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Using Claims Data to Map Unmet Service Needs for Early Childhood Developmental Disabilities in Virginia

  • Bergen B. Nelson
    Correspondence
    Address correspondence to Bergen B. Nelson, MD, MS, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, 1000 E Broad St, Richmond, VA 23298.
    Affiliations
    Children's Hospital of Richmond at VCU (BB Nelson and ER Wolf), Richmond, Va

    Department of Pediatrics, Virginia Commonwealth University (BB Nelson and ER Wolf), Richmond, Va
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  • Daniel Ratushnyak
    Affiliations
    School of Medicine, Virginia Commonwealth University (D Ratushnyak), Richmond, Va
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  • Alicia Richards
    Affiliations
    Department of Biostatistics, Virginia Commonwealth University (A Richards and RT Sabo), Richmond, Va

    Department of Family Medicine and Population Health, Virginia Commonwealth University (A Richards, RT Sabo, and AH Krist), Richmond, Va
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  • Roy T. Sabo
    Affiliations
    Department of Biostatistics, Virginia Commonwealth University (A Richards and RT Sabo), Richmond, Va

    Department of Family Medicine and Population Health, Virginia Commonwealth University (A Richards, RT Sabo, and AH Krist), Richmond, Va
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  • Elizabeth R. Wolf
    Affiliations
    Children's Hospital of Richmond at VCU (BB Nelson and ER Wolf), Richmond, Va

    Department of Pediatrics, Virginia Commonwealth University (BB Nelson and ER Wolf), Richmond, Va
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  • Alex H. Krist
    Affiliations
    Department of Family Medicine and Population Health, Virginia Commonwealth University (A Richards, RT Sabo, and AH Krist), Richmond, Va
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Published:September 12, 2022DOI:https://doi.org/10.1016/j.acap.2022.09.003

      Abstract

      Background

      Developmental disabilities (DD) affect over 10% of children 0 to 5 years of age, and early interventions are known to improve outcomes, yet barriers remain in connecting children to these services.

      Objective

      To identify gaps in services for young children with DD and established risk conditions in Virginia.

      Methods

      Data from the 2018 Virginia All Payers Claim Database and the American Community Survey were used to estimate the proportion of children with DD, and among those children, the proportion that received at least one intervention service. Logistic and binomial regression models were used to examine the socio-demographic associations with having developmental needs met, at the individual and zip code tabulation (ZCTA) level.

      Results

      Approximately 12% of children 0 to 5 years were found to have DD or established risk condition diagnosis, and only 54% of these received intervention services during that year. Individual-level analyses suggest that odds of having developmental needs met are higher among older children, boys, and children with public insurance. ZCTA-level analyses suggested higher odds of developmental needs being met in areas with higher levels of unemployment, while areas with high proportions of people with limited English proficiency and a high school education or less had lower odds of having needs met.

      Conclusions

      Receiving early childhood developmental services in Virginia is associated with having public insurance and living in an area with higher levels of unemployment, higher education, and English-proficiency. Efforts are needed to improve delivery of services overall, specifically targeted to those areas with high levels of unmet need.

      Keywords

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