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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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Rapid weight gain during the first year of life is associated with childhood obesity, adult obesity, and all its concomitant morbidities. 1,2 Over the past 30 years, obesity among children 2 to 5 years old doubled. 3 As pediatric health care providers interact with young families routinely throughout the first few years of life, they may be in an ideal position to influence the rate of weight gain.Innovations in care are needed: although past interventions have demonstrated that intensive anticipatory guidance leads to improved diet and eating habits, 4 within the current system of 12-to 18-minute well-child visits, it is unlikely that pediatric providers can provide this additional support. 5 Group well-child care, one such innovation, the provision of well-child care to 4 to 8 infant/parent dyads, allows providers greater interaction with patients. 6,7 Prior analyses of group well-child care have found that group visits allow increased time for education, modeling behaviors, and parent-to-parent support. [8][9][10][11] In group well-child care, there is an emphasis on maternal/infant relationships and parental selfefficacy, both of which have been associated with less obesity among preschool children, school-age children, and adolescents. 12,13 We, thus, designed a follow-up study of participants in a group well-child randomized controlled trial (RCT) at Yale New Haven Hospital (YNHH) to determine the impact of group well-child care on childhood obesity.This study is a follow-up of our initial RCT, conducted in 2008-2009. For the initial study, inclusion criteria were a mother/infant dyad with the infant in the mother's care, gestation ≥37 weeks and born at YNHH, planning to use the YNHH primary care center (PCC), and with English as the primary language. On consenting to participate in the study, the mother/infant dyad was randomized to receive either group or individual care. In both arms, mother/infant dyads received the initial pediatric assessment at 2 to 4 days of life in a traditional model by a pediatric resident or a nurse practitioner (NP). In the control arm, for the first year of life, dyads received standard individual care provided by pediatric 623230C PJXXX10.

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