Refining and Implementing Technology-Enhanced Family Navigation to Promote Early Access and Engagement with Mental Health Services for Youth with Autism

12.项目总结 针对PAR-18-429，我们建议完善和测试技术家庭的实施情况 导航以促进及早获得初级保健和精神卫生(MH)保健，并促进它们之间的接触 患有自闭症谱系障碍和MH共病(ASD+)的儿童(5-13岁)。未满足的MH需求(例如， 焦虑、扰乱行为)是与有害公共健康有关的共同和主要关切 对患有自闭症儿童的影响。虽然针对ASD+的循证MH干预措施是可用的(例如，AIM HI5，6)， 在限制获得此类治疗方面存在多层次的挑战。家庭导航，世俗案例的典范 旨在减少专科医疗障碍的管理是克服这些障碍的一个有前途的解决方案 ASD+儿童面临的挑战。家庭导航是一种既定的模式，以促进参与 诊断和治疗服务，包括对有ASD风险的婴儿和蹒跚学步的儿童进行早期干预。然而， 家庭导航尚未在患有ASD+的儿童中进行测试。卫生信息技术还没有被 作为家庭导航的一个组成部分进行了系统的测试。集成这些技术是关键的下一步 在增加家庭导航的有效性和实施性方面。这项提案接下来要解决的问题是 通过测试家庭导航的有效性和实施情况，进行了系统的设计 针对ASD+儿童(5-13岁)的导航器实施技术增强。加速型 将使用创建到持续(ACTS)模式来指导技术增强的设计和试验 家庭导航。ACTS模型基于以用户为中心的设计原则和实现科学， 提供从设计(阶段1：创建)快速转变为支持技术的服务的系统指导 到实施(第二阶段：试验)和维持(第三阶段：维持)。我们建议使用一个社区- 由ACTS模型指导的合作方法，以改进和测试技术增强的家庭导航，以 促进对ASD+儿童的早期和持续的综合MH护理。这项建议对 NIMH战略计划中的研究重点，在数字卫生技术方面，以推进MH服务提供模式 和HHS机构间自闭症协调委员会战略计划。此外，这项提议还充分利用了 NIMH资助的现有倡议，旨在建设在MH环境下治疗ASD+儿童的能力。具体目标 目的1：适应ASD+学龄儿童家庭导航(FN)内容和训练。目标2： 开发FN技术工具，以增强FN for ASD+的导航器实施。目标3：研究 通过混合型技术增强的FN在ASD+中的实施、服务和临床影响 I.有效性--在初级保健中实施试验。初级保健中的随机阶梯楔形设计 将在5个诊所、30个初级保健医生和160个家庭中进行，以检查变化的机制和结果。 在成功实现这些目标的基础上，我们将为ASD+准备好一个技术增强型FN 用于在不同的初级保健环境中进行大规模的R01实施和维持测试。

12. Project Summary In response to PAR-18-429, we propose to refine and test implementation of technology-enabled family navigation to promote early access to, and engagement between, primary and mental health (MH) care for children (ages 5-13 years) with autism spectrum disorder plus MH comorbidity (ASD+). Unmet MH needs (e.g., anxiety, disruptive behaviors) are a common and principal concern, associated with deleterious public health effects for children with ASD. While evidence-based MH interventions for ASD+ are available (e.g., AIM HI5,6), there are multi-level challenges limiting access to such treatment. Family navigation, a model of lay case management designed to mitigate barriers to specialty healthcare, is a promising solution to overcome these challenges for children with ASD+. Family navigation is an established model to facilitate engagement in diagnostic and treatment services including early intervention for infants and toddlers at risk for ASD. However, family navigation has not been tested with children with ASD+. Health information technologies have not been systematically tested as a component of family navigation. Integrating these technologies is a critical next step in increasing the effectiveness and implementation of family navigation. This proposal addresses this next step by testing the effectiveness and implementation of family navigation with systematically designed navigator implementation technology enhancements for children (5-13 years) with ASD+. The Accelerated Creation-to-Sustainment (ACTS) model will be used to guide the design and trial of technology enhancement to family navigation. The ACTS model, based on user-centered design principles and implementation science, provides systematic guidance in rapidly moving from design (Phase 1: Create) of a technology-enabled service to implementation (Phase 2: Trial) and sustainment (Phase 3: Sustain). We propose to use a community- partnered approach guided by the ACTS model to refine and test technology-enhanced family navigation to promote early and ongoing integrated MH care for children with ASD+. This proposal is highly responsive to research priorities in the NIMH Strategic Plan, in digital health technology to advance MH service delivery models and the HHS Interagency Autism Coordinating Committee Strategic Plan. Further, this proposal capitalizes on existing NIMH-funded initiatives to build capacity to treat children with ASD+ in MH settings. The specific aims are: Aim 1: Adapt family navigation (FN) content and training for school-age children with ASD+. Aim 2: Develop FN technology tools to enhance navigator implementation of FN for ASD+. Aim 3: Examine the implementation, service and clinical impacts of technology-enhanced FN for ASD+ through a hybrid type I effectiveness-implementation trial in primary care. A randomized stepped wedge design in primary care will be conducted with five clinics, 30 PCPs and 160 families to examine mechanisms of change and outcomes. Based on successful execution of these aims, we will have a technology-enhanced FN for ASD+ that is ready for large-scale R01 implementation and sustainment testing within diverse primary care settings.