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

项目摘要 沟通障碍(CDS)，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儿童早期最常见的残疾。早些时候 CD的识别和治疗支持儿童短期和长期的社会、情感、行为、 学术、心理和身体健康结果，并减少教育、刑事司法和医疗保健 成本。然而，来自种族、民族和/或语言少数群体的儿童，包括那些生活在农村的儿童 在贫困地区和(或)贫困地区，无法及时获得高质量的光盘护理。虽然长期存在的结构性 卫生和教育环境中的不平等是这些差异的基础，是影响SRD的特定来源 儿童彩色CD的转诊、鉴定和治疗过程，均不为人知。合伙经营 我们将与美国五个州和不同的利益攸关方一起，进行第一个全面的多州 分析早期识别和初级鉴定系统中的结构性种族主义和歧视 CDS的治疗：《残疾人教育法》C部分早期干预(EI)系统。 这项研究的目标是为以证据为基础的干预措施奠定基础，以改善 0-3岁的彩色CD儿童。为了做到这一点，这项研究将健康差异框架应用于 检测、了解和开发解决方案，以解决EI中SRD的来源， 和社区层面。在目标1中，我们将利用5个州的EI数据系统来识别 根据儿童交叉身份的EI转诊、评估、资格和服务分配结果， 社区资源和机会的指标，以及EI流程特征。在目标2中，我们将结合具体情况 通过与患有CD的有色儿童的父母的焦点小组，在目标1中发现了分配不平等， 在EI中提供CD护理的主要专业人员的调查(即儿科初级保健医生、语言 病理学家、EI发育专家)，以及与EI行政领导的访谈。在《目标3》中，我们将 使用名义小组技术，这是一个利益相关者共识过程，以生成实践并确定优先顺序 政策建议，以破坏患有CD儿童的SRD。顾问，包括有色人种儿童的父母 与CD、残疾成年人、EI提供者、父母残疾倡导者、EI管理人员和 肤色和/或残疾，将为研究的方方面面提供信息。该项目最终将产生一套 全面、利益相关者知情、数据驱动且可行的建议，以提高 早期CD对1/5受早期CD影响的彩色儿童的护理。

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.