Purpose: Linguistically diverse children face health disparities in special education services in part due to limited linguistic responsivity in communication assessment practices. This study uses the first application of the Theoretical Domains Framework (TDF) to reveal the various factors that affect the implementation of linguistically responsive practices and their respective barriers and facilitators. Method: Two focus groups were conducted in Oregon with a total of nine speech-language pathologists, most of whom were multilingual. A deductive and inductive analytical approach in a two-stage process was employed, whereby barriers and facilitators were deductively coded using TDF domains (content analysis) and analyzed for subthemes within each domain as well as barriers and facilitators for each domain. Barriers and facilitators were summarized across overarching themes. Results: A total of 33 themes were extracted from all the domains. The most commonly coded TDF domains in the focus group transcript were knowledge (69%), beliefs about consequences (48%), and environmental context and resources (33%). The overarching themes identified across domains were related to the role of family, flexibility and adaptability, limitations of assessment tools, need for help through experts, research and training, and approach to language differences. Conclusions: The findings from this study offer a precise initial characterization of the barriers and facilitators to linguistically responsive communication assessment of children from birth to age 5 years. Future research should focus on supporting facilitators while eliminating barriers to ensure equitable service provision for all children.
What makes this study unique is that it is the first to apply the Theoretical Domains Framework (TDF) to explore barriers and facilitators to linguistically responsive communication assessments in early childhood. While linguistically diverse children have long faced inequities in special education services, research has rarely focused on the real-world factors that shape how practitioners implement equitable assessment practices, primarily through a well-established implementation science lens like the TDF. By combining both deductive and inductive approaches, this study goes beyond just identifying what the issues are. It shows how and why these barriers and facilitators exist across multiple behavioral domains, such as knowledge, beliefs, resources, and social influences. This nuanced insight helps move the conversation from simply acknowledging disparities to strategically addressing them. For readers, especially clinicians, researchers, and policymakers, this study offers a structured, actionable framework to understand what supports or hinders linguistically responsive practices in early childhood assessments. It provides not just a list of challenges but a map for intervention design and future research that can support real change.
Read more on KudosThe following have contributed to this summary: Sabreen NoorAli