Advertisement

Factors Contributing to Early Intervention Evaluation

Published:March 18, 2021DOI:https://doi.org/10.1016/j.acap.2021.03.010

      Abstract

      Objective

      Early Intervention (EI) programs promote early childhood development but remain underutilized. Few studies have examined correlations with completion of EI referrals using a standardized referral system. Our study examined a minority, underserved population for characteristics that affect this critical step.

      Methods

      Subjects were referred from an inner-city pediatric primary care clinic for EI evaluation from 3/1/15-5/31/18. Subjects were <3 years of age at the time of referral, received pediatric care at the clinic, and were referred for EI. The dependent variable was completion of EI evaluation, verified by the medical record. Independent variables included demographic, maternal (eg, depression), child (eg, chronic illness), and referral characteristics. A multivariable logistic regression model was used to determine the predictors for completing an evaluation.

      Results

      Of 181 children referred to EI, 61.9% completed an EI evaluation; the average age was 18.9 (SD 7.4) months at first referral. For every additional month of age at the initial referral, a child was 5.0% less likely to complete an evaluation (adjusted odds ratio [aOR], 0.95; 95% confidence interval [CI], 0.90–0.99; P = .02). Two factors more than doubled the odds of completing an EI evaluation: having a chronic medical illness at the time of referral (aOR = 2.41, CI 1.21–4.79; P = .01), and being a child from a non-English speaking family (aOR = 2.22, CI 1.09–4.50; P = .03).

      Conclusions

      The child's age and medical history, and language spoken at home affected the odds of successfully completing an EI evaluation. These findings can help clinicians target families at risk of failing to complete EI programs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. US Department of Education. Office of Special Education Programs DASD. OMB #1820-0557: infants and toddlers receiving early intervention services in accordance with Part C, 2010. Table 8-16. Number and percentage of infants and toddlers, ages birth to three, receiving early intervention services under IDEA, Part C, by state:2010.

        • Anderson LM
        • Shinn C
        • Fullilove MT
        • et al.
        The effectiveness of early childhood development programs. A systematic review.
        Am J Prev Med. 2003; 24: 32-46https://doi.org/10.1016/s0749-3797(02)00655-4
        • Rosenberg SA
        • Robinson CC
        • Shaw EF
        • et al.
        Part C early intervention for infants and toddlers: percentage eligible versus served.
        Pediatrics. 2013; 131: 38-46https://doi.org/10.1542/peds.2012-1662
        • Zablotsky B
        • Black LI
        • Maenner MJ
        • et al.
        Prevalence and trends of developmental disabilities among children in the United States: 2009–2017.
        Pediatrics. 2019; 144e20190811https://doi.org/10.1542/peds.2019-0811
        • Jimenez ME
        • Fiks AG
        • Shah LR
        • et al.
        Factors associated with early intervention referral and evaluation: a mixed methods analysis. Article.
        Acad Pediatr. 2014; 14: 315-323https://doi.org/10.1016/j.acap.2014.01.007
      2. Developmental surveillance and screening of infants and young children.
        Pediatrics. 2001; 108: 192-195https://doi.org/10.1542/peds.108.1.192
        • Meisels SJ
        • Provence S.
        Screening and Assessment. Guidelines for Identifying Young Disabled and Developmentally Vulnerable Children and Their Families.
        National Center for Clinical Infant Programs, 1989
        • King TM
        • Tandon SD
        • Macias MM
        • et al.
        Implementing developmental screening and referrals: lessons learned from a national project.
        Pediatrics. 2010; 125: 350-360https://doi.org/10.1542/peds.2009-0388
        • Hirai AH
        • Kogan MD
        • Kandasamy V
        • et al.
        Prevalence and variation of developmental screening and surveillance in early childhood.
        JAMA Pediatr. 2018; 172: 857-866https://doi.org/10.1001/jamapediatrics.2018.1524
        • Rice CE
        • Naarden Braun KV
        • Kogan MD
        • et al.
        Screening for developmental delays among young children–National Survey of Children’s Health, United States, 2007.
        MMWR Suppl. 2014; 63: 27-35
        • Khetani MA
        • Richardson Z
        • McManus BM.
        Social disparities in early intervention service use and provider-reported outcomes. Article.
        J Dev Behav Pediatr. 2017; 38: 501-509https://doi.org/10.1097/DBP.0000000000000474
        • Khetani M
        • Graham JE
        • Alvord C.
        Community participation patterns among preschool-aged children who have received Part C early intervention services. Article.
        Child Care Health Dev. 2013; 39: 490-499https://doi.org/10.1111/cch.12045
        • Magnusson D
        • Palta M
        • McManus B
        • et al.
        Capturing unmet therapy need among young children with developmental delay using national survey data.
        Acad Pediatr. 2016; 16: 145-153https://doi.org/10.1016/j.acap.2015.05.003
        • Jimenez ME BF
        • Guevara JP
        • Gerdes M
        • et al.
        Barriers to evaluation for early intervention services: parent and early intervention employee perspectives.
        Acad Pediatr. 2012; 12: 551-557
        • Schonhaut L
        • Armijo I
        • Schönstedt M
        • et al.
        Validity of the Ages and Stages Questionnaires in term and preterm infants.
        Pediatrics. 2013; 131: e1468-e1474https://doi.org/10.1542/peds.2012-3313
        • Robins DL
        • Casagrande K
        • Barton M
        • et al.
        Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F).
        Pediatrics. 2014; 133: 37-45https://doi.org/10.1542/peds.2013-1813
      3. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.
        Pediatrics. 2006; 118: 405-420https://doi.org/10.1542/peds.2006-1231
        • Simon TD
        • Haaland W
        • Hawley K
        • et al.
        Development and validation of the pediatric medical complexity algorithm (PMCA) version 3.0.
        Acad Pediatr. 2018; 18: 577-580https://doi.org/10.1016/j.acap.2018.02.010
        • Guevara JP
        • Gerdes M
        • Localio R
        • et al.
        Effectiveness of developmental screening in an urban setting.
        Pediatrics. 2013; 131: 30-37https://doi.org/10.1542/peds.2012-0765
        • Feinberg E
        • Silverstein M
        • Donahue S
        • et al.
        The impact of race on participation in part C early intervention services. Article.
        J Dev Behav Pediatr. 2011; 32: 284-291https://doi.org/10.1097/DBP.0b013e3182142fbd
        • Clements KM
        • Barfield WD
        • Kotelchuck M
        • et al.
        Maternal socio-economic and race/ethnic characteristics associated with early intervention participation.
        Matern Child Health J. 2008; 12 (2008/11/01): 708-717https://doi.org/10.1007/s10995-007-0291-3
        • Voigt RG
        • Accardo PJ.
        Mission impossible? Blaming primary care providers for not identifying the unidentifiable.
        Pediatrics. 2016; 138e20160432https://doi.org/10.1542/peds.2016-0432
        • Silverstein M
        • Sand N
        • Glascoe FP
        • et al.
        Pediatrician practices regarding referral to early intervention services: is an established diagnosis important?.
        Ambulat Pediat. 2006; 6 (2006/03/01/): 105-109https://doi.org/10.1016/j.ambp.2005.09.003
        • Epps S
        • Kroeker R.
        Physician early intervention referral as a function of child age and level of developmental delay.
        Ment Retard. 1995; 33: 104-110
        • Zuckerman KE
        • Cai X
        • Perrin JM
        • et al.
        Incomplete specialty referral among children in community health centers.
        J Pediatr. 2011; 158 (2011/01/01/): 24-30https://doi.org/10.1016/j.jpeds.2010.07.012
      4. Hebbeler K, Wagner M, Spiker D, et al. National early intervention longitudinal study: a first look at the characteristics of children and families entering early intervention services. 01/01 2001;

        • Kokotos F.
        The vulnerable child syndrome.
        Pediatr Rev. 2009; 30: 193-194https://doi.org/10.1542/pir.30-5-193
        • Perrin EC
        • West PD
        • Culley BS.
        Is my child normal yet? Correlates of vulnerability.
        Pediatrics. 1989; 83: 355-363
        • Flores G
        • Abreu M
        • Tomany-Korman SC.
        Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters.
        Public Health Reports. 2005; 120 (2005/07/01): 418-430https://doi.org/10.1177/003335490512000409
        • Hernandez D
        • Charney E.
        From Generation to Generation: The Health and Well-being of Children in Immigrant Families.
        National Academics Press, 1998
        • Flores G.
        The impact of medical interpreter services on the quality of health care: a systematic review.
        Med Care Res Rev. 2005; 62 (2005/06/01): 255-299https://doi.org/10.1177/1077558705275416
        • Zamora ER
        • Kaul S
        • Kirchhoff AC
        • et al.
        The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer.
        Pediatr Blood Cancer. 2016; 63: 2173-2180https://doi.org/10.1002/pbc.26150
        • Juckett G.
        Caring for Latino patients.
        Am Fam Physician. 2013; 87: 48-54
        • Olsen R
        • Basu Roy S
        • Tseng H-K.
        The Hispanic health paradox for older Americans: an empirical note.
        Int J Health EconManage. 2019; 19 (2019/03/01): 33-51https://doi.org/10.1007/s10754-018-9241-4
        • King TM
        • Glascoe FP.
        Developmental surveillance of infants and young children in pediatric primary care.
        Curr Opin Pediatr. 2003; 15: 624-629https://doi.org/10.1097/00008480-200312000-00014