Community Partner Perceptions of Equitable Implementation Practices for a Promotores de Salud Intervention: A Qualitative Assessment.

We conducted focus groups with staff from 5 community-based organizations (21 participants; 86% female, 52% Hispanic/Latino/a/x and 24% Mexican/Mexican American) between August and October 2021. Results highlighted community partner perceptions of practices congruent (e.g., communication that built trust and dismantled power dynamics, a shared mission) and incongruent (e.g., intervention-community misalignment, research driven decision-making) with equitable implementation in the development, implementation, and evaluation of a promotores de salud intervention to increase COVID-19 testing and preventive behaviors among Latinx communities in Oregon. (Am J Public Health. 2024;114(S5):S377-S383. https://doi.org/10.2105/AJPH.2024.307686).

Sentence Diversity in Spanish-English Bilingual Toddlers.

PURPOSE: There remain few available tools to assess language development in Spanish-English dual language learner (DLL) toddlers in the United States. Of interest is the development of early sentences as children move from producing single words to producing multiword utterances. This study is the first to extend sentence diversity to the context of Spanish-English DLLs by describing development from 24 to 30 months of age in children with and without language delays (LDs). METHOD: Spontaneous language samples were collected from Spanish-dominant DLL children and their mothers as they were observed during a free-play interaction. Existing sentence diversity protocols were adapted for the DLL context to describe children's flexibility in combining subjects and verbs to form utterances in Spanish and English. RESULTS: Children maintained an accurate separation in their grammars for subject-verb combinations in Spanish versus English. There was an overwhelming preference for Spanish subject-verb combinations with null subjects. The emergence of sentence diversity distinguished children with and without early LD unlike the emergence of word combinations. CONCLUSIONS: Consistent with prior research, findings showed that DLLs did not confuse grammatical structures across languages. Instead, they showed a differential pattern of results in each language, such that the strongest grammatical skills were evinced first in the dominant language. Sentence diversity shows promise for assessment and progress monitoring in Spanish-English DLLs in the United States.

Estimating Early Language Input in Deaf and Hard of Hearing Children With the Language Access Profile Tool.

PURPOSE: The purpose of this study was to describe the Language Access Profile Tool (LAPT) and its psychometric properties with the aim of evaluating its suitability as an alternative to the deaf or hard of hearing (DHH) Language Exposure Assessment Tool (D-LEAT) in clinical practice with DHH children age 12 years and younger. METHOD: We administered both the LAPT and D-LEAT to the caregivers of 105 DHH children 12 years old and younger from across the United States, 40% of whom were interviewed again after a delay of at least 1 month. Each interview resulted in a child-specific estimate of their cumulative experience with language input, expressed as a proportion divided across eight categories. RESULTS: Participants in the sample reported experience with all eight input categories, but four categories were common and four were rare. Estimates for all input categories were consistent at both initial and follow-up interviews. Estimates for each input category were also strongly correlated with the corresponding estimates from the D-LEAT, although correlations for the rare categories should be interpreted cautiously. CONCLUSIONS: The LAPT demonstrates sufficient test-retest reliability and convergent validity to be a useful and more user-friendly alternative to the D-LEAT. We provide recommendations for how the LAPT and the D-LEAT can be best used in their current form. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20669001.

Learning Words in Two Languages: Manipulating Exemplar Variability for Within- and Cross-Language Generalization.

PURPOSE: This article aims to describe how exemplar variability can manipulate the word learning environment to maximize within- and cross-language generalization in Spanish-English bilinguals. Furthermore, we examined sources of individual variability that predicted word learning. METHOD: Nineteen Spanish-English bilingual children participated in a word learning task presenting words in both languages. Children learned words either in a high variability condition (in which multiple exemplars are introduced with the target word) or in a no variability condition (in which the same referent is used with the target word). Word learning was tracked over the course of the training, and retention was examined once the training was discontinued. Children's generalization of referents within and across languages was also examined. RESULTS: The exemplar variability effect was observed in within-language generalization trials, whereas cross-language generalization was less robust. Nevertheless, cross-language associations emerged in examining the role of language proficiency, such that semantic skills in English predicted word retention across languages. Similarly, children's propensity to code-switch during language production was positively correlated with retention of words learned in the high variability condition. CONCLUSIONS: The findings show that Spanish-English bilingual children may make use of exemplar variability to support word learning in different ways compared with monolinguals. The exemplar variability effect interacts with children's acquired language skills and word learning abilities at the start of the intervention. This study provides preliminary evidence from which future research can develop word learning interventions that are responsive to the needs of multilinguals. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19241856.

Psychometric Properties of the English-Spanish Vocabulary Inventory in Toddlers With and Without Early Language Delay.

PURPOSE: Despite the increasing population of dual language learners (DLLs) in the United States, vocabulary measures for young DLLs have largely relied on instruments developed for monolinguals. The multistudy project reports on the psychometric properties of the English-Spanish Vocabulary Inventory (ESVI), which was designed to capture unique cross-language measures of lexical knowledge that are critical for assessing DLLs' vocabulary, including translation equivalents (whether the child knows the words for the same concept in each language), total vocabulary (the number of words known across both languages), and conceptual vocabulary (the number of words known that represent unique concepts in either language). METHOD: Three studies included 87 Spanish-English DLLs (M age = 26.58 months, SD = 2.86 months) with and without language delay from two geographic regions. Multiple measures (e.g., caregiver report, observation, behavioral tasks, and standardized assessments) determined content validity, construct validity, social validity, and criterion validity of the ESVI. RESULTS: Monolingual instruments used in bilingual contexts significantly undercounted lexical knowledge as measured on the ESVI. Scores on the ESVI were related to performance on other measures of communication, indicating acceptable content, construct, and criterion validity. Social validity ratings were similarly positive. ESVI scores were also associated with suspected language delay. CONCLUSIONS: These studies provide initial evidence of the adequacy of the ESVI for use in research and clinical contexts with young children learning English and Spanish (with or without a language delay). Developing tools such as the ESVI promotes culturally and linguistically responsive practices that support accurate assessment of DLLs' lexical development. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.17704391.

Maternal education revisited: Vocabulary growth in English and Spanish from 16 to 30 months of age.

This paper reports on a cross-language longitudinal study in which we extend previous research on the effects of maternal education on vocabulary growth in Spanish- and English-dominant children at three time points: 16 months, 22 months, and 30 months of age. This study addresses recent conflicting evidence regarding the role of maternal education in children's acquisition of Spanish. Participants were 62 English-dominant children, 47 Spanish-dominant children, and their mothers. Growth curve models were constructed separately for English and Spanish vocabulary. Strong growth rate reliability and effect sizes were evinced for vocabulary across samples. As expected, in English-dominant children, maternal education predicted English vocabulary and growth from 16 to 30 months of age. However, in Spanish-dominant children, there was no significant effect of maternal education on vocabulary or growth, although there was a descriptive advantage for children of college-educated mothers at 30 months of age. In conjunction with prior evidence, we conclude that the effect of maternal education on maternal input and child vocabulary does not generalize readily to children whose first language is Spanish. Our findings contribute to a literature that suggests that focusing on maternal beliefs, input, and the home literacy environment are more fruitful approaches in the study of children learning Spanish in the U.S. Further, the importance of maternal beliefs highlights the need to support parent investment in the quantity and quality of input in the home language.

Moving Through the Pipeline: Ethnic and Linguistic Disparities in Special Education from Birth Through Age Five.

This study examined Oregon's early intervention (EI) and early childhood special education (ECSE) pipelines as a function of children's intersecting ethnicity and home language(s) with a focus on children from Latino/a backgrounds with communication disorders. We found differences in children's referral source and age of referral, likelihood of evaluation and placement, and type of placement for conditions related to communication, including autism spectrum disorder and hearing impairment. Results showed differences in EI and ECSE; however, disproportionality appeared greatest among Spanish-speaking Latino/a children and non-Latino/a children who spoke languages other than English compared to non-Latino/a English-speaking counterparts. Our findings suggest attending to children's intersecting ethnicity and language backgrounds in referral, evaluation, and placement add nuance to examinations of disproportionality. Results also indicate that practices related to characterizing children's communication disorders likely make substantial contributions to inequities in EI and ECSE. Precise identification of differences in service provision can lead to targeted policy and practice solutions to reduce structural barriers to care in EI/ECSE systems and improve equity, particularly as related to placement for children of color with communication concerns.

Serving young children with communication disabilities from Latinx backgrounds and their families with equity: Provider perspectives.

INTRODUCTION: Latinx children with communication disorders from birth to age 5 and their families are increasingly served in United States (US) educational and medical settings where longstanding structural barriers threaten their access to equitable assessment and intervention. However, little is known about providers' perceptions serving this highly diverse population as they relate to reducing disparities in care for communication disorders. METHODS: This exploratory qualitative study interviewed 24 speech-language pathologists (SLPs) and early intervention (EI)/early childhood special education (ECSE) developmental specialists serving young Latinx children with communication disorders to offer targeted recommendations toward improving equity. The semi-structured interview included questions regarding communication assessment, diagnostics/eligibility, intervention, interpretation, translation, and solutions to enhance EI/ECSE. Interviews were coded with content analysis using elements of grounded theory, and responses from SLPs in medical versus education settings and from EI/ECSE developmental specialists were compared. Data triangulation was used to validate themes. RESULTS: Analysis revealed the following themes related to provider challenges and resources: family factors, provider factors, cultural and linguistic differences, assessment approaches, eligibility determinations, translation and interpretation, and institutional factors. Few variations in themes between provider types (SLPs vs. EI/ECSE developmental specialists) and settings (medical vs. educational) were found. Providers also offered several policy and practice solutions. CONCLUSIONS: Findings suggest minimal advances in improving equity for young Latinx children with communication disorders over prior decades. Results also indicate that providers may benefit from reflecting on their cultures and biases as well as systemic racism within EI/ECSE.

Development and design of a culturally tailored intervention to address COVID-19 disparities among Oregon's Latinx communities: A community case study.

Background: Latinx communities are disproportionately affected by COVID-19 compared with non-Latinx White communities in Oregon and much of the United States. The COVID-19 pandemic presents a critical and urgent need to reach Latinx communities with innovative, culturally tailored outreach and health promotion interventions to reduce viral transmission and address disparities. The aims of this case study are to (1) outline the collaborative development of a culturally and trauma-informed COVID-19 preventive intervention for Latinx communities; (2) describe essential intervention elements; and (3) summarize strengths and lessons learned for future applications. Methods: Between June 2020 and January 2021, a multidisciplinary team of researchers and Latinx-serving partners engaged in the following intervention development activities: a scientific literature review, a survey of 67 Latinx residents attending public testing events, interviews with 13 leaders of community-based organizations serving Latinx residents, and bi-weekly consultations with the project's Public Health and Community Services Team and a regional Community and Scientific Advisory Board. After launching the intervention in the field in February 2021, bi-weekly meetings with interventionists continuously informed minor iterative refinements through present day. Results: The resulting intervention, Promotores de Salud, includes outreach and brief health education. Bilingual, trauma-informed trainings and materials reflect the lived experiences, cultural values, needs, and concerns of Latinx communities. Interventionists (21 Promotores) were Latinx residents from nine Oregon counties where the intervention was delivered. Conclusions: Sharing development and intervention details with public health researchers and practitioners facilitates intervention uptake and replication to optimize the public health effect in Oregon's Latinx communities and beyond.

Effectiveness of a COVID-19 Testing Outreach Intervention for Latinx Communities: A Cluster Randomized Trial.

Importance: Latinx individuals have been disproportionately affected during the COVID-19 pandemic caused by the spread of SARS-CoV-2. It is imperative to evaluate newly developed preventive interventions to assess their effect on COVID-19 health disparities. Objective: To examine the effectiveness of a culturally tailored outreach intervention designed to increase SARS-CoV-2 testing rates among Latinx populations. Design, Setting, and Participants: In this cluster randomized trial performed from February 1 to August 31, 2021, in community settings in 9 Oregon counties, 38 sites were randomized a priori (19 to the community health promoters intervention and 19 to outreach as usual wait-listed controls). Thirty-three sites were activated. A total of 394 SARS-CoV-2 testing events were held and 1851 diagnostic samples collected, of which 919 were from Latinx persons. Interventions: A culturally informed outreach program was developed that made use of promotores de salud (community health promoters) to increase Latinx SARS-CoV-2 testing. Strategies addressed barriers by disseminating information on testing events in English and Spanish, mitigating misinformation, and increasing trust. Main Outcomes and Measures: The primary outcomes were the count of sample tests from Latinx persons and the sampled proportion of the Latinx populace. Site-level covariates included census tract Latinx populace, nativity (number of US-born individuals per 100 population), median age, and income inequality. Time-varying covariates included number of new weekly SARS-CoV-2-positive cases and percentage of vaccine coverage at the county level. Results: A total of 15 clusters (sites) were randomized to the control group and 18 to the community health promoters group. A total of 1851 test samples were collected, of which 995 (53.8%) were from female participants and 919 (49.6%) were from Latinx individuals. The intervention tested 3.84 (95% CI, 2.47-5.97) times more Latinx individuals per event than controls (incident rate ratio, 0.79; 95% CI, 0.46-1.34; Cohen d = 0.74; P < .001). The intervention was associated with a 0.28 increase in the proportion of Latinx populace being tested compared with control sites for the dependent variable scaled as the proportion of the Latinx populace ×100, or a 0.003 proportion of the raw populace count. The use of a standardized scaling of the proportion of Latinx individuals showed that the relative percentage increase was 0.53 (95% CI, 0.21-0.86) in the intervention sites compared with controls, representing a medium effect size. Conclusions and Relevance: To our knowledge, this was the first randomized evaluation of an outreach intervention designed to increase SARS-CoV-2 testing among Latinx populations. Findings could be used to implement strategies to reduce other health disparities experienced by these groups. Trial Registration: ClinicalTrials.gov Identifier: NCT04793464.

Media exposure and language experience: Examining associations from home observations in Mexican immigrant families in the US.

The current exploratory study describes exposure to digital media in young children from Mexican immigrant homes and its association with language input and output. Using multiple recordings of children's home environments, we report on the rate (i.e., percentage of total recording time), language (Spanish or English), and type (adult- or child-directed programming) of auditory media exposure in toddlers under three years of age (N = 30; Mage = 20;3 months). We also examine total adult words and adult-child conversational turns, as indicators of child language input, and the number of child language vocalizations as a measure of early language development. Findings showed that digital media comprised approximately 14 % of the child language environment that families selected to record, with wide variability observed. Children were more likely to be exposed to media in Spanish than English and adult-directed than child-directed programming. Children's general media exposure was negatively associated with the amount of children's vocalizations and conversational turns but not the quantity of adult words in the environment, suggesting that the relation between media exposure and child language development is likely not mediated by a general decrease in adult input in Mexican immigrant homes. Instead, media exposure may decrease opportunities for children to engage in conversation and practice language expression, both critical mechanisms for successful language acquisition. Selection of child-directed programming may encourage child vocalizations but is less likely to be in Spanish in these homes, which may reduce opportunities for engagement with Spanish-dominant adults. Together these findings provide a window into the nature of media exposure in children from Mexican immigrant homes and into the associations between media and language input and output. Directions for future research are discussed.

Measuring "Language Access Profiles" in Deaf and Hard-of-Hearing Children With the DHH Language Exposure Assessment Tool.

Purpose The purposes of this study were (a) to introduce "language access profiles" as a viable alternative construct to "communication mode" for describing experience with language input during early childhood for deaf and hard-of-hearing (DHH) children; (b) to describe the development of a new tool for measuring DHH children's language access profiles during infancy and toddlerhood; and (c) to evaluate the novelty, reliability, and validity of this tool. Method We adapted an existing retrospective parent report measure of early language experience (the Language Exposure Assessment Tool) to make it suitable for use with DHH populations. We administered the adapted instrument (DHH Language Exposure Assessment Tool [D-LEAT]) to the caregivers of 105 DHH children aged 12 years and younger. To measure convergent validity, we also administered another novel instrument: the Language Access Profile Tool. To measure test-retest reliability, half of the participants were interviewed again after 1 month. We identified groups of children with similar language access profiles by using hierarchical cluster analysis. Results The D-LEAT revealed DHH children's diverse experiences with access to language during infancy and toddlerhood. Cluster analysis groupings were markedly different from those derived from more traditional grouping rules (e.g., communication modes). Test-retest reliability was good, especially for the same-interviewer condition. Content, convergent, and face validity were strong. Conclusions To optimize DHH children's developmental potential, stakeholders who work at the individual and population levels would benefit from replacing communication mode with language access profiles. The D-LEAT is the first tool that aims to measure this novel construct. Despite limitations that future work aims to address, the present results demonstrate that the D-LEAT represents progress over the status quo.

Cultural and Linguistic Adaptations of Early Language Interventions: Recommendations for Advancing Research and Practice.

Purpose Speech-language pathologists are responsible for providing culturally and linguistically responsive early language intervention services for legal, ethical, and economic reasons. Yet, speech-language pathologists face challenges in meeting this directive when children are from racial, ethnic, or linguistic backgrounds that differ from their own. Guidance is needed to support adaptation of evidence-based interventions to account for children's home culture(s) and language(s). This review article (a) describes a systematic review of the adaptation processes applied in early language interventions delivered to culturally and linguistically diverse populations in the current literature and (b) offers a robust example of an adaptation of an early language intervention for families of Spanish-speaking Mexican immigrant origin. Method Thirty-three studies of early language interventions adapted for culturally and linguistically diverse children ages 6 years and younger were reviewed. Codes were applied to describe to what extent studies document the purpose of the adaptation, the adaptation process, the adapted components, and the evaluation of the adapted intervention. Results Most studies specified the purpose of adaptations to the intervention evaluation, content, or delivery, which typically addressed children's language(s) but not culture. Study authors provided limited information about who made the adaptations, how, and when. Few studies detailed translation processes or included pilot testing. Only one used a comprehensive framework to guide adaptation. A case study extensively documents the adaptation process of the Language and Play Every Day en español program. Conclusions Future early language intervention adaptations should focus on both linguistic and cultural factors and include detailed descriptions of intervention development, evaluation, and replication. The case study presented here may serve as an example. Increased access to such information can support research on early language interventions for diverse populations and, ultimately, responsive service provision.

Lexical-Semantic Development in Bilingual Toddlers at 18 and 24 Months.

An important question in early bilingual first language acquisition concerns the development of lexical-semantic associations within and across two languages. The present study investigates the earliest emergence of lexical-semantic priming at 18 and 24 months in Spanish-English bilinguals (N = 32) and its relation to vocabulary knowledge within and across languages. Results indicate a remarkably similar pattern of development between monolingual and bilingual children, such that lexical-semantic development begins at 18 months and strengthens by 24 months. Further, measures of cross-language lexical knowledge are stronger predictors of children's lexical-semantic processing skill than measures that capture single-language knowledge only. This suggests that children make use of both languages when processing semantic information. Together these findings inform the understanding of the relation between lexical-semantic breadth and organization in the context of dual language learners in early development.

Cross-Morpheme Generalization Using a Complexity Approach in School-Age Children.

Purpose This single-case study examines a complexity approach to target selection in grammatical intervention in three children with varying levels of mastery of tense and agreement. Specifically, we examine whether targeting a complex tense and agreement grammatical structure (auxiliary BE in questions) leads to generalization to other less complex and related tense and agreement markers (auxiliary BE in declaratives, copula BE, third-person singular -s, and past tense -ed). Method Three children (all boys; aged 5;5-9;7 [years;months]) with deficits in morphosyntax were enrolled in a treatment program targeting a complex grammatical structure (auxiliary BE in questions) following collection of multiple baselines. Children's performance on the complex structure and related tense and agreement markers were tracked before, during, and after the intervention across three different tasks. Results Results show that, despite its grammatical complexity, the target was elicited in all three children with incomplete mastery of the tense and agreement system. Furthermore, all children demonstrated generalization to expressive language by increasing their mean length of utterance by approximately one morpheme during spontaneous language production following intervention. All children demonstrated individual patterns of generalization to other tense and agreement structures not targeted during intervention. Conclusions These functional changes observed following intervention set the stage for future controlled studies to establish a stronger cause-effect relation. Taken together, this study contributes to an emerging body of work showing that complex grammatical targets may be used in intervention earlier than previously thought.

Code-switching in young bilingual toddlers: A longitudinal, cross-language investigation.

Although there is a body of work investigating code-switching (alternation between two languages in production) in the preschool period, it largely relies on case studies or very small samples. The current work seeks to extend extant research by exploring the development of code-switching longitudinally from 31 to 39 months of age in two distinct groups of bilingual children: Spanish-English children in San Diego and French-English children in Montréal. In two studies, consistent with previous research, children code-switched more often between than within utterances and code-switched more content than function words. Additionally, children code-switched more from Spanish or French to English than the reverse. Importantly, the factors driving the rate of code-switching differed across samples such that exposure was the most important predictor of code-switching in Spanish-English children whereas proficiency was the more important predictor in French-English children.

Adaptation of a Caregiver-Implemented Naturalistic Communication Intervention for Spanish-Speaking Families of Mexican Immigrant Descent: A Promising Start.

Purpose Caregiver-implemented naturalistic communication interventions (CI-NCIs) support the communication abilities of young children with language disorders and enhance the communication behaviors of their caregivers. Yet, few CI-NCIs have been adapted and tested for feasibility with families who speak Spanish at home. This study addresses this gap in the literature by examining the social validity and preliminary outcomes of an adapted CI-NCI program with families who identified as Mexican immigrants and spoke Spanish. Method A multiphase cultural adaptation process enhanced the Language and Play Every Day program for Spanish-speaking Mexican immigrant families in the United States. Six families, including eight caregivers and eight toddlers, participated. Caregivers received coaching on the use of language-facilitating strategies within existing home routines. Multiple measures of the social validity of the intervention's goals, procedures, and outcomes were collected. Changes in caregivers' reported confidence, knowledge, and use of language-facilitating strategies and children's receptive and expressive communication were examined to determine preliminary outcomes. Results Overall, caregivers perceived many of the intervention's goals, procedures, and outcomes as socially valid and specified aspects of the intervention needing improvement. Caregivers and children showed modest but potentially clinically meaningful gains in their communication skills following the intervention despite wide individual variability. Conclusions Given some recommendations to further adapt the intervention, this CI-NCI appears to be feasible for supporting the communication development of children of Spanish-speaking Mexican immigrant descent. Thus, future research on the efficacy of the intervention is warranted. Supplemental Material https://doi.org/10.23641/asha.12269081.