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BMC Psychiatry. 2018 Mar 27;18(1):79. doi: 10.1186/s12888-018-1661-7.

A hybrid type I randomized effectiveness-implementation trial of patient navigation to improve access to services for children with autism spectrum disorder.

Author information

1
Department of Pediatrics, Boston University School of Medicine, Boston, MA, 02114, USA. Sarabeth.Broder-Fingert@bmc.org.
2
Division of General Pediatrics, Boston University School of Medicine, 850 Harrison Ave, Room 310A, Boston, MA, 02118, USA. Sarabeth.Broder-Fingert@bmc.org.
3
Department of Pediatrics, Boston University School of Medicine, Boston, MA, 02114, USA.
4
Division of Developmental and Behavioral Pediatrics, Boston University School of Medicine, Boston, MA, 02114, USA.
5
Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
6
National Center for PTSD, Dissemination and Training Division, Menlo Park, CA, 94025, USA.
7
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, 02114, USA.

Abstract

BACKGROUND:

Significant racial, ethnic, and socioeconomic disparities exist in access to evidence-based treatment services for children with autism spectrum disorder (ASD). Patient Navigation (PN) is a theory-based care management strategy designed to reduce disparities in access to care. The purpose of this study is to test the effectiveness of PN a strategy to reduce disparities in access to evidence-based services for vulnerable children with ASD, as well as to explore factors that impact implementation.

METHODS:

This study uses a hybrid type I randomized effectiveness/implementation design to test effectiveness and collect data on implementation concurrently. It is a two-arm comparative effectiveness trial with a target of 125 participants per arm. Participants are families of children age 15-27 months who receive a positive screen for ASD at a primary care visit at urban clinics in Massachusetts (n = 6 clinics), Connecticut (n = 1), and Pennsylvania (n = 2). The trial measures diagnostic interval (number of days from positive screen to diagnostic determination) and time to receipt of evidence-based ASD services/recommended services (number of days from date of diagnosis to receipt of services) in those with PN compared to and activated control -Conventional Care Management - which is similar to care management received in a high quality medical home. At the same time, a mixed-method implementation evaluation is being carried out.

DISCUSSION:

This study will examine the effectiveness of PN to reduce the time to and receipt of evidence-based services for vulnerable children with ASD, as well as factors that influence implementation. Findings will tell us both if PN is an effective approach for improving access to evidence-based care for children with ASD, and inform future strategies for dissemination.

TRIAL REGISTRATION:

NCT02359084 Registered February 1, 2015.

KEYWORDS:

Autism spectrum disorder; Disparities; Navigation

PMID:
29587698
PMCID:
PMC5870193
DOI:
10.1186/s12888-018-1661-7
[Indexed for MEDLINE]
Free PMC Article

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