Advancing health equity: a scoping review of interventions for multiply marginalized children with disabilities in the United States

Abstract Background Multiply marginalized children with disabilities disproportionately experience health disparities resulting from compounding experiences of systemic discrimination and oppression. Purpose To characterize interventions addressing health outcomes or social determinants of health for multiply marginalized children with disabilities in the United States. Methods We conducted a scoping review of peer-reviewed and grey literature. Search results were independently and dually screened by abstract then by full-text for eligibility criteria: available in English; original data from 2014 onward; intervention addressing health outcomes or social determinants of health; multiply marginalized children with disabilities; and US-based. Data were individually abstracted and checked by a second reviewer and narratively summarized. Results Twenty-seven articles from peer-reviewed sources met inclusion criteria. The majority were descriptive or pilot and feasibility studies, with only eight including a control or comparison group. Participants were most often children with disability broadly, type unspecified ( n = 14) or intellectual and developmental disabilities ( n = 10) and families with low socioeconomic status ( n = 14). Other marginalized identities and circumstances were rarely represented: immigration status ( n = 3), foster care ( n = 2), and justice system involvement ( n = 1). No included article reported an intervention for marginalized gender or sexuality. Slightly over half intervened at the level of the individual or caregiver ( n = 15) versus professionals or institutions ( n = 12). Interventions included telehealth integration ( n = 2); interprofessional programs and clinics ( n = 3); supports for system navigation ( n = 4); comprehensive programs for educational and post-secondary attainment ( n = 6); and, most commonly, training interventions for individual agency and skill development ( n = 12). Outcomes evaluated varied from rates of program use to educational attainment and were most commonly intervention acceptability ( n = 13); only one included article measured a health outcome directly. Reported involvement of community partners was limited, most commonly only during evaluation ( n = 14), with three studies reporting involvement across design, implementation, and evaluation. Conclusions Identified interventions centered on navigating or mitigating the downstream consequences of structural inequity, rather than changing the conditions producing it. Future efforts should prioritize interventions that shift the work of navigating inequitable systems away from families and address the conditions producing disparities, engage multiply marginalized communities as partners throughout design and evaluation, and attend to long-term sustainability from the outset.