Updates to the Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda

Introduction: Autistic individuals, now representing one in 36 individuals in the U.S., experience disproportionate physical health challenges relative to non-autistic individuals. The Health Resources and Services Administration's (HRSA) Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multi-center Research Network that aims to increase the health, well-being, and quality of life of autistic individuals. The current paper builds on the initial AIR-P Research Agenda (proposed in Year 1) and provides an updated vision for the Network. Methods: Updates to the Research Agenda were made via the administration of a Qualtrics survey, and disseminated widely to all AIR-P entities, including the Research Node Leaders, Steering Committee, Autistic Researcher Review Board, and collaborating academic and non-academic entities. Network members were tasked with evaluating the Year 1 Research Agenda and proposing additional priorities. Results: Within each Research Node, all Year 1 priorities were endorsed as continued priorities for research on autism and physical health. Specific topics, including co-occurring conditions and self-determination, advocacy, and decision-making, were particularly endorsed. Opportunities for exploratory studies and intervention research were identified across Research Nodes. Qualitative responses providing feedback on additional research priorities were collected. Conclusion: The updated AIR-P Research Agenda represents an important step toward enacting large-scale health promotion efforts for autistic individuals across the lifespan. This updated agenda builds on efforts to catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health promotion.


Introduction
Autistic individuals, currently one in 36 (2.8%) [1], demonstrate disproportionate rates of co-occurring and chronic conditions, including cardiovascular diseases, diabetes, epilepsy, psychiatric conditions, gastrointestinal disorders, and mobility challenges.They also experience disproportionate psychosocial challenges, low self-reported quality of life, and a low life expectancy [2][3][4][5][6][7][8][9].Health challenges in autistic populations are due to myriad factors, including genetic predispositions and co-occurring conditions, barriers to high-quality healthcare services and supports, including high administrative burden and resulting service fragmentation, and persistent exposure to implicit and explicit stigma and stress across interpersonal, educational, healthcare, and other contexts [10,11].
In light of these disparities, the Autism Intervention Research Network on Physical Health (AIR-P) seeks to establish and maintain a research network to enhance the physical health and well-being of autistic children, adolescents, and adults, particularly underserved and vulnerable individuals and families.The AIR-P is funded by the Health Resources and Services Administration Maternal and Child Health Bureau (MCHB) and places a strong emphasis on developing network priorities in partnership with autistic community members, service providers, family members, advocates, and academics.

Background and context
The initial (Year 1) Research Agenda process involved collaborations among select entities within the AIR-P through a three-pronged methodology.This included: 1) Ideation and design: Through a series of planning meetings, the National Coordinating Center (NCC) and Steering Committee (SC) identified preliminary priority domains based on their areas of expertise and background knowledge of the literature; 2) Literature review and synthesis: The NCC and SC created a targeted annotated bibliography of quantitative and qualitative research in the identified domains and synthesized the findings in a literature review to refine the domains; and 3) Network engagement: Experts across the network engaged in a two-step process via Qualtrics surveys with 24 AIR-P members to identify priority research topics within each domain based on three criteria (need and urgency; research impact; and person-and family-centeredness).
The initial Research Agenda process resulted in the Year 1 Research Agenda which comprised six core research priority domains: 1) Primary Care Services and Quality; 2) Community-Based Lifestyle Interventions; 3) Gender, Sexuality, and Reproductive Health; 4) Health Systems and Services; 5) Neurology; and 6) Genetics.The Research Agenda also comprised four cross-cutting priorities that applied across all domains: 1) neurodiversity-oriented care; 2) facilitating developmental transitions; 3) methodologically rigorous interventions; and 4) health disparities.

The current study
The current paper describes updates to the Year 1 AIR-P Research Agenda.Specifically, this research aimed to 1) assess continued endorsement of Research Agenda priorities; and 2) identify emerging priorities for subsequent years of the cooperative agreement.Our efforts to update the Year 1 Research Agenda included an added focus on the specific research activities necessary to advance topical research priorities, including exploratory studies, intervention research, and big data approaches.These activities were added to ensure that the Network and all members of the autism community committed to advancing research that improves the health, well-being, and quality of life of autistic individuals can become better equipped to translate research priorities into new studies.In addition to this change, the AIR-P has since expanded and further developed collaborations across the Network; as such, the updated Research Agenda sought to reflect the perspectives of a wider range of the AIR-P community.The AIR-P Research Agenda will be iteratively revised as the field continues to advance to ensure that ongoing efforts within the Network reflect state-of-the-art research, practice, and policy priorities.

Materials And Methods
The current study used a cross-sectional, web-based Qualtrics survey administered to the AIR-P with the purpose of updating the initial Research Agenda, proposed in Year 1 and published in Kuo et al. (2022) [10].
All AIR-P members were invited to participate in the survey.

Sample recruitment and eligibility
There were two waves of recruitment.We first focused on obtaining responses from our proximal Network.The AIR-P entities are listed in Table 1.

Measures
The Qualtrics survey was developed through both informal and formal collaborative synchronous and asynchronous discussions occurring via the Zoom platform and e-mail among the AIR-P entities (Table 1).
A collaborative approach to survey development was useful in determining the optimal methodology for ascertaining continuous or emerging priorities within the Network.Generally speaking, the AIR-P elected to garner feedback on the Year 1 AIR-P Research Agenda as written, but select updates were made accordingly.
As an example, the Year 1 Research Agenda identified three Primary Care priorities; in the updated Research Agenda survey, one of these priorities was disaggregated into two priorities in order to glean more specific and informative feedback.The Genetics priority areas were revised upon collaborations with the ARRB.The survey included the following specific assessments:

Continued Node Priority Area Endorsements
Priority areas identified from the Year 1 Research Agenda were re-assessed for each Node using five-point Likert scale items.Participants were asked to indicate the extent to which they agreed that each priority area remains an important priority for the AIR-P.Three to five topics per research Node were included.Network endorsement of each topic was determined based on whether more than 50% of respondents responded "agree" or "strongly agree" for a particular item.
Participants were asked to select the top two research activity priorities for each Node.Options were derived from Node Leader consensus and included three types of research activities: 1) intervention research; 2) exploratory studies; 3) linked datasets and big data analytic approaches.

Additional Research Priorities
Within each Research Node topic, participants were invited to provide open-ended responses about additional research priorities that should be considered for the AIR-P Research Agenda.

Sample
The sample characteristics are reported in Table 2.The full sample included 89 interdisciplinary professionals and individuals with lived experience affiliated with the AIR-P.Within the full sample, 70 completed the survey in its entirety, including the demographic items at the end of the survey (79% completion rate).To confirm that the survey responses did not significantly differ between those who completed all survey questions versus those who did not, we checked the first set of priority items within each sub-group and confirmed that the findings were consistent across both groups.
The sample included respondents who identified as autistic (22.9%), a family member or close friend of an autistic individual (51.4%), or a caregiver of an autistic individual (21.4%).Importantly, several participants identified with more than one of these categories, with 16% identifying as both autistic and a family member or close friend of an autistic individual and 4% identifying as an autistic caregiver.

Continued node priority area endorsements
Continued AIR-P priorities with examples are presented in Table 3.The findings are presented by Research Node.This information is graphically depicted in Figure 1.LGBTQ+: lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more All of the priorities asked about on the survey, derived from the Year 1 survey, were endorsed as continued priorities (as demonstrated by more than 50% indicating "agree" or "strongly agree" that the topic remains an important priority for the network).Within each Node, the following priorities received the highest proportion of "strongly agree" or "agree" responses: Primary Care Services and Quality: co-occurring mental health conditions (93.3%) and clinical care quality (93.3%);Community-Based Lifestyle Interventions: relationships and social connectedness (86.6%) and self-determination, advocacy, and decision-making (85.4%);Gender, Sexuality, and Reproductive Health: family education (90.4%) and self-determination, advocacy, and decision-making (87.7%);Health Systems and Services: co-occurring mental health conditions (90.0%), navigating systems and service models (87.1%) and physician training and quality care provision (87.1%);Neurology: co-occurring conditions (82.9%) and care coordination (80.0%); and Genetics: ethical issues surrounding autism genetics research (78.6%) and research on improving genetic counseling outcomes (67.1%).

Priority research activities
The survey included an assessment of participants' top two highest-ranked methodological priorities for each of the topical priorities specified above (Table 4).For Neurology, interventions were selected as the highest priorities for research on co-occurring conditions (54.3%).Exploratory studies were identified as the highest priorities for adult neurologic outcomes (48.6%) and care coordination (48.6%).

Interventions
For Genetics, linked and big data approaches were identified as the highest priorities for research on exploring the role of rare genetic variants in co-occurring conditions (61.4%).Exploratory studies were the highest priority for research on ethical issues surrounding autism genetics research (67.1%) and improving genetic counseling outcomes (52.9%).

Additional research priorities
We obtained qualitative responses from participants on additional research priorities that should be considered within the Network (Table 5).

Node / Priority Example Topics
Primary Care Services and Quality

Updated AIR-P research agenda
All findings led to the updated Research Agenda (Table 6).AIR-P) 1 Based on Network revisions prior to survey administration (generated through informal consensus) and survey feedback. 2Example topics within each priority area are provided in Table 3.

Discussion
The Health Resources and Services Administration (HRSA) AIR-P is an interdisciplinary, multicenter research network that aims to increase the health, well-being, and quality of life of autistic individuals.The current paper builds on the initial development of the AIR-P Research Agenda (proposed in Year 1) [10] and provides an updated vision for the Network.This study yielded several findings.

Continued node priority area endorsements
There was a continued endorsement of all Research Node priorities identified in the development of the Year 1 AIR-P Research Agenda.This finding suggests that each of the six AIR-P Research Nodes representing six physical health topics relevant to autistic populations is supported by diverse members of the autism research community.
In addition to confirming continued endorsement of each Research Node, we were able to identify priority topics, determined by the highest proportion of participant endorsement.Within Primary Care, Health Systems and Services, and Neurology, co-occurring conditions were among the highest priorities.It is well established that co-occurring conditions, including anxiety, depression, sleep-wake disorders, and others, are more prevalent in the autistic population than in the general population [12].The state of the evidence on the mechanisms underlying these differences is inconclusive, yet consistently underscores a confluence of interacting individual and environmental factors.The majority endorsed the need for interventions targeting co-occurring mental health conditions in autistic individuals.Indeed, although the focus of the AIR-P is predominantly centered on physical health, there is wide consensus in the evidence base that mental and physical health are inextricably linked and there is a need for holistic assessment, evaluation, and care.
Within both Community-Based Lifestyle Interventions and Gender, Sexuality, and Reproductive Health, self-determination, advocacy, and decision-making emerged as some of the most highly endorsed priorities.This finding aligns with research that highlights the importance of these capacities for autistic individuals across the life course [13,14].Despite the burgeoning evidence base on the utility of self-advocacy, there remains a paucity of research on self-advocacy as it pertains to physical health (e.g., agency and selfefficacy in making doctor's appointments, setting health goals, navigating insurance, and implementing health-promoting lifestyle strategies), which is particularly critical in light of the systemic barriers that challenge these capacities for this population (e.g., healthcare fragmentation and lack of provider training).
Additional exploratory research on health-related self-advocacy can complement existing initiatives geared towards promoting health-related self-advocacy, including the Academic-Autistic Spectrum Partnership in Research and Education (AASPIRE) toolkits [15], efforts within the Autistic Self-Advocacy Network, and the Special Olympics [16], as well as inform the development of new interventions.It will be critical to spur additional partnerships led by groups with multiple marginalized intersectional identities to ensure that health-related self-advocacy initiatives directly address the unique circumstances of diverse families.
Within Genetics, ethical issues surrounding autism genetics research emerged as the highest priority, with a strong need identified for exploratory research.Indeed, exploitation and abuse often occur in genetics research on marginalized populations, including those with developmental differences [17].There is increasing attention to the myriad ethical issues in genomic medicine, particularly in the context of neurodevelopmental traits [17].Imperatively, genetic autism research must result in research benefits for autistic people, accomplished by minimizing risk and potential harm and enhancing well-being and selfdetermination [17].While parents' and clinicians' views on genetic counseling have been surveyed [17], information on autistic people's needs, concerns, and views regarding genetic testing and genetic counseling is lacking.Existing studies on genetic counseling for autism focus on transgenerational risk and the genetic diagnosis of autism.However, as endorsed by survey participants, research is needed on the genetic underpinnings of conditions that disproportionately affect autistic people, as well as on genetic counseling and the communication of genetic information.Generally speaking, these results are consistent with our Year 1 Research Agenda, which elucidated support within the Network for identifying genes linked to co-occurring conditions or treatment responses, addressing the autistic community's concerns about genetics research, and moving away from cure and cause research toward increasing quality of life.

Priority research activities
In addition to the research activities required to further study co-occurring mental health challenges and self-advocacy, the Network emphasized the need for exploratory studies on a range of topics.These included intentionally prioritizing vulnerable, marginalized, and diverse populations.For example, neurological outcomes among autistic adults, often de-prioritized relative to younger age groups, were specifically endorsed.Exploratory studies were also endorsed for studying intersectionality, a theoretical framework for understanding how social categorizations (gender, class, disability, race, and others) operate to disadvantage people and legitimize power [18].Public health often conceptualizes marginalized groups as monolithic, rather than recognizing the myriad ways in which multiple disadvantaged identities interact and compound to negatively affect lifelong health [18].Social injustices magnified by the COVID-19 pandemic spurred a renewed recognition of the importance of intersectionality in understanding and addressing health disparities, and it is possible that our findings reflect this trend [19].
Exploratory research was also a high priority for healthcare and coordination topics.As an example, exploratory studies were cited as important for research on all topics within the Health Systems and Services Node, including general healthcare transitions, navigating systems and service models, physician training and quality care provision, family support, and co-occurring mental health conditions, as well as care coordination within the Neurology Node.This is consistent with research that finds high healthcare fragmentation, low healthcare quality, administrative burden, and a resounding need in the field for service coordination models and healthcare provider training that meet the needs of autistic individuals and their families [20].
Participants identified potential opportunities for intervention studies across all Nodes (with the exception of the Health Systems and Services and Genetics Nodes).The Primary Care, Community-Based Lifestyle, and Gender Nodes revealed the greatest number of potential intervention opportunities.Across each of these Nodes, interventions included individual-level (e.g., identifying educational, psychosocial, or other strategies to promote active engagement in healthcare among autistic individuals and their families) and systemic (e.g., testing innovative training or care models) interventions.
In the context of the Genetics Node, almost two-thirds endorsed the need for methodological approaches that utilized linked datasets and big data.Large-scale genetic testing and tracking within databases have the potential to inform research and clinical practice.Such datasets can help identify specific gene contributions and interactions while serving to advance the diagnostic yield of genetic testing [21].When implemented to promote self-determination and well-being, these approaches have the potential to positively contribute to the quality of life of autistic individuals.The AIR-P Genetics Node is uniquely poised to help facilitate the creation of registries for health conditions that disproportionately affect autistic people and will continue to advance these efforts.
Importantly, big data approaches were not cited as a priority research activity beyond the Genetics Node.This finding contrasts with other studies that indicate a need for large-scale, population-level data analysis to account for the lack of socioeconomically diverse samples in autism research.Our results may, in large part, be attributable to the lack of large, high-quality datasets in autism and physical health research.Indeed, research suggests the need for greater data infrastructure (e.g., improved linkages among national, regional, and local data sources) to increase researchers' capacity to leverage existing data, improve power, and conduct hypothesis testing.To be sure, big data approaches have the potential to capture the health experiences of diverse and underserved autistic individuals and produce findings that are translatable to public health and health equity initiatives.

Additional research priorities
We obtained qualitative responses from participants on additional research priorities that should be considered within the Network.The data revealed potential areas of focus for each Node.There were also priorities that emerged multiple times that we considered to be updated cross-Node priorities: making interventions more accessible, prioritizing intersectionality, developmental and lifespan considerations, provider and physician training, person-and family-centeredness in research, and trauma-informed care.
Although we didn't specifically assess participants' endorsement of the Year 1 cross-cutting themes, including neurodiversity-oriented care, facilitating developmental transitions, methodologically rigorous intervention studies, and addressing health disparities, the qualitative findings from the current study clearly align with and expand on these previously identified themes.Moving forward, it is anticipated that research that prioritizes cross-Node themes will lead to research that is maximally beneficial for autistic populations.

Updated AIR-P research agenda and its implications
All findings coalesced into the updated Research Agenda.The purpose of delineating the AIR-P Research Agenda in the current study was twofold: 1) to spur research in alignment with the priorities of both interdisciplinary experts in the field and individuals with lived experience; and 2) more broadly, to serve as the impetus for more generalized research, practice, and policy transformation.Such transformations include promoting the inclusion of autistic individuals as both researchers and research participants (research) [22]; preventing and addressing implicit and explicit stigma that both indirectly and directly bars autistic individuals from quality care (practice) [23]; and dismantling administrative burden that perpetuates fragmented healthcare (policy) [11].The AIR-P will continue to be responsive to emerging priorities in the field moving forward and consider the Research Agenda as a continuously evolving blueprint for the next steps.

Limitations
This research had several limitations.Although we captured a range of perspectives, our survey was indepth, time-consuming, and administered without participant incentive, which impeded our ability to collect data from a large sample.Further, our full response rate, albeit low, is also imprecise, given the challenges of parsing out the full reach of our recruitment efforts through listservs and the anonymity of our survey.As reliance on wide-scale recruitment tools such as social media continues to increase in research, it will be exceedingly important for researchers to employ more precise tracking.
Due to our restricted sample, there were instances in which the highest endorsed research priority in a particular category was only endorsed by one or two participants more than the second and/or third-highest endorsed research priorities.Future research should address priorities that were highly endorsed but perhaps not discussed in detail in our Discussion section, as well as priorities that emerged through our open-ended items.
Another limitation is that the rationale underlying a particular endorsement was not assessed in this research.This shortcoming could have critical implications for interpreting these findings, as endorsement could potentially represent 1) that a particular research topic is important or 2) that current research on a particular topic is low-quality or exploitative to the autistic community, and significant efforts are required to improve research in this area.This may be particularly salient for controversial areas of research, such as genetics [21].The general nature of the survey also impeded our capacity to report on research activity priorities with a higher level of granularity; for example, exploratory studies may include participatory action research, qualitative methodologies, and ethnographic approaches, which have been identified in previous autism research as critical, or could simply refer to quantitative studies that seek to summarize particular topics.Further research should seek to discern greater detail in this regard.
An advantage of our research was that we were able to survey experts in the field of autism research.Given this facet of our research, the majority of our sample had obtained doctoral degrees.Additional research, however, is necessary to capture large samples more reflective of diverse autism professional communities.Further, although our survey sampled interdisciplinary autism professionals and we had a 100% response rate from the ARRB, the individuals with lived experience in our sample were often also researchers or professionals within the autism community.Future research should prioritize perspectives from individuals, caregivers, and family members who do not have autism-related professions to ensure that research is driven by these communities.This will have myriad downstream effects, including providing instrumental and social resources to those who have been particularly marginalized within the healthcare system by administrative burden, stigma, and other factors [11].

Conclusions
The updated AIR-P Research Agenda represents an important step forward for continuing to enact largescale health promotion efforts for autistic individuals across the lifespan.This updated Agenda will build on efforts to catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach.
the collaboration efforts of all entities specified below.The NCC has been instrumental in the design and implementation of innovative and impactful autism research by building and supporting an infrastructure that enables collaborative research activities among diverse groups of experts.Node Leaders* Autism research leaders across the country with expertise in each Node topic:1) Primary Care Services and Quality; 2) Community-Based Lifestyle Interventions; 3) Gender, Sexuality, and Reproductive Health; 4) Health Systems and Services; 5) Neurology; and 6autistic scholars provides Network guidance and consultation for research studies within the Network.comprised of the NCC, Node leaders, ARRB representatives, and technical assistance entities.The focus of this committee is to guide Network decisions to promote growth and innovation.Scholars The Scholars include early-career researchers seeking to promote the health and well-being of autistic individuals across the lifespan through research.They receive pilot and feasibility funding for their proposed projects, mentorship and training, and professional development and collaboration opportunities.

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Support for learning about one's sexual orientation and gender identity and finding community • The role of trauma in gender, sexuality, and reproductive health Health Systems and Services • Accessibility in health systems and services, including addressing systemic barriers to accessibility • Diagnostic overshadowing and disability discrimination • The role of early and childhood interventions in providing resources and supports for adults • Staff and service provider education to increase confidence in supporting autistic individuals, particularly autistic individuals with chronic conditions • Guidelines for effective transition, including trauma-informed transition services • Interagency collaboration to connect young adults with other systems (e.g., Medicaid) and support different outcomes (e.g., employment) as well as the use of patient navigators • Pathways for diagnosis and treatment of co-occurring psychiatric conditions Neurology • Strategies for making neurology services more accessible • Aging-related and/or other chronic neurological conditions in autistic individuals • Brain-gut connection • Enhancing the capacity of neurologists to support autistic patients • Enhancing understanding of families' perspectives and priorities related to neurological care Genetics • Enhancing the accessibility and awareness of genetics services • The genetic linkages among autism, PTSD, and trauma • Availability and accessibility of genetics counseling • Ensuring genetics research provides valuable information and support to individuals and families • Increasing input from families on genetics services • Physical health issues in autistic people with rare genetic disorders • Training practitioners at all levels regarding the role of genetics for autistic patients Updated

TABLE 1 :
AIR-P entities*These entities were involved in the Year 1 Research Agenda Process.All of the entities listed above were involved in efforts in the current study to update the Research Agenda.AIR-P: Autism Intervention Research Network on Physical HealthOur response rate over a two-week period for the National Coordinating Center (NCC), SC, Autistic Researcher Review Board (ARRB), Scholars, and collaborating research entities (CREs) was 31/72 (43%).To solicit additional feedback, we invited those who were distally affiliated with the AIR-P as webinar attendees or LISTSERV members.The survey was disseminated via email and was open for an additional two weeks to all eligible participants (n = 884).With this broader recruitment strategy, we had 89 survey respondents (10% response rate).

/Topic remains an important priority for the AIR-P Research Network* Strongly disagree/disagree
Co-occurring mental health conditions, e.g., ADHD, anxiety, depression, stress-Community-Based Lifestyle Interventions (n = 82)Nutrition/ physical activity, e.g., engaging families and individuals in activity; increasing community support; strengthening the evidence base 3 3.7% 13 15.9% 76.8%Relationships/social connectedness/community participation, e.g., interventions/supports that engage communities, families, children, and peers;

Gender, Sexuality, and Reproductive Health (n=73)
Navigating systems and service models, e.g., health care navigation for adolescents and adults; models of effective transition Physician training and quality care provision, e.g., preparing PCPs in the adult health care system to serve the autistic

TABLE 4 : The highest-ranked Network priorities (methodological)
: lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more Options included (a) intervention research, (b) exploratory studies, and (c) linked datasets and big data approaches.For Primary Care Services and Quality intervention research was the highest priority for research on primary care health service delivery (66.3%), co-occurring mental health conditions (66.3%), and clinical care quality (65.1%).Exploratory studies were the highest priority for research on selfdetermination, advocacy, and decision-making (72.1%).
*Options to select research activities were not mutually exclusive.LGBTQ+For Gender, Sexuality, and Reproductive Health, interventions were the highest priority for physician training and quality care provision (67.1%); sexual education and knowledge (64.4%); and family and parent education and support (63.0%).Exploratory studies were the highest priorities for research on intersectionality (64.4%); self-determination, advocacy, and decision-making (60.3%); interventions were also highly endorsed for this priority (43; 58.9%); and vulnerable, marginalized, and diverse populations (58.9%).Prior to survey dissemination, there was consensus among the Health Systems and Services Research Node to focus efforts more on exploratory studies and big data approaches than intervention research, given the Node capacities and resources.Between those two methodological options, respondents indicated exploratory studies as the highest priorities for research on co-occurring mental health conditions (74.3%); family support (72.9%); navigating systems and service models (68.6%), physician training and quality care provision (68.6%); and general healthcare transitions (67.1%).
Enhancing systems and services, including improving access to community-based services; development of primary care models to facilitate transition and bridge sub-specialty care; and telehealth 2023 Hotez et al.Cureus 15(8): e44388.DOI 10.7759/cureus.44388• Trauma-informed care •

TABLE 5 : Open-ended responses to additional priorities ESL
: English as a second language; PTSD: post-traumatic stress disorder Select priorities emerged multiple times, and we considered these priorities to be updated cross-Node priorities: making interventions more accessible, prioritizing intersectionality, developmental and lifespan considerations, provider and physician training, person-and family-centeredness in research, and traumainformed care.