Telehealth Family Navigation for Early Autism Services Access: The Autism ALERT Project

Background: Delays in access to educational services for autism are common and more likely among children from families of color and/or with low income. In-person family navigation accelerates autism diagnosis; however, the effectiveness of telehealth autism diagnostic navigation is unknown. Objectives: To test preliminary feasibility and efficacy of a telehealth autism navigation program. Method: This was a site-randomized pilot trial of autism family navigation for Oregon children in 2021-2022. The intervention used layperson family resource specialists based at Oregon’s Help Me Grow program as navigators for families of children with autism symptoms. Pediatric clinics with \u3e30% Medicaid, located in 5 Oregon counties, were invited to enroll children in the study. 7 clinics (49 primary care providers [PCPs]) participated; 4 were randomized to the family navigation intervention and 3 to usual care. PCPs in both arms received training on autism screening and referral to medical/educational services. PCPs then referred any child age 1-55 months with a positive screen and/or provider autism concern to the study. For children in intervention arm clinics, the navigator called parents, providing information about autism and the autism diagnostic process, assistance with paperwork, social support, and appointment reminders. Control arm clinics/children received no calls. Study enrollment continued until 50 children (30 intervention, 20 control) enrolled. Child Early Intervention/Early Childhood Special Education (EI/ECSE) data were collected from Oregon’s state database 6 months after enrollment. Primary study outcomes compared intervention and control arms on: % of children receiving EI/ECSE referrals within 6 months, % receiving an evaluation in EI/ECSE within 6 months, time from enrollment to EI/ECSE evaluation, and % of evaluated children receiving an autism educational label within 6 months. Results: All clinics enrolled children; children were 40.8% (n=20) white, 26.5% (n=13) Latino, and 32.7% (n=9) multiracial and/or other race/ethnicity. 16% were female (n=8); median age was 2. Intervention families received a median of 12 navigator telehealth contacts. Overall, 70% (n=21) of intervention arm and 42% (n =8) of control arm families were successfully referred to EI/ECSE (p = 0.05). Of those referred, 86% (n=18) of intervention arm and 100% (n=8) of control arm children were evaluated in EI/ECSE (n.s.). Median time to EI/ECSE evaluation was 103 days in the intervention and 162 days in the control arm (p = 0.68; Figure 1). Overall, 40% of intervention arm (n = 12) and 21% (n = 4) of control arm children had an autism placement, with a trend toward autism as the primary placement type in the intervention arm (p = 0.12). Conclusion: Telehealth family navigation shows promise for improving access to autism services in EI/ECSE, especially for securing an early EI/ECSE evaluation, and increasing autism educational labels. A full-scale trial can investigate more distal outcomes including receipt of medical diagnosis and therapeutic services use

Parent Concerns are Associated with Early Intervention Outcomes

Objective: To test the association of parents’ concerns with Early Intervention (EI) developmental services outcomes including evaluation, eligibility, and enrollment in services. Method: We collected survey data on parents’ concerns and EI service use data from a sample of 428 children referred to EI in 2016-2018 from six Oregon primary care clinics serving lower income families as part of a developmental and autism spectrum disorder screening intervention. We assessed EI service use trajectories and associations of parent concern presence, age of child at time of parents’ concerns, number of concerns, and type of provider concern, with EI evaluation, EI eligibility, and enrollment in EI services, using bivariate testing and multivariable logistic regression. Results: Only 22.9% of children referred to EI were enrolled in services six months later. Children whose parents had developmental and/or behavioral concerns were more likely to receive an EI evaluation and were also more likely to be eligible for services, compared to children whose parents had no concerns. There was no association between age, number of concerns, or type of concern with EI evaluation, eligibility, or services enrollment. Conclusion: Though only a minority of children referred to EI enroll in services, presence of parent concern is strongly associated with EI services evaluation and eligibility outcomes. Study results suggest that providers should assess the presence of parent concern when deciding on EI referrals, and provide more support to parents who are not concerned at all

An Intervention to Increase Detection of Developmental Delays in WIC Programs

Background: Low-income children are at risk for under-detection of developmental disabilities DD. WIC clinics see low-income children regularly in early childhood and could be an important source of referrals to developmental services. Objectives: To increase the number of referrals to EI/ECSE from non-primary care settings such as WIC. Methods: This was a site-randomized trial of an intervention to train WIC staff in early identification of DD’s, using CDC’s LTSAE developmental monitoring materials. 7 county WIC agencies in Oregon enrolled; 4 intervention agencies and 3 control agencies. The intervention consisted of an on-site, half-day training regarding signs of developmental delays, use of LTSAE materials, and referral to EI/ECSE. WIC staff were encouraged to identify and refer at-risk children to EI/ECSE. Control sites received no training and continued their usual processes. Primary study outcome was number of children referred from WIC to EI/ECSE in control vs. experimental counties as well as % of referrals evaluated based on data obtained Oregon’s EI/ECSE program. Results: Data for 46 children referred to EI/ECSE were obtained. Overall, 3 of 4 intervention sites increased their referrals to EI, and 0 of 3 control sites increased referrals. Total referrals in the intervention arm increased from 5 to 33 in the intervention arm, but decreased from 6 to 2 in the control arm. Conclusion: This brief intervention with WIC staff led to short-term increases in EI referrals and evaluations

Associations with Early Intervention Evaluation, Eligibility, and Services Engagement in a multi-site sample

TITLE: Associations with Early Intervention Evaluation, Eligibility, and Services Engagement in a multi-site sample Background: Parental concerns are usually highly predictive of child developmental delays; however, the relationship of parent concerns with Part C Early Intervention (EI) service use is unclear. Objective: The goals of this project were to test the associations of parent concern presence, age of child at time of parent concerns, number of concerns, type of parental concern, and recency of parental concerns, with EI evaluation, eligibility, and services engagement after referral. Design/Methods: We collected survey data on parent concerns, EI service use data, and family demographics from a sample of 483 children referred to EI in 2016-2018 from six Oregon primary care clinics serving lower income families as part of a developmental and autism screening intervention. Survey results were linked with Oregon EI database information, including if the child was evaluated, deemed eligible for services, and (if deemed eligible) whether they were engaged in services 6 months after referral. Bivariate testing and multivariable logistic regression were used to test the association of presence of parental concern, child age at time of concern, type of concern, number of concerns, and recency of concern, with EI evaluation, eligibility determination and engagement of services six months later. Results: 483 children were referred to EI, 268 (55.5%) were evaluated, 85 (63.4% of evaluated) were found eligible, and 71 (85.5% of eligible) were engaged in services six months later. Among family demographic characteristics, boys were more likely to be evaluated than girls based on bivariate analysis but not on multivariable analysis (69.9% vs. 57.5%; p = 0.011). Presence of parent concern was strongly associated with evaluation on bivariate and multivariable analysis (67.3% versus 44.2%; aOR 5.32 [2.10-13.47]). Presence of parental concern was also associated with eligibility (63.4% versus 33.3%, p = 0.001), and service engagement (85.5% vs. 64.3%, p Conclusion(s): Gender, presence of concern and recency of concern are associated with EI services use. Study results suggest that providers should assess presence of parent concern and provide additional support to parents who are not concerned at all or are concerned prior to the visit

نقش تعدیل‌کنندۀ اشتغال در رابطۀ بین کظم غیظ و سلامت روان در زنان شاغل و خانه‌دار

خلفية البحث وأهدافه: تشير دراسات المصادر البشرية الإيجابية والمتقدمة إلى أن الغضب والعداء يهددان الصحة العقلية وقد يضران بالصحة العقلية لدرجة أن تأثيرهما يصل إلى الاضطرابات النفسية. من جهة أخرى، ومن أجل السيطرة على الغضب بشكل صحيح، استخدم دين الإسلام صفة "كظم الغيظ" ودعا الناس إلى تحكم في الغضب وادارته. لذلك تم اجراء البحث الحالي بهدف دراسة الدور الوسيط للوظيفة في العلاقة بين كظم الغيظ والصحة العقلية للنساء العاملات وربات البيوت. منهجية البحث: الدراسة الحالية هي دراسة ارتباطية وصفية. اشتمل المجتمع الاحصائي، النساء العاملات وربات البيوت اللواتي يعشن في مدينتي طهران وكرج في عام 16-2015 الدراسي. تم اختيار 384 اسرة بطريقة أخذ العينات المتاحة بناءً على جدول Krejcie وMorgan. اشتملت ادوات البحث على استبيان كظم الغيظ الذي اعدده الباحث، واستبيان غولدنبرغ للصحة النفسية. لغرض تحلیل البیانات، تم استخدام اختبار ارتباط "بيرسون" وتحليل الانحدار الهرمي. تمت مراعاة جميع الموارد الأخلاقية في هذا البحث واضافة الى هذا فإن مؤلفي البحث لم يشيروا الى اي تضارب في المصالح. المعطيات: اظهرت النتائج ان هناك علاقة ايجابية ذات دلالة احصائية بين كظم الغيظ والصحة العقلية (01/0>P) وللوظيفة ايضاً دور وسيط للعلاقة بين كظم الغيظ والصحة العقلية. الاستنتاج: تشير نتائج الدراسة الى أهمية متغيرات "الوظيفة" و"كظم الغيظ" على الصحة العقلية لدى النساء العاملات وربات البيوت.   يتم استناد المقالة على الترتيب التالي: Safara M, Rezaei SM, Solgi M, Nabavi ZS. The Moderating Role of Employment in the Relationship between Restraining Anger and Mental Health of Working Women and Housewives. Journal of Pizhūhish dar dīn va salāmat. 2021;7(3):80-91. https://doi.org/10.22037/jrrh.v7i3.30379Background and Objective: Studies on advanced positive human resources indicate that anger and hostility affect mental health and can be so harmful and destructive to mental health that its impact goes as far as mental disorders. Islam has referred to the term "anger management" inviting people to swallow and manage their anger; therefore, the present study was conducted with the aim of examining the moderating role of employment on the relationship between anger and mental health in employed women and housewives. Methods: The present study is descriptive correlational. The sample population included working women and housewives of Tehran and Karaj in the 2015-2016 academic year; 384 families were selected by convenience sampling method based on Krejcie and Morgan’s table. The research instruments included a researcher-made questionnaire and the Goldenberg Mental Health Questionnaire. Pearson correlation test and hierarchical regression analysis were used. In this study, all ethical considerations were observed and no conflict of interest was reported by the authors. Results: The results showed that there was a positive and significant relationship between anger and mental health (P<0.01). Also, occupation has a moderating effect on the relationship between anger and mental health. Conclusion: The results of this study indicate the importance of the variables of employment and anger on the mental health of working women and housewives.   Please cite this article as: Safara M, Rezaei SM, Solgi M, Nabavi ZS. The Moderating Role of Employment in the Relationship between Restraining Anger and Mental Health of Working Women and Housewives. Journal of Pizhūhish dar dīn va salāmat. 2021;7(3):80-91. https://doi.org/10.22037/jrrh.v7i3.30379سابقه و هدف: مطالعات منابع انسانی پیشرفتۀ مثبت گویای این مهم است که خشم و خصومت سلامت روان را تحت تأثیر قرار می‌دهد و آنچنان می‌تواند برای سلامت روان مضر و مخرب باشد که سیر تأثیرگذاری آن تا مرز اختلالات روانی پیش می‌رود. از سویی اسلام نيز براى كنترل صحيح خشم، صفت «كظم غيظ» را به ‌کار برده و افراد را به فروخوردن و مديريت آن دعوت نموده است؛ بنابراین پژوهش حاضر با هدف نقش تعدیل‌کنندۀ اشتغال بر رابطۀ بین کظم غیظ و سلامت روان در زنان شاغل و خانه‌دار انجام شده است. روش کار: پژوهش حاضر توصیفی از نوع همبستگی است. جامعۀ مورد مطالعه زنان شاغل و خانه‌دار شهر تهران و کرج در سال تحصیلی 95-1394 بود که به‌روش نمونه‌گیری دردسترس 384 خانواده بر اساس جدول کرجسی و مورگان انتخاب شدند. ابزارهای پژوهش شامل پرسش‌نامۀ محقق‌ساختۀ کظم غیظ و پرسش‌نامۀ سلامت روان گلدنبرگ بود و برای تحلیل داده‌ها از آزمون همبستگی پیرسون و تحلیل رگرسیون سلسله‌مراتبی استفاده شد. در این پژوهش همۀ موارد اخلاقی رعایت شده است و مؤلفان مقاله تضاد منافعی گزارش نکرده‌اند. یافته‌ها: نتایج نشان داد بین کظم غیظ و سلامت روان رابطۀ مثبت و معناداری وجود داشت (01/0>P) و شغل نیز اثر تعدیل‌کننده‌ای بر رابطۀ بین کظم غیظ و سلامت روان داشت. نتیجه‌گیری: یافته‌های پژوهش بیانگر اهمیت متغیّرهای اشتغال و کظم غیظ بر سلامت روان زنان شاغل و خانه‌دار است.   استناد مقاله به این صورت است: Safara M, Rezaei SM, Solgi M, Nabavi ZS. The Moderating Role of Employment in the Relationship between Restraining Anger and Mental Health of Working Women and Housewives. Journal of Pizhūhish dar dīn va salāmat. 2021;7(3):80-91. https://doi.org/10.22037/jrrh.v7i3.3037