Background

The American Academy of Pediatrics recently declared a National State of Emergency in Children’s Mental Health due to pandemic-related stressors. Latinx communities in the U.S. bear a disproportionate burden of COVID-related morbidity and mortality, and have lacked adequate access to testing, healthcare and vaccination services. Latinx children likely experience a substantial mental health burden in this context.

As the pandemic has emphasized, there are far-reaching structural inequities that contribute to disparities in access to and quality of health care. Barriers include lack of health insurance, limited culturally and linguistically appropriate services, low diversity of the healthcare workforce, discrimination when navigating the health care system and fears of immigration enforcement. As need has substantially increased during the pandemic, these disparities in access are likely to worsen, risking delays in diagnoses and worsened health outcomes.

Project Description

Building on the work of previous NC Early Childhood Action Plan teams, this project team will build on cross-sector early childhood research to address the scarcity of child-focused developmental and behavioral health services and the complexities in navigating service bureaucracies. Team members will work to understand the barriers faced by Latinx families when attempting to access community, educational and health system-based developmental, behavioral and mental health services for children. 

Team members will engage stakeholders across various settings to identify barriers that children in immigrant families face when accessing mental health services, and key components of cross-sector systems and policies that may serve to overcome barriers. The team will also propose recommendations for a future pilot intervention to promote access to developmental, behavioral and mental health services in the community and healthcare system that reach children among immigrant families in an equitable manner.

Team members will engage with community-based mental health organizations serving children, immigrant families, mental health providers, payors and medical interpreters from a range of community, clinical and policy contexts. Recommendations from the team will include proposing strategies to increase feasibility and acceptability and improve patient-level outcomes.

The team will ground its project in the Health Equity Implementation Framework, which considers factors that may influence outcomes of implementing a program and can help identify barriers and strengths specific to areas where there are healthcare disparities.

Anticipated Outputs

Policy brief; presentations; dissemination of findings

Timing

Summer 2022 – Spring 2023

• Summer 2022 (Margolis Summer Intern only): Obtain IRB approval; conduct desk review; develop interview guide; write policy brief; present findings at the Margolis Summer Internship Symposium 
• Fall 2022: Conduct community-engaged interviews including community stakeholders (e.g., La Smilla and El Centro Hispano); conduct key informant interviews with Duke colleagues 
• Spring 2023: Complete interviews; start analysis; disseminate research findings

See earlier related team, NC Early Childhood Action Plan: Evidence-based Policy Solutions (2021-2022).

Image: Young girl holding adult person's hand, by Nenad Stojkovic, licensed under CC BY 2.0