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Social and Functional Characteristics of Receipt and Service Use Intensity of Core Early Intervention Services
Zachary S Richardson1, Mary A Khetani2, Elizabeth Scully3
1Department of Health Systems, Management and Policy (ZS Richardson and BM McManus); Department of Occupational Therapy, College of Applied Health Sciences (MA Khetani), University of Illinois at Chicago.
Insights
Early intervention (EI) services for children often have low intensity, particularly for those with specific language needs or functional challenges. Service delivery improvements are needed for vulnerable subgroups to ensure equitable access and effectiveness.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Early intervention (EI) services are crucial for supporting infants and toddlers with developmental delays.
- Understanding the characteristics of children receiving EI services and the intensity of these services is essential for optimizing outcomes.
- Variations in service delivery may exist based on child demographics and functional status.
Purpose of the Study:
- To describe the diagnostic, social, and functional characteristics of children utilizing core early intervention (EI) services.
- To analyze the association between child characteristics and the receipt and intensity of EI services.
- To identify potential disparities in EI service delivery.
Main Methods:
- Analysis of data from 2045 infants and toddlers discharged from an urban EI program (2014-2016).
- Use of adjusted logit models to estimate the effects of receiving core EI services.
- Application of adjusted median regression to determine EI core service intensity, controlling for child characteristics.
Main Results:
- The median EI service intensity was below 3 hours per month.
- Children whose primary language was English were more likely to receive occupational therapy.
- Age and functional performance at EI entry were significantly associated with service receipt and intensity, with variations observed in speech and occupational therapy utilization.
Conclusions:
- Many children enrolled in EI receive low-intensity services, influenced by caregiver's primary language, child's age, and functional status.
- Results highlight a need for targeted interventions to enhance service delivery for vulnerable EI subgroups.
- Addressing these disparities can improve the effectiveness of early intervention programs.
Objective:
Describe children's diagnostic, social, and functional characteristics associated with the use of core early intervention (EI) services.
Methods:
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.
Results:
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.
Conclusions:
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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