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Background: The experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents of children with developmental disabilities (DDs) in health and early learning systems are largely understudied. Inclusive, affirming services are critical to timely identification and intervention for DDs. This literature review aimed to establish whether LGBTQ parents experience structural bias and discrimination when accessing care for their children in health and early learning systems. Methods: PubMed, ERIC, and Scopus were searched for empirical research from 1990 to 2020 on: LGBTQ; parents, children, families; bias, disparities, discrimination; and health and early learning services. Themes were analyzed by conceptual model bias levels, participant type, and setting. Results: The search yielded 1,872 unduplicated records (three through hand search). Twenty-nine articles representing 26 studies in health and early learning in eight countries met the inclusion criteria. Biases common across sectors included challenges surrounding LGBTQ status disclosures; lack of acknowledgment of non-biological parents; and heterosexist forms. Knowledge gaps and negative attitudes about LGBTQ families were found among some professionals and students. Conclusion: Some LGBTQ parents experienced bias and discrimination while accessing care for their children in health and early learning systems. Policies and programs to implement and monitor LGBTQ-inclusive health education and evaluate practice changes are recommended to improve professionals' knowledge, attitudes, and behavior. Multilevel workforce development (e.g., accreditation standards, organizational audits, and training) is needed to create and sustain LGBTQ-affirming health and education environments. Honoring LGBTQ family diversity and reducing health and early learning inequities are critical for improving children's health and education outcomes.

Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. We examined the barriers to initiation of T-CPR. We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., "snoring", "slow") or to confirm that breathing was effective in an unconscious victim. We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions. [ABSTRACT FROM AUTHOR]