Addressing Structural Disparities for Children with Early Communication Disorders (ASCEND)

项目摘要 沟通障碍（CD），包括初级发育性言语和语言障碍，自闭症 谱系障碍和听力障碍是幼儿期最常见的残疾。早期 CD的识别和治疗支持儿童的短期和长期社会，情感，行为， 学术，心理和身体健康的结果，并减少教育，刑事司法和医疗保健， 成本然而，来自种族、族裔和/或语言少数群体的儿童，包括生活在农村地区的儿童， 贫困地区和/或贫困地区的儿童无法及时获得高质量的CD护理。虽然长期以来， 卫生和教育环境中的不平等是这些差异的基础， 整个CD色儿转诊、鉴定、治疗过程，都是未知数。合作 与美国五个州和不同的利益相关者，我们将进行第一次全面的多州 分析早期识别初级系统中的结构性种族主义和歧视， CD的治疗：残疾人教育法C部分早期干预（EI）系统。 本研究的目的是为改善健康公平性的循证干预奠定基础， 彩色儿童CD年龄0-3。为了做到这一点，这项研究采用了一个健康差距框架， 检测，理解，并制定解决方案，解决个人，组织， 和社区层面。在目标1中，我们将利用5个州的EI数据系统来确定 根据儿童交叉身份的EI转介、评估、资格和服务分配结果， 社区资源和机会的指标，EI过程的特点。在目标2中，我们将 目标1中通过焦点小组与有色人种儿童的父母确定的分布不平等， 在EI中提供CD护理的关键专业人员的调查（即，儿科初级保健医生，言语-语言 病理学家，EI发展专家），并与EI行政领导访谈。在目标3中，我们 使用名义团体技术，利益相关者共识过程，以产生和优先考虑实践， 政策建议，以中断SRD的儿童与CD。顾问，包括有色人种儿童的父母 与CD，残疾成人，EI提供者，父母残疾倡导者，EI管理者和学者， 肤色和/或残疾，将告知研究的各个方面。该项目最终将产生一套 全面的，知情的，数据驱动的，可行的建议，以提高公平性， 早期CD护理为受早期CD影响的五分之一的有色人种儿童。

PROJECT ABSTRACT Communication disorders (CDs), including primary developmental speech and language disorders, autism spectrum disorder, and hearing impairment, are the most prevalent disabilities in early childhood. Early identification and treatment of CDs supports children's short- and long-term social, emotional, behavioral, academic, mental, and physical health outcomes and reduces educational, criminal justice, and health care costs. Yet, children from racial, ethnic, and/or linguistic minority populations, including those living in rural areas and/or in poverty, do not receive timely access to high-quality CD care. While long-standing structural inequities in health and educational settings underlie these disparities, specific sources of SRD that impact children of Color across the CD referral, identification, and treatment process, are unknown. In partnership with five US states and diverse stakeholders, we will undertake the first comprehensive multi-state analysis of structural racism and discrimination (SRD) in the primary system of early identification and treatment for CDs: the Individuals with Disabilities Education Act Part C Early Intervention (EI) system. The goal of this study is to lay the foundation for evidence-based interventions that improve health equity for children of Color with CDs age 0-3. To do so, this study applies a health disparities framework to precisely detect, understand, and develop solutions that address sources of SRD in EI at the individual, organizational, and community levels. In Aim 1, we will leverage 5 states' EI data systems to identify distributional inequities in EI referral, evaluation, eligibility, and service allocation outcomes according to child intersecting identities, indicators of community resources and opportunities, and EI process features. In Aim 2, we will contextualize distributional inequities identified in Aim 1 through focus groups with parents of children of Color with CDs, surveys of key professionals providing CD care in EI (i.e., pediatric primary care physicians, speech-language pathologists, EI developmental specialists), and interviews with EI administrative leadership. In Aim 3, we will use Nominal Group Technique, a stakeholder consensus process, to generate and prioritize practice and policy recommendations to disrupt SRD for children with CDs. Advisors, including parents of children of Color with CDs, adults with disabilities, EI providers, parent disability advocates, EI administrators, and scholars of Color and/or with disabilities, will inform all aspects of the study. This project will ultimately result in a set of comprehensive, stakeholder-informed, data-driven, and feasible recommendations to improve equity in early CD care for the 1 in 5 children of Color affected by early CDs.