Examining co-production as an implemntation strategy for autism early intervention delivered in Part C service systems

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PROJECT SUMMARY/ABSTRACT The purpose of this K23 Career Development Award is to support the applicant in acquiring the knowledge and skills needed for an independent research career as an implementation scientist who evaluates strategies that enhance the impact of early intervention for children with Autism Spectrum Disorder (ASD) when delivered in diverse service systems. It will achieve this by complementing the candidate’s background in community engaged research with expert mentorship in intervention fidelity and adaptation, clinical decision making, clinical trial design and evaluation, and [autism service inequities among underrepresented children]. Persistent disparities accessing early intervention compromise the quality of life of autistic children and their families and can be addressed by translating evidence-based treatments, such parent-mediated interventions (PMIs), into service systems that are an access point to care for young children. Although translation efforts are under way, high attrition has compromised the impact of PMIs when delivered win marginalized communities. This gap may reflect an emphasis on implementing PMIs in a manner that maintains fidelity while also at times conflicting with the complex needs of underrepresented families that inevitably arise in PMI. This K23 proposal will address this gap by evaluating co-production, or the balance between fidelity and family- centered care, within an evidence-based PMI for ASD, Project ImPACT, delivered in a state-funded Early Intervention system. Mixed-methods findings from the first research aim will be used by key stakeholders to develop and evaluate an implementation strategy that targets ideal co-production to enhance caregiver engagement within Project ImPACT. Under the primary mentorship of Lawrence Scahill, Ph.D., an expert in clinical trials for ASD, and co-mentorship from Aubyn Stahmer, Ph.D., Chris Sheldrick, Ph.D., [and Jennifer Singh, PhD.], the applicant will pursue training in: 1) early intervention fidelity and adaptation; 2) clinical and shared decision making; 3) the design and execution of clinical trials; and [4) cultural diversity and systemic inequities]. Training in these areas will enhance the applicant’s pursuit of the following research aims: 1) Evaluate co-production within Project ImPACT; 2) Develop an implementation strategy that targets ideal co- production within Project ImPACT by teaching the balance of fidelity and family-centered care; and 3) Conduct a pilot randomized trial to assess the feasibility of evaluating Project ImPACT training when paired with the co- production implementation strategy (Project ImPACT-C) in comparison to Project ImPACT training as usual (Project ImPACT-TAU). This proposal is aligned with NIMH’s strategic objective [4.3a to adapt evidence-based intervention to account for moderators, including social determinants of health, that impact effectiveness among underrepresented groups]. Further, the strong training and research plans embedded within this K23 proposal will effectively position the applicant for an independent research career evaluating strategies that enhance the service outcomes of ASD interventions when implemented within diverse service systems.