One goal of the Healthy People 2010 program is to reduce health disparities across different segments of the population. Identification of language impairment (SLI) in bilingual children and developing interventions for bilingual children with language impairment is one area in which disparities exists. Important gains have been made in the identification of markers of language impairment in young bilingual (Spanish-English) children. These studies are a source of much needed data on the semantic and grammatical skills of bilingual children with language impairment (e.g., Gutiirrez-Clellen, Restrepo, &Simon-Cereijido, 2006;Gutiirrez- Clellen &Simon-Cereijido, 2007). There is also information about the kinds of language changes that bilingual children make in their two languages as they transition from the home to the school language (Hammer, Lawrence, &Miccio, 2008). These studies suggest that bilingual children with language impairment have difficulties in the phonological, semantic, and morphosyntactic domains and that these difficulties will interfere with their abilities to gain access to school language and literacy. A number of studies examine reading outcomes in bilingual children as well (Vaughn, et al., 2008;Vaughn, Linan-Thompson, et al., 2006;Vaughn, Mathes, et al., 2006). With this research as a base we are in the position to begin to systematically evaluate language interventions for bilingual children. Literacy intervention research demonstrates that direct instruction in key preliteracy skills (phonological awareness, text decoding, and text comprehension) is an effective intervention strategy leading to long lasting change in literacy skills. These interventions have successfully been delivered in Spanish and in English and provide a logical starting point for developing a bilingual language intervention that focuses on the language and literacy needs of bilingual children with SLI. We propose to develop an intervention focusing on the development of language and literacy together based on the Proactive model employed by Vaughn and colleagues. We will enhance this model by selecting semantic and morphosyntax targets that we have identified as challenging for Spanish-English bilinguals, optimizing language intervention strategies, and planning for cross language transfer. The intervention will be focused on the needs of first graders. In the R-33 phase we will systematically test the language and literacy outcomes when this intervention is delivered in English versus Spanish and at two levels of language and literacy instruction (35 minutes language/15 minutes literacy per session vs. 15 minutes language/35 minutes literacy). Our primary goal will be clinically significant change in language production and comprehension. We will also evaluate change in literacy skills and cross language transfer. If successful, this intervention will increase clinical capacity because it would be efficient, addressing language and literacy needs simultaneously and could be delivered in English or Spanish, a practical necessity for use in school settings. PUBLIC HEALTH RELEVANCE: One goal of the Healthy People 2010 program is to reduce health disparities across different segments of the population. Spanish English bilinguals and other English language learners tend to be under-referred for language intervention in the schools and over referred for learning disabilities. Even when children are accurately referred, clinicians are unsure of which language to provide intervention in and what interventions targets will yield the most effective outcomes (Kritikos, 2003). An added challenge for sequential bilinguals is that they are learning English at the same time that they are expected to make gains in academic skills (in English in many cases). The result can be increased risk for poor language and educational outcomes for this segment of the population. This proposal will modify an existing literacy intervention for designed for and tested with English and Spanish speaking children. The language modifications will target the grammatical and lexical semantic difficulties that characterize language impairment with a focus on bilingual English Spanish speakers. The resulting interventional strategy will address health disparities by developing an interventional strategy for language and literacy that will improve the communication function of bilingual children with language impairment. These findings will contribute to our developing individualized intervention treatment strategies for children with language impairment. This work conducted under this proposal addresses health disparities by developing a language intervention specifically addressing the needs language and literacy needs of bilingual children with language impairment. As part of this work we will develop and use a screening tool for Spanish English bilingual first graders. We will also obtain data about the co-occurrence of language and literacy risk in first graders and about how skills in these domains develop together in bilingual children. Evaluating children's performance on these tasks will help us better define the clinical phenotype for bilingual children with SLI and provide much needed data for setting diagnostic criterion for children and future language interventions.