Examining the Effectiveness of the Early Start Denver Model in Community Programs serving Young Autistic Children

项目总结 越来越多的自闭症儿童被确认为自闭症患者，这导致营利性应用程序呈指数级增长 行为分析(ABA)机构为他们服务，使用可能不是高度结构化的方法 在发展上适合幼儿1，并限制跨环境和跨时间使用所学技能， 以及对有限的有效性数据和服务成本的日益增长的公共卫生担忧。 有效性测试导致了循证自闭症干预(EBI)的发展，特别是自然主义的 发展行为干预(NDBI)，由多项临床试验支持。NDBIS集成了理论和 来自ABA和发展科学的战略，被认为是年幼自闭症儿童的最佳实践。 缺乏关于社区机构(CBA)使用NDBI的有效性数据有助于有限的 作为支付者的资金更有可能承认较旧的、结构化的方法。早起的丹佛模式 (ESDM)是一项全面的NDBI，旨在提高青少年的社交能力和语言水平 自闭症儿童的多项对照疗效研究。ESDM将社会激励作为一种机制 使儿童更多地参与环境中的社会学习机会，从而提高 儿童学习。ESDM包括符合资助者要求的评估和数据收集方法，以及 测试了社区培训模式。了解ESDM是否有效，以及相同的治疗方法 在有效性试验中运作的机制也在社区实施中运作，使用不同的样本 是确定像ESDM这样的NDBI实现公共卫生目标的潜力的关键科学问题 改善范围广泛的自闭症儿童获得高质量、适合发展的护理的机会 以及他们的家人。为了促进扩大规模，我们与自闭症CBAS合作，这项研究将确定影响因素 影响社区实施可持续发展管理的问题。该项目将使用混合类型1随机 受控设计，以检查ESDM在社区中的有效性并收集实施数据 决定因素。儿童的主要结果包括语言和社会交流。次要结果 包括自适应行为、父母对ESDM策略的使用以及提供者对模型的忠诚度。社会动机 而照顾者的忠诚度将作为中介变量进行衡量。母性教育的调节作用， 将审查儿童种族/民族，以及提供商ESDM的忠诚度。ESDM实施的决定因素将是 探索过了。了解像ESDM这样的干预措施的有效性，中介和 适中的儿童结局及其行动机制在社区使用中的参与，有可能 增加可获得性，从而使所有自闭症儿童都能获得高质量的干预，特别是 来自不同背景、依赖公共服务的人。了解实施的决定因素 将支持在整个社区推广有效的模式。

PROJECT SUMMARY The rising number of children being identified as autistic has led to exponential growth in for-profit applied behavior analysis (ABA) agencies serving them, the use of highly structured approaches that may not be developmentally appropriate for young children1 and that limit use of learned skills across settings and time, and growing public health concerns regarding limited effectiveness data combined with the cost of services. Efficacy testing has led to growth in evidence-based autism interventions (EBI), especially naturalistic developmental behavior interventions (NDBIs), supported by multiple clinical trials. NDBIs integrate theory and strategies from ABA and developmental science and are considered best practice for young autistic children. The lack of effectiveness data regarding NDBI use in community-based agencies (CBAs) contributes to limited funding as payors are more likely to recognize older, structured methods. The Early Start Denver Model (ESDM) is a comprehensive NDBI shown to improve social communication and language outcomes for young autistic children in multiple controlled efficacy studies. ESDM engages social motivation as a mechanism to increase child engagement in social learning opportunities in the environment resulting in increased rate of child learning. ESDM includes assessment and data collection methods that meet funder requirements and a tested community training model. Understanding whether ESDM is effective and whether the same treatment mechanisms operating in efficacy trials are also operating in community implementation with diverse samples are critical scientific questions to determine the potential of NDBIs like ESDM to meet the public health goals of improving access to high quality, developmentally appropriate care for a broad range of young autistic children and their families. To facilitate scale up, we have partnered with autism CBAs and this study will identify factors that affect implementation of ESDM in the community. This project will use a hybrid type 1 randomized controlled design to examine ESDM effectiveness in the community and to gather data on implementation determinants. Primary child outcomes include language and social communication. Secondary outcomes include adaptive behavior, parent use of ESDM strategies, and provider fidelity to the model. Social motivation and caregiver fidelity will be measured as mediating variables. The moderating effects of maternal education, child race/ethnicity, and provider ESDM fidelity will be examined. ESDM implementation determinants will be explored. Understanding the effectiveness of an intervention like ESDM, the variables that mediate and moderate child outcomes, and engagement of its mechanisms of action in community use, has the potential to increase availability, and therefore, access to high quality intervention for all young autistic children, especially those from diverse backgrounds who depend on public services. Understanding implementation determinants will support scale-up of effective models throughout communities.