Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Clinical Psychology

First Advisor

Alice S. Carter

Second Advisor

Karen L. Suyemoto

Third Advisor

Margarita Alegria


Racial and ethnic disparities exist in Autism Spectrum Disorder (ASD) diagnosis, time of detection, and access to services. Early ASD screening approaches have neglected evaluating relational factors in the context of early childhood intervention service systems that may perpetuate these disparities. The current study was embedded within a larger ASD early screening study of toddlers enrolled in Early Intervention (EI) programs in the Greater Boston Area. For this study, sixty-six parents of 107 children between the ages of 16- to 37-month-old who were at risk for ASD completed a semi-structured interview and questionnaires focused on children’s EI service receipt, the parent-provider working alliance, and parents’ perceptions of their provider’s cultural competence. In addition, fifty-eight EI providers completed questionnaires for 102 of the 107 children about each child’s EI service receipt, their working alliance with the child’s parent, and their self-ratings of cultural competence. Multilevel analyses to account for the nonindependence in the data were conducted to: 1) examine the relation between perceptions of the EI providers’ cultural competence and the parent-provider working alliance; 2) evaluate parents’ cultural identity as a moderator of the relationship between parents’ perceptions of the providers’ cultural competence and the parent-provider working alliance; and 3) investigate the contributions of parents’ perceptions of the providers' cultural competence and the parent-provider working alliance on the child’s prescribed EI service time and actual service time received in the last month. In addition, hierarchical linear regression analyses were conducted to determine the effects of parents’ perceptions of working alliance and cultural competence on their perceptions of EI service quality and their service satisfaction. Results indicated that parents’ perceptions of their providers’ cultural competence did not predict their perception of the parent-provider working alliance. This lack of association did not change as function of parents’ reports of their cultural identity. Moreover, parents’ and providers’ ratings of the providers’ cultural competence and working alliance did not appear to be associated with parents’ or providers’ reports of the child’s EI prescribed service time. However, parents’ reports of providers’ cultural competence predicted the actual amount of EI services parents reported their child had received in the last month. Parents’ ratings of provider cultural competence, as well as of working alliance, were also significantly predictive of their perceptions of service quality. While providers’ self-ratings of cultural competence were not related to parents’ ratings of service satisfaction, parents’ ratings of working alliance were related to their service satisfaction. The implications of these findings for EI service delivery with racial and ethnically diverse populations are discussed.


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