Project Initiate: A Clinical Feasibility Trial of Equitable Access to Early Neurodevelopmental Therapy

Background/Objectives: Despite evidence of the effectiveness of early intervention (EI) programs, eligible infants often experience delays in initiation of services or fail to receive services entirely. Disparities have been documented, including lower enrollment rates for infants with public insurance. The objective of this pilot study was to evaluate the feasibility of initiating home physical therapy (PT) services promptly after neonatal or cardiac intensive care unit (NICU/CICU) discharge for infants with public insurance and to assess early motor outcomes for children who received study therapy compared with a standard of care group. Methods: Infants were recruited if discharged from a study NICU/CICU, had public insurance, and were eligible for Illinois EI services. Infants living in Chicago (n = 46) received weekly home-based PT from a study therapist until 3-4 months corrected age (CA). Infants living outside Chicago received standard of care services and served as a control group (n = 14). At discharge, infants were referred to EI and underwent the Test of Infant Motor Performance (TIMP). Outcomes at 3-4 months CA included initiation rates for study PT and EI and follow-up TIMP testing. Results: By 3-4 months CA, 78% of the intervention group had received ≥1 PT session. In contrast, just 13% of the entire cohort had received any EI therapy. Infants who had 8-10 PT sessions in the first 3-4 months after discharge were more likely to have a change in the TIMP Z-score of >0.5 SD. Conclusions: Prompt transition to home therapy was feasible for infants with public insurance in an urban setting who may benefit most due to the potential for neuroplastic change. Addressing barriers identified in this study may assist in improving access to EI for young infants.