Reducing Disparities in Early Intervention Use: The Opening Doors to Early Intervention Study

项目摘要 发育迟缓在幼儿中经常遇到， 贫困的少数民族儿童导致儿童早期发展的不平等。促进儿童健康 残疾人教育法（IDEA）规定了早期干预（EI）服务。 但只有一半的高危儿童开始并完成了EI 服务因此，许多面临风险的儿童可能得不到改善其发展所需的服务。到 促进启动和完成EI服务，我们开发了早期干预计划的开放之门， 基于健康信念模型的患者导航干预，针对高危城市少数群体 孩子在风险儿童中进行的初步试点研究证明了可行性，并产生了可喜的成果。 因此，这个以社区为基础的前瞻性研究应用程序建议测试这种方法的有效性。 计划在一个单一的城市县使用随机试验设计。具体目标是：1）确定 早期干预敞开大门计划对儿童发展状况和EI转诊的有效性 和服务使用，2）评估父母参与早期干预是否介导了 项目，以及3）探讨家庭学习环境，父母健康素养和贫困 缓和该计划的影响。该应用程序通过测试解决了幼儿期的健康差异 一项旨在提高城市少数民族儿童及其家庭参与教育的干预措施 儿童早期发展和教育机构服务使用的措施。三到四个初级保健儿科诊所， 为这个多元化的城市社区提供关爱的人将被招募参加。360名儿童 年龄小于30个月，已被确定为发育风险，并被转介到EI服务 在参与的诊所，将被随机分配接受早期干预计划的开放之门或常规治疗。 在乎以前参加过EI服务的城市少数民族父母将接受培训， 导航员为开始和完成EI的家庭提供教育，激励和帮助 转介和服务。临床医生和儿童寻找工作人员将提供常规护理，包括发展 在没有援助的情况下进行筛查和转诊。关于参与者人口统计特征、健康状况 识字率和基线的家庭学习环境;家长参与和EI转介和服务 在第3、6、9和12个月时完成;在第12个月时的儿童发育将在计划的 研究访问。干预组和对照组受试者之间的结果差异将使用 意向治疗分析。这项比较有效性研究的结果可以传播到类似的 美国各大城市县，以告知儿童查找和EI程序，并解决早期 儿童发展。

Project Summary Developmental delays are frequently encountered among young children and disproportionately affect impoverished minority children leading to disparities in early child development. To promote healthy child development, the Individuals with Disabilities Education Act (IDEA) mandated early intervention (EI) services be made available to young children with delays, but only half of at-risk children initiate and complete EI services. As a result, many at-risk children may not receive needed services to improve their development. To foster initiation and completion of EI services, we developed the Opening Doors to Early Intervention Program, a patient navigation intervention based on the Health Belief Model and targeted to at-risk urban minority children. An initial pilot study among at-risk children demonstrated feasibility and generated promising results. Therefore, this Community-Based Participatory Research application proposes to test the effectiveness of this program in a single urban county using a randomized trial design. The specific aims are to 1) determine the effectiveness of the Opening Doors to early Intervention Program on child developmental status and EI referral and services use, 2) assess whether parent engagement in early intervention mediates the effects of the program, and 3) explore whether the home learning environment, parental health literacy, and poverty moderate the effects of the program. This application addresses health disparities in early childhood by testing an intervention designed to improve participation rates in EI among urban minority children and their families on measures of early child development and EI services use. Three to four primary care pediatric clinics that provide care to this diverse urban community will be recruited to participate. Three hundred sixty children who are less than 30 months of age and have been identified as developmentally at-risk and referred for EI services at participating clinics will be randomized to receive the Opening Doors to Early Intervention Program or usual care. Urban minority parents who have previously participated in EI services will be trained as patient navigators to provide education, motivation, and assistance for families with initiation and completion of EI referrals and services. Clinicians and Child Find staff will provide usual care consisting of developmental screening and referrals without assistance. Information on participant demographic characteristics, health literacy, and the home learning environment at baseline; parent engagement and EI referral and services completion at 3, 6, 9, and 12 months; and child development at 12 months will be collected during scheduled study visits. Differences in outcomes between intervention and control participants will be compared using intention-to-treat analysis. Findings from this comparative effectiveness study can be disseminated to similar large urban counties across the U.S. to inform Child Find and EI procedures and address disparities in early child development.