Educational-Clinical Linkage to Improve Health Outcomes for Children with Developmental Delays and Disabilities

University Of Illinois At Chicago, Chicago IL

Investigators

Abstract

Many preschool-age children with developmental delays and disabilities face significant challenges accessing early educational and therapeutic supports that foster healthy development and improve later academic, economic, and health outcomes. Studies also indicate when children receive these needed services, their parents benefit with improvements in mental health, stress, and quality of life. The scientific objectives of this proposal are to 1) test effective strategies to increase access to early childhood special education (ECSE) services for PCw/DD within pediatric clinical settings serving lower-resourced communities, and 2) characterize potential mechanisms by which such strategies may lead to improved multilevel health outcomes. Preschool and Me (PreM) is a novel community clinical linkage (CCL) designed for pediatric settings where families often experience fragmented or delayed connections to developmental services. Combining key components of CCLs with a personalized medical-education care plan and remote navigator support, PreM targets different levels of influence impacting therapeutic access identified in our prior research. In pilot testing, PreM was feasible, acceptable to families, and demonstrated preliminary efficacy on completed ECSE evaluations. Thus, this R01 application proposes to utilize a hybrid effectiveness-implementation approach to test PreM in two real-world service delivery models. Participants (n=320) will be randomized to either: 1) 6 months of PreM (intervention group) or 2) a waitlist control arm beginning the intervention after a 6-month delay. We will follow all participants for 12 months with data collection occurring at 4 timepoints (baseline, 3-, 6- and 12-months). Our specific aims are to test effectiveness of PreM on indicators of ECSE access (primary) and child-, parent-, family- and health service outcomes (secondary); examine theoretically derived mediators of intervention effects using a mixed methods approach; and explore social variables that may influence variability in intervention effects. We will also simultaneously conduct a mixed methods implementation evaluation focusing on implementation outcomes to serve as indicators for implementation success; measures of implementation quality; and intermediate outcomes to understand and address successes and failures in relation to clinical outcomes. The results of this project have the potential to: 1) advance scientific knowledge about how gaps and delays in educational and therapeutic services impact health outcomes among PCw/DD and their families; 2) identify mechanisms to reduce delays in developmental support; and 3) support effective implementation of educational-clinical linkage models within pediatric systems of care which can be utilized to improve health outcomes for families and their children with a range of health conditions.