Abstract
BackgroundSignificant 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.MethodsThis 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.DiscussionThis 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 registrationNCT02359084 Registered February 1, 2015.
Highlights
Significant racial, ethnic, and socioeconomic disparities exist in access to evidence-based treatment services for children with autism spectrum disorder (ASD)
Evidence-based services for autism spectrum disorder Over 15 years of data support the notion that earlier access to evidence-based services (EBS) improves both short and long-term outcomes for children with autism spectrum disorder (ASD) [1]
Studies consistently demonstrate that intensive early intervention improves cognition, language skills, and reduces the core symptoms of ASD [2,3,4], and that earlier access to these services leads to both immediate benefits, and gains over time [5]
Summary
Significant racial, ethnic, and socioeconomic disparities exist in access to evidence-based treatment services for children with autism spectrum disorder (ASD). 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. Evidence-based services for autism spectrum disorder Over 15 years of data support the notion that earlier access to evidence-based services (EBS) improves both short and long-term outcomes for children with autism spectrum disorder (ASD) [1]. Because earlier access to evidence-based ASD services improves both short and long-term outcomes, delayed engagement with these services can be responsible for substantial morbidity [8]. Barriers to timely ASD diagnostic and treatment services can result from a variety of factors including the availability of services, patient-provider miscommunication, parental stress, complex payment systems, and culturally biased care [10,11,12]
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