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

解决早期沟通障碍儿童的结构性差异 (ASCEND)

• 批准号: 10610479
• 负责人: Lauren M. Cycyk
• 金额: $ 77.39万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10610479
• 关键词: Address; Administrator; Adult; Advocate; Affect; Age; Attitude; Behavioral; Belief; Big Data; Caring; Characteristics; Child; Child Care; Child Support; Child health equity; Childhood; Clinical; Color; Communication; Communication impairment; Communities; Complex; Consensus; Criminal Justice; Data; Development; Disabled Persons; Discrimination; Disparity; Early Intervention; Early identification; Early treatment; Education; Eligibility Determination; Emotional; Equity; Ethnic Origin; Evaluation; Evidence based intervention; Exclusion; Face; Family; Family Characteristics; Focus Groups; Foundations; Funding; Goals; Health; Health Care Costs; Health Disparities Research; Health Services Accessibility; Home; Human; Individual; Information Systems; Intervention; Interview; Language; Language Disorders; Leadership; Linguistics; Locales; Mental Health; Methods; Minority Groups; National Institute on Deafness and Other Communication Disorders; Organizational Policy; Outcome; Parents; Pathologist; Personal Satisfaction; Policies; Population; Poverty; Poverty Areas; Primary Care Physician; Process; Provider; Race; Recommendation; Regulation; Reproducibility; Research; Resources; Risk; Rural; School-Age Population; Services; Source; Specialist; Speech; Speech Disorders; Structural Racism; Structure; Surveys; Symptoms; System; Techniques; US State; Variant; autism spectrum disorder; child services; children of color; community-level factor; disability; early childhood; early satiety; experience; health disparity; health inequalities; hearing impairment; improved; improved outcome; inequitable distribution; innovation; marginalized population; member; physical conditioning; policy recommendation; programs; provider intervention; rural area; rural poverty; service intervention; service providers; social; stakeholder perspectives; structural determinants

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.

项目摘要 沟通障碍 (CD)，包括原发性言语和语言发育障碍、自闭症 频谱障碍和听力障碍是幼儿期最常见的残疾。早期的 CD 的识别和治疗支持儿童的短期和长期社交、情感、行为、 学业、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，包括生活在农村的儿童 地区和/或贫困地区，无法及时获得高质量的 CD 护理。虽然长期以来的结构 健康和教育环境中的不平等是这些差异的根源，影响SRD的具体来源 有色人种儿童的整个 CD 转诊、识别和治疗过程，都是未知的。合作伙伴 我们将与美国五个州和不同的利益相关者一起开展第一个全面的多州合作 早期识别和歧视初级系统中的结构性种族主义和歧视（SRD）分析 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的循证干预措施奠定基础 拥有 0-3 岁 CD 的有色人种儿童。为此，本研究应用了健康差异框架来精确地 检测、理解和开发解决方案，以解决个人、组织和 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 转介、评估、资格和服务分配结果， 社区资源和机会指标以及 EI 流程特征。在目标 2 中，我们将结合实际情况 通过与持有 CD 的有色人种儿童家长进行焦点小组讨论，确定目标 1 中的分配不平等， 对 EI 中提供 CD 护理的主要专业人员（即儿科初级保健医生、言语语言 病理学家、EI 发展专家），以及对 EI 行政领导的采访。在目标 3 中，我们将 使用名义小组技术（利益相关者共识流程）来生成实践和优先级并确定其优先顺序 扰乱持有 CD 的儿童的 SRD 的政策建议。顾问，包括有色人种儿童的父母 带有 CD 的人、残疾人、EI 提供者、家长残疾倡导者、EI 管理员和学者 肤色和/或残疾将影响研究的各个方面。该项目最终将产生一系列 全面、利益相关者知情、数据驱动且可行的建议，以提高公平性 为五分之一受早期 CD 影响的有色人种儿童提供早期 CD 护理。