Improving Health Equity for Children Who Are Multiply Marginalized: A Narrative Review of Intersectional Interventions

The chance to attain and maintain the best possible health and participation is a human right and the crux of occupational therapy (Berger et al., 2018). Yet, children with disabilities experience more health disparities than their peers without. Disparities disproportionately worsen for children with multiple identities that face oppression, i.e., multiple marginalization (Meadan et al., 2019). We aimed to summarize existing interventions that address health equity for children with disability who experience multiple marginalization via a scoping review of peer-reviewed and grey literature. A librarian designed and executed our search protocol. Two reviewers individually screened results first by title and abstract, then by full text for the following criteria: U.S.-based original research with data on health equity interventions for children with disability and multiple marginalization from 2014 onward. Discrepancies were adjudicated with the senior author. Data were dually extracted for 10 (32%) articles, the remaining articles were individually extracted. Data included study characteristics, sample description, and details on intervention design, execution, and results. Thirty-one articles were included. Studies most commonly recruited children with intellectual and developmental disabilities or disability broadly (32%, each). Secondary identities recruited most commonly were race and/or ethnicity (35%) and socioeconomic status (32%). Ongoing analyses suggest interventions of care coordination and medical home models are most commonly studied and demonstrated potential for eliminating health disparities. Children’s health disparities can be reduced through intentional intervention. As occupational therapists, it is our duty to be at the forefront of identifying and addressing drivers of inequity. To reduce inequities and improve access for all.

References

Berger, S., Escher, A., Mengle, E., & Sullivan, N. (2018). Effectiveness of health promotion, management, and maintenance interventions within the scope of occupational therapy for community-dwelling older adults: A systematic review. The American Journal of Occupational Therapy, 72(4). https://doi.org/10.5014/ajot.2018.030346

Meadan, H., Adams, N. B., Hacker, R. E., Ramos-Torres, S., & Fanta, A. (2019). Supporting Spanish-speaking families with children with disabilities: Evaluating a training and coaching program. Journal of Developmental and Physical Disabilities, 32(3), 489–507. https://doi.org/10.1007/s10882-019-09704-1