Factors Influencing the Enrollment of Eligible Extremely-Low-Birth-Weight Children in the Part C Early Intervention Program

Abstract

Objective To determine whether eligible extremely-low-birth-weight children (<1000 g) were enrolled in the federally enacted, state-coordinated Early Intervention (EI) program intended to help children with developmental delay or disability regardless of parental income, and the factors associated with enrollment. Methods Retrospective analysis of 884 EI-eligible ELBW children born in South Carolina with birth weight 401 to 999 g, gestation ≥24 weeks, and survival for the first 120 days of life. We created a linked data set with data from Early Intervention (1996–2001), Vital Records (1996–1998), death certificates, and Medicaid. Each child was followed from birth to 3 years old, the program eligibility period. Results A total of 54% of ELBW children were enrolled in EI at any time from birth to 36 months. Even among children ever enrolled in Medicaid (83% of all ELBW children), only 63% were enrolled in EI. Being born in a multiple gestational birth, having heavier birth weight (750 to 999 g), and having ever enrolled in Medicaid were positively associated with EI enrollment. Among Medicaid patients for whom perinatal data were available, additional risk adjustment showed that EI enrollment was more likely with birth in level 3 hospitals, birth weight 750 to 999 g, Neonatal Medical Index severity level V (most severe), and longer initial length of hospital stay. Conclusions Only about half of eligible ELBW children in South Carolina were enrolled—much lower than reported elsewhere. Efforts are needed to understand why eligible infants are not being enrolled and to develop strategies to remedy the situation.

Missed Opportunities in the Referral of High-Risk Infants to Early Intervention

“…[17][18][19][20] In one (4) 1 (1) 5 (14) 1 (2) 30 (2) Referred to EI + OTH 14 (2) 5 (2) 17 (21) 11 (31) 3 (5) 50 (4) Referred to OTH 104 (14) 46 (13) 34 (41) 7 (20) 5 (9) population-based study of nationally represented children, only 10% of developmentally delayed children received EI at 24 months. 19 The current study is the first, to our knowledge, to look at EI referral rates among a population of high-risk infants after NICU discharge.…”

Missed Opportunities in the Referral of High-Risk Infants to Early Intervention

“…17,25,26 Wang et al 20 reported higher EI enrollment among children with birth weights ,1000 g who were receiving public insurance. Results from our regression analyses also showed that EI referrals were positively associated with public insurance.…”

Developmental screening: predictors of follow-up adherence in primary health care

“…The risk factors were chosen based on factors that other studies have investigated or recommended for future studies with regards to follow-up adherence. The risk factors were the age 16 and gender 15,16,18,19,[33][34][35] of the child, maternal and caregiver age [15][16][17]19,21,23,35,36 , who the primary caregiver is, marital status of caregivers 19,20,37 , educational qualifications [15][16][17][18][19][20]23,35,36 , employment 18,20,35 , average household income [16][17][18][19][20]33,35,36 , type of housing 18 and number of people living in the household 35 . In addition, the effect of text message reminders on follow-up adherence was investigated 22,38 .…”

“…Comprehensive tracking and follow-up systems are however required to ensure that children are not only identified through screening, but also return for the appropriate assessments and intervention 14 . Various studies have, however, reported poor follow-up adherence for children who were referred for an early intervention evaluation [15][16][17][18] . Low participation rates lead to diminished effectiveness of early intervention programmes 18 .…”

“…Various reasons for poor follow-up adherence to early intervention services have been reported 15,17,19,20 . In developed countries, findings indicate that factors such as being non-English speaking, non-White race, part of a minority group, and having fewer economic resources and young, poorly educated parents, puts a family at risk of defaulting on referrals for early intervention 17,19,20 .…”