Social and Functional Characteristics of Receipt and Service Use Intensity of Core Early Intervention Services

Published:February 21, 2019DOI:



      Describe children's diagnostic, social, and functional characteristics associated with the use of core early intervention (EI) services.


      The sample included infants and toddlers (N = 2045) discharged from an urban EI program (2014–2016). Adjusted logit models estimated the marginal effects and 95% confidence intervals (CIs) of receipt of any of the 4 core EI services, controlling for the child's developmental condition type, race and ethnicity, primary language, sex, insurance type, age at referral, and functional performance at EI entry. Adjusted median regression estimated EI core service intensity controlling for child characteristics.


      The median per-child EI service intensity was less than 3 h/mo (median, 2.7; interquartile range, 2.1–3.5). Children whose primary language was English were 6% more likely to receive occupational therapy (marginal effect = 0.063; 95% CI, 0.010–0.115). Compared to infants, 1- to 2-year-old children were less likely to receive physical therapy and occupational therapy but more likely to receive speech therapy. Compared to infants, 1-year-olds received more intensive speech therapy (β = 0.42; 95% CI, 0.10–0.70), and 2-year-olds received less intensive occupational therapy (β = –0.70; 95% CI, –1.35 to –0.10). Children's functional performance at EI entry was significantly associated with the receipt and intensity of EI services.


      Many EI-enrolled children received low-intensity services, a result that was associated with the primary language of the caregiver and the child's age and functional status. Results suggest the need for interventions to improve service delivery for vulnerable EI subgroups.


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      1. US Government. Individuals with Disabilities Education Act, Reauthorization 2004, PL 108-446. Available at: Accessed August 8, 2014.

      2. Early Childhood Technical Assistance Center. Outcomes. Available at: Accessed February 21, 2018.

        • Feinberg E
        • Silverstein M
        • Donahue S
        • et al.
        The impact of race on participation in Part C early intervention services.
        J Dev Behav Pediatr. 2012; 32: 284-291
        • Twardzik E
        • Cotto-Negron C
        • MacDonald M
        Factors related to early intervention Part C enrollment: a systematic review.
        Disabil Health J. 2017; 10: 467-474
        • McManus BM
        • Rapport MJ
        • Richardson Z
        • et al.
        Therapy use for children with developmental conditions: analysis of Colorado Medicaid data.
        Pediatr Phy Ther. 2017; 29: 192-198
        • Khetani M
        • Richardson Z
        • McManus BM
        Social disparities in early intervention service use and provider-reported outcomes.
        J Dev Behav Pediatr. 2017; 38: 501-509
      3. Early Childhood Technical Assistance Center. Child Outcomes Summary (COS) Process. Available at: Accessed March 14, 2018.

      4. Early Childhood Technical Assistance Center. Part C Infant and Toddler Program Federal Appropriations and National Child Count 1987-2015. Available at:∼pdfs/growthcomppartc.pdf. Accessed December 1, 2017.

        • Aday LA
        • Andersen R
        A framework for the study of access to medical care.
        Health Serv Res. 1974; 9: 208-220
        • Hirai AH
        • Kogan MD
        • Kandasamy V
        • et al.
        Prevalence and variation of developmental screening and surveillance in early childhood.
        JAMA Pediatr. 2018; 172: 857-866
      5. Established Condition Database—Early Intervention Colorado. Medical Diagnosis. Available at: Accessed October 22, 2018

      6. Barton L, Taylor C, Spiker D, et al. Validity of the Data from the Child Outcomes Summary Process: Findings from the ENHANCE Project. Available at:∼pdfs/calls/2016/ENHANCEbrief_03-02-16Final.pdf. Accessed October 22, 2018.

      7. Early Childhood Technical Assistance Center. Definitions for Child Outcomes Summary (COS) Ratings. Available at:∼pdfs/eco/definitions_outcome_ratings.pdf. Accessed October 22, 2018.

        • Bailes AF
        • Reder R
        • Burch C
        Development of guidelines for determining frequency of therapy services in a pediatric medical setting.
        Pediatr Phys Ther. 2008; 20: 194-198
        • Gannotti M
        • Christy J
        • Heathcock J
        • et al.
        A path model for evaluating dosing parameters for children with cerebral palsy.
        Phys Ther. 2014; 94: 411-421
      8. StataCorp. Stata® Release 15. Available at: Accessed March 5, 2019.

      9. Davies HT, Crombie IK, Tavakoli M. When can odds ratios mislead? BMJ. 316:989–991.

        • Brzoska P
        Using average marginal effects over odds ratios as measures of effect size in epidemiology.
        Ann Epidemiol. 2017; 27: 525-526
      10. Hebbeler K, Spiker D, Bailey D, et al. Early intervention for infants and toddlers with disabilities and their families: participants, services, and outcomes. Available at: Accessed December 1, 2017.

        • Bruder MB
        • Dunst CJ
        Factors related to the scope of early intervention service coordinator practices.
        Infants Young Child. 2008; 21: 176-185
        • Dunst CJ
        • Bruder MB
        Early intervention service coordination models and service coordinator practices.
        J Early Interv. 2006; 28: 155-165
        • Kingsley K
        • Mailloux Z
        Evidence for the effectiveness of different service delivery models in early intervention services.
        Am J Occup Ther. 2013; 67: 431-436
      11. Agency for Healthcare Research and Quality. National Healthcare Disparities Report. Available at: Accessed October 24, 2018.

      12. Data Resource Center for Child & Adolescent Health. 2016 and 2016-2017 Combined National Survey of Children's Health Interactive Data Query. Available at: Accessed October 24, 2018.

        • Mosquera RA
        • Samuels C
        • Flores G
        Family language barriers and special-needs children.
        Pediatrics. 2016; 138e20160321
        • Sousa VD
        • Rojjanasrirat W
        Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline.
        J Eval Clin Pract. 2001; 17: 268-274
        • Beaton DE
        • Bombardier C
        • Guillemin F
        • et al.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        Spine. 2000; 25: 3186-3191
        • Wild D
        • Grove A
        • Martin M
        • et al.
        Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation.
        Value Health. 2005; 8: 94-104
        • Arestad KE
        • MacPhee D
        • Lim CY
        • et al.
        Cultural adaptation of a pediatric functional assessment for rehabilitation outcomes research.
        BMC Health Serv Res. 2017; 17: 658
        • Council on Children with Disabilities
        • Section on Developmental Behavioral Pediatrics
        • Bright Futures Steering Committee
        Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.
        Pediatrics. 2006; 118: 405-420
        • Beckmann KA.
        Mitigating adverse childhood experiences through investments in early childhood programs..
        Acad Pediatr. 2017; 17: S28-S29
        • Litt JS
        • Glymour MM
        • Hauser-Cram P
        • et al.
        Early intervention services improve school-age functional outcome among neonatal intensive care unit graduates.
        Acad Pediatr. 2018; 18: 468-474