Schuh Tina L, Diviak Kathleen R, Coba-Rodriguez Sarai, Pela Emily, Kinney Raphael, Berbaum Michael L, Klemas Amanda, Acharya Kruti, Martin Molly, Shah Reshma
Institute of Health Research and Policy, University of Illinois, Chicago, IL, 60608, USA.
Department of Educational Psychology, University of Illinois, Chicago, IL, 60607, USA.
Contemp Clin Trials Commun. 2024 Dec 9;43:101412. doi: 10.1016/j.conctc.2024.101412. eCollection 2025 Feb.
Societal and structural inequities have resulted in longstanding health care disparities among Black, Latino/a/e, and low-income preschool children with developmental delays and disabilities (PCw/DD), depriving them of educational and therapeutic services that improve future academic, economic, and health outcomes. To address this issue, we developed Preschool and Me (PreM), a community-clinical linkage (CCL) implemented within healthcare settings serving historically marginalized communities. This novel CCL, an educational-medical linkage model, aims to increase access to school-based services for PCw/DD. Combining key components of CCLs with a personalized medical-education care plan and remote navigator support, PreM targets multiple levels of influence impacting access to school-based therapeutic and educational services. We will utilize a hybrid effectiveness-implementation approach in two models of real-world service delivery conditions. Participants (n = 320) will be randomized to either 6 months of PreM or a waitlist control arm beginning the intervention after a 6-month delay. Our specific aims are to test the effectiveness of PreM on access to school-based services as well as health service outcomes; examine mediators of intervention effects using a mixed-methods approach; and explore social determinants of health as potential moderators. We will simultaneously conduct an implementation evaluation. The results of this study have the potential to support effective implementation of CCL 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.
社会和结构上的不平等导致了黑人、拉丁裔和低收入学龄前发育迟缓及残疾儿童（PCw/DD）在医疗保健方面长期存在差距，使他们无法获得有助于改善未来学业、经济和健康状况的教育和治疗服务。为了解决这一问题，我们开发了“学前与我”（PreM）项目，这是一种在为历史上被边缘化社区提供服务的医疗机构内实施的社区-临床联系（CCL）模式。这种新颖的CCL模式，即一种教育-医疗联系模型，旨在增加PCw/DD儿童获得校内服务的机会。PreM将CCL的关键组成部分与个性化的医学-教育护理计划及远程导航支持相结合，针对影响获得校内治疗和教育服务的多个影响层面。我们将在两种现实世界服务提供条件模型中采用混合效果-实施方法。参与者（n = 320）将被随机分为两组，一组接受为期6个月的PreM项目，另一组为等待名单对照组，在延迟6个月后开始干预。我们的具体目标是测试PreM项目在获得校内服务以及健康服务结果方面的有效性；采用混合方法研究干预效果的中介因素；并探索健康的社会决定因素作为潜在的调节因素。我们将同时进行实施评估。本研究的结果有可能支持在为历史上被边缘化社区提供服务的儿科临床环境中有效实施CCL模式，这可用于改善患有一系列健康状况的家庭及其子女的健康结果。
