Characteristics of Study Cohort
The cohort included 14,710 children with either a developmental delay or a developmental disability. Of the 14,710 children, 2,746 (18.7%) were referred to EI and of those referred, 722 (26.3%) received an IFSP (Figure 1, Table 1). Of those with an IFSP, 571 initiated EI services, and of those, 448 had complete COS information (Figure 1, Table 2). Children with and without complete COS information did not differ by clinical or sociodemographic characteristics (results not shown). Among children EI-referred and with an IFSP, 12.3% had a diagnosed condition, over 90% had an annual family income of less than $20,000, 73.7% were Hispanic, 15% were white, non-Hispanic (WNH), and 13% were black, non-Hispanic (BNH); 62.0% were under 12 months of age, and 70.6% had no chronic condition (Table 1).
Table 1. Characteristics of study sample children with developmental delays and disabilities (n=14,710) within the study healthcare system.
|
Not Referred (n = 11,964)
|
Referred, but not Receiving EI
(n = 2,024)
|
Referred and Received IFSP
(n = 722)
|
Condition Type
|
|
|
|
Developmental Delay (DD)
|
97.5
|
90.5
|
87.7
|
Diagnosed Condition (DC)
|
2.5
|
9.5
|
12.3
|
Condition Severity Group
|
|
|
|
No Condition
|
89.5
|
74.8
|
70.6
|
Mild
|
6.8
|
10.9
|
10.2
|
Moderate
|
2.0
|
9.0
|
11.0
|
Severe
|
1.6
|
5.4
|
8.2
|
Birthweight by Category
|
|
|
|
Less than 1.5kg
|
0.5
|
3.6
|
3.46
|
1.5kg to 2.5kg
|
4.8
|
8.3
|
8.45
|
Greater than 2.5kg
|
94.7
|
88.1
|
88.1
|
Child's Age
|
|
|
|
Less than 12-Months
|
59.4
|
58.9
|
62.0
|
12-24 Months
|
21.0
|
23.3
|
28.7
|
Greater than 24 Months
|
19.6
|
17.8
|
9.3
|
Family Income (annually)
|
|
|
|
Less than $19,999
|
93.8
|
94.6
|
91.8
|
Greater than $20,000
|
6.2
|
5.4
|
8.2
|
Race/Ethnicity
|
|
|
|
White, non-Hispanic
|
15.0
|
14.4
|
14.5
|
Black, non-Hispanic
|
12.8
|
11.2
|
9.3
|
Hispanic
|
69.0
|
70.4
|
73.7
|
Other, non-Hispanic
|
3.2
|
4.0
|
2.5
|
Primary LanguageA
|
|
|
|
English
|
-
|
-
|
55.0
|
Other
|
-
|
-
|
45.0
|
Child's sex, Female
|
51.0
|
37.8
|
36.7
|
Insurance Type, Medicaid and CHP+A
|
-
|
-
|
87.7
|
ACharacteristics only collected through EI program, not pediatric primary care office
Mean (SD) entry COS scores were 3.7 (1.5) for Acquiring and Using Knowledge and Skills, 4.3 (1.7) for Adaptive/Self-Care, and 4.6 (1.8) for Positive Social Emotional function. Twenty-one percent of the EI sample received PT, 17.3% received OT, 74.4% received ST, and 49.4% received DI (Table 2).
Table 2. Service Use among sample children who received EI referral and initiated EI services.
|
Characteristic
|
% (n)
|
Type of EI Services Received (n=571)A
|
|
|
Physical Therapy
|
21.4 (122)
|
Occupational Therapy
|
17.3 (99)
|
Speech and Language Pathology
|
74.4 (425)
|
Developmental Intervention
|
49.4 (282)
|
Number of EI Services Received (n=571)
|
|
|
One Service
|
18.2 (104)
|
Two Services
|
35.2 (201)
|
Three or more Services
|
46.6 (266)
|
|
Mean (SD)
|
Child Outcome Survey (COS) score at EI entry (n=448)B
|
|
Positive Social Emotional Skills
|
4.6 (1.8)
|
Acquiring and Using Knowledge and Skills
|
3.7 (1.5)
|
Taking Appropriate Action to Meet Needs
|
4.3 (1.7)
|
ADoes not add up to 100% since some children received more than one type of EI service; sub-sample of study children who initiated EI services.
BEach COS sub-scale score is derived from provider clinical judgment, parent concerns, and developmental assessment results and measured on a 7-point scale, from 1=very early skills (i.e., child does not use any immediate foundational skills related to this outcome) to 7=all skills expected (i.e., there are no concerns about the child’s function in this area).
Aim 1. Characteristics of EI-Referral Gaps
Children who had a diagnosis versus a developmental delay were 4.6% less likely (ME=-0.046 [-0.087, -0.005)] to be EI-referred. Normal birthweight (>2500 grams), and low birthweight (1501-2500 grams) infants were 26.9% (ME=-0.269 [-0.365, -0.174) and 17.6% less likely (ME=-0.176 [-0.276, -0.077]) than very low birthweight (<1500 grams) infants to be referred. One-year olds were more likely to be EI-referred [ME=0.023 [0.006, 0.041]) and 2-year olds were less likely to be EI-referred [ME= -0.042 [-0.058, -0.025]) than infants. BNH children were 2.9% less likely than WNH children (ME=-0.029 [-0.054, -0.004]) to be referred. Children with severe, moderate, and mild conditions were 33.4% (ME=.334 [0.249, 0.420]), 33.8% (ME=0.338 [0.314, 0.461]), and 9.8% (ME=0.098 [0.070, 0.127]), respectively, more likely than children with no special health care condition to be referred (Table 3).
Aim 2. Characteristics of EI Access Gaps
Children with severe, moderate, and mild conditions were 15.6% (ME=0.156 [0.088, 0.223]), 15.4% (ME=0.154 [0.095, 0.213]), and 2.4% (ME=0.024, [0.008, 0.040]), respectively, more likely than children with no special health care condition to receive an IFSP. One-year olds were more likely [ME=0.014 [0.004, 0.025]) and two-year olds were less likely to receive an IFSP [ME= -0.031 [-0.039, -0.023]) than infants (Table 3).
Aim 3. Characteristics of EI Service Type Gaps
Children with diagnosed conditions were 22.5% more likely to receive PT (ME=0.225 [0.104, 0.347]), 21.4% more likely to receive OT (ME=0.214 [0.091, 0.337]), and 22.4% more likely to receive DI (ME=0.224 [0.088, 0.360]) than children with a developmental delay (Table 4), and were also more likely to receive three or more services (ME=0.319 [0.199, 0.440]; Table 5). Low-income children were 13.6% less likely to receive PT (ME=-0.136 [-0.201, -0.071]) and 10.4% less likely to receive OT (ME=-0.104 [-0.197, -0.011]) than higher income children. Compared to children with birthweights less than 1500 grams, children in other birthweight groups were more likely to receive PT. One-year olds were 11.4% less likely (ME=-0.114 [-0.213, -0.016]) and 2-year olds were 23.4% (ME=-0.234 [-0.400, -0.086]) less likely to receive DI than infants (Table 4).
Children with higher baseline Social-Emotional function were 5% more likely to receive PT (ME=0.054 [0.026, 0.082]) and 7.3% less likely to receive DI (ME=-0.073 [-0.112, -0.034]. Children with higher baseline cognitive function were 3.9% more likely to receive PT (ME=0.039 [0.010 0.068]) and 4.9% less likely to receive ST (ME=-0.049 [-0.086, -0.011]). Children with higher baseline Adaptive/Self-Care function were 5.1% less likely to receive OT (ME=-0.051 [-0.078, -0.025]), 5.1% less likely to receive ST (ME=-0.051 [-0.078, -0.025]), and 5.8% more likely to receive DI (ME=0.058 [0.027, 0.090]) (Table 4).
Table 3. Adjusted marginal effects [95% CI] of EI Referred Only (n = 2,024) and Referred and Received IFSP (n = 722) sub-groups for each child characteristic.
|
|
|
Independent Variables
|
Referred Only
|
Referred and Received IFSP
|
|
|
|
|
|
Diagnosed ConditionA
|
-0.046*
|
-0.015
|
|
[-0.087, -0.005]
|
[-0.030, 0.001]
|
|
Condition Severity Group
|
|
|
|
No Condition
|
ref
|
ref
|
|
|
Mild
|
0.098***
|
0.024**
|
|
[0.070, 0.127]
|
[0.008, 0.040]
|
|
Moderate
|
0.388***
|
0.154***
|
|
[0.314, 0.461]
|
[0.095, 0.213]
|
|
Severe
|
0.334***
|
0.156***
|
|
[0.249, 0.420]
|
[0.088, 0.223]
|
|
Birthweight by Category
|
|
|
|
Less than 1.5kg
|
ref
|
ref
|
|
|
1.5kg to 2.5kg
|
-0.176***
|
-0.000
|
|
[-0.276, -0.077]
|
[-0.036, 0.036]
|
|
Greater than 2.5kg
|
-0.269***
|
-0.021
|
|
[-0.365, -0.174]
|
[-0.054, 0.012]
|
|
Child's Age
|
|
|
|
Less than 12-Months
|
ref
|
ref
|
|
|
12-24 Months
|
0.023**
|
0.014**
|
|
[0.006, 0.041]
|
[0.004, 0.025]
|
|
Greater than 24-Months
|
-0.042***
|
-0.031***
|
|
[-0.058, -0.025]
|
[-0.039, -0.023]
|
|
Family Income (annually)
|
|
|
|
Greater than $20,000
|
-0.009
|
0.011
|
|
[-0.034, 0.017]
|
[-0.004, 0.027]
|
|
Race/Ethnicity
|
|
|
|
White, non-Hispanic
|
ref
|
ref
|
|
|
Black, non-Hispanic
|
-0.029*
|
-0.012
|
|
[-0.054, -0.004]
|
[-0.025, 0.002]
|
|
Hispanic
|
0.017
|
0.006
|
|
[-0.002, 0.037]
|
[-0.005, 0.017]
|
|
Other, non-Hispanic
|
0.019
|
-0.015
|
|
[-0.024, 0.061]
|
[-0.035, 0.004]
|
|
Child's sex, Female
|
-0.078***
|
-0.020***
|
|
[-0.091, -0.065]
|
[-0.027, -0.012]
|
|
ADiagnosed conditions for EI eligibility can be found in the Colorado Established Condition Database20, the referent group is children with developmental delay only
*p<.05; **p<.01; ***p<.001
Table 4. Adjusted marginal effects [95% CI] of receiving a core EI service among sample children with complete outcomes information. A
|
|
|
Independent Variables
|
Marginal Effects of any PT
|
Marginal Effects of any OT
|
Marginal Effects of any ST
|
Marginal Effects of any DI
|
|
Had a Diagnosis
|
0.225***
|
0.214***
|
0.084
|
0.224**
|
|
[0.104, 0.347]
|
[0.091, 0.337]
|
[-0.030, 0.197]
|
[0.088, 0.360]
|
|
Birthweight by Category
|
|
|
|
|
|
Less than 1.5kg
|
ref
|
ref
|
ref
|
ref
|
|
|
1.5kg to 2.5kg
|
0.177*
|
-0.056
|
-0.210
|
-0.010
|
|
[0.026, 0.328]
|
[-0.260, 0.148]
|
[-0.463, 0.044]
|
[-0.331, 0.311]
|
|
Greater than 2.5kg
|
0.135**
|
-0.014
|
-0.102
|
-0.121
|
|
[0.041, 0.228]
|
[-0.194, 0.167]
|
[-0.318, 0.115]
|
[-0.406, 0.164]
|
|
Child's Age
|
|
|
|
|
|
Less than 12-Months
|
ref
|
ref
|
ref
|
ref
|
|
|
12-24 Months
|
-0.024
|
-0.037
|
-0.080
|
-0.114*
|
|
[-0.096, 0.048]
|
[-0.111, 0.036]
|
[-0.179, 0.018]
|
[-0.213, -0.016]
|
|
Greater than 24-Months
|
0.013
|
0.045
|
0.034
|
-0.234**
|
|
[-0.112, 0.138]
|
[-0.103, 0.192]
|
[-0.103, 0.170]
|
[-0.400, -0.068]
|
|
Family Income (annually)
|
|
|
|
|
|
Greater than $20,000
|
-0.136***
|
-0.104*
|
-0.078
|
0.057
|
|
[-0.201, -0.071]
|
[-0.197, -0.011]
|
[-0.230, 0.075]
|
[-0.092, 0.207]
|
|
Race/Ethnicity
|
|
|
|
|
|
White, non-Hispanic
|
ref
|
ref
|
ref
|
ref
|
|
|
Black, non-Hispanic
|
0.034
|
-0.003
|
0.045
|
0.041
|
|
[-0.125, 0.193]
|
[-0.157, 0.152]
|
[-0.142, 0.232]
|
[-0.156, 0.239]
|
|
Hispanic
|
0.001
|
-0.037
|
-0.004
|
-0.097
|
|
[-0.097, 0.099]
|
[-0.144, 0.071]
|
[-0.126, 0.118]
|
[-0.243, 0.048]
|
|
Other, non-Hispanic
|
0.056
|
-0.093
|
-0.036
|
-0.047
|
|
[-0.141, 0.253]
|
[-0.357, 0.172]
|
[-0.339, 0.267]
|
[-0.332, 0.238]
|
|
Child's sex, Female
|
0.028
|
-0.054
|
-0.026
|
-0.006
|
|
[-0.040, 0.096]
|
[-0.121, 0.014]
|
[-0.112, 0.060]
|
[-0.100, 0.087]
|
|
Primary Language, English
|
0.013
|
0.017
|
-0.028
|
0.049
|
|
[-0.062, 0.088]
|
[-0.062, 0.097]
|
[-0.121, 0.064]
|
[-0.053, 0.151]
|
|
Insurance Type, Medicaid and CHP+
|
-0.067
|
0.007
|
0.039
|
0.157*
|
|
[-0.186, 0.053]
|
[-0.109, 0.122]
|
[-0.111, 0.188]
|
[0.005, 0.309]
|
|
Entry Child Outcome Summary Sub-ScalesB
|
|
|
|
|
|
Positive Social Emotional Skills
|
0.054***
|
-0.002
|
-0.017
|
-0.073***
|
|
[0.026, 0.082]
|
[-0.032, 0.028]
|
[-0.055, 0.020]
|
[-0.112, -0.034]
|
|
Acquiring and Using Knowledge and Skills
|
0.039**
|
0.009
|
-0.049*
|
0.032
|
|
[0.010, 0.068]
|
[-0.021, 0.039]
|
[-0.086, -0.011]
|
[-0.009, 0.072]
|
|
Taking Appropriate Action to Meet Needs
|
-0.095***
|
-0.051***
|
0.058***
|
0.033
|
|
[-0.125, -0.066]
|
[-0.078, -0.025]
|
[0.027, 0.090]
|
[-0.003, 0.068]
|
|
ASample includes 448 children with complete baseline Child Outcomes Summary Data
*p<.05; **p<.01; ***p<.001
B Each COS sub-scale score is derived from provider clinical judgment, parent concerns, and developmental assessment results and measured on a 7-point scale, from 1=very early skills (i.e., child does not use any immediate foundational skills related to this outcome) to 7=all skills expected (i.e., there are no concerns about the child’s function in this area).
Table 5. Adjusted marginal effects [95% CI] of the number of EI services among sample children who initiated EI services and have complete child outcomes information.A
|
|
|
|
Marginal Effects of Number of Services (Compared to other Service Groups)
|
|
Independent Variables
|
One Service
|
Two Services
|
Three or More Services
|
|
Had a Diagnosis
|
-0.143***
|
-0.176***
|
0.319***
|
|
[-0.194, -0.092]
|
[-0.257, -0.095]
|
[0.199, 0.440]
|
|
Birthweight by Category
|
|
|
|
|
Less than 1.5kg
|
ref
|
ref
|
ref
|
|
|
1.5kg to 2.5kg
|
-0.025
|
-0.018
|
0.043
|
|
[-0.201, 0.151]
|
[-0.132, 0.096]
|
[-0.247, 0.332]
|
|
Greater than 2.5kg
|
0.001
|
0.000
|
-0.001
|
|
[-0.161, 0.162]
|
[-0.099, 0.099]
|
[-0.262, 0.260]
|
|
Child's Age
|
|
|
|
|
Less than 12-Months
|
ref
|
ref
|
ref
|
|
|
12-24 Months
|
0.078*
|
0.044*
|
-0.122*
|
|
[0.006, 0.151]
|
[0.009, 0.078]
|
[-0.226, -0.019]
|
|
Greater than 24-Months
|
0.073
|
0.042
|
-0.114
|
|
[-0.052, 0.197]
|
[-0.010, 0.093]
|
[-0.288, 0.060]
|
|
Family Income (annually)
|
|
|
|
|
Greater than $20,000
|
-0.054
|
-0.044
|
0.098
|
|
[-0.134, 0.025]
|
[-0.124, 0.036]
|
[-0.060, 0.257]
|
|
Race/Ethnicity
|
|
|
|
|
White, non-Hispanic
|
ref
|
ref
|
ref
|
|
|
Black, non-Hispanic
|
-0.021
|
-0.024
|
0.045
|
|
[-0.111, 0.069]
|
[-0.127, 0.079]
|
[-0.148, 0.238]
|
|
Hispanic
|
0.061
|
0.046
|
-0.107
|
|
[-0.015, 0.137]
|
[-0.022, 0.114]
|
[-0.249, 0.035]
|
|
Other, non-Hispanic
|
0.084
|
0.056
|
-0.140
|
|
[-0.037, 0.205]
|
[-0.019, 0.132]
|
[-0.331, 0.051]
|
|
Child's sex, Female
|
-0.003
|
-0.002
|
0.005
|
|
[-0.061, 0.054]
|
[-0.039, 0.034]
|
[-0.089, 0.100]
|
|
Primary Language, English
|
-0.016
|
-0.010
|
0.026
|
|
[-0.079, 0.047]
|
[-0.049, 0.029]
|
[-0.075, 0.128]
|
|
Insurance Type, Medicaid and CHP+
|
-0.040
|
-0.021
|
0.061
|
|
[-0.166, 0.086]
|
[-0.074, 0.032]
|
[-0.118, 0.239]
|
|
Child Outcomes Summary Sub-ScalesB
|
|
|
|
|
Positive Social Emotional Skills
|
0.027*
|
0.017*
|
-0.044*
|
|
[0.002, 0.053]
|
[0.001, 0.033]
|
[-0.084, -0.004]
|
|
Acquiring and Using Knowledge and Skills
|
-0.008
|
-0.005
|
0.013
|
|
[-0.032, 0.016]
|
[-0.020, 0.010]
|
[-0.026, 0.052]
|
|
Taking Appropriate Action to Meet Needs
|
-0.007
|
-0.004
|
0.012
|
|
[-0.029, 0.014]
|
[-0.018, 0.009]
|
[-0.023, 0.047]
|
|
ASample includes 448 children with complete baseline Child Outcomes Summary Data
*p<.05; **p<.01; ***p<.001
B Each COS sub-scale score is derived from provider clinical judgment, parent concerns, and developmental assessment results and measured on a 7-point scale, from 1=very early skills (i.e., child does not use any immediate foundational skills related to this outcome) to 7=all skills expected (i.e., there are no concerns about the child’s function in this area).