Family Navigation helps as Diagnostic Ascertainment Among Ch
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Early identification of autism spectrum disorder (ASD) is associated with improved cognitive and behavioral outcomes. A Study was conducted 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.

This 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.

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.

The 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.

--Children who received FN had a greater likelihood of reaching diagnostic ascertainment over the course of 1 year (FN, 108 of 126; CCM, 94 of 123; unadjusted hazard ratio [HR], 1.39).

--Site and ethnicity moderated the effect of FN (treatment×site interaction; Boston: HR, 2.07; New Haven: HR, 1.91; and Philadelphia: HR, 0.91) (treatment×ethnicity interaction; Hispanic families: HR, 2.81 vs non-Hispanic families: HR, 1.49).

--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%, and CCM, 53.3%; vs non-Hispanic families: FN, 89.7%, and CCM, 77.5%).

Finally, the probability of diagnostic evaluation among racial/ethnic minority children, low-income families who are detected at risk for ASD in primary care, improved in the navigation of the families. The findings show the site and ethnicity differential effects of FN.

Source: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2775015
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