A Screen-Refer-Treat (SRT) Model to Promote Earlier Access to ASD Intervention

描述（由申请人提供）：虽然照顾者经常在17-19个月大的时候开始关心他们的孩子，但孩子通常在41/2岁之前不会接受自闭症谱系障碍（ASD）的诊断，或者对于西班牙裔家庭来说，年龄更大。现在有充分的证据表明，早期参与ASD专门干预可以显著改善ASD幼儿的技能和行为。然而，尽管有公共资助的C部分早期干预（EI）服务，但长期等待正式的ASD诊断可能会阻止幼儿在关键的出生到三年期间接受适当的专门干预。此外，关心ASD的照顾者在等待期间会经历高度的不确定性和压力。该项目将实施和评估一种创新的医疗服务提供模式，旨在促进ASD幼儿早期获得专门干预。筛查-转诊-治疗（SRT）模式通过医疗和EI提供者的参与，为早期识别和干预提供了一种协调且具有成本效益的方法，并代表了一种弥合ASD关注和ASD干预之间差距的实用且可持续的策略。SRT模型建立在经验证的ASD筛查工具和低成本的基于行为的ASD干预措施的可用性基础上，将在华盛顿州的四个不同社区实施，以评估西班牙裔和非西班牙裔背景幼儿的服务提供实践的变化。 SRT模型包括三个组成部分：（1）在16-20个月时进行普遍ASD筛查，并由初级保健医生（PCP）迅速转诊至EI项目;（2）在EI项目中加速ASD评估;（3）由EI提供者使用廉价的、基于证据的ASD专门干预。将向PCP实践提供具有自动评分（包含相关后续问题）的改良自闭症检查表（M-CHAT）的电子版本，并将通过远程医疗向EI提供者提供远程辅导，以支持其ASD评估和干预活动。将使用阶梯楔形群RCT设计评价SRT模型的实施和结局。在SRT实施之前和之后，将从全州40个PCP和80个EI提供者收集有关筛查、转诊、评估和干预实践的数据，以确定实践的变化。此外，将在SRT实施前后从社区招募患有ASD问题的幼儿的照顾者的单独样本（n=245），并进行前瞻性随访，以测量照顾者幸福感、养育效能、对医疗保健系统的满意度和幼儿的社交行为随时间的差异和变化。我们预测，SRT模型的实施将与PCP的ASD筛查率更高、更早转诊至EI项目、更早启动ASD专门干预、减少ASD关注和诊断之间的时间以及改善护理人员和儿童结局相关。

DESCRIPTION (provided by applicant): Although caregivers often become concerned about their child by 17-19 months of age, children do not typically receive a diagnosis of autism spectrum disorder (ASD) until they are 41/2 years old, or older for Hispanic families. It is now well documented that early participation in ASD-specialized intervention can lead to significant improvements in skills and behavior for toddlers with ASD. However, despite the availability of publicly funded Part C early intervention (EI) services, long waits for a formal ASD diagnosis can prevent toddlers from receiving appropriately specialized intervention during the critical birth-to-three years. In addition, caregivers concerned about ASD experience high levels of uncertainty and stress during this waiting period. This project will implement and evaluate an innovative healthcare service delivery model designed to promote earlier access to specialized intervention for toddlers with ASD. The Screen-Refer-Treat (SRT) model provides a coordinated and cost-effective approach to early identification and intervention by involving both medical and EI providers, and represents a practical and sustainable strategy for bridging the gap between ASD concerns and ASD intervention. The SRT model, which builds on the availability of validated ASD screening tools and low-cost behaviorally-based ASD interventions, will be implemented in four diverse communities across Washington State to evaluate changes in service delivery practices for toddlers with Hispanic as well as Non- Hispanic backgrounds. The SRT model comprises three components: (1) universal ASD screening at 16-20 months and prompt referral to EI programs by primary care physicians (PCPs); (2) expedited ASD assessments within EI programs; and (3) use of an inexpensive, evidence-based ASD-specialized intervention by EI providers. An electronic version of the Modified Checklist for Autism (M-CHAT) with automated scoring that incorporates relevant follow-up questions will be provided to PCP practices, and distance coaching via telemedicine will be available to EI providers to support their ASD assessment and intervention activities. A stepped wedge cluster RCT design will be used to evaluate implementation and outcomes of the SRT model. Data on screening, referral, assessment, and intervention practices will be collected from 40 PCPs and 80 EI providers across the state prior to and following SRT implementation to identify practice changes. In addition, separate samples of caregivers of toddlers with ASD concerns (n=245) will be recruited from communities before and after SRT implementation and followed prospectively to measure differences and changes over time in caregiver well- being, parenting efficacy, satisfaction with healthcare systems, and toddler's social-communicative behaviors. We predict that implementation of the SRT model will be associated with higher rates of ASD screening by PCPs, earlier referral to EI programs, earlier initiation of ASD-specialized intervention, reduced time between ASD concerns and diagnosis, and improved caregiver and child outcomes.