In response to PAR-18-429, we propose to refine and test implementation of technology-enabled family navigation to promote early access to, and engagement between, primary and mental health (MH) care for children (ages 5-13 years) with autism spectrum disorder plus MH comorbidity (ASD+). Unmet MH needs (e.g., anxiety, disruptive behaviors) are a common and principal concern, associated with deleterious public health effects for children with ASD. While evidence-based MH interventions for ASD+ are available (e.g., AIM HI5,6), there are multi-level challenges limiting access to such treatment. Family navigation, a model of lay case management designed to mitigate barriers to specialty healthcare, is a promising solution to overcome these challenges for children with ASD+. Family navigation is an established model to facilitate engagement in diagnostic and treatment services including early intervention for infants and toddlers at risk for ASD. However, family navigation has not been tested with children with ASD+. Health information technologies have not been systematically tested as a component of family navigation. Integrating these technologies is a critical next step in increasing the effectiveness and implementation of family navigation. This proposal addresses this next step by testing the effectiveness and implementation of family navigation with systematically designed navigator implementation technology enhancements for children (5-13 years) with ASD+. The Accelerated Creation-to-Sustainment (ACTS) model will be used to guide the design and trial of technology enhancement to family navigation. The ACTS model, based on user-centered design principles and implementation science, provides systematic guidance in rapidly moving from design (Phase 1: Create) of a technology-enabled service to implementation (Phase 2: Trial) and sustainment (Phase 3: Sustain). We propose to use a community- partnered approach guided by the ACTS model to refine and test technology-enhanced family navigation to promote early and ongoing integrated MH care for children with ASD+. This proposal is highly responsive to research priorities in the NIMH Strategic Plan, in digital health technology to advance MH service delivery models and the HHS Interagency Autism Coordinating Committee Strategic Plan. Further, this proposal capitalizes on existing NIMH-funded initiatives to build capacity to treat children with ASD+ in MH settings.
The specific aims are:
Aim 1 : Adapt family navigation (FN) content and training for school-age children with ASD+.
Aim 2 : Develop FN technology tools to enhance navigator implementation of FN for ASD+.
Aim 3 : Examine the implementation, service and clinical impacts of technology-enhanced FN for ASD+ through a hybrid type I effectiveness-implementation trial in primary care. A randomized stepped wedge design in primary care will be conducted with five clinics, 30 PCPs and 160 families to examine mechanisms of change and outcomes. Based on successful execution of these aims, we will have a technology-enhanced FN for ASD+ that is ready for large-scale R01 implementation and sustainment testing within diverse primary care settings.
This proposal aims to test the effectiveness and implementation of technology-enhanced family navigation to promote early access to, and engagement in evidence-based mental health care for children (ages 5-13 years) with autism spectrum disorder plus mental health comorbidity.