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Can paraprofessional home visitation enhance early intervention service delivery?
Stephen D Vogler1, Arthur J Davidson, Lori A Crane
1Department of Community Health Services, Denver Health, University of Colorado Health Sciences Center, Denver, USA. stephen.vogler@dhha.org
Insights
Intensive case management (ICM) for children with developmental delays showed faster assessment intervals and more recommended services compared to basic case management (BCM). However, overall service initiation and compliance rates remained similar, indicating a need for further improvements in early intervention.
Area of Science:
- Pediatrics
- Public Health
- Healthcare Management
Background:
- Early intervention (EI) services are crucial for children with developmental delays.
- Effective case management models are needed to optimize EI service utilization.
- Previous research indicates variability in case management approaches and their impact on EI outcomes.
Purpose of the Study:
- To compare the effectiveness of intensive case management (ICM) versus basic case management (BCM) in facilitating EI service use among at-risk preschool-aged children.
- To evaluate the impact of ICM and BCM on the timeliness of assessment and service initiation.
- To determine differences in the number of recommended and initiated EI services between ICM and BCM groups.
Main Methods:
- A 1-year randomized trial involving 159 families with preschool-aged children experiencing developmental delays or at risk.
- Participants were assigned to either ICM (n=88) delivered by paraprofessionals or BCM (n=71) delivered by a nurse.
- Key outcome measures included time to assessment, assessment rates, number of services recommended and initiated, and EI program initiation and compliance rates.
Main Results:
- The ICM group demonstrated a significantly shorter interval to assessment (98 vs. 140 days, p = .05) but similar assessment rates (86% vs. 80%, p = .29) compared to the BCM group.
- Children in the ICM group received more services recommended per child (1.64 vs. 1.16, p < .004) and initiated (1.20 vs. 0.85, p < .04).
- No significant differences were found in the median time to EI program initiation (228 vs. 200 days, p = .88) or EI service compliance rates between the two groups.
Conclusions:
- Intensive case management shows potential in accelerating the initial stages of early intervention by reducing assessment times and increasing service recommendations.
- Despite improvements in early engagement metrics, current case management models, including ICM, do not significantly shorten the overall time to EI program initiation or improve compliance.
- Further targeted strategies are necessary to enhance the efficiency and effectiveness of early intervention pathways, addressing both initiation time and service utilization.
Abstract:
A 1-year randomized trial compared intensive case management (ICM) versus basic case management (BCM) in facilitating early intervention (EI) service use among children in an urban health system. Of 159 participating families with delayed or at-risk preschool-aged children, 88 received ICM from paraprofessionals versus 71 families who received less comprehensive BCM from a nurse. In the ICM versus BCM group, a shorter interval to assessment (98 vs 140 d, p =.05) but similar assessment rate (86% vs 80%, p =.29) was observed. The ICM group had more services recommended per child (1.64 vs 1.16, p < .004) and initiated (1.20 vs 0.85, p < .04). There was no difference in median time to EI program initiation for ICM versus BCM (228 vs 200 d, p = .88) or initiation and visit compliance rate for EI services. Specific efforts to improve outcomes (e.g., decrease initiation time and increase use of EI services) are still needed.