Health disparities associated with access to disability evaluations for toddlers in Early Head Start.
Even inside Early Head Start, Black, Hispanic, and uninsured toddlers are less likely to receive the developmental evaluations they need.
01Research in Context
What this study did
The team looked at toddlers in Early Head Start. They asked which kids actually got a full developmental check-up before age three.
They used parent answers and community data. Then they ran math models to see what predicted getting an evaluation.
What they found
Black and Hispanic/Latino toddlers were less likely to be evaluated. Kids without insurance were also left behind.
Family income, parent education, and neighborhood traits all mattered too. Even inside the same program, gaps stayed wide.
How this fits with other research
Spriggs et al. (2016) saw the same race split. In their data, steady doctor visits helped white kids get an ASD label faster, but did nothing for Black kids.
Stewart et al. (2018) looked later in the pipe. They found almost a three-year wait from ASD diagnosis to starting Medicaid EIBI, yet race did not predict that wait. Together the papers show race blocks the first door, not the second.
Dimian et al. (2021) prove the clock keeps ticking. Kids who start EIBI sooner have better school outcomes. Diemer et al. (2023) explain why some toddlers never even get the chance to start.
Why it matters
You cannot treat a child you never assess. If you work in Early Head Start, Head Start, or any preschool screen-to-service path, flag uninsured and minority toddlers for priority scheduling. One extra phone call or ride voucher can move them from the wait list to the evaluation chair and, down the road, into early intervention.
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02At a glance
03Original abstract
BACKGROUND: The aim of this investigation was to examine developmental, sociodemographic and familial factors associated with parent reported access to an evaluation in an Early Head Start sample. Children with developmental disabilities often require evaluations to access early interventions, which can improve their long-term outcomes. METHODS: This study (n = 191) examined how developmental, sociodemographic and parent factors at age 2 were associated with parent reporting the child being evaluated by age 3. Two logistic regression analyses were conducted. The first model included children at age 2 with scores at least in the monitoring zone of developmental risk, and the second model included children with high developmental risk. RESULTS: The first model found that children in the monitoring zone of developmental risk were more likely to be evaluated per parent report if they were born preterm, male, with increased behaviour problems, higher economic risk, increased maternal education, increased parental depressive symptoms and in urban areas and less likely if they were of Black or Hispanic/Latino ethnicity, had no health insurance or more home disorganisation. The second model found that children with high developmental risk were less likely to be evaluated per parent report if they were female, of Hispanic/Latino ethnicity, had better language skills and increased home disorganisation and more likely if their parents reported increased depressive symptoms or less economic risk. CONCLUSIONS: This study highlights barriers associated with access to developmental and disability evaluations for children in at-risk families. Health disparities are negatively associated with children's access to evaluations, even when supported by systems like Early Head Start.
Journal of intellectual disability research : JIDR, 2023 · doi:10.1111/jir.13003