Bouchard Isaac, Martinez Kassandra, Gomez-Patino Pollyanna, Navarro Felice, Brookman-Frazee Lauren, Holmquist Kimberly J, Negriff Sonya, Barnett Miya, Broder-Fingert Sarabeth, Stadnick Nicole A
Department of Psychology, California State University Northridge, Northridge, CA, USA.
Doctoral Program in Clinical Psychology, San Diego State University, University of California San Diego Joint, San Diego, CA, USA.
Adm Policy Ment Health. 2025 Jun 9. doi: 10.1007/s10488-025-01452-z.
Autistic youth often experience co-occurring mental health needs, yet they have multi-level barriers to accessing needed care. To address these barriers, the ATTAIN NAV (Access to Tailored Autism Integrated Care through Family Navigation) intervention was co-designed with caregiver and healthcare partners and delivered by lay health navigators to facilitate access to and engagement with mental health services for school-age autistic youth. This manuscript describes the multi-method, partner-engaged, longitudinal adaptation process to (1) identify intervention content and implementation refinements prior to the hybrid trial and (2) track ongoing research, intervention, and implementation adaptations during the trial and their impacts on study outcomes. The adaptation processes used the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (Miller et al., 2021) to guide data collection and evaluation approaches. From the qualitative co-design activities with caregivers (n = 5), primary care providers (n = 6), developmental care clinicians (n = 4), and health informatics staff (n = 3), several intervention content and implementation adaptations were identified and integrated prior to the trial. From the longitudinal adaptation tracking process during the trial, a total of 19 adaptations were documented throughout the implementation trial. The adaptations were related to maintaining the feasibility and acceptability of the study procedures (32%), increasing family recruitment/engagement (26%), increasing the acceptability of the intervention components (16%), increasing physician recruitment/engagement (11%), expanding mental health resources (5%), complying with partnered healthcare organization policy (5%), and increasing navigator workflow efficiency (5%). Findings offer a structured and replicable approach adoptable by non-traditional mental health intervention and implementation research.
患有自闭症的青少年常常同时有心理健康需求，但他们在获得所需护理方面存在多层次障碍。为了解决这些障碍，“ATTAIN导航”（通过家庭导航获得量身定制的自闭症综合护理）干预措施是与照顾者及医疗合作伙伴共同设计的，并由非专业健康导航员实施，以促进学龄期自闭症青少年获得心理健康服务并参与其中。本手稿描述了多方法、合作伙伴参与的纵向调整过程，以（1）在混合试验之前确定干预内容和实施改进措施，以及（2）在试验期间跟踪正在进行的研究、干预和实施调整及其对研究结果的影响。调整过程使用了《基于证据的实施策略的调整和修改报告框架》（米勒等人，2021年）来指导数据收集和评估方法。通过与照顾者（n = 5）、初级保健提供者（n = 6）、发育护理临床医生（n = 4）和健康信息学工作人员（n = 3）进行的定性共同设计活动，在试验之前确定并整合了若干干预内容和实施调整措施。从试验期间的纵向调整跟踪过程来看，在整个实施试验过程中共记录了19项调整措施。这些调整措施与维持研究程序的可行性和可接受性（32%）、增加家庭招募/参与度（26%）、提高干预组成部分的可接受性（16%）、增加医生招募/参与度（11%）、扩大心理健康资源（5%）、遵守合作医疗保健组织政策（5%）以及提高导航员工作流程效率（5%）有关。研究结果提供了一种结构化且可复制的方法，可供非传统心理健康干预和实施研究采用。
