Health Disparities in Early Developmental Screening in Minnesota

Minnesota is a state with a rich, diverse, and evolving cultural landscape. In the past two decades, Minnesota has seen a significant increase in the number of children and families from culturally and linguistically diverse communities. Each of these communities is unique in their culture, values, and perceptions of child development and disabilities.

A growing body of research reveals that significant health disparities exist across racial groups in early screening, identification, and diagnosis of developmental delays (CDC, 2014; Mandell et al, 2002; Shattuck et al, 2009; Zuckerman et al., 2014). Further, a recent research study in Minneapolis revealed similar rates of ASD in some communities such as White (1 in 36) and Somali (1in 32), other racial ethnic groups such as Asian, Native American, and Hispanic were identified at extremely low rates (Hewitt et al, 2013). The ongoing rise of developmental delays and other neurodevelopmental disabilities highlight a significant need for ongoing developmental screening, early diagnosis, and timely early intervention services and supports in culturally and linguistically communities.

Cultural competence is the foundation for decreasing these health care disparities through a well-informed, culturally sensitive approach to care.

Our work with children and families is embedded in a larger cultural context. Common pediatric health care practices such as regular developmental screening and early intervention are all culturally bound constructs (Bronheim, 2015). Screening children from culturally and linguistically diverse communities requires an expanded set of professional knowledge, experience, and skills. This skill set includes knowledge of common cultural values, community norms, and cultural views on typical expectations for child

development.

A key component to effectively working with culturally diverse families requires an understanding of their culturally based views and perspectives. Cultural viewpoints on child development influence family perspectives on cause for concern and if they will report a concern to a health care provider. Further, there is a wide spectrum of diverse cultural perspectives on typical versus atypical development (Bronheim, 2015). For example, common observed behaviors such as eye contact, social play skills, and a child’s activity level are all influenced by cultural expectations. Further, in many cultures, even bringing up an area of concern before the age of 2 may seem inappropriate or strange to a family. Other cultures may view the screening process itself as a way “looking for a problem”.

There is growing demand for health care providers to provide culturally competent care to young children and their families. Culturally competent practitioners address cultural and
linguistic differences when presenting early developmental screening and developmental concerns. Effective communication and cultural understanding are essential elements for valid cross-cultural screening (Gabovitch et al., 2014; Gokiert et al., 2010). Some best practices in culturally competent screening include:

• Use of well-trained interpreters or cultural liaisons with both an understanding of developmental screening and culture.
• Provide translated materials. Consider both literacy level and home language. Provide local cultural adaptations to make culturally relevant to local community. Note: Many commonly used terms in developmental screening may not exist in native language.
• Use validated screening tools that have been developed with and normed on the cultural population being screened (when possible).
• Ask the family first about concerns in child’s development or behavior. Let them share a story or observation about their child.
• Look for common ground between what the family is seeing and your developmental concerns. Use this as a way to build connection and trust.

Becoming a culturally competent health care provider is an ongoing, evolving process for both individual professionals and the larger organizations in which we work (Hewitt & Gulaid, 2015). Developing these strong and trusting family-professional partnerships that respect cultural views is key to providing high quality care to children and families from culturally and linguistically diverse communities.