Educational-Clinical Linkage to Improve Health Equity for Children with Developmental Delays and Disabilities from Marginalized Communities

摘要 社会和结构性不平等导致黑人、西班牙裔、 和低收入学龄前儿童的发展迟缓和残疾（PCw/DD），剥夺了他们的 教育和治疗服务，促进发展和提高后来的学术，经济， 健康成果。研究还表明，当儿童接受这些必要的服务时，他们的父母会受益于 心理健康、压力和生活质量的改善。该提案的科学目标是：1）测试 采取有效战略，增加历史上被边缘化的PCW/DD获得ECSE服务的机会 2）描述这些战略可能导致改善的潜在机制 多层次的健康结果。学前教育和我（PreM）是一种新型的社区临床联系（CCL）， 为历史上被边缘化的社区提供医疗服务。将CCL的关键组件与 个性化的医疗教育护理计划和远程导航支持，PreM针对不同层次的 在我们之前的研究中确定了影响治疗途径的影响。在试点测试中，PreM是可行的， 在完成的ECSE评价中， 参加儿科诊所的家庭，主要服务于来自低收入社区的黑人和西班牙裔家庭。 因此，该R01申请提出利用混合有效性-实现方法来测试PreM， 现实世界服务提供条件的两种模型。受试者（n = 320）将随机分配至：1）6 2）6个月的PreM（干预组）或2）6个月后开始干预的等待名单对照组 延迟我们将对所有参与者进行为期12个月的随访，在4个时间点（基线，3-， 6-12个月）。我们的具体目标是测试PreM在ECSE获取（初级）指标上的有效性 和儿童，父母，家庭和卫生服务成果（次要）;检查理论推导的调解人 使用混合方法的干预效果;探索健康的社会决定因素， 版主。我们还将同时进行混合方法实施评估，重点是 执行成果作为执行成功的指标;执行措施 质量;和中间结果，以了解和解决与临床相关的成功和失败 结果。该项目的结果有可能：1）推进关于差距如何的科学知识 教育和治疗服务的延误影响PCW/DD及其家庭的健康结果; 2)确定增加获得幼儿保育和教育服务机会的机制，解决长期存在的保健差距; 支持在儿科临床环境中有效实施教育-临床联系模式 为历史上被边缘化的社区提供服务，可用于改善家庭的健康成果 和他们的孩子有一系列的健康问题。

ABSTRACT Societal and structural inequities have resulted in longstanding health care disparities among Black, Hispanic, and low-income preschool-age children with developmental delays and disabilities (PCw/DD) depriving them of educational and therapeutic services which foster development and improve later academic, economic, and health outcomes. Studies also indicate when children receive these needed services, their parents benefit with improvements in mental health, stress, and quality of life. The scientific objectives of this proposal are to 1) test effective strategies to increase access to ECSE services among PCw/DD from historically marginalized communities; and 2) characterize potential mechanisms by which such strategies may lead to improved multilevel health outcomes. Preschool and Me (PreM) is a novel community clinical linkage (CCL) designed for clinical settings serving historically marginalized communities. Combining key components of CCLs with a personalized medical-education care plan and remote navigator support, PreM targets different levels of influence impacting therapeutic access identified in our prior research. In pilot testing, PreM was feasible to deliver, acceptable to parents, and demonstrated preliminary efficacy on completed ECSE evaluations among families attending a pediatric clinic serving largely Black and Hispanic families from low-income communities. Thus, this R01 application proposes to utilize a hybrid effectiveness-implementation approach to test PreM in two models of real-world service delivery conditions. Participants (n=320) will be randomized to either: 1) 6 months of PreM (intervention group) or 2) a waitlist control arm beginning the intervention after a 6-month delay. We will follow all participants for 12 months with data collection occurring at 4 timepoints (baseline, 3-, 6- and 12-months). Our specific aims are to test effectiveness of PreM on indicators of ECSE access (primary) and child-, parent-, family- and health service outcomes (secondary); examine theoretically derived mediators of intervention effects using a mixed methods approach; and explore social determinants of health as potential moderators. We will also simultaneously conduct a mixed methods implementation evaluation focusing on implementation outcomes to serve as indicators for implementation success; measures of implementation quality; and intermediate outcomes to understand and address successes and failures in relation to clinical outcomes. The results of this project have the potential to: 1) advance scientific knowledge about how gaps and delays in educational and therapeutic services impact health outcomes among PCw/DD and their families; 2) identify mechanisms to increase access to ECSE services and address longstanding health care disparities; and 3) support effective implementation of educational-clinical linkage models within pediatric clinical settings serving historically marginalized communities which can be utilized to improve health outcomes for families and their children with a range of health conditions.