Can paraprofessional home visitation enhance early intervention service delivery?

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.