Disparities in developmental-behavioral diagnoses in Hispanic immigrant children: role of parent concern and screening

西班牙裔移民儿童发育行为诊断的差异：父母关注和筛查的作用

基本信息

批准号：
10575994
负责人：
Stacey Luen Bevan
金额：
$ 3.38万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-01 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10575994
关键词：
Address Affect Appointment Behavior Behavior Disorders Behavioral Behavioral Symptoms Caring Child Child Behavior Child Health Childhood Clinical Cluster Analysis Communities Country Data Development Developmental Disabilities Diagnosis Diagnostic Diagnostic tests Disadvantaged Discrimination Disease Disparity Disparity in diagnosis Early identification Equation Equity Ethnic Origin Ethnic Population Exposure to Family Goals Health Health Services Accessibility High Prevalence Hispanic Immigrant Immigrant family Immigration Inequality Intervention Knowledge Literature Low Prevalence Mediating Mediator Modeling National Institute of Mental Health Outcome Parents Pediatric Hospitals Pediatrics Perception Philadelphia Population Prevalence Primary Care Problem behavior Process Provider Race Refugees Reporting Research Risk Risk Behaviors Sampling Screening Result Sensory Services Site Social Conditions Social status Social support Societies Stress Testing United States Visit accurate diagnosis autism spectrum disorder behavioral health burden of illness caucasian American clinical care clinical diagnosis clinical diagnostics clinical predictors design disability ethnic health disparity ethnic minority population experience health care availability health disparity improved instrument low socioeconomic status migration parental influence parental role pediatrician poor health outcome primary care visit psychologic racial population screening secondary analysis social social determinants social integration structural health determinants trend

项目摘要

PROJECT SUMMARY Developmental-behavioral disabilities are present in nearly 1 in 5 children in the United States and are among the most common concerns parents discuss at primary care visits. Autism Spectrum Disorder (ASD) is one of these conditions, which is characterized by differences in social and sensory processing. While ASD occurs in approximately 1 in 53 children, racial-ethnic groups are diagnosed at different rates. White children have the highest prevalence (2.65%), and Hispanic children are least likely to be diagnosed (1.94%). Moreover, 0.5% of Spanish-speaking children and 0.3% of children with two foreign-born parents have a documented diagnosis. This disparity is similar for other conditions and has a profound impact in access to treatment. Screening in primary care pediatrics is one mechanism for early identification of child risk behaviors; however, this process does not facilitate diagnosis as expected for Hispanic children. This is likely a function of the interplay between parental report of behaviors, validity of screening instruments in this population and provider diagnostic practices. While disparities for Hispanic immigrants and provider’s views are well documented, the mechanisms underpinning differences in diagnosis are not well understood. Additionally, parental perspectives on child’s behavior and diagnosis are insufficiently represented. Rich data on socioecological factors in the context of immigration and child health outcomes are not readily available and relationships are subsequently underexplored. Profound challenges related to resettlement in the United States contribute to risk for developmental-behavioral disorders. Apart from this direct relationship, these immigration-related factors influence how parent’s behavioral concerns develop and are represented on clinical screening instruments. For example, discrimination can increase risk for behavioral disorders in children while simultaneously impacting parent’s perception of these behaviors. This will subsequently affect how well screening instruments capture parent concerns. This study will quantitatively assess how these relationships contribute to diagnostic disparities. The study uses an adaptation of the Trajectory Model for Immigrant/Refugee Health to model relationships between socioecological factors, parent concern for behavior, screening results and clinical diagnosis. This conceptual orientation emphasizes structural contributions to inequalities while providing evidence to support improvements in clinical care for this population. This secondary analysis uses a community sample collected by PolicyLab Research Center at The Children’s Hospital of Philadelphia. Aim 1 will determine the relationship between socioecological clusters and parent reported child concerns. Aim 2 will assess concordance between parental concern and clinical screening results. Aim 3 will test the model proposing parental concern and screening as mediators of socioecological predictors of clinical diagnosis. Analytical strategies include cluster analysis, regression, and structural equation modeling. This study will provide foundational evidence to reduce diagnostic disparities for Hispanic immigrant children.

项目摘要在美国，发育行为的不像近来有近1个儿童中的近1个帕伦斯在初级保健访问中讨论的最常见问题。这些条件以社交和感官处理的差异为特征。大约有53名儿童中有1个，种族群体被诊断出来。可能会诊断出最高的患病率（2.65％）和西班牙裔儿童（1.94％）讲西班牙语的孩子和0.3％的外国出生父母的孩子有记录的诊断。这种差异对于其他条件类似，并且对接受治疗产生了深远的影响初级保健儿科是食欲识别儿童风险行为的一种机制；不像西班牙裔儿童那样促进诊断。父母的行为报告，筛查该人群的筛查有效性和提供者诊断练习。诊断中差异的机制尚不清楚关于孩子的行为和诊断，我不足以压抑。移民和儿童健康成果的背景不是关系与美国重新安置有关的深刻挑战有助于发育行为疾病除了直接关系外影响父母在临床滚动中的行为问题例如，歧视可以增加儿童行为的风险父母对这些行为的看法。父母的关注差异。该研究使用移民/难民健康的轨迹模型的改编社会生态因素，父母对行为的关注，筛查结果和临床之间的关系诊断。支持人群临床护理的证据。费城儿童医院的社区样本收集研究中心将确定社会生物学群体与父母报告的儿童关注之间的关系。评估父母关注和临床筛查结果之间的一致性。提出父母的关注和筛查，作为临床诊断社会生态学预测指标的介体。分析策略包括集群分析，回归和结构方程模型提供基本证据，以减少西班牙裔移民儿童的诊断差异。