Abstract
Federal per-child early intervention (EI) appropriations have declined, while accountability for improving children's development and function has increased. It is critical to understand high-value EI services and systems. To examine EI service timeliness and intensity, and the association between service intensity and outcomes. This secondary data analysis cohort study linked pediatric primary care electronic health records and EI program records from October 1, 2014, to September 30, 2016. Sample children from a large, urban safety-net health system and EI program who were younger than 35 months with a developmental disability or delay were examined. Data analysis was conducted from December 15, 2017, to May 15, 2018. The study included measures of condition type and severity, race and ethnicity, family income, insurance type, sex, birth weight, and language. The timeliness of EI (days from referral to EI care plan), service intensity (hours per month) overall and for core EI services (physical, occupational, speech therapy, and developmental intervention), and change in function (measured on a 13-point scale). Adjusted quantile median regression estimated timeliness and intensity. Adjusted linear regression estimated change in function. Of the 722 children who received an EI care plan (median [interquartile range] time to receive EI care plan, 56.0 [1.0-111.0] days) 457 (63.3%) were male, 447 (62.0%) were younger than 12 months, 207 (28.7%) were 12 to 24 months, and 68 (9.3%) were 25 to 35 months. A total of 663 children (91.8%) had a household income of less than $20 000 annually; 305 (43%) of the sample children received an EI care plan within the 45-day deadline. Median (interquartile range) for EI intensity was 2.7 (2.3-3.6) hours per month. Children living above the federal poverty threshold received greater occupational therapy intensity (b, 1.9; 95% CI, 0.9-3.0). Greater clinical severity was associated with more timely receipt of an EI care plan. Compared with infants, 2-year-old children received a care plan almost 2 months sooner (b, -52.0; 95% CI, -79.7 to -24.3). An additional hour per month of EI service was associated with a 3-point functional gain (b, 3.0; 95% CI, 1.5-5.9) among children with complete outcomes information (n = 448). In this study, greater EI service intensity was associated with better functional gains, yet most children in the study received delayed care and/or low service intensity. Clinical and EI record linkages could serve as a framework for improving EI processes.
Highlights
IntroductionThe benchmark for early intervention (EI) timeliness is driven by federal EI policy, which mandates that an EI care plan be written within 45 days of referral receipt.[1] Previous research, conducted nearly a decade ago, suggests that children living in poor neighborhoods have less timely EI access.[2] this research focused on service provider designation (not subject to the 45-day deadline) rather than care plan development
The Individuals with Disabilities Education Act provides funding to states to establish statewide early intervention (EI) systems of care to provide developmental and therapeutic services for infants and toddlers with developmental delays and disabilities.[1]The benchmark for EI timeliness is driven by federal EI policy, which mandates that an EI care plan be written within 45 days of referral receipt.[1]
Children living above the federal poverty threshold received greater occupational therapy intensity (b, 1.9; 95% CI, 0.9-3.0)
Summary
The benchmark for EI timeliness is driven by federal EI policy, which mandates that an EI care plan be written within 45 days of referral receipt.[1] Previous research, conducted nearly a decade ago, suggests that children living in poor neighborhoods have less timely EI access.[2] this research focused on service provider designation (not subject to the 45-day deadline) rather than care plan development. Current patterns of EI timeliness in an era of fiscal constraints to support EI programming need to be evaluated. The benchmark for optimal EI service intensity is less clear. While pediatric therapy intensity guidelines exist,[3,4] these do not always translate to EI, which includes a clinically diverse population and different service delivery model. The first step to understanding optimal EI therapy intensity is to establish current EI service intensity and evaluate how this varies by clinical and social factors and relates to functional gains
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
