Developmental status and service use among children in the child welfare system: a national survey.

OBJECTIVES To estimate the prevalence of developmental delay and service use among children in the child welfare system and to identify factors that influence these outcomes. DESIGN A descriptive study using wave 1 of the National Survey of Child and Adolescent Well-Being. PARTICIPANTS AND SETTING Children aged 0 to 10 years (n = 4324) and their caregivers were interviewed within 60 days of a report being made to the child welfare system. Children's development was measured directly using standardized assessment tools. Three questions from the caregiver interviews estimated receipt of developmental services. MAIN EXPOSURES Subjects were characterized as having developmental delay if any developmental measure fell more than 2 SDs below the mean. Prevalence of developmental delay and service use by age group, type of maltreatment, type of placement, race, sex, and income were reported. Odds that children aged 0 to 2, 3 to 5, and 6 to 10 years with developmental delay would receive developmental services were calculated using weighted logistic regression. main outcome measure: Receipt of developmental services by children with developmental delay. RESULTS Younger children aged 0 to 2 and 3 to 5 years had higher rates, 33% and 36%, respectively, of developmental delay than school-aged children (13%) (P<.01). Despite their high prevalence of developmental delay, children aged 0 to 2 years were less likely to receive developmental services than preschool-aged children (odds ratio, 2.4; 95% confidence interval, 1.6-3.7) or school-aged children (odds ratio, 4.2; 95% confidence interval, 2.9-6.0). CONCLUSIONS Rates of developmental delay are high and developmental services are underused, particularly by young children in the child welfare system. Strategies for overcoming barriers to using early intervention services should be implemented.