的儿童。然而，有一个17年的研究与实践的差距，其中循证实践(EBP) 在实验室环境中开发的技术最终达到了社区环境。咨询模式通常包括 这可能会对提供商的行为产生不同的影响。这是一个单一案例的实验 设计将试验性地操纵咨询模型的三个潜在的有效成分(反馈 4个应用行为分析(ABA)机构的录音会议、案例支持和技能排练)，以便 确定咨询模式的潜在有效成分。会诊将重点放在远程医疗服务上 一项经验性支持的针对自闭症儿童的人工父母干预(项目影响)。 将从与地区签订合同的4个机构(总共N=~20个提供商)招聘3-5个提供商小组 密歇根州医疗补助自闭症福利内的社区精神卫生机构，提供适用的 为参加医疗补助的患有自闭症的青年提供行为分析服务。提供商将完成自我定向的在线 关于项目影响的教程。每个服务提供者将在他们的工作量中登记至少一名有孩子的照顾者 参加密歇根州医疗补助自闭症福利(N=~20名照顾者)。下一步，每个机构将随机 分配给a)基准期的长度(3-6周之间)和b)他们将收到 咨询部分。提供商将每周录制一次与其注册家庭的会议，并通过 符合HIPAA标准的Dropbox链接。他们还将每周完成关于执行情况的在线问卷 结果。将通过每周会议的观察性编码来评估实施结果 治疗依从性和治疗能力，以及每周提供者关于病例的问卷分析 项目影响的渗透性、可行性、可接受性和适当性 咨询阶段。提供商将在8周后提交最终录制的课程和调查问卷- 咨询。照顾者将通过在线为孩子完成一定程度的社交交流 在基线时、会诊期间两次和会诊后8周后进行问卷调查。资料分析 包括多层次建模和可视化分析。结果将确定咨询的有效成分 模型，稍后将用来开发协商改进机制的因果模型 实施成果。培训计划包括指导、课程、研讨会和体验式培训。 该中心还将在自闭症领域内开展疗效和实施研究方面的专门知识。

PROJECT SUMMARY/ABSTRACT Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disability that affects 1 in 54 children in the United States. Many evidence-based interventions have been developed that improve child outcomes for children with ASD. Yet there is a 17-year research-to-practice gap in which evidence-based practices (EBPs) developed in laboratory settings finally reach community settings. Consultation models are typically comprised of multiple components, which may differentially influence provider behavior. This single-case experimental design will experimentally manipulate three potential active ingredients of a consultation model (feedback on taped sessions, case support, and skill rehearsal) in 4 applied behavior analysis (ABA) agencies in order to identify potential active ingredients of the consultation model. Consultation will focus on telehealth delivery of an empirically supported manualized parent-mediated intervention for children with ASD (Project ImPACT). Groups of 3-5 providers will be recruited from 4 agencies (N = ~20 providers in total) that contract with regional community mental health agencies within the Michigan Medicaid Autism Benefit, which provides applied behavior analysis services to Medicaid-enrolled youth with ASD. Providers will complete a self-directed online tutorial on Project ImPACT. Each provider will enroll at least one caregiver on their caseload who has a child enrolled in the Michigan Medicaid Autism Benefit (N = ~20 caregivers). Next, each agency will be randomly assigned to a) the length of the baseline period (between 3-6 weeks) and b) the order that they will receive the consultation components. Providers will record one session per week with their enrolled family and submit it via a HIPAA compliant Dropbox link. They will also complete weekly online questionnaires on implementation outcomes. Implementation outcomes will be assessed via observational coding of weekly sessions for treatment adherence and competence, and analysis of weekly provider questionnaires regarding case penetration, and feasibility, acceptability, and appropriateness of Project ImPACT and each of the 3 consultation phases. Providers will submit a final recorded session and questionnaire 8-weeks post- consultation. Caregivers will complete a measure of social communication for their child via online questionnaire at baseline, twice during consultation, and after 8 weeks post-consultation. Data analysis includes multilevel modeling and visual analysis. Results will identify active ingredients of the consultation model which will later be used to develop a causal model of the mechanism by which consultation improves implementation outcomes. The training plan consists of mentorship, courses, workshops, and experiential learning and will develop expertise in efficacy and implementation research within the autism field.