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Randomized Controlled Trial
. 2023 Jul;23(5):904-912.
doi: 10.1016/j.acap.2023.03.013. Epub 2023 Mar 31.

Effect of Family Navigation on Participation in Part C Early Intervention

Emily Feinberg  1 , Michelle L Stransky  2 , Marilyn Augustyn  3 , Sarabeth Broder-Fingert  4 , Amanda Bennett  5 , Carol Weitzman  6 , Jocelyn Kuhn  7 , Andrea Chu  8 , Howard J Cabral  9 , Ada M Fenick  10 , Nathan J Blum  11
Affiliations
Randomized Controlled Trial

Effect of Family Navigation on Participation in Part C Early Intervention

Emily Feinberg et al. Acad Pediatr. 2023 Jul.

Abstract

Objective: Part C Early Intervention (EI) services have been shown to reduce autism symptoms and promote healthy development among young children. However, EI participation remains low, particularly among children from structurally marginalized communities. We investigated whether family navigation (FN) improved EI initiation following positive primary care screening for autism compared to conventional care management (CCM).

Methods: We conducted a randomized clinical trial among 339 families of children (ages 15-27 months) who screened as having an increased likelihood for autism at 11 urban primary care sites in 3 cities. Families were randomized to FN or CCM. Families in the FN arm received community-based outreach from a navigator trained to support families to overcome structural barriers to autism evaluation and services. EI service records were obtained from state or local agencies. The primary outcome of this study, EI service participation, was measured as the number of days from randomization to the first EI appointment.

Results: EI service records were available for 271 children; 156 (57.6%) children were not engaged with EI at study enrollment. Children were followed for 100 days after diagnostic ascertainment or until age 3, when Part C EI eligibility ends; 65 (89%, 21 censored) children in the FN arm and 50 (79%, 13 censored) children in the CCM arm were newly engaged in EI. In Cox proportional hazards regression, families receiving FN were approximately 54% more likely to engage EI than those receiving CCM (1.54 (95% confidence interval: 1.09-2.19), P = .02).

Conclusions: FN improved the likelihood of EI participation among urban families from marginalized communities.

Keywords: Part C Early Intervention; autism; family navigation.

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Conflict of interest statement

Declaration of Competing Interest Amanda Bennett reports a relationship with National Institute of Mental Health that includes: funding grants. Amanda Bennett reports a relationship with Autism Speaks that includes: funding grants. Nathan Blum reports a relationship with Health Resources and Services Administration that includes: funding grants. Nathan Blum reports a relationship with Elsevier that includes: consulting or advisory. Sarabeth Broder-Fingert reports a relationship with EarliTech Dx, Inc. that includes: board membership. Emily Feinberg reports a relationship with National Institutes of Health that includes: funding grants. Emily Feinberg reports a relationship with Richard and Susan Smith Family Foundation that includes: funding grants. Emily Feinberg reports a relationship with Klarman Family Foundation that includes: funding grants. Ada Fenick reports a relationship with Bristol Myers Squibb Co that includes: equity or stocks. Carol Weitzman reports a relationship with Journal of Developmental and Behavioral Pediatrics that includes: consulting or advisory. Carol Weitzman reports a relationship with Up to Date that includes: consulting or advisory. Carol Weitzman reports a relationship with Helios that includes: board membership. Carol Weitzman reports a relationship with Meliora Health that includes: board membership. Dr. Bennett’s spouse is employed at Pfizer but not in a field relevant to this research.

Figures

Figure 1.
Figure 1.
Participant Flow Diagram aChild was enrolled from a non-participating primary care site.
Figure 2.
Figure 2.
Time to Part C EI Services, by Treatment Group EI= Early Intervention; FN=Family Navigation; CCM=Conventional Care Management. Hazard ratio from Cox proportional hazards model controlling for whether the child was engaged with EI services >30 days before study enrollment, clustered on site. Time 0 represent study enrollment. These are the estimated probabilities based on the Kaplan-Meier curve. Censoring was set at the end of the study (n=31) or age three (n=3), whichever came first.
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