There is growing interest in Family Navigation as an approach to improving access to care for children with autism spectrum disorder, yet little data exist on the implementation of Family Navigation. The aim of this study was to identify potential failures in implementing Family Navigation for children with autism spectrum disorder, using a failure modes and effects analysis. This mixed-methods study was set within a randomized controlled trial testing the effectiveness of Family Navigation in reducing the time from screening to diagnosis and treatment for autism spectrum disorder across three states. Using standard failure modes and effects analysis methodology, experts in Family Navigation for autism spectrum disorder (n = 9) rated potential failures in implementation on a 10-point scale in three categories: likelihood of the failure occurring, likelihood of not detecting the failure, and severity of failure. Ratings were then used to create a risk priority number for each failure. The failure modes and effects analysis detected five areas for potential "high priority" failures in implementation: (1) setting up community-based services, (2) initial family meeting, (3) training, (4) fidelity monitoring, and (5) attending testing appointments. Reasons for failure included families not receptive, scheduling, and insufficient training time. The process with the highest risk profile was "setting up community-based services." Failure in "attending testing appointment" was rated as the most severe potential failure. A number of potential failures in Family Navigation implementation-along with strategies for mitigation-were identified. These data can guide those working to implement Family Navigation for children with autism spectrum disorder. Article reuse guidelines: sagepub.com/journals-permissions
Also in eTable 9 in the Supplement, 1 for sertraline vs CBT, the RR of remission should be 1.00 (95% CI, 0.77-1.29) and not 0.57 (95% CI, 0.48-0.69), and the RR of response should be 0.92 (95% CI, 0.75-1.33) and not 0.97 (95% CI, 0.80-1.17).Other errors regarding the number of patients in the same study included in the meta-analysis was introduced during the manuscript editing and publishing process, when a figure was created from a table of data. In Figure 1, 1 the number of patients in the arm evaluating CBT + sertraline vs CBT should be 279 and not 41, and the number of patients in the arm evaluating CBT + sertraline vs sertraline should be 273 and not 272. The same errors occurred in Figure 2 and eTable 9 in the Supplement. 1 Another error relates to the omission or incorrect reporting of the quality of evidence for a few of the studies. In Figure 1 and eTable 9 in the Supplement, 1 for "SSRI vs pill placebo: primary anxiety, child report," the quality of evidence should have been rated as low. For "CBT vs attention control/treatment as usual: primary anxiety, clinician report," the quality of evidence should also have been rated as low. In Figure 2 and eTable 9 in the Supplement, 1 the quality of evidence for CBT + sertraline vs sertraline for remission should have been rated as moderate. In eTable 9 in the Supplement, for sertraline vs CBT, the entry in the "Factors that affect the quality of evidence" column should read, "Severe imprecision (wide CIs and small sample size)," and the overall quality of evidence should be rated as low.Finally, these numerical errors led to an incorrect wording in the text. In the Results section of the Abstract, the sentence that reads "Cognitive behavioral therapy reduced primary anxiety symptoms more than fluoxetine and improved remission more than sertraline" should not include "and improved remission more than sertraline." 1 In the Results section of the main article, under the heading "Combination of CBT and Medications," the second sentence should read, "The combination of sertraline and CBT significantly reduced primary anxiety symptoms by clinician report and improved treatment response and remission more than either treatment alone (moderate QOE [quality of evidence]) (Figure 1 and Figure 2)." 1 Under the heading "CBT vs Medications," the third sentence should read, "No significant difference was found between CBT and sertraline (class: SSRI) (eTable 9 in the Supplement)." In the Discussion section, in the first paragraph, the seventh sentence should read, "The combination of SSRIs and CBT reduced primary anxiety symptoms and improved treatment response and remission compared with either approach alone."We regret and take responsibility for the errors that were published. We have reviewed the original article and confirm that there are no other errors and that the corrections to the numbers and analysis do not change the overall conclusions that evidence supports the effectiveness of CBT and SSRIs for reducing childhood anxiety symptoms. We have requested that rel...
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