家庭导航对参与 C 部分早期干预的影响。
Effect of Family Navigation on Participation in Part C Early Intervention.
机构信息
Hassenfeld Child Health Innovation Institute (E Feinberg and A Chu), Brown University, Providence, RI.
Division of General Academic Pediatrics (ML Stransky and J Kuhn), Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Mass.
出版信息
Acad Pediatr. 2023 Jul;23(5):904-912. doi: 10.1016/j.acap.2023.03.013. Epub 2023 Mar 31.
OBJECTIVE
Part C Early Intervention (EI) services have been shown to reduce autism symptoms and promote healthy development among young children. However, EI participation remains low, particularly among children from structurally marginalized communities. We investigated whether family navigation (FN) improved EI initiation following positive primary care screening for autism compared to conventional care management (CCM).
METHODS
We conducted a randomized clinical trial among 339 families of children (ages 15-27 months) who screened as having an increased likelihood for autism at 11 urban primary care sites in 3 cities. Families were randomized to FN or CCM. Families in the FN arm received community-based outreach from a navigator trained to support families to overcome structural barriers to autism evaluation and services. EI service records were obtained from state or local agencies. The primary outcome of this study, EI service participation, was measured as the number of days from randomization to the first EI appointment.
RESULTS
EI service records were available for 271 children; 156 (57.6%) children were not engaged with EI at study enrollment. Children were followed for 100 days after diagnostic ascertainment or until age 3, when Part C EI eligibility ends; 65 (89%, 21 censored) children in the FN arm and 50 (79%, 13 censored) children in the CCM arm were newly engaged in EI. In Cox proportional hazards regression, families receiving FN were approximately 54% more likely to engage EI than those receiving CCM (1.54 (95% confidence interval: 1.09-2.19), P = .02).
CONCLUSIONS
FN improved the likelihood of EI participation among urban families from marginalized communities.
目的
C 部分早期干预（EI）服务已被证明可以减少幼儿自闭症症状并促进其健康发展。然而，EI 的参与率仍然很低，尤其是在来自结构边缘化社区的儿童中。我们研究了家庭导航（FN）是否比传统的护理管理（CCM）在经过积极的初级保健自闭症筛查后，能提高 EI 的启动率。
方法
我们在三个城市的 11 个城市初级保健点进行了一项随机临床试验，共有 339 名年龄在 15-27 个月的儿童的家庭参与，这些家庭在筛查中显示出患有自闭症的可能性增加。家庭被随机分配到 FN 或 CCM。FN 组的家庭接受了受过培训的导航员的社区外展服务，以支持家庭克服自闭症评估和服务的结构性障碍。EI 服务记录是从州或地方机构获得的。本研究的主要结果，即 EI 服务参与度，是通过从随机分组到第一次 EI 预约的天数来衡量的。
结果
EI 服务记录可用于 271 名儿童；在研究入组时，有 156 名（57.6%）儿童未接受 EI。在诊断确定后的 100 天内或在 3 岁时（C 部分 EI 资格结束），对儿童进行了随访；FN 组有 65 名（89%，21 个截尾）儿童和 CCM 组有 50 名（79%，13 个截尾）儿童新接受 EI。在 Cox 比例风险回归中，接受 FN 的家庭比接受 CCM 的家庭更有可能接受 EI，其比值比为 1.54（95%置信区间：1.09-2.19），P=0.02）。
结论
FN 提高了来自边缘化社区的城市家庭接受 EI 的可能性。
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