Predictors of receiving therapy among very low birth weight 2-year olds eligible for Part C early intervention in Wisconsin

Abstract

BackgroundThe Individuals with Disabilities Education Act (Part C) authorizes states to establish systems to provide early intervention services (e.g., therapy) for children at risk, with the incentive of federal financial support. This study examines family and neighborhood characteristics associated with currently utilizing physical, occupational, or speech therapy among very low birthweight (VLBW) 2-year-old children who meet Wisconsin eligibility requirements for early intervention services (EI) due to developmental delay.MethodsThis cross-sectional analysis used data from the Newborn Lung Project, a regional cohort study of VLBW infants hospitalized in Wisconsin’s newborn intensive care units during 2003–2004. We included the 176 children who were age two at follow-up, and met Wisconsin state eligibility requirements for EI based on developmental delay. Exact logistic regression was used to describe child and neighborhood socio-demographic correlates of parent-reported receipt of therapy.ResultsAmong VLBW children with developmental delay, currently utilizing therapy was higher among children with Medicaid (aOR = 5.3, 95% CI: 1.3, 28.3) and concomitant developmental disability (aOR = 5.2, 95% CI: 2.1, 13.3) and lower for those living in a socially more disadvantaged neighborhood (aOR=0.48, 95% CI: 0.21, 0.98, per tertile).ConclusionsAmong a sample of VLBW 2-year olds with developmental delays who are EI-eligible in WI, 4 out of 5 were currently receiving therapy, per parent report. Participation in Medicaid positively influences therapy utilization. Children with developmental difficulties who live in socially disadvantaged neighborhoods are at highest risk for not receiving therapy.

Early Intervention Before Autism Diagnosis in Children Referred to a Regional Autism Clinic

“…This varies from previous reports of race and insurance type impacting access to early intervention and is an encouraging finding. 11,12 We found that children referred for diagnostic ASD evaluation were receiving a mixture of both federally funded programing and privately obtained therapies. Among our sample, almost 70% of children received services under the Individuals with Disabilities Education Act (Part C and Part B).…”

“…11 Furthermore, utilization of Part C services has also been reported as higher among children with Medicaid. 12 Despite such disparities, recent outcome reports have shown that 71% of all Part C Infant and Toddler Program participants less than 3 years of age have greater than expected growth in knowledge and skills, and 52% of these participants exit the early intervention program with development within age-appropriate limits. 13 In conjunction with these concerns about service acquisition, increasing recognition of ASD behaviors by families and primary pediatric health care providers has led to long wait lists at tertiary ASD diagnostic clinics, with families waiting as long as 6 to 12 months or more for an evaluation.…”

Who Receives Speech/Language Services by 5 Years of Age in the United States?

“…However, vocabulary delays were not included as a predictor in the study's analyses. Recent analyses by McManus et al (2013) of a very low birth weight cohort similarly did not include vocabulary delays as a predictor. Morgan et al (2012) reported that 48-month-old children with greater receptive vocabulary knowledge were less likely to be identified as developmentally delayed or disabled, including being diagnosed for communication problems.…”

Early Therapy Services Following Neonatal Intensive Care Unit Discharge

“…Barriers for accessing early therapy services include low income, low maternal education and single family households (McManus et al, 2013). Caucasian children are five times more likely to access early intervention services than African-American children (Feinberg et al, 2012).…”

“…Caucasian children are five times more likely to access early intervention services than African-American children (Feinberg et al, 2012). Some studies have shown that children with Medicaid are less likely to access early intervention and early therapy services (Barfield et al, 2008; Rosenberg et al, 2008); while other studies suggest that children with public insurance, or specifically Medicaid, are more likely to enroll in therapy services than children with private insurance (McManus et al, 2013; Shapiro-Mendoza et al, 2013). Low referral rates, lack of family follow through, and stigma associated with utilizing services are also suggested to be the factors influencing under-enrollment for services for extremely low birth weight children (Wang et al, 2009).…”