Examining Contextual and Protective Factors on Racial/Ethnic Health Disparities Among Preschool Children with Developmental Delays

ABSTRACT Black and Hispanic preschool children with developmental and disabilities (DD) have endured longstanding disparities in accessing therapies depriving them of services across medical and educational systems that foster developmental, behavioral, and educational outcomes. Studies also indicate parents benefit when their

children receive needed therapies with improvements in mental health, stress, and quality of life. Thus, a lack of clinic- and early childhood special education (ECSE)-based therapies during critical periods of brain development, including the preschool years, can substantially contribute to preventable morbidity. Racial and

ethnic health care disparities for children with DD have been documented for decades. The scientific community has now urged for research which advances knowledge regarding the etiology of these disparities. Much of the emphasis to date has focused on how individual-level factors contribute to disparities in

therapeutic access for children with DD. However, contextual factors, including structural racism and discrimination (SRD), are likely a significant, but unexplored influence. The scientific objectives of this research are to address the following existing gaps in the literature: 1) the degree to which contextual factors, as

evidenced by educational, healthcare and neighborhood indicators of SRD, drive disparities in therapeutic access among Black and Hispanic preschool-age children with DD and impact child, parent, family and community outcomes; and 2) the identification of modifiable protective determinants that may mitigate the

relationship between SRD and access to therapies. Our interdisciplinary team will meet the objectives of this study by conducting a mixed methods longitudinal study enrolling 300 Black and Hispanic children with DD and their parents from clinics across Chicago and collecting multilevel prospective data five times over a three-year

period. We will also create a Multidisciplinary Advisory Board who will meet biannually to consider how our research findings can inform educational and health care intervention and policy. The proposed research is significant for its potential to advance scientific knowledge about the role of SRD in sustaining health inequities;

how gaps and delays in therapeutic services impact multilevel health outcomes among Black and Hispanic PCw/DD and their families; and the role of key protective factors in mitigating these effects. Results from this study will provide actionable data to inform policy and the development of medical, educational, and public

health interventions towards achieving health equity for Black and Hispanic children with DD and their families.