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Srinivasan AP, Nishiguchi EP, Gonzalez C, Jimenez ME, Zuckerman KE, Lion KC. Toward More Equitable Care: A Closer Look at Autism Clinic Intake Practices and Paperwork. J Dev Behav Pediatr 2024:00004703-990000000-00200. [PMID: 39140899 DOI: 10.1097/dbp.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 06/20/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To describe intake requirements among autism clinics and to assess how well intake paperwork aligns with national standards for enhancing language and literacy accessibility. METHODS This was a survey of 126 autism clinics in the Children's Hospital Association, assessing intake processes and intake paperwork readability conducted between November 2021 and August 2022. Descriptive analyses characterized intake requirements and paperwork components. Free-text responses about intake support strategies were categorized into themes. Logistic regression models examined associations between clinic patient demographics and odds of requiring intake paperwork. Intake packet length, content, and reading grade level were examined. RESULTS Of the invited clinics, 73% completed the survey. Among the participating clinics, 55% required intake paperwork before scheduling appointments, 34% offered English forms only, and 89% had no plain language forms. Clinic patient demographics were not associated with intake paperwork requirements. Analyzed intake packets (n = 67) averaged 11 pages long, and most were written above the fifth-grade reading level. Most packets solicited medical, developmental, and educational/therapy history. Many also requested psychoeducational evaluations and teacher rating forms. Reported intake support strategies for families with language or literacy needs included making ad hoc exceptions to the usual process, task shifting to outside organizations, providing support at family's request, and delegating to support staff. CONCLUSION Many autism clinics nationwide require intake paperwork before diagnostic evaluation. Many clinics offer intake paperwork in English only, and paperwork often does not meet health literacy standards. Reducing paperwork requirements and providing more routine and robust intake support may facilitate equitable access to autism diagnostic evaluations.
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Affiliation(s)
- Anisha P Srinivasan
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California, Davis, Sacramento, CA
- MIND Institute, University of California, Davis, Sacramento, CA
| | - Erika Phelps Nishiguchi
- Department of Pediatrics, University of Hawai'i, Honolulu, HI
- Division of Community Pediatrics, Hawai'i Pacific Health, Kapi'Olani Medical Center for Women and Children, Honolulu, HI
| | | | - Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Child Health Institute of New Jersey, New Brunswick, NJ
- Boggs Center on Developmental Disabilities, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
- Children's Specialized Hospital, New Brunswick, NJ
| | | | - Katherine C Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Center for Child Health, Behavior and Development, Seattle Children's Hospital and Research Institute, Seattle, WA
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2
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Nelson EL, Punt S, Stiles R, Cain SE. Community Health Workers: Bridge to Pediatric Mental Health Equity. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)01313-3. [PMID: 39098720 DOI: 10.1016/j.jaac.2024.07.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 06/03/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
We currently face a national crisis1 in youth mental health and well-being and significant child behavioral health inequities. There is a growing recognition among health care institutions, policymakers, researchers, and communities that major health problems of our time, including this crisis, must be confronted by addressing the underlying "causes of the causes,"2 or social determinants of health. Social determinants of health3 are defined by the US Centers for Disease Control and Prevention as the conditions in which people live, learn, work, play, worship, and age and highlight the role that power and privilege occupy in shaping societal access to these resources. Social determinants of mental health (SDoMH) encompass the same conditions of social determinants of health, with the addition of the stigma often associated with mental health and substance use disorders. SDoMH focus on the social/environmental factors that place certain groups at increased risk for mental health concerns and worsening outcomes for individuals who already have mental health concerns.4 Addressing SDoMH is a key strategy to toward Healthy People 20305 goals and "the attainment of the highest level of health for all people."
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Affiliation(s)
| | | | - Robert Stiles
- University of Kansas Medical Center, Kansas City, Missouri
| | - Sharon E Cain
- University of Kansas Medical Center, Kansas City, Missouri
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3
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Nelson BB, Dudovitz RN, Thompson LR, Vangala S, Zevallos-Roberts E, Gulsrud A, Porras-Javier L, Romley JA, Herrera P, Aceves I, Chung PJ. Early Childhood Care Coordination Through 211: A Randomized Clinical Trial. Pediatrics 2024; 154:e2023065232. [PMID: 39054946 PMCID: PMC11291962 DOI: 10.1542/peds.2023-065232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Early intervention services can improve outcomes for children with developmental delays. Health care providers, however, often struggle to ensure timely referrals and services. We tested the effectiveness of telephone-based early childhood developmental care coordination through 211 LA, a health and human services call center serving Los Angeles County, in increasing referral and enrollment in services. METHODS In partnership with 4 clinic systems, we recruited and randomly assigned children aged 12 to 42 months with upcoming well-child visits and without a known developmental delay, to intervention versus usual care. All children received developmental screening and usual clinic care. Intervention children also received telephone connection to a 211 LA early childhood care coordinator who made referrals and conducted follow-up. Primary outcomes at a 6-month follow-up included parent-reported referral and enrollment in developmental services. Secondary outcomes included referral and enrollment in early care and education (ECE). Logistic regression models were used to estimate the odds of outcomes, adjusted for key covariates. RESULTS Of 565 families (282 intervention, 283 control), 512 (90.6%) provided follow-up data. Among all participants, more intervention than control children were referred to (25% vs 16%, adjusted odds ratio [AOR] 2.25, P = .003) and enrolled in (15% vs 9%, AOR 2.35, P = .008) ≥1 service, and more intervention than control children were referred to (58% vs 15%, AOR 9.06, P < .001) and enrolled in (26% vs 10%, AOR 3.75, P < .001) ECE. CONCLUSIONS Telephone-based care coordination through 211 LA is effective in connecting young children to developmental services and ECE, offering a potentially scalable solution for gaps and disparities.
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Affiliation(s)
- Bergen B. Nelson
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca N. Dudovitz
- Departments of Pediatrics and Children’s Development and Innovation Institute
| | | | - Sitaram Vangala
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Amanda Gulsrud
- Psychiatry, Semel Institute for Neuroscience and Human Behavior
| | | | - John A. Romley
- Price School of Public Policy and School of Pharmacy, University of Southern California, Los Angeles, California
| | - Patricia Herrera
- California State Council on Developmental Disabilities, Sacramento, California
| | | | - Paul J. Chung
- Medicine Statistics Core
- Pediatrics and Health Policy & Management
- Department of Health Systems Science
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Schmidt D, Urias C, Dufek S, Talbott MR. Caregiver Perspectives on Telehealth Assessment and Other Supports for Infants with Early Developmental Concerns. J Autism Dev Disord 2024:10.1007/s10803-024-06483-3. [PMID: 39066971 DOI: 10.1007/s10803-024-06483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
This study examined the experiences of families of children with developmental concerns in the first year of life, before formal diagnostic evaluations are typically conducted. We aimed to understand the impact of participation in a telehealth-based research evaluation in infancy, identify existing community-based supports perceived favorably by caregivers, and identify suggestions for future directions. Participants were recruited from an prior study evaluating a telehealth assessment for infants with early social communication delays. Here, we interviewed caregivers (n = 19) who participated in follow-up study in toddlerhood. Transcripts from the semi-structured interviews were transcribed and analyzed using both inductive thematic and content coding approaches. Analysis of these interviews resulted in four core themes describing caregiving during this time: (1) Caregivers felt lonely, overwhelmed, and dismissed by providers, leading to feelings of uncertainty about their child's development and future; (2) Telehealth assessments were appreciated because external supports are minimal, complex to navigate, and do not address all areas of need; (3) Desire for additional community and connection; and (4) Information is power. Caregivers reported participating in the telehealth assessments helped them to feel reassured, validated and supported. Outside the study, they sought a wide variety of services and resources. The most frequent requests were for parent coaching sessions and family navigation. Caregivers experienced uncertainty and disempowerment during the pre-diagnostic period and sought education and guidance during this time. Findings reflect the importance of centering family priorities when developing early intervention services for infants with elevated likelihood of autism.
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Affiliation(s)
- Daltrey Schmidt
- MIND Institute, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Chloe Urias
- MIND Institute, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Sarah Dufek
- MIND Institute, 2825 50th Street, Sacramento, CA, 95817, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, California, USA
| | - Meagan R Talbott
- MIND Institute, 2825 50th Street, Sacramento, CA, 95817, USA.
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, California, USA.
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5
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Mazurek MO, Nevill RE, Orlando K, Page K, Howard M, Davis BE. Integration of Family Navigation into ECHO Autism for Pediatric Primary Care in Underserved Communities. J Autism Dev Disord 2024:10.1007/s10803-024-06445-9. [PMID: 38954361 DOI: 10.1007/s10803-024-06445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
Children with autism from underserved communities face complex system-, provider-, and family-level barriers to accessing timely diagnosis and early intervention. The current study evaluated the preliminary effects and feasibility of a new program (ECHO Autism LINKS) that integrated pediatric primary care provider (PCP) training with family navigation (FN) to bridge the gaps between screening, referral, and service access. Three cohorts of PCPs (n = 42) participated in the program, which consisted of 60-minute sessions delivered by Zoom twice per month for 12 months. Each session included didactics, case-based learning, and collaborative discussion with participants and an interdisciplinary team of experts. Family navigators were members of the expert team and provided FN services to families referred by PCP participants. Program attendance and engagement were strong, with 40 cases presented and 258 families referred for FN services, most of whom (83%) needed help accessing and connecting with services, and 13% required ongoing support due to complex needs. PCPs demonstrated significant improvements in self-efficacy in providing best-practice care for children with autism, reported high satisfaction, and observed improved knowledge and practice as a result of the program. The results of this initial pilot provide support for the feasibility, acceptability, and preliminary efficacy of the ECHO Autism LINKS program. The model holds promise in addressing complex barriers to healthcare access by providing both PCPs and families with the knowledge and support they need. Future research is needed to evaluate the efficacy and effectiveness of the program in improving child and family outcomes.
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Affiliation(s)
- Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA.
| | - Rose E Nevill
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Karen Orlando
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Keith Page
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Mya Howard
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Beth Ellen Davis
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
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Klein B, Ramaker M, Fitterling C, James C, Rouse M, Fauntleroy-Love KD, McNally Keehn R, Enneking B. Engagement and Satisfaction With Care Navigation Support Following Telehealth Autism Evaluation. J Dev Behav Pediatr 2024; 45:e309-e316. [PMID: 39146229 DOI: 10.1097/dbp.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Care navigation support is designed to help connect families with health care resources. Given that children with autism have more unmet needs than their peers, such a service may be especially valuable to families who have recently received a diagnosis. This study sought to examine engagement in care navigation support after an autism telehealth evaluation. Specifically, we report on what demographic and diagnostic factors predicted engagement in care navigation support and satisfaction with this service. METHODS Care navigation was offered to 220 families receiving autism telehealth evaluations between April 2020 and April 2022. Survey data from initial evaluation appointments and 2 follow-up care navigation meetings (approximately 1-3 months and approximately 9-12 months after evaluation), along with data from medical records, were collected and analyzed to determine whether any traits predicted engagement in care navigation. Satisfaction with care navigation was also analyzed. RESULTS Of 220 families, 48.2% (n = 106) participated in a care navigation meeting within 1 to 3 months after an evaluation and 59.5% (n = 131) participated in at least 1 meeting across 2 time periods. The findings did not support the hypothesis that a diagnosis of autism would predict engagement. Analyses found that child sex (female compared with male) and child race and ethnicity (children of color compared with White children) predicted engagement. For those who engaged in care navigation, high satisfaction was reported. CONCLUSION Participants' engagement rates and satisfaction levels suggest care navigation is a valuable service for families after a telehealth autism evaluation.
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Affiliation(s)
- Brian Klein
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Samuel PS, Marsack-Topolewski CN, Janks E, Raoufi G, Milberger S. Family Support of Older Caregivers: Factors Influencing Change in Quality of Life. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:308-325. [PMID: 38917996 DOI: 10.1352/1944-7558-129.4.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/30/2024] [Indexed: 06/27/2024]
Abstract
Understanding factors that can improve the quality of life (QOL) of older caregivers of people with intellectual and developmental disabilities (IDD) is important in broadening participation in family empowerment interventions. The purpose of this study was to identify the factors influencing the QOL of older caregivers (50+) of adults with IDD who participated in a peer-mediated state-wide family support project. The research study used a quasi-experimental research design grounded in the family quality of life (FQOL) framework, with pretest and posttest data gathered from 82 caregivers. Correlation and regression analyses were conducted to identify factors influencing changes in the QOL of study participants. Findings indicated that improvements in caregiver QOL after participating in the project could be explained by caregiver's employment status, increased global FQOL, and decreased caregiver stress and depression.
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Affiliation(s)
| | | | - Elizabeth Janks
- Elizabeth Janks, Gelareh Raoufi, and Sharon Milberger, Wayne State University
| | - Gelareh Raoufi
- Elizabeth Janks, Gelareh Raoufi, and Sharon Milberger, Wayne State University
| | - Sharon Milberger
- Elizabeth Janks, Gelareh Raoufi, and Sharon Milberger, Wayne State University
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8
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Blakey AO, Eilenberg JS, Cardona N, Kizildag D, Broder-Fingert S, Feinberg E, Long KA. Family Involvement During Comprehensive Developmental Evaluations: Perspectives of Diverse Mothers. J Dev Behav Pediatr 2024; 45:e325-e333. [PMID: 39108071 PMCID: PMC11326989 DOI: 10.1097/dbp.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/04/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE Early diagnosis and social support postdiagnosis (i.e., family involvement) can lead to improved outcomes for children with autism spectrum disorder (ASD) and other developmental disorders. Children of minority ethnic and racial groups are typically diagnosed later in childhood compared with White children, contributing to disparities in outcomes. Research has not yet explored family involvement during comprehensive developmental evaluations nor accounted for cross-cultural differences in family roles and involvement. This qualitative study sought to characterize the nature and impact of family involvement during the developmental evaluation process among racially and ethnically marginalized mothers of children with developmental delays and possible ASD. METHODS Mothers (N = 27) of children who had a positive autism screen during their 18- or 24-month well-child visit but did not receive an ASD diagnosis after comprehensive developmental evaluation participated in individual semi-structured interviews exploring experiences with developmental screening, related services, and family involvement/social support. Qualitative data were transcribed, coded, and analyzed using applied thematic analysis. Data were stratified by partner status (i.e., partnered vs. nonpartnered) to examine differences in support and family involvement across varying family compositions. RESULTS Three qualitative themes emerged: (1) mothers sought family involvement when making decisions about pursuing developmental evaluations, (2) family involvement affected mothers' navigation of logistical challenges, and (3) mothers involved family members for emotional support. Differences by partner status emerged in themes 1 and 2. CONCLUSION Findings highlight benefits of and potential approaches to harnessing family involvement to support parents' navigation of the developmental evaluation process and ultimately improve child outcomes.
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Affiliation(s)
- Ariel O Blakey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | | | - Nicole Cardona
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Deniz Kizildag
- Department of Anthropology, Brandeis University, Waltham, MA
| | - Sarabeth Broder-Fingert
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA
| | - Emily Feinberg
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Kristin A Long
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
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9
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Guastaferro K, Sheldrick RC, Strayhorn JC, Feinberg E. Operationalizing Primary Outcomes to Achieve Reach, Effectiveness, and Equity in Multilevel Interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:397-406. [PMID: 38047992 PMCID: PMC11239781 DOI: 10.1007/s11121-023-01613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
When intervention scientists plan a clinical trial of an intervention, they select an outcome metric that operationalizes their definition of intervention success. The outcome metric that is selected has important implications for which interventions are eventually supported for implementation at scale and, therefore, what health benefits (including how much benefit and for whom) are experienced in a population. Particularly when an intervention is to be implemented in a population that experiences a health disparity, the outcome metric that is selected can also have implications for equity. Some outcome metrics risk exacerbating an existing health disparity, while others may decrease disparities for some but have less effect for the larger population. In this study, we use a computer to simulate implementation of a hypothetical multilevel, multicomponent intervention to highlight the tradeoffs that can occur between outcome metrics that reflect different operationalizations of intervention success. In particular, we highlight tradeoffs between overall mean population benefit and the distribution of health benefits in the population, which has direct implications for equity. We suggest that simulations like the one we present can be useful in the planning of a clinical trial for a multilevel and/or multicomponent intervention, since simulated implementation at scale can illustrate potential consequences of candidate operationalization of intervention success, such that unintended consequences for equity can be avoided.
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Affiliation(s)
- Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA.
| | - R Christopher Sheldrick
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jillian C Strayhorn
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Emily Feinberg
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, RI, USA
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10
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Olson LM, Perry GN, Yang S, Galyean PO, Zickmund SL, Sorenson S, Pinto NP, Maddux AB, Watson RS, Fink EL. Parents' Experiences Caring for a Child after a Critical Illness: A Qualitative Study. J Pediatr Intensive Care 2024; 13:127-133. [PMID: 38919699 PMCID: PMC11196146 DOI: 10.1055/s-0041-1740450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022] Open
Abstract
Objectives This article described parents' experience and identifies outcomes important to parents following their child's critical illness. Methods Semistructured interviews with 22 female and 4 male parents representing 26 critically ill children with predominately neurologic and respiratory diagnoses. Most children were younger than 5 years at discharge with a median (interquartile range) of 2 (2.0-3.0) years from discharge to interview. Results Many children returned home with life-altering physical and cognitive disabilities requiring months to years of rehabilitation. Parents remembered feeling unprepared and facing an intense, chaotic time when the child first returned home. They described how they suddenly had to center their daily activities around the child's needs amidst competing needs of siblings and partners, and in some cases, the medicalization of the home. They recounted negotiating adjustments almost daily with insurance agencies, medical doctors and therapists, employers, the child, and other family members to keep the family functioning. In the long term, families developed a new norm, choosing to focus on what the child could still do rather than what they could not. Even if the child returned to baseline, parents remembered the adjustments made to keep the child alive and the family functioning. Conclusion Heightened awareness of family experiences after pediatric critical illness will allow health care providers to improve family preparedness for the transition from hospital to home.
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Affiliation(s)
- Lenora M. Olson
- Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, United States
| | - Grace N. Perry
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Serena Yang
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Patrick O'Roke Galyean
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Susan L. Zickmund
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
| | - Samuel Sorenson
- Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, United States
| | - Neethi P. Pinto
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Aline B. Maddux
- Department of Pediatrics, Critical Care Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States
| | - R. Scott Watson
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Ericka L. Fink
- Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
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11
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Weitzman C, Nadler C, Blum NJ, Augustyn M. Health Care for Youth With Neurodevelopmental Disabilities: A Consensus Statement. Pediatrics 2024; 153:e2023063809. [PMID: 38596852 DOI: 10.1542/peds.2023-063809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Individuals with a neurodevelopmental disability (NDD) face significant health care barriers, disparities in health outcomes, and high rates of foregone and adverse health care experiences. The Supporting Access for Everyone (SAFE) Initiative was developed to establish principles of health care to improve equity for youth with NDDs through an evidence-informed and consensus-derived process. With the Developmental Behavioral Pediatric Research Network, the SAFE cochairs convened a consensus panel composed of diverse professionals, caregivers, and adults with NDDs who contributed their varied expertise related to SAFE care delivery. A 2-day public forum (attended by consensus panel members) was convened where professionals, community advocates, and adults with NDDs and/or caregivers of individuals with NDDs presented research, clinical strategies, and personal experiences. After this, a 2-day consensus conference was held. Using nominal group technique, the panel derived a consensus statement (CS) on SAFE care, an NDD Health Care Bill of Rights, and Transition Considerations. Ten CSs across 5 topical domains were established: (1) training, (2) communication, (3) access and planning, (4) diversity, equity, inclusion, belonging, and anti-ableism, and (5) policy and structural change. Relevant and representative citations were added when available to support the derived statements. The final CS was approved by all consensus panel members and the Developmental Behavioral Pediatric Research Network steering committee. At the heart of this CS is an affirmation that all people are entitled to health care that is accessible, humane, and effective.
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Affiliation(s)
| | - Cy Nadler
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Nathan J Blum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marilyn Augustyn
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts
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Chronis-Tuscano A, Bounoua N. ADHD Prevalence Rose, Yet Disparities Remain: Commentary on the 2022 National Survey of Children's Health. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:361-372. [PMID: 38905157 PMCID: PMC11193851 DOI: 10.1080/15374416.2024.2359075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
This is a commentary on Danielson and colleagues' report entitled "ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment," which provides updated prevalence rates related to ADHD diagnosis and treatment utilization using data from the 2022 National Survey of Children's Health (NSCH). This timely article is among the first to report on ADHD prevalence rates since the COVID-19 pandemic, and highlights important patterns related to ADHD diagnosis and treatment utilization. In this commentary, we contextualize these findings with consideration to the COVID-19 pandemic and within the existing literature on health disparities among youth with ADHD and their families. We end with recommendations for future work involving researchers, clinicians, and policymakers with the intention of reducing disparities in ADHD diagnosis and treatment in the U.S.
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Sheldrick RC, Hooker JL, Carter AS, Feinberg E, Croen LA, Kuhn J, Slate E, Wetherby AM. The influence of loss to follow-up in autism screening research: Taking stock and moving forward. J Child Psychol Psychiatry 2024; 65:656-667. [PMID: 37469104 PMCID: PMC10801774 DOI: 10.1111/jcpp.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND How best to improve the early detection of autism spectrum disorder (ASD) is the subject of significant controversy. Some argue that universal ASD screeners are highly accurate, whereas others argue that evidence for this claim is insufficient. Relatedly, there is no clear consensus as to the optimal role of screening for making referral decisions for evaluation and treatment. Published screening research can meaningfully inform these questions-but only through careful consideration of children who do not complete diagnostic follow-up. METHODS We developed two simulation models that re-analyze the results of a large-scale validation study of the M-CHAT-R/F by Robins et al. (2014, Pediatrics, 133, 37). Model #1 re-analyzes screener accuracy across six scenarios, each reflecting different assumptions regarding loss to follow-up. Model #2 builds on this by closely examining differential attrition at each point of the multi-step detection process. RESULTS Estimates of sensitivity ranged from 40% to 94% across scenarios, demonstrating that estimates of accuracy depend on assumptions regarding the diagnostic status of children who were lost to follow-up. Across a range of plausible assumptions, data also suggest that children with undiagnosed ASD may be more likely to complete follow-up than children without ASD, highlighting the role of clinicians and caregivers in the detection process. CONCLUSIONS Using simulation modeling as a quantitative method to examine potential bias in screening studies, analyses suggest that ASD screening tools may be less accurate than is often reported. Models also demonstrate the critical importance of every step in a detection process-including steps that determine whether children should complete an additional evaluation. We conclude that parent and clinician decision-making regarding follow-up may contribute more to detection than is widely assumed.
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Affiliation(s)
| | | | - Alice S. Carter
- Department of Psychology, University of Massachusetts Boston, Boston, MA
| | - Emily Feinberg
- School of Public Health, Brown University, Providence, MA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jocelyn Kuhn
- School of Public Health, Brown University, Providence, MA
| | - Elizabeth Slate
- Department of Statistics, Florida State University, Tallahassee, FL
| | - Amy M. Wetherby
- College of Medicine, Florida State University, Tallahassee, FL
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14
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Feinberg E, Eilenberg JS. Role of Community Health Workers in Promoting Health Equity in Pediatrics. Acad Pediatr 2024; 24:199-200. [PMID: 37739310 PMCID: PMC10939957 DOI: 10.1016/j.acap.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Emily Feinberg
- Brown University School of Public Health (E. Feinberg), Hassenfeld Child Health Innovation Institute, Providence, RI.
| | - Jenna Sandler Eilenberg
- Boston University (JS Eilenberg), Department of Psychological & Brain Sciences, Boston, Mass.
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15
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Hightshoe K, Gutiérrez-Raghunath S, Tomcho MM, Rosenberg CR, Rosenberg SA, Dooling-Litfin JK, Cordova JM, Colborn K, DiGuiseppi C. Barriers to referral and evaluation and corresponding navigation services for toddlers screening positive for autism spectrum disorder. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:342-357. [PMID: 37732975 PMCID: PMC10516304 DOI: 10.1037/fsh0000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Children from disadvantaged populations receive referrals, diagnoses, and services for autism spectrum disorder (ASD) late or not at all. We describe barriers to referral for and receipt of evaluation for ASD among young children from disadvantaged families and activities by autism family navigators (AFNs) to address these barriers. METHOD Trained AFNs offered navigation to families of children aged 16-30 months with positive ASD screens from community health center clinics in 2015-2018. AFNs interviewed families to identify perceived barriers to care and documented system barriers and navigation activities. We coded, categorized, and described barriers and AFN activities. Case studies illustrate barriers and navigation activities. RESULTS Of 22 participating mothers, 82% were Latinx and 64% were native Spanish-speaking; 71% had household incomes <$30,000/year and 57% had no high school diploma. Half of the families experienced five or more barriers to ASD evaluation, most commonly pragmatic barriers. Information barriers/needs were 5 times more common among Spanish-speaking than English-speaking mothers. One-fifth of families identified negative experiences or expectations of care. System barriers included incomplete screening tests, inadequate referrals, and waiting lists. AFNs implemented navigation activities, most frequently categorized as care coordination (95%), education (68%), social/emotional support (36%), family advocacy (27%), and self-advocacy coaching (23%). AFNs also trained providers and staff to improve screening and referral implementation. DISCUSSION In this largely Latinx sample, families experienced numerous barriers to obtaining ASD evaluations for their screen-positive children, likely reflecting the complexity of negotiating both healthcare and educational systems. Trained AFNs can assist parents to overcome barriers to timely diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Kathryn Colborn
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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16
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Feinberg E, Stransky ML, Augustyn M, Broder-Fingert S, Bennett A, Weitzman C, Kuhn J, Chu A, Cabral HJ, Fenick AM, Blum NJ. Effect of Family Navigation on Participation in Part C Early Intervention. Acad Pediatr 2023; 23:904-912. [PMID: 37004879 PMCID: PMC10330889 DOI: 10.1016/j.acap.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
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.
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Affiliation(s)
- Emily Feinberg
- Hassenfeld Child Health Innovation Institute (E Feinberg and A Chu), Brown University, Providence, RI.
| | - Michelle L Stransky
- Division of General Academic Pediatrics (ML Stransky and J Kuhn), Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Mass.
| | - Marilyn Augustyn
- Center for the Urban Child and Healthy Family (M Augustyn), Boston Medical Center, Mass; Division of Developmental and Behavioral Pediatrics (M Augustyn), Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Mass.
| | - Sarabeth Broder-Fingert
- Department of Pediatrics (S Broder-Fingert), University of Massachusetts Chan Medical School, Worcester.
| | - Amanda Bennett
- Division of Developmental and Behavioral Pediatrics (A Bennett), Department of Pediatrics, Children's Hospital of Philadelphia, Pa.
| | - Carol Weitzman
- Division of Developmental Medicine (C Weitzman), Boston Children's Hospital, Mass; Department of Pediatrics (C Weitzman), Harvard Medical School, Boston, Mass.
| | - Jocelyn Kuhn
- Division of General Academic Pediatrics (ML Stransky and J Kuhn), Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Mass.
| | - Andrea Chu
- Hassenfeld Child Health Innovation Institute (E Feinberg and A Chu), Brown University, Providence, RI.
| | - Howard J Cabral
- Department of Biostatistics (HJ Cabral), Boston University School of Public Health, Mass.
| | - Ada M Fenick
- Developmental and Behavioral Pediatrics (AM Fenick), Division of General Pediatrics, Department of Pediatrics, Yale School of Medicine, New Haven, Conn.
| | - Nathan J Blum
- Division of Developmental and Behavioral Pediatrics (NJ Blum), Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
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Levinson J, Hickey E, Fuchu P, Chu A, Barnett M, Stadnick NA, Feinberg E, Broder-Fingert S. Recommendations for post-implementation adaptations to optimize family navigation in pediatric primary care: a qualitative study with parents and navigators. BMC PRIMARY CARE 2023; 24:123. [PMID: 37328810 PMCID: PMC10273746 DOI: 10.1186/s12875-023-02072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Family Navigation (FN) is an evidence-based care management intervention designed to reduce disparities in access to care by providing families with individually tailored support and care coordination. Early data suggest FN is effective, but effectiveness is significantly influenced by both contextual (e.g. setting) and individual (e.g., ethnicity) variables. To better understand how FN could be tailored to address this variability in effectiveness, we set forth to explore proposed adaptations to FN by both navigators and families who received FN. METHODS This study was a nested qualitative study set within a larger randomized clinical trial of FN to improve access to autism diagnostic services in urban pediatric primary care practices in Massachusetts, Pennsylvania, and Connecticut serving low-income, racial and ethnic minority families. Following FN implementation, key informant interviews were conducted based on the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) with a purposeful sample of parents of children who received FN (n = 21) and navigators (n = 7). Interviews were transcribed verbatim and were coded using framework-guided rapid analysis to categorize proposed adaptations to FN. RESULTS Parents and navigators proposed 38 adaptations in four domains: 1) content of the intervention (n = 18), 2) context of the intervention (n = 10), 3) training and evaluation (n = 6), and 4) implementation and scale-up (n = 4). The most frequently endorsed adaptation recommendations focused on content (e.g., lengthening FN, providing parents with additional education on autism and parenting children with autism) and implementation (e.g., increasing access to navigation). Although probes targeted critical feedback, parents and navigators were overwhelmingly positive about FN. CONCLUSIONS This study builds upon prior FN effectiveness and implementation research by providing concrete areas for adaptation and refinement of the intervention. Recommendations by parents and navigators have the potential to inform improvement of existing navigation programs and development of new programs in similarly underserved populations. These findings are critical as adaptation (cultural and otherwise) is an important principle in the field of health equity. Ultimately, adaptations will need to be tested to determine clinical and implementation effectiveness. TRIAL REGISTRATION ClinicalTrials.gov, registration number NCT02359084, February 9, 2015.
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Affiliation(s)
| | | | - Plyce Fuchu
- University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA, 01605, USA.
| | | | - Miya Barnett
- University of California, Santa Barbara, Santa Barbara, USA
| | | | - Emily Feinberg
- Boston Medical Center, Boston, USA
- Boston University School of Medicine, Boston, USA
| | - Sarabeth Broder-Fingert
- University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA, 01605, USA
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18
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Kellom KS, Flaherty CM, Cacia J, Christiansen A, Cordero L, Hah J, Kennelly A, Ortiz P, Stefanski K, Wozniak SN, Wallis KE. Provider and Caregiver Perspectives on Telehealth Assessments for Autism Spectrum Disorder in Young Children: A Multimethod DBPNet Study Exploring Equity. J Dev Behav Pediatr 2023; Publish Ahead of Print:00004703-990000000-00111. [PMID: 37315107 DOI: 10.1097/dbp.0000000000001198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/18/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Telehealth uptake increased dramatically during the COVID-19 pandemic, including for autism spectrum disorder (ASD) assessment by developmental-behavioral pediatric (DBP) clinicians. However, little is known about the acceptability of telehealth or its impact on equity in DBP care. OBJECTIVE Engage providers and caregivers to glean their perspectives on the use of telehealth for ASD assessment in young children, exploring acceptability, benefits, concerns, and its potential role in ameliorating or exacerbating disparities in access to and quality of DBP care. METHODS This multimethod study used surveys and semistructured interviews to describe provider and family perspectives around the use of telehealth in DBP evaluation of children younger than 5 years with possible ASD between 3/2020 and 12/2021. Surveys were completed by 13 DBP clinicians and 22 caregivers. Semistructured interviews with 12 DBP clinicians and 14 caregivers were conducted, transcribed, coded, and analyzed thematically. RESULTS Acceptance of and satisfaction with telehealth for ASD assessments in DBP were high for clinicians and most caregivers. Pros and cons concerning assessment quality and access to care were noted. Providers raised concerns about equity of telehealth access, particularly for families with a preferred language other than English. CONCLUSION This study's results can inform the adoption of telehealth in DBP in an equitable manner beyond the pandemic. DBP providers and families desire the ability to choose telehealth care for different assessment components. Unique factors related to performing observational assessments of young children with developmental and behavioral concerns make telehealth particularly well-suited for DBP care.
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Affiliation(s)
| | - Carina M Flaherty
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jaclyn Cacia
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Audrey Christiansen
- Boston University School of Medicine, Boston, MA
- Division of Developmental-Behavioral Pediatrics Boston Medical Center, Boston MA
| | - Lucero Cordero
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia Hah
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Annie Kennelly
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
| | - Priscilla Ortiz
- Language Services Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristen Stefanski
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
| | - Sarah N Wozniak
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kate E Wallis
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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19
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Marsack-Topolewski C, Milberger S, Janks E, Anderson N, Bray M, Samuel PS. Evaluation of peer-mediated systems navigation for ageing families of individuals with developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:462-474. [PMID: 36866717 DOI: 10.1111/jir.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND As individuals with intellectual and developmental disabilities (I/DD) age, services often diminish, with many family caregivers experiencing challenges finding and navigating services. The purpose of this study was to examine the benefits of a state-wide family support project for ageing caregivers (50+) of adults with I/DD in accessing and using services. METHOD A one-group pre-test-post-test design was used to determine if participation in the MI-OCEAN intervention grounded in the Family Quality of Life (FQOL) theory reduced ageing caregivers' (n = 82) perceptions of barriers to accessing, using and needing formal services. RESULTS After participating in the study, there was a reduction in reported barriers to accessing services. There was also greater use and reduced need for 10 of the 23 listed formal services. CONCLUSIONS Findings indicate that a peer-mediated intervention grounded in FQOL theory can be beneficial in empowering ageing caregivers by reducing perceived barriers to accessing services and increasing their use of advocacy and support services.
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Affiliation(s)
- C Marsack-Topolewski
- School of Social Work, Eastern Michigan University, Ypsilanti, MI, USA
- Michigan Developmenal Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - S Milberger
- Michigan Developmenal Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - E Janks
- Michigan Developmenal Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - N Anderson
- Michigan Developmenal Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - M Bray
- Michigan Developmenal Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - P S Samuel
- Department of Health Care Sciences, Wayne State University, Detroit, MI, USA
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20
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Garcia D, Barnett ML, Rothenberg WA, Tonarely NA, Perez C, Espinosa N, Salem H, Alonso B, Juan JS, Peskin A, Davis EM, Davidson B, Weinstein A, Rivera YM, Orbano-Flores LM, Jent JF. A Natural Helper Intervention to Address Disparities in Parent Child-Interaction Therapy: A Randomized Pilot Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:343-359. [PMID: 36524764 PMCID: PMC10213097 DOI: 10.1080/15374416.2022.2148255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Parent-child interaction therapy (PCIT) is an effective intervention to address child externalizing behaviors. However, disparities in access and retention are pervasive, which relate to the availability of PCIT in low-income communities, inadequate workforces to provide culturally appropriate care, and distrust in services due to systemic discrimination. This study incorporated natural helpers who had been trained as community health workers into PCIT delivery to improve disparities in engagement and outcomes. METHOD Families from three low-income, predominately Latino/a/x and Black neighborhoods in Miami qualified for services if they had a child aged 2-8 with clinically elevated externalizing behaviors. Families were randomly assigned into either Standard-PCIT group (N = 30 families; 80% boys, 57% Latino/a/x, 27% Black) or a PCIT plus Natural helper (PCIT+NH) group (N = 51 families; 66% boys, 76% Latino/a/x, 18% Black). Families in the PCIT+NH group received home visits and support addressing barriers to care from a natural helper. Path analyses within an intention-to-treat framework examined group-differences in treatment engagement, child behavior, and parenting skills and stress. RESULTS Families in both groups demonstrated large improvements in child externalizing behavior, caregiver stress, and parenting skills from pre-to-post-treatment. Externalizing behavior improved significantly more in the PCIT+NH group compared to the Standard-PCIT group. There were no significant group differences in parenting skills or caregiver stress. Though differences in engagement were not significant, the PCIT+NH group had a small effect on treatment retention. CONCLUSIONS Natural helpers may help to address structural barriers that systematically impact communities of color, apply treatment in naturalistic environments, and promote improved treatment outcomes.
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Affiliation(s)
- Dainelys Garcia
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Miya L. Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA 93106-9490
| | - W. Andrew Rothenberg
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
- Duke University Center for Child and Family Policy, 302 Towerview Rd, Durham, NC, USA 27708
| | - Niza A. Tonarely
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Camille Perez
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Natalie Espinosa
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Hanan Salem
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Betty Alonso
- ConnectFamilias, 1111 SW 8 Street, Miami, FL, USA 33130
| | | | - Abigail Peskin
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Eileen M. Davis
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Bridget Davidson
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | - Allison Weinstein
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
| | | | | | - Jason F. Jent
- University of Miami Miller School of Medicine, Mailman Center for Child Development, 1600 NW 12 Ave, Miami, FL, USA 33136
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21
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Pham C, Bacon EC, Grzybowski A, Carter-Barnes C, Arias S, Xu R, Lopez L, Courchesne E, Pierce K. Examination of the impact of the Get SET Early program on equitable access to care within the screen-evaluate-treat chain in toddlers with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221147416. [PMID: 36629055 PMCID: PMC10333446 DOI: 10.1177/13623613221147416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
LAY ABSTRACT Delays in autism spectrum disorder identification and access to care could impact developmental outcomes. Although trends are encouraging, children from historically underrepresented minority backgrounds are often identified at later ages and have reduced engagement in services. It is unclear if disparities exist all along the screen-evaluation-treatment chain, or if early detection programs such as Get SET Early that standardize, these steps are effective at ameliorating disparities. As part of the Get SET Early model, primary care providers administered a parent-report screen at well-baby examinations, and parents designated race, ethnicity, and developmental concerns. Toddlers who scored in the range of concern, or whose primary care provider had concerns, were referred for an evaluation. Rates of screening and evaluation engagement within ethnic/racial groups were compared to US Census data. Age at screen, evaluation, and treatment engagement and quantity was compared across groups. Statistical models examined whether key factors such as parent concern were associated with ethnicity or race. No differences were found in the mean age at the first screen, evaluation, or initiation or quantity of behavioral therapy between participants. However, children from historically underrepresented minority backgrounds were more likely to fall into the range of concern on the parent-report screen, their parents expressed developmental concerns more often, and pediatricians were more likely to refer for an evaluation than their White/Not Hispanic counterparts. Overall results suggest that models that support transparent tracking of steps in the screen-evaluation-treatment chain and service referral pipelines may be an effective strategy for ensuring equitable access to care for all children.
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Affiliation(s)
| | | | | | | | | | - Ronghui Xu
- University of California, San Diego, USA
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22
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Gardiner E, Wong V, Miller AR. Proceedings of the BC Summit on Navigation for Children and Youth with Neurodevelopmental Differences, Disabilities, and Special Needs. BMC Proc 2022; 16:1. [PMID: 35581655 PMCID: PMC9112278 DOI: 10.1186/s12919-022-00232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patient navigation (PN) represents a branch of service delivery traditionally aimed at coordinating disjointed care services for patients with particular health conditions (e.g., cancer, HIV, diabetes). Over time, this approach has been extended to various social and health contexts, including most recently to children with neurodisability and their families. In this context, PN involves the provision of information, advice, education, and emotional support, coordination of services both within and across sectors, and the work is guided by person- and family-centred principles of practice. This manuscript documents the proceedings of the BC Summit on Navigation for Children and Youth with Neurodevelopmental Differences, Disabilities, and Special Needs, which took place on January 18 and 19, 2021 and was developed in collaboration with a Provincial Advisory Group. Our Summit brought together over 120 individuals, including researchers, government personnel, service providers, educators, healthcare workers, and family advocates. As part of the event, attendees learned from families with lived experience navigating the British Columbian (BC) service system, from BC Children’s Hospital Research Institute investigators, and from exemplar providers who deliver navigation services in various contexts (e.g., locally, regionally, and provincially). Attendees also participated in various engagement opportunities, and collaboratively identified directions for developing a future community of navigation and related services in BC.
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Affiliation(s)
- Emily Gardiner
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada. .,Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Vivian Wong
- Sunny Hill Health Centre at BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Anton R Miller
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.,Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
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23
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Wallis KE, Abdul-Chani MM, Zuckerman KE. Screen Often and With Trusted Community Members to Improve Autism Identification for Latine Children. JAMA Pediatr 2022; 176:229-231. [PMID: 34982108 DOI: 10.1001/jamapediatrics.2021.5377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Katharine E Zuckerman
- Division of General Pediatrics, Oregon Health & Science University, Portland.,Oregon Health & Science University-Portland State University School of Public Health, Portland
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24
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Eilenberg JS, Kizildag D, Blakey A, Cardona ND, Oberoi A, Broder-Fingert S, Feinberg E, Long KA. Implications of Universal Autism Screening: Perspectives From Culturally Diverse Families With False-Positive Screens. Acad Pediatr 2022; 22:279-288. [PMID: 34963655 PMCID: PMC8939055 DOI: 10.1016/j.acap.2021.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The American Academy of Pediatrics (AAP) recommends that pediatricians screen all young children for autism spectrum disorder (ASD). However, the US Preventive Services Task Force stated that there is insufficient evidence about the potential harms and benefits of universal ASD screening. To address this gap, we conducted qualitative interviews with caregivers of children who received a false-positive ASD screen to learn about families' perceptions of the harms and benefits of universal ASD screening. METHODS Culturally diverse caregivers (N = 26) of children with false-positive ASD screens completed qualitative interviews focused on parents' experiences with and recommendations to improve the ASD screening and evaluation process. Interviews were transcribed verbatim, coded, and analyzed using applied thematic analysis. RESULTS Parents explained that the ASD screening and evaluation process increased their knowledge about child development and substantiated existing concerns. The ASD screening and evaluation process resulted in connecting their child to services, which parents felt led to improvements in their child's delays. Parents endorsed anxiety during wait times for the formal developmental assessment. However, all parents expressed that, if given the option, they would repeat the screening and evaluation process again. Caregivers recommended universal screening for ASD and suggested that screening extend beyond the pediatrician to other settings. CONCLUSIONS From parents' perspectives, the connection to developmental services and increased knowledge of child development that resulted from the false-positive ASD screen outweighed the time-limited emotional distress triggered by a positive ASD screen. Overall, parents' preferences for universal ASD screening align with the AAP's recommendations.
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Affiliation(s)
- Jenna Sandler Eilenberg
- Department of Psychological and Brain Sciences, Boston University (JS Eilenberg, D Kizildag, AO Blakey, ND Cardona, A Oberoi, and KA Long), Boston, Mass.
| | - Deniz Kizildag
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Ariel Blakey
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Nicole D. Cardona
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Anjali Oberoi
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
| | - Sarabeth Broder-Fingert
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Emily Feinberg
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA,Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA
| | - Kristin A. Long
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd Floor, Boston, MA, 02215, USA
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Gardner L, Campbell JM, Gilchrest C, McClain MB, Shahidullah JD. Identification of autism spectrum disorder and interprofessional collaboration between school and clinical settings. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lauren Gardner
- Psychology and Neuropsychology Division Johns Hopkins All Children's Hospital St Petersburg Florida USA
| | - Jonathan M. Campbell
- Department of Psychology Western Carolina University Cullowhee North Carolina USA
| | - Callie Gilchrest
- Psychology and Neuropsychology Division Johns Hopkins All Children's Hospital St Petersburg Florida USA
| | | | - Jeffrey D. Shahidullah
- Department of Psychiatry and Behavioral Sciences The University of Texas at Austin Austin Texas USA
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26
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Zeng W, Magaña S, Lopez K, Xu Y, Marroquín JM. Revisiting an RCT study of a parent education program for Latinx parents in the United States: Are treatment effects maintained over time? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:499-512. [PMID: 34320853 PMCID: PMC8795242 DOI: 10.1177/13623613211033108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
LAY ABSTRACT Background: We conducted a follow-up investigation of a two-site randomized controlled trial in the United States. We examined whether the treatment effects in a culturally tailored parent education program for Latinx families of children with autism spectrum disorder were maintained over time.Methods: Using linear mixed models, we compared differences in parent and child outcomes across three timepoints: baseline, 4 months after baseline (Time 2), and 8 months after baseline (T3). Parent outcomes included family empowerment, self-reported confidence in, and frequency of using evidence-based strategies. Child outcomes included parent-reported challenging behaviors, social communication impairments, and the number of services received. Participants were 109 Latina mothers (intervention = 54, control = 55) of children with autism spectrum disorder.Results: After intervention at both Time 2 and Time 3 in both sites, mothers in the intervention groups reported significantly greater confidence in and frequency of using evidence-based strategies, and that their child received significantly more services. We also found that there were treatment differences across the two study sites in several outcomes.Implications: The intervention for Latinx parents of children with autism spectrum disorder was efficacious and could be maintained, and that site-specific policy and service differences may need to be examined in future research to inform dissemination and implementation.
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Affiliation(s)
- Weiwen Zeng
- Steve Hicks School of Social Work, University of Texas at Austin, TX, USA
| | - Sandy Magaña
- Steve Hicks School of Social Work, University of Texas at Austin, TX, USA
| | - Kristina Lopez
- School of Social Work, Arizona State University, AZ, USA
| | - Yue Xu
- Department of Disability and Human Development, University of Illinois at Chicago, IL, USA
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Differences in Processes Underlying Autism Service Engagement Among Latina and Non-Latina Mothers. J Autism Dev Disord 2022; 52:5440-5450. [DOI: 10.1007/s10803-021-05403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
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28
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Family Impact During the Time Between Autism Screening and Definitive Diagnosis. J Autism Dev Disord 2021; 52:4908-4920. [PMID: 34797470 DOI: 10.1007/s10803-021-05354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
Over the past 10 years, identification of Autism Spectrum Disorder (ASD) risk has dramatically increased due to the wide-spread implementation of screening programs; yet, there is limited understanding about parent perceptions and experiences during the time period when risk is identified, but prior to receiving a formal diagnosis-a period that can last months to years given the long wait-lists for formal ASD evaluations. The current study aimed to examine parent perceptions of family impact (i.e., the impact their child's behaviors have on the family) between the time of risk-identification and formal diagnosis among 277 children identified as at-risk for ASD through screening positive in primary care. We aimed to compare family impact among those whose child met diagnostic criteria for ASD and those who did not. Parents of children who received a non-ASD diagnosis reported a higher baseline level of family impact (F[1, 274] = 5.82, p = .017); however, perceived difficult child behavior was a stronger predictor of family impact (t[6] = 13.11, p < .001) than later diagnostic group (t[6] = - 2.10, p = .037), and child functioning did not predict family impact (t[6] = -0.31, p = .76). These results suggest that in this population, perceived difficult child behavior is a stronger predictor of family impact than later diagnostic category and should be considered an important factor in family support.
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29
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Barnett ML, Luis Sanchez BE, Green Rosas Y, Broder-Fingert S. Future Directions in Lay Health Worker Involvement in Children's Mental Health Services in the U.S. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:966-978. [PMID: 34554014 PMCID: PMC8633058 DOI: 10.1080/15374416.2021.1969655] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs' different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidence-based practices for historically marginalized communities within the U.S.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, University of California Santa Barbara
| | | | | | - Sarabeth Broder-Fingert
- Department of Pediatrics, University of Massachusetts Medical School
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School
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30
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Kuhn J, Levinson J, Udhnani MD, Wallis K, Hickey E, Bennett A, Fenick AM, Feinberg E, Broder-Fingert S. What Happens After a Positive Primary Care Autism Screen Among Historically Underserved Families? Predictors of Evaluation and Autism Diagnosis. J Dev Behav Pediatr 2021; 42:515-523. [PMID: 33631787 PMCID: PMC8380258 DOI: 10.1097/dbp.0000000000000928] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Families, pediatric providers, and service systems would benefit from expanded knowledge regarding (1) who is most likely to receive a recommended diagnostic evaluation after a positive primary care-administered autism screen and (2) of those who screen positive, who is most likely to be diagnosed with autism? METHOD Participants included 309 predominantly low-income, racial/ethnic minority parents and their child, aged 15 to 27 months, who screened positive on the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Generalized estimating equations were used to fit models of predictors for each binary outcome: receiving a diagnostic evaluation and receiving an autism diagnosis on evaluation. RESULTS Significant predictors of diagnostic evaluation receipt included the parent being older or non-Hispanic and the child having private insurance, lower child communication functioning, or receiving Early Intervention services. Significant predictors of an autism diagnosis on evaluation included male child, lower child communication functioning, screening directly in the parent's preferred language, White/non-Hispanic parent, and no parent history of mood disorder. CONCLUSION Children with younger parents, Hispanic ethnicity, relatively higher communication skills, public insurance, and no Early Intervention services were less likely to receive recommended diagnostic care. Reduced likelihood of autism diagnosis after a positive screen in non-White/non-Hispanic subgroups supports previous research indicating issues with M-CHAT-R/F positive predictive power for racial/ethnic minorities. The use of telephonic interpreters to administer screens, as opposed to directly screening in families' preferred languages, may lead to identification of fewer true autism cases. Thus, multilingual clinical staff capacity may improve positive predictive power of autism screening.
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Affiliation(s)
| | | | | | - Kate Wallis
- Children’s Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania
| | | | | | | | - Emily Feinberg
- Boston University School of Public Health
- Boston University School of Medicine
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31
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Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiatry Rep 2021; 23:66. [PMID: 34402984 PMCID: PMC8961310 DOI: 10.1007/s11920-021-01278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. RECENT FINDINGS Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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32
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Hickey EJ, Stransky M, Kuhn J, Rosenberg JE, Cabral HJ, Weitzman C, Broder-Fingert S, Feinberg E. Parent stress and coping trajectories in Hispanic and non-Hispanic families of children at risk of autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1694-1708. [PMID: 33908306 PMCID: PMC8324513 DOI: 10.1177/13623613211001611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Little is known about parent experiences throughout the diagnostic process for autism or how these parent experiences may help explain the disparities that exist between Hispanic and non-Hispanic families in time-to-diagnosis among children identified as at risk for autism. The current study examined trajectories of parenting stress, coping, and perceived family impact over time, throughout the autism diagnostic process among Hispanic and non-Hispanic families. Hispanic families reported lower levels of parenting stress, coping, and negative family impact across time. Further, there were differences in the change in use of coping and the amount of negative family impact reported between Hispanic and non-Hispanic parents over time. These differences shed light on the unique experiences and strengths of Hispanic families demonstrate. Interventions that leverage those strengths and focus on education, empowerment, and resilience might be particularly beneficial for Hispanic families and may also better inform work to increase resilience.
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Affiliation(s)
| | | | | | | | | | | | | | - Emily Feinberg
- Boston Medical Center, USA
- Boston University School of Public Health, USA
- Boston University School of Medicine
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33
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Errors in Byline and Author Contributions. JAMA Pediatr 2021; 175:538. [PMID: 33683315 PMCID: PMC7941247 DOI: 10.1001/jamapediatrics.2021.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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