Date of Award

2026

Document Type

Thesis

Degree Name

Master of Science in Speech-Language Pathology

Department

Communication Sciences and Disorders (CSD)

Committee Chair and Members

Reem Khamis, Chair

George Pagano

Miriam Baigorri

Keywords

Adolescents, Racial inequality, School-toconfinement pipeline, Social determinants of health, Speech-language pathology, Traumatic brain injury

Abstract

Purpose: Adolescents are at greater risk for traumatic brain injury (TBI), and TBI-related symptoms may contribute to disciplinary actions that increase their risk of entering the school-toconfinement pipeline. Given the disproportionate representation of racially marginalized male adolescents within this pipeline, this critically appraised topic (CAT) examined how race, gender, and socioeconomic status may influence school-based speech-language pathology (SLP) services and clinical decision-making following TBI. Method: A structured search of five electronic databases was conducted to identify studies examining speech-language pathologists’ (SLPs’) clinical decision-making and management of adolescents with TBI in relation to race, gender, and socioeconomic status. Relevant studies were critically appraised for methodological quality, relevance, and applicability to the focused clinical question. Findings were narratively synthesized to identify the best available evidence to guide equitable school-based SLP practice. Results: Four studies met the CAT inclusion criteria. The available evidence revealed substantial gaps in the literature, with most studies providing limited consideration of how race, gender, socioeconomic status, or broader structural inequities influence SLP decision-making following TBI. Only one study (Brown, 2025) explicitly examined the intersection of social determinants of health in clinical practice, identifying intersectionality as a comprehensive framework for informing equitable school-based SLP decision-making. Conclusions: Current evidence is insufficient to guide integration of social determinants of health into school-based SLP practice for adolescents with TBI. Limited demographic reporting and attention to structural inequities constrain the development of evidence-based recommendations for equitable SLP services. An intersectionality framework provides the strongest conceptual foundation for understanding how multiple social determinants interact to influence educational and rehabilitation experiences and for supporting culturally responsive clinical decision-making. Future research should directly examine how sociodemographic factors shape clinical decision-making and how broader systems of structural inequity may contribute to disparities in care.

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