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.
