Graduation Year
2026
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Educational and Psychological Studies
Major Professor
Kathy Bradley-Klug, Ph.D.
Committee Member
Stacy-Ann January, Ph.D.
Committee Member
Emily Shaffer-Hudkins, Ph.D.
Committee Member
Jennifer Wolgemuth, Ph.D.
Keywords
Referral, Developmental Delay, Early Intervention, Mixed Methods, Equity
Abstract
Research indicates that for children with or at risk for developmental delays, early intervention services are associated with improvements in academic and cognitive skills by the time they reach kindergarten (Atkins et al., 2020; Litt et al., 2017). Untreated developmental delays are linked to early school failure and social and emotional problems (Sher et al., 2020). Black children are 5 times less likely to receive early intervention services when compared to their White peers (Barnard-Brak et al., 2021; Feinberg et al.,2011). Thus, they often do not have the opportunity to receive early intervention services. The literature in this area suggests that multiple variables could be related to this phenomenon, including lack of referrals, stigma, and bias (Dababnah et al., 2018; Drame et al., 2020; Fisher et al., 2022; Onovbiona et al., 2024; Zwaigenbaum et al., 2015). The purpose of this study was to examine progress in reducing disparities in the referral process for Black children with developmental delays and to explore the factors that may contribute to delays in diagnoses and limited access to early intervention services among Black youth with developmental delays. This mixed-methods study examined referral patterns, eligibility outcomes, and caregiver experiences for Black families who participated in an Early Steps program in Florida. Quantitative analyses were conducted using secondary data collected between 2020 and 2025 to examine changes in referral rates, referral sources, and eligibility outcomes for Black children referred for developmental evaluation. Qualitative data were collected through semi-structured interviews with five Black caregivers whose children had been evaluated through Early Steps. Reflexive thematic analysis and narrative analysis were used to examine caregiver experiences navigating the referral pathway. Quantitative and qualitative findings were integrated through joint display analysis. Findings indicated that referrals for Black children increased substantially over the five-year period, and a high proportion of referred children were found eligible for services. Self-referrals were the most common referral pathway, followed by physician referrals. Qualitative findings revealed that caregivers often recognized developmental concerns early but experienced delays prior to referral due to factors such as the “wait-and-see” approach, logistical barriers, limited access to information, and challenges navigating the healthcare system. Caregivers also described relying on advocacy, prior knowledge, and social support to obtain referrals and services. Findings highlight persistent inequities in referral pathways for Black children with developmental delays and underscore the need for systemic changes to improve equitable access to services.
Scholar Commons Citation
Fleming, Zelda, "Examining the Referral Pathway for Black Families Evaluated through the Early Steps Program" (2026). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/11286
