Improving Family Navigation for Children With Autism: A Comparison of Two Pilot Randomized Controlled Trials

Feinberg, Emily; Kuhn, Jocelyn; Eilenberg, Jenna Sandler; Levinson, Julia; Patts, Gregory; Cabral, Howard; Broder‐Fingert, Sarabeth

doi:10.1016/j.acap.2020.04.007

Cited by 21 publications

(13 citation statements)

References 26 publications

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“…See Figure 2 for breakdown of studies demonstrating low risk , some concerns , and high risk of bias. All three studies had an overall rating of some concerns for bias (Feinberg et al, 2016, 2021; Kutash et al, 2013), meaning that some concerns were reported in at least one domain, but no study was rated as having high risk in any domain. Five studies that used study intervention designs other than RCTs (i.e., controlled clinical trials, prospective, retrospective designs) were evaluated with the Quality Assessment Tool for Quantitative Studies.…”

Section: Resultsmentioning

confidence: 99%

“…high risk of bias. All three studies had an overall rating of some concerns for bias (Feinberg et al, 2016(Feinberg et al, , 2021Kutash et al, 2013), meaning that some concerns were reported in at least one domain, but no study was rated as having high risk in any domain.…”

Section: Risk Of Bias Graphmentioning

confidence: 99%

“…Participant ages varied broadly. Four studies focused on toddlers, with the average age ranging from 18.4 months to around 3 years (Feinberg et al, 2016(Feinberg et al, , 2021Guevara et al, 2016;Roth et al, 2016). The other four studies included ranges from school age (around 5 years) to adolescence (Koroloff et al, 1996;Kutash et al, 2011Kutash et al, , 2013Sprecher et al, 2018).…”

Section: Study/participant Characteristicsmentioning

confidence: 99%

“…Study participants were relatively diverse, with 75% of studies (n = 6) having samples where the most frequently reported race/ethnicity was Black or Latinx. Four studies reported on language and/or English language proficiency, with between 35% and 51% of parents speaking a language other than English within the home (Feinberg et al, 2016(Feinberg et al, , 2021Guevara et al, 2016) and one study with 20% of the sample requiring a translator for services (Sprecher et al, 2018). Insurance status was reported in half of the studies, ranging from 46% to 87% of participants using public insurance (Feinberg et al, 2021;Guevara et al, 2016;Roth et al, 2016;Sprecher et al, 2018).…”

Section: Study/participant Characteristicsmentioning

confidence: 99%

“…A quantitative synthesis of the data was not feasible given the heterogeneity of study designs and In a later study, Feinberg et al (2021) modified their FN model, targeting the age range of 15-36 months only, augmenting their navigator training with the addition of motivational interviewing skills, and increasing the number of family contacts (to at least four in-person visits, with e-mail and phone supplementary contacts). The main goal of navigators (i.e., to support families in ASD diagnosis within a DBP clinic) remained the same, as did their support services (i.e., identify barriers to care, provide emotional and instrumental support across the health system).…”

Section: Service Outcomesmentioning

confidence: 99%

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System navigation models to facilitate engagement in pediatric behavioral health services: A systematic review.

Petts

McClain

Azad

et al. 2021

Families, Systems, & Health

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Introduction: Despite increased prevalence and identification of pediatric behavioral health concerns, families face many barriers when attempting to access behavioral health services. System navigators, or individuals experienced in navigating the health system, help to engage families in services by helping individuals overcome barriers for accessing care. However, limited research to date has systematically reviewed the implementation and effectiveness of navigation models in pediatric populations. Method: We systematically reviewed published studies examining navigation models for pediatric populations (up to age 18) referred to behavioral health services. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for studies that evaluated a navigation model and included service use outcomes. We aggregated data pertaining to characteristics of the study and navigation model, service use outcomes, and implementation outcomes. Results: Eight studies met inclusion criteria. Families who participated in navigation services were more likely to complete diagnostic assessments and received an increased dosage (e.g., time spent, services completed) of behavioral health treatments. There was notable variability across studies in terms of processes involved in the navigation models. Discussion: Findings indicate that system navigation is a promising method for improving service use for pediatric populations referred to behavioral health services. Future research may continue to examine the effectiveness and implementation of the model, to best understand its benefits and what processes may contribute to improved service outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Of Bias Graphmentioning

confidence: 99%

Section: Study/participant Characteristicsmentioning

confidence: 99%

Section: Study/participant Characteristicsmentioning

confidence: 99%

Section: Service Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

System navigation models to facilitate engagement in pediatric behavioral health services: A systematic review.

Petts

McClain

Azad

et al. 2021

Families, Systems, & Health

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Effect of Family Navigation on Diagnostic Ascertainment Among Children at Risk for Autism

et al. 2021

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IMPORTANCEEarly identification of autism spectrum disorder (ASD) is associated with improved cognitive and behavioral outcomes. Targeted strategies are needed to support equitable access to diagnostic services to ensure that children from low-income and racial/ethnic minority families receive the benefits of early ASD identification and treatment.OBJECTIVE To test the efficacy of family navigation (FN), an individually tailored, culturally informed care management strategy, to increase the likelihood of achieving diagnostic ascertainment among young children at risk for ASD. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial of 249 families of children aged 15 to 27 months who had positive screening results for possible ASD was conducted in 11 urban primary care sites in 3 cities. Data collection occurred from February 24, 2015, through November 5, 2018. Statistical analysis was performed on an intent-to-treat basis from November 5, 2018, to July 27, 2020.INTERVENTIONS Families were randomized to FN or conventional care management (CCM). Families receiving FN were assigned a navigator who conducted community-based outreach to families to address structural barriers to care and support engagement in recommended services. Families receiving CCM were assigned to a care manager, who did limited telephone outreach. Families received FN or CCM after positive initial screening results and for 100 days after diagnostic ascertainment. MAIN OUTCOMES AND MEASURESThe primary outcome, diagnostic ascertainment, was measured as the number of days from randomization to completion of the child's clinical developmental evaluation, when a diagnosis of ASD or other developmental disorder was determined.RESULTS Among 250 families randomized, 249 were included in the primary analysis (174 boys [69.9%]; mean [SD] age, 22.0 [3.5] months; 205 [82.3%] publicly insured; 233 [93.6%] non-White). Children who received FN had a greater likelihood of reaching diagnostic ascertainment over the course of 1 year (FN, 108 of 126 [85.7%]; CCM, 94 of 123 [76.4%]; unadjusted hazard ratio [HR], 1.39 [95% CI, 1.05-1.84]). Site (Boston, New Haven, and Philadelphia) and ethnicity (Hispanic vs non-Hispanic) moderated the effect of FN (treatment × site interaction; P = .03; Boston: HR, 2.07 [95% CI, 1.31-3.26]; New Haven: HR, 1.91 [95% CI, 0.94-3.89]; and Philadelphia: HR, 0.91 [95% CI, 0.60-1.37]) (treatment × ethnicity interaction; P < .001; Hispanic families: HR, 2.81 [95% CI, 2.23-3.54] vs non-Hispanic families: HR, 1.49 [95% CI,). The magnitude of FN's effect was significantly greater among Hispanic families than among non-Hispanic families (diagnostic ascertainment among Hispanic families: FN, 90.9% [30 of 33], and CCM, 53.3% [16 of 30]; vs non-Hispanic families: FN, 89.7% [35 of 39], and CCM, 77.5% [31 of 40]). CONCLUSIONS AND RELEVANCEFamily navigation improved the likelihood of diagnostic ascertainment among children from racial/ethnic minority, low-income families who were detected as at risk for ASD in primary care. Results suggest ...

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A Systematic Review of Therapeutic Process Factors in Mental Health Treatment for Autistic Youth

Albaum

Vashi

Bohr

et al. 2022

Clin Child Fam Psychol Rev

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Understanding the role of therapeutic process factors in treatment change may prove useful for discerning why some autistic youth benefit from psychosocial interventions that target emotional and psychological aspects of mental health, while others do not. The aim of the current study was to synthesize what is currently known about therapeutic process factors in mental health treatment of emotional and psychological challenges for autistic youth, regarding how process factors have been measured in past research, and the relation between process factors and treatment outcome. A systematic review of the literature was conducted to narratively synthesize all articles published up until June 2021. Methodological quality of included studies was appraised. Twenty-five studies met inclusion criteria. Process factors assessed across studies included relational factors; treatment expectations, readiness, and satisfaction; and treatment engagement from youth and their parents. Process-outcome associations were reported for a limited number of constructs. There is a limited, albeit growing, body of high-quality research evaluating the role of process factors in the treatment of mental health issues for autistic youth. Future research should continue to examine process factors in relation to treatment outcome, and validate measures to accurately capture process-related constructs in mental health treatment for this population. Greater understanding of therapy processes can lead to developing evidence-informed strategies that clinicians can implement to promote positive expectations, relationships, and engagement.

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Improving Family Navigation for Children With Autism: A Comparison of Two Pilot Randomized Controlled Trials

Cited by 21 publications

References 26 publications

System navigation models to facilitate engagement in pediatric behavioral health services: A systematic review.

System navigation models to facilitate engagement in pediatric behavioral health services: A systematic review.

Effect of Family Navigation on Diagnostic Ascertainment Among Children at Risk for Autism

A Systematic Review of Therapeutic Process Factors in Mental Health Treatment for Autistic Youth

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