Chavez Alison E, Feldman Melanie S, Carter Alice S, Eisenhower Abbey, Mackie Thomas I, Ramella Leah, Hoch Noah, Sheldrick R Christopher
Department of Psychology, University of Massachusetts Boston, Boston, MA, USA.
Department of Health Policy and Management, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Evid Based Pract Child Adolesc Ment Health. 2022;7(2):275-293. doi: 10.1080/23794925.2021.2001772. Epub 2021 Dec 22.
Promoting equity in health services requires an understanding of the mechanisms that produce disparities. Utilizing a sequential, mixed-methods, explanatory study design, we analyzed child-, family-, and organizational-level factors and their association with wait times for an ASD diagnostic evaluation among 353 families scheduled for English and Spanish language appointments (27% Spanish language). A subset of parents and caregivers participated in English and Spanish language focus groups to provide their perspectives on the diagnostic process. Spanish language was associated with greater completion of, and time to evaluations than English language. The only variable found to mediate associations with time-to-evaluation was appointment availability - an organizational factor. Qualitative results elucidate potential explanations for greater Spanish language evaluation completion (e.g., fewer community-based diagnostic options). Results serve as a case study to support the utility and importance of analyzing the influence of organizational-level factors on delays and disparities for childhood health and mental health services. We discuss our findings in relation to strategies that can be widely applied to support equitable services access for childhood diagnostic and intervention services.
促进卫生服务公平性需要了解导致差异的机制。我们采用顺序式、混合方法、解释性研究设计，分析了353个安排了英语和西班牙语预约的家庭（27%为西班牙语预约）中儿童、家庭和组织层面的因素及其与自闭症谱系障碍（ASD）诊断评估等待时间的关联。一部分家长和照料者参加了英语和西班牙语焦点小组，以提供他们对诊断过程的看法。与英语预约相比，西班牙语预约的评估完成率更高，完成评估所需时间也更长。唯一被发现介导与评估时间关联的变量是预约可得性——一个组织层面的因素。定性结果阐明了西班牙语评估完成率较高的潜在原因（例如，基于社区的诊断选择较少）。研究结果作为一个案例研究，支持分析组织层面因素对儿童健康和心理健康服务延误及差异影响的效用和重要性。我们结合可广泛应用于支持儿童诊断和干预服务公平获取的策略来讨论我们的研究发现。
