Social Determinants for Early Intervention Participation and Efficacy

描述(由申请人提供)：2001年有特殊卫生保健需要的儿童调查(CSHCN)显示，在3岁以下儿童中，健康和发育障碍的发生率为6.5%，严重到需要增加医疗或治疗服务或影响日常生活(数据资源中心)。然而，这一数据低估了处于发育困难风险中的儿童。在一项类似的具有全国代表性的调查--《全国儿童健康调查》中，40%的5岁以下儿童的父母报告说，他们的孩子面临神经发育困难的风险，包括语言学习延迟、社交技能差和行动不便(《儿童的健康和福祉：国家和国家的肖像》，2005年)。颁布了儿童早期社会政策，即《残疾人教育法》C部分，以创建国家早期干预(EI)方案，以改善婴幼儿的神经发育风险。定性研究表明，在C部分计划编制的许多方面存在着极大的差异，包括资格要求(Spiker，2001)、服务协调模式(Scarborough，2004)，而定量研究表明，在小样本中，EI的影响是混合的(Shonkoff，1986；Hebbeler，2007)。目前尚不清楚的是，精神分裂症参与的可变性的社会决定因素，健康和发展服务的协调和无缝程度，以及精神分裂症是否与改善人口一级的神经发育结果有关。这项研究的目的是在一组有神经发育困难风险的幼儿中，1)参与早期干预服务的社会决定因素，以及这些决定因素可以在多大程度上被相关的社会政治、背景因素解释(文件1)，2)对护理协调的满意的社会决定因素，以及这些因素可以被相关的社会政治、背景因素解释的程度(文件2)，以及3)神经发育随时间的变化与参与早期干预之间的关系(文件3)。这项研究将完成，以满足我的博士论文三篇可发表的高质量稿件的要求。这将需要利用两项具有全国代表性的调查--2005年全国特殊保健需要儿童调查和幼儿纵向研究出生队列--进行次级数据分析。对于前两篇论文，将使用多水平建模，这允许同时调查个人和背景水平的变量，同时适当地解决国家内个人的集群问题。第三篇论文将进行纵向分析，以便研究EI参与和神经发育结果之间的关系。这项研究将有助于公共卫生领域，因为它不仅与旨在解决弱势群体在获得卫生和发展服务方面的社会差距的社会政策和方案倡议直接相关，而且与疾控中心促进“生命每个阶段的健康人”的目标是一致的。早期干预(EI)是一项由联邦授权、以州为基础的计划，旨在降低婴幼儿的发育风险。这项研究将探索在全国有发展困难风险的儿童样本中，获得EI方案的机会、满意度和有效性的社会决定因素。

DESCRIPTION (provided by applicant): The 2001 Survey of Children with Special Health Care Needs (CSHCN) shows that, among children less than 3 years of age, the prevalence of health and developmental impairments significant enough to warrant increased medical or therapeutic services or to impact daily living is 6.5% (Data Resource Center, CSHCN). However, this data underestimates children at risk for developmental difficulties. In a similar nationally representative survey, the National Survey of Children's Health, 40% of parents of children less than 5 reported concern that their child was at risk for neurodevelopmental difficulties including delayed language acquisition, poor social skills, and limited mobility (The Health and Well-Being of Children: A Portrait of States and the Nation, 2005). Early childhood social policy, the Individuals with Disabilities Education Act Part C, was promulgated to create state Early Intervention (EI) programs in order to ameliorate neurodevelopmental risk among infants and toddlers. Qualitative studies reveal that there exists extreme variation across states in many facets of Part C programming including eligibility requirements (Spiker, 2001), models of service coordination (Scarborough, 2004) while quantitative studies suggest mixed effect of EI in small samples (Shonkoff, 1986; Hebbeler, 2007). What is unknown are the social determinants of variability of EI participation, the degree to which health and developmental services are coordinated and seamless, and whether EI is associated with improved neurodevelopmental outcomes at the population level. The purpose of this research is to examine, among a cohort of young children at risk for neurodevelopmental difficulties, 1) the social determinants in participation In Early Intervention services and the extent to which these might be explained by relevant sociopolitical, contextual factors (Paper 1), 2) the social determinants in satisfaction with care coordination and the extent to which these might be explained by relevant sociopolitical, contextual factors (Paper 2), and 3) the relationship between changes in neurodevelopment over time and participation in Early Intervention (Paper 3). This research will be completed to fulfill my doctoral dissertation requirement of three publishable quality manuscripts. It will entail secondary data analyses using two nationally representative surveys, the 2005 National Survey of Children with Special Healthcare Needs and the Early Childhood Longitudinal Study Birth Cohort. For the first two papers, multi-level modeling will be used, which allows for investigation of individual and contextual level variables simultaneously while appropriately addressing the clustering of individuals within states. The third paper will entail a longitudinal analysis which will allow for an investigation of the relationship between EI participation and neurodevelopmental outcomes over time. This research will contribute to the field of public health as it directly relates to not only social policy and programmatic initiatives aimed at addressing social disparities in access to health and developmental services for vulnerable populations, but also is consonant with the CDC's objective of promoting "Healthy People at Every Stage of Life." Early Intervention (EI) is a federally mandated, state-based program to reduce developmental risk in infants and toddlers. This study will explore social determinants of access to, satisfaction with, and effectiveness of EI programming among a nationally representative sample of children at risk for developmental difficulties.