The disability population in the United States has grown, with an estimated 2.6 million households having at least one child with a disability in 2019 (Young, 2019). Racially minoritized children disproportionately represent disability categories with Black and Indigenous children being overdiagnosed with emotional disturbance disabilities (Oswald & Coutinho, 2001). Further, minoritized children often experience greater rates of complex trauma (Horowitz, Weine, & Jekel, 1995) and this exposure significantly impacts minoritized children’s mental health (Flannery, Wester, & Singer, 2004). Included in these social determinants of health are the impacts of racism and racial trauma. Racism has been associated with mental health disparities from birth (Pachter & Coll, 2009). Yet, Black children are more likely to be misdiagnosed compared to their White peers (Mandell, Ittenbach, Levy, & Pinto-Martin, 2007; Szymanski, Sapanski, & Conway, 2011). A hurdle to accurate identification and treatment of trauma/racial trauma for minoritized families is the availability of quality services which is impacted by bias in healthcare and systemic barriers. To effectively address systemic needs, practitioners must adopt a preventative approach early in developmental care and target universal settings by providing psychoeducation. Pre-service trauma-informed training serves as an avenue to educate healthcare providers, paraprofessionals, and policymakers about disparities in healthcare (Beach et al., 2005). Research has demonstrated pre-service training impacts intermediate outcomes such as the knowledge, attitudes, and skills of health professionals, whereas, others question longitudinal effectiveness (Shepherd, 2019). Although opinions on the benefits and limitations of pre-service training in healthcare are mixed, there is consensus that pre-service training centered on cultural responsiveness and humility improves patient-provider communication, increases patient satisfaction, and compliance over time (Shepherd, 2019).

To address this concern the University Centers for Excellence in Developmental Disabilities (UCEDD), the Leadership Education in Neurodevelopmental Disabilities program, and the Child Development Clinic at the Children's Hospital of Richmond partnered to develop a pilot training series for 0-6 professionals across the state. This 3-part training series was sponsored by Head Start State Collaboration Office in partnership with the Early Childhood Mental Health Virginia initiative (a jointly funded initiative at the UCEDD). The training was designed for Head Start Health Specialists, Mental Health Specialists, or Education Specialists and designed to provide interactive information on implicit biases, social determinants of health, the intersectionality of racism, and trauma to improve culturally-responsive care and address disparities. The Diversity Informed Tenants for Work with Infants, Children, and Families were incorporated into the training. Preliminary qualitative and quantitative results demonstrate participants’ attributional shifts and a commitment to incorporating culturally responsive efforts in their communities and workplaces.

The pilot was expanded to include mental health practitioners across central Virginia. Overall, results demonstrate a successful training model for early childhood practitioners' understanding of diversity, equity, and inclusion, and have aided in developing a system that supports diversity. This underscores the need for interactive training for paraprofessionals that provide psychoeducation that also addresses individual understanding of implicit biases/roles within systems. This training can be utilized with other early childhood professionals to build a culturally responsive system of care for children 0-6.

Plain Language Summary

Professionals who work with young children need to understand the impacts of racism on development. The authors developed two models to address this need. One training model was held over the course of six months and contained three sessions. The other training model was a brief training that occurred one time. Both training models helped professionals understand their own biases; however, the three session training showed greater understanding of bias. The training sessions were interactive and gave participants resources to use in their setting. This article compares the results of the two training models.

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