Examining feasibility, acceptability, and participant experiences of an anti-racist parenting intervention for White U.S. parents.

Many White parents engage in minimal discussion of race and racism with their children, instead engaging in color-evasive practices that communicate that race is unimportant and that White people are racially neutral. Even White parents who express a commitment to anti-racist parenting frequently struggle to act on this commitment and feel underprepared to do so. The current mixed methods pilot study focused on the feasibility, acceptability, and participant experiences of an intervention ("CounterACT") that aimed to address this gap in White U.S.-based parents' skills and knowledge. Participants in the study were 27 White U.S.-based parents of 4- to 6-year-old White children who completed pre- and postintervention surveys as well as postintervention interviews. Findings suggest that the CounterACT model was feasible and acceptable. Parent self-report further suggests that CounterACT had beneficial effects on parenting, parents' beliefs regarding White privilege, and children's critical reflection. Parents reported positive experiences of CounterACT, particularly group components of the intervention. Key elements of participants' experience included learning to understand their own and their children's experience of Whiteness; learning to better tolerate and regulate emotional discomfort; connecting with others for motivation, accountability, and learning; and approaching racial socialization with greater intentionality. However, parents also experienced limits in their progress toward anti-racist parenting. Many indicated a desire for more concrete guidance and greater support enacting what they were learning in their own parenting. A particular concern was how to discuss White racial identities effectively. Our discussion highlights the implications of these findings for future work in this area. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Delays in autism diagnosis for U.S. Spanish-speaking families: The contribution of appointment availability.

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.

Adolescent Mental Health in Relation to Anti-Racism Critical Action.

The relation between critical action and mental health in youth is unclear, despite theory suggesting that engagement in critical action may support adaptive mental health functioning for youth experiencing oppressive systems. The current study contributed to the literature in this understudied area by analyzing the relations between youth critical anti-racism action and their depressive symptoms and psychological well-being, as well as testing two potential moderators of these relations: parent critical motivation and community anti-racism. The study sample consisted of 430 13-to-17-year-old adolescents (M age = 15.3 years, 54% girls, 48% black and 52% white). The findings suggest that critical action is often associated with negative mental health outcomes; however, parent critical motivation and community anti-racism were protective in some instances and communal anti-racism action was more frequently linked to adaptive mental health outcomes than other forms of action. The findings underscore that both psychological risks and rewards are present for youth engaging in critical action for racial justice and highlight the importance of future research to identify malleable factors that are protective for these youth.

Effectiveness of Screening in Early Intervention Settings to Improve Diagnosis of Autism and Reduce Health Disparities.

IMPORTANCE: The American Academy of Pediatrics recommends referring children at elevated risk of autism spectrum disorder (ASD) for Part C early intervention (EI) services, but notes that EI services often fail to provide ASD screening. OBJECTIVE: To evaluate the hypothesis that a multistage screening protocol for ASD implemented in 3 EI settings will increase autism detection, especially among Spanish-speaking families. DESIGN, SETTING, AND PARTICIPANTS: Difference-in-differences analyses with propensity score weighting of a quasi-experimental design using administrative data on 3 implementation EI agencies and 9 comparison EI agencies from 2012 to 2018 provided by the Massachusetts Department of Public Health. Eligible children were aged 14 to 36 months, enrolled in EI, had no prior ASD diagnosis or medical condition precluding participation, and had parents who spoke English or Spanish. The final analytic sample included 33 326 unique patients assessed across 150 200 person-quarters. EXPOSURES: Multistage ASD assessment protocol including ASD screening questionnaires, observational screener, and diagnostic evaluation. MAIN OUTCOMES AND MEASURES: Increased incidence of ASD diagnoses as documented in Department of Public Health records and reductions in language-associated health care disparities. RESULTS: Implementation of screening at 3 EI sites was associated with a significant increase in the rate of ASD diagnoses (incidence rate ratios [IRR], 1.6; 95% CI, 1.3-2.1; P < .001), representing an additional 8.1 diagnoses per 1000 children per quarter. Among Spanish-speaking families, screening was also associated with a significant increase in the rate of ASD diagnoses (IRR, 2.6; 95% CI, 1.6-4.3; P < .001), representing 15.4 additional diagnoses per 1000 children per quarter-a larger increase than for non-Spanish-speaking families (interaction IRR, 1.8; 95% CI, 1.0-3.1; P = .005). Exploratory analyses revealed that screening was associated with a larger increase in the rate of ASD diagnoses among boys (IRR, 1.8; 95% CI, 1.4-2.3; P < .001) than among girls (IRR, 1.1; 95% CI, 0.6-1.7; P = .84). CONCLUSIONS AND RELEVANCE: In this study, associations between increased rates of ASD diagnoses and reductions in disparities for Spanish-speaking households support the effectiveness of multistage screening in EI. This study provides a comprehensive evaluation of ASD screening in EI settings as well as a rigorous evaluation of ASD screening in any setting with a no-screening comparison condition. Given that the intervention included multiple components, mechanisms of action warrant further research, as do disparities by child sex.

Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities.

Health disparities in ASD detection affect children's access to subsequent interventions. We examined potential disparities in implementation of a multi-stage ASD screening and diagnostic evaluation protocol in Part C Early Intervention with 4943 children ages 14-36 months (mean 22.0 months; 62.9% boys, 73.3% children of color, 34.9% non-English-primary language, 64.5% publicly-insured). Participation and follow-through were high (64.9% and 65.3% at first- and second-stage screening, respectively, 84.6% at diagnostic evaluation). Logistic regressions identified predictors of screening participation and outcomes at each stage; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children. Results suggest the multi-stage screening protocol shows promise in addressing disparities in early diagnosis.

What Drives Detection and Diagnosis of Autism Spectrum Disorder? Looking Under the Hood of a Multi-stage Screening Process in Early Intervention.

U.S. guidelines for detecting autism emphasize screening and also incorporate clinical judgment. However, most research focuses on the former. Among 1,654 children participating in a multi-stage screening protocol for autism, we used mixed methods to evaluate: (1) the effectiveness of a clinical decision rule that encouraged further assessment based not only on positive screening results, but also on parent or provider concern, and (2) the influence of shared decision-making on screening administration. Referrals based on concern alone were cost-effective in the current study, and reported concerns were stronger predictors than positive screens of time-to-complete referrals. Qualitative analyses suggest a dynamic relationship between parents' concerns, providers' concerns, and screening results that is central to facilitating shared decision-making and influencing diagnostic assessment.