Social Disparities in Early Intervention Service Use and Provider-Reported Outcomes.

Abstract

To describe social disparities in early intervention (EI) service use and provider-reported outcomes. Secondary data analysis of administrative data to ascertain EI service use of all EI and discipline-specific services and child and family characteristics. Adjusted logistic regression models estimated the odds of receiving each type of core EI service. Adjusted median regression models estimated differences in EI intensity for each type of core EI service. Adjusted ordinal regression models estimated the association between each type of EI therapy service and provider estimates of children's global functional improvement. Children with a diagnosis (b = 0.8, SE = 0.2) and those whose caregiver had 12 years of education or less (b = 0.6, SE = 0.3) had higher EI intensity. Black, non-Hispanic (BNH) children had nearly 75% lower odds of receiving physical therapy (PT) (odds ratio [OR] = 0.3, 95% confidence interval [CI], 0.1-0.7) and greater odds of receiving speech therapy (ST) (OR = 3.4, 95% CI, 1.3-9.3) than their white, non-Hispanic (WNH) peers. BNH children who received PT received about an hour less per month (b = -0.7, SE = 0.4) than their WNH peers. Hispanic children (b = 1.0, SE = 0.3) and those with higher family income (b = 0.7, SE = 0.3) received greater intensity of PT compared with their peers who are WNH and from low-income families. Publically insured children had lower intensity of occupational therapy (b = -0.5, SE = 0.3) and ST (b = -0.6, SE = 0.3). Greater intensity of EI services was not associated with greater provider-perceived improvement. Results suggest disparities, by race and family income, in receipt of EI therapy services. These findings highlight opportunities to customize and coordinate care for improved EI access and care quality.