Project Summary Over one-third of all U.S. children are at-risk for negative long-term health, behavioral and emotional outcomes, due to circumstances of poverty. Beginning in early childhood, children living in low-income circumstances are twice as likely to experience developmental delay in one or more developmental domains including: 1) motor, 2) cognitive, 3) communication, and 4) social-emotional. For Black and Latino children this risk is compounded due to structural racism. Specifically, racial and ethnic minority children and children living in low-income circumstances experience severe inequities in access to appropriate developmental screening and support. These inequities result in missed opportunities to intervene at critical developmental periods, contributing to economic and racial disparities in school readiness and long-term cognitive and behavioral disabilities. A report by the American Academy of Pediatrics identified two key barriers to enhancing screening and referral practices: 1) lack of provider time to carry out more frequent screenings, and 2) difficulty accessing services once families are referred. To address these barriers, I will design specifications of a computer adaptive developmental assessment that includes contextually and culturally appropriate items, to be used by parents, clinicians, and community health workers to improve developmental assessment in primary care settings. Informed by principles of patient-centered measurement and user-centered design I will carry out the following specific aims of this project: Aim 1: Identify optimal items in English and Spanish to include in a new developmental assessment – computer adaptive test; Aim 2: Develop a prototype for a new developmental assessment – computer adaptive test informing a primary care based developmental support intervention. This project will result in 1) culturally and contextually appropriate developmental assessment items in English and Spanish ready for standardization to nationally representative samples, and 2) design specifications to inform building a high- fidelity developmental assessment - computer adaptive test for clinical integration. This research plan is part of a K01 proposal designed to provide me with scholarly training, mentorship, and support to gain skills and experience needed to be an independent investigator, conducting community-engaged research to design effective developmental assessment and response practices, to address economic and racial disparities in child development outcomes. To achieve this objective, I will pursue training in: (1) advanced Item Response Theory, (2) user centered design, (3) clinical effectiveness research.