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Reason for Referral Predicts Utilization and Perceived Impact of Early Intervention Services

Javalkar, Karina BA*; Litt, Jonathan S. MD, MPH, ScD

Journal of Developmental & Behavioral Pediatrics: November/December 2017 - Volume 38 - Issue 9 - p 706–713
doi: 10.1097/DBP.0000000000000494
Original Articles

Objective: Children participating in early intervention (EI) vary in their medical needs and degree of delay, and previous studies have shown significant differences in EI enrollment based on the reason for referral. The effect of reason for referral on service provision and family satisfaction is largely unknown.

Methods: We used data from the National Early Intervention Longitudinal Study for our secondary data analysis. The main predictor was the reason for referral: a diagnosed condition, documented developmental delay, or other risk factors. Outcomes included unmet service needs, program dropout, and family satisfaction with services.

Results: The 2966 participants were mostly white (51.9%), male (60.3%), and had an annual household income at or below $50,000 (77.0%). There were 1924 referred due to diagnosis, 691 due to delay, and 351 due to other risks. Compared with the diagnosis group, children with delays were more likely (adjusted odds ratio [aOR] 1.38, 95% confidence interval [CI], 1.02–1.87) to have unmet service needs and to drop out of EI programs (aOR 1.44, 95% CI, 1.07–1.96); their families were less likely to report that services were highly individualized (aOR 0.80, 95% CI, 0.65–0.98) or had an impact on their children's development (aOR 0.77, 95% CI, 0.62–0.96).

Conclusion: Children participating in EI because of developmental delays are more likely to have unmet service needs, drop out of services because of a reason other than ineligibility (family or child-related reason), and have lower caregiver satisfaction than those participating because of diagnosed conditions. It is important to determine reasons for these differences and their impact on developmental outcomes.

*University of North Carolina School of Medicine, Chapel Hill, NC;

Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA.

Address for reprints: Jonathan S. Litt, MD, MPH, ScD, Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose 3, Boston, MA 02215; e-mail:

Disclosure: The authors declare no conflict of interest.

Received December 29, 2016

Accepted June 23, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.