799 - Improving Adoption of an Educational-Medical Linkage to Increase Access to School-Based Services for Preschoolers With Developmental Delays and Disabilities

Publication Number: 799.5407

Reshma Shah, University of Illinois Chicago, Chicago, IL, United States; Tina L. Schuh, University of Illinois College of Medicine, Chicago, IL, United States; Giovanna E. Savastano, University of Illinois at Chicago, New York, NY, United States

Background: Societal inequities limit access to therapies across medical and educational systems, disproportionately affecting Black, Latino/a/e, and low-income preschoolers with developmental delays and disabilities (PCw/DD). While community-clinical linkages (CCLs) improve access to care, no model currently connects school and medical systems for PCw/DD. Preschool and Me (PreM) is a novel CCL integrating a personalized medical-education care plan with virtual navigator support to bridge clinical settings with city and educational systems, aiming to reduce disparities in access to early childhood special education (ECSE) services. Research is needed to ensure effective implementation in clinics serving historically marginalized communities to support effectiveness and avoid exacerbating health disparities.

Objective: As part of a hybrid implementation-effectiveness randomized control trial (RCT), we examined PreM’s implementation in two real-world service delivery conditions (federally qualified health center, academic-affiliated clinics) serving predominantly Black and Latino/a families in low-income Chicago communities.

Design/Methods: To address contextual barriers, implementation strategies included developing a learning collaborative, community advisory board, and a computer-based quality monitoring tool. Implementation outcomes (feasibility, fidelity, reach, cost) were assessed using the Proctor framework (Table 1) with data from fidelity checklists, patient navigator (PN) recordings, electronic medical records, and process and training logs.

Results: Thirteen undergraduates were selected for PN training across three cohorts, averaging 9.5 hours per session; 12 completed the training. From March to October 2024, 65 families were randomized to receive PreM (from 125 RCT-enrolled families; 50 provider-referred). PNs reached 98% (n=62) of families and met a 99% protocol fidelity rate. Of PreM-assigned families, 36 (69%) completed Individualized Education Plan (IEP) evaluations with six awaiting results and 30 (83%) eligible for an IEP. Of these, 19 (63%) are receiving ECSE services, and 11 await school placement. Another 26 families are in early steps to secure ECSE services, a process that can legally extend over 4.5 months in Illinois.

Conclusion(s): This study evaluates PreM’s implementation to inform the scalability and sustainability of educational-clinical linkages, aiming to enhance equitable access to ECSE. Future work will examine PreM acceptability from parent and clinician perspectives and how implementation variations impact ECSE access.

Table 1
table1.pdfTable 1. Implementation outcomes examined with corresponding measures and source