Stahmer Aubyn C, Dababnah Sarah, Rieth Sarah R
University of California Davis, Sacramento, CA, USA.
University of Maryland, Baltimore, MD, USA.
Pediatr Med. 2019 May;2. doi: 10.21037/pm.2019.05.01. Epub 2019 May 29.
Evidence-based practices (EBPs) in early intervention for autism spectrum disorder (ASD) have the potential to improve children's developmental trajectories and address family needs. However, the successful use of EBPs in community early intervention settings requires careful attention to the context in which services are delivered. Implementation science, and specifically the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model, provides a framework to examine context across multiple levels and identify barriers and facilitators to community EBP use. This article identifies several considerations most relevant for early intervention in ASD at the outer and inner context levels, as well as bridging and innovation factors. Outer context considerations include the policies and funding streams surrounding service delivery, the role of advocacy in shaping the service landscape, the availability of appropriate specialists to provide services, and family cultural characteristics. Inner context factors include the individual characteristics of both the children receiving the service as well as the provider delivering the service, in addition to the leadership and organizational climate surrounding the use of a particular EBP. We also discuss considerations of the specific innovation (in this case, EBP early interventions) to be deployed, as well as bridging factors.
自闭症谱系障碍（ASD）早期干预中的循证实践（EBPs）有潜力改善儿童的发展轨迹并满足家庭需求。然而，要在社区早期干预环境中成功应用循证实践，需要密切关注提供服务的背景。实施科学，特别是探索、准备、实施和维持（EPIS）模型，提供了一个框架，用于在多个层面审视背景，并识别社区循证实践应用的障碍和促进因素。本文确定了在外部和内部背景层面与ASD早期干预最相关的几个考量因素，以及衔接和创新因素。外部背景考量包括围绕服务提供的政策和资金流、倡导在塑造服务格局中的作用、提供服务的合适专家的可获得性以及家庭文化特征。内部背景因素包括接受服务的儿童和提供服务的提供者的个人特征，以及围绕特定循证实践应用的领导力和组织氛围。我们还讨论了要部署的具体创新（在这种情况下是循证实践早期干预）的考量因素以及衔接因素。
