Early Intervention Enrollment Among Substance-exposed Infants in Massachusetts: A Population-level Analysis

Area of Science:

• Public Health
• Pediatrics
• Neonatology

Background:

• Substance-exposed newborns (SENs) require timely developmental support.
• Early Intervention (EI) services aim to address developmental needs in infants and toddlers.
• Understanding referral and enrollment patterns for SENs is crucial for effective service delivery.

Purpose of the Study:

• To assess EI referral and enrollment rates for SENs in Massachusetts.
• To compare these rates between SENs with and without Neonatal Abstinence Syndrome (NAS) diagnoses.
• To compare SEN EI rates with those of infants and toddlers without known substance exposure.

Main Methods:

• Analysis of the 2013-2020 Pregnancy to Early Life Longitudinal dataset.
• Identification of SENs and NAS using ICD-9/10 codes.
• Descriptive and bivariate analyses comparing EI referral and enrollment rates.

Main Results:

• 85.3% of 6565 SENs were referred to EI; 49.5% of those referred enrolled.
• SENs with NAS diagnoses had higher referral (87.6%) and enrollment (53.2%) rates than those without (79.0% and 38.2%).
• Unexposed infants had lower referral (34.6%) but higher enrollment (56.7%) among those referred.

Conclusions:

• MA SENs exhibit high EI referral but low enrollment rates.
• A notable referral-to-enrollment gap exists, particularly for SENs without NAS diagnoses.
• These findings highlight disparities in accessing early intervention services for vulnerable infants.