Burkett Karen, Brown Courtney M, Pickler Rita, Stanton-Chapman Tina, Sharps Phyllis, Jacquez Farrah, Smith Teresa, Holland Amy, Heeman Anna, Froehlich Tanya
Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Department of Patient Services, Cincinnati, OH.
Primary Care Pediatrics Livingston Ambulatory Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
J Dev Behav Pediatr. 2025;46(1):e45-e55. doi: 10.1097/DBP.0000000000001327. Epub 2024 Oct 23.
The purpose of this study was to discover the care meanings of facilitators and barriers to detection and intervention for developmental delay among Head Start preschool-aged children, as viewed by parents, teachers, and primary care providers.
We used a qualitative focus group design and broad cultural lens to understand similarities and differences in family and professional care, as Head Start programs educate preschoolers living in poverty who are disproportionately from ethno-racial minoritized groups. We sought the perspectives of 15 Head Start parents equally representing Black, Latino(a), and White parents, 17 teachers, and 11 healthcare providers to discover facilitators and barriers to adherence with professional recommendations.
We found that silos in professional communications, parent distrust, knowledge deficits, and stigma were barriers to obtaining developmental recommendations. Participants also identified missed opportunities to facilitate interagency coordination, parental advocacy of a child's developmental needs, and professional alliances to take collaborative actions for early identification and treatment. Furthermore, a subculture of poverty adversely influenced adherence to developmental recommendations, and ethno-racial biases affected Black and Latino(a) families' follow-through.
Our findings highlight how the lack of coordination between sectors resulted in the dismissal of parental concerns or denial of services by 1 system or the other, thus, at the very least reducing the child's chances for earlier intervention and treatment. We also identified potential benefits to children when the barriers of poverty and ethnoracial bias are addressed by professionals with coordinated actions, and new systems are developed for sharing developmental screening results and partnering to coordinate care across the preschool and primary healthcare settings.
本研究旨在探寻家长、教师和初级保健提供者眼中，开端计划学龄前儿童发育迟缓检测与干预的促进因素及障碍的护理意义。
我们采用定性焦点小组设计和广泛的文化视角，以了解家庭和专业护理中的异同，因为开端计划为生活贫困、来自少数族裔群体比例过高的学龄前儿童提供教育。我们征求了15位开端计划家长（黑、拉丁裔和白人家长各占同等比例）、17名教师和11名医疗保健提供者的意见，以发现遵循专业建议的促进因素和障碍。
我们发现，专业沟通中的孤立状态、家长的不信任、知识缺陷和耻辱感是获取发育建议的障碍。参与者还指出，存在错失促进跨机构协调、家长对孩子发育需求的倡导以及采取协作行动进行早期识别和治疗的专业联盟的机会。此外，贫困亚文化对遵循发育建议产生了不利影响，种族偏见影响了黑人和拉丁裔家庭的后续行动。
我们的研究结果凸显了各部门之间缺乏协调如何导致一方系统驳回家长的担忧或拒绝提供服务，从而至少减少了儿童获得早期干预和治疗的机会。我们还确定，当专业人员通过协调行动消除贫困和种族偏见障碍，并开发新系统以共享发育筛查结果并合作协调学前和初级医疗保健环境中的护理时，对儿童可能带来的益处。
