The Effect of State Early Intervention Eligibility Policy on Participation Among a Cohort of Young CSHCN

OBJECTIVE: This purpose of this study was to describe differences in early intervention (EI) participation according to state among a cohort of young children with parent-reported developmental delays and disabilities. METHODS: Data were obtained from the 2005–2006 National Survey of Children With Special Health Care Needs to describe state differences in EI participation. Multilevel modeling was used to estimate the relative contributions of child sociodemographic and developmental characteristics, and state EI eligibility policy on EI participation. RESULTS: The overall rate of EI participation was 45.7% (23.1%–83.3% across the states). EI participants were less likely to be Hispanic, live in amultiracial family, be poor, have a developmental delay, or have a less severe condition/delay. The predicted probability of receiving EI was lower for children who lived in states with more strict EI eligibility criteria than those with liberal criteria (.43 vs .52). Poverty influenced this association, with the adjusted probabilities of receiving EI for poor ( 100% federal poverty level) and nonpoor ( 185% federal poverty level) children being .18 and .36, respectively (P .05). Among nonpoor children, those who lived in states with strict eligibility criteria were nearly as likely as poor children who lived in states with liberal eligibility criteria to receive EI (.33 vs .36; P .05). CONCLUSIONS: The results of this study reveal marked disparities and unmet needs in EI participation as a function of both characteristics of the child and the state program. Improving developmental services for vulnerable populations requires addressing these sources of disparity. Pediatrics 2009;124:S368–S374 AUTHORS: Beth McManus, PT, MS, MPH,a Marie C. McCormick, MD, ScD,a Dolores Acevedo-Garcia, MPA-URP, PhD,a Michael Ganz, MS, PhD,a,b and Penny Hauser-Cram, EdDc aDepartment of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts; bAbt Bio-Pharma Solutions, Inc, Lexington, Massachusetts; and cLynch School of Education, Boston College, Boston, Massachusetts