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

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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.