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Early Intervention Service Intensity and Change in Children’s Functional Capabilities

Published:November 25, 2019DOI:https://doi.org/10.1016/j.apmr.2019.10.188

      Abstract

      Objective

      To estimate correlates of early intervention (EI) service dosage and gains in children’s functional capabilities from EI entry and discharge.

      Design

      Retrospective cohort study.

      Setting

      Secondary analyses of a subset of data (N=1005) collected from an EI administrative database on children discharged from a large, urban EI program between October 1, 2014 and September 30, 2016.

      Participants

      Children who were EI eligible due to developmental delay, had received an EI care plan and at least 1 billable EI service, and had outcomes data at EI entry and exit (N=1005). Measured child characteristics included age (49.0% 12-24mo; n=492), sex (36.0% female; n=362), number of developmental delays (76.1% had 1 developmental delay; n=765), and number of EI services received (78.5% received multiple; n=789).

      Intervention

      Not applicable.

      Main Outcome Measures

      Outcomes were EI service intensity (hours per month) and change in functional capabilities as measured via the state-mandated Child Outcomes Summary (COS). Adjusted quantile median regression estimated EI intensity. Adjusted linear regression estimated change in function for social-emotional, cognitive, and adaptive domains of the COS. Measures of children’s developmental delay severity, age at EI entry, race and ethnicity, sex, and language.

      Results

      Children older than 24 months old experienced significantly higher EI service intensity (b=0.40; 95% confidence interval, 0.18-0.63). Child age and EI service intensity were significantly linked to gains in social and cognitive COS score changes from EI entry to exit.

      Conclusions

      Older children receive a higher intensity of EI services. EI service intensity and age were linked with positive changes in functional gains.

      Keywords

      List of abbreviations:

      BNH (black, non-Hispanic), CI (confidence interval), COS (Child Outcomes Summary), DI (developmental intervention), EI (early intervention), IQR (interquartile range), ONH (other, non-Hispanic), OT (occupational therapy), PT (physical therapy), ST (speech therapy), WNH (white, non-Hispanic)
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      References

        • IDEA Infant and Toddlers Coordinators Association
        Your source for part C news and point-of-views.
        (Available at:)
        • Bruder M.B.
        Early childhood intervention: a promise to children and families for their future.
        Except Child. 2010; 76: 339-355
        • Whipple W.
        Key principles of early intervention and effective practices: a crosswalk with statements from discipline specific literature.
        (Available at:)
        • Bruder M.B.
        • Dunst C.J.
        Factors related to the scope of early intervention service coordinator practices.
        Infants Young Child. 2008; 21: 176-185
        • Khetani M.A.
        • Richardson Z.
        • McManus B.M.
        Social disparities in early intervention service use and provider-reported outcomes.
        J Dev Behav Pediatr. 2017; 38: 501-509
        • McManus B.M.
        • Rapport M.J.
        • Richardson Z.
        • Lindrooth R.
        Therapy use for children with developmental conditions: analysis of Colorado Medicaid data.
        Pediatr Phys Ther. 2017; 29: 192-198
        • Noyes-Grosser D.M.
        • Elbaum B.
        • Wu Y.
        • et al.
        Early intervention outcomes for toddlers with autism spectrum disorder and their families.
        Infants Young Child. 2018; 31: 177-199
        • World Health Organization
        International classification of functioning, disability, and health: children & youth version: ICF-CY.
        World Health Organization, Geneva, Switzerland2007
        • Miller A.R.
        • Rosenbaum P.
        Perspectives on “disease” and “disability” in dhild health: the case of childhood neurodisability.
        Front Public Heal. 2016; 4: 1-13
        • Imms C.
        • Granlund M.
        • Wilson P.H.
        • Steenbergen B.
        • Rosenbaum P.L.
        • Gordon A.M.
        Participation, both a means and an end: a conceptual analysis of processes and outcomes in childhood disability.
        Dev Med Child Neurol. 2017; 59: 16-25
        • Msall M.E.
        • Rogers B.T.
        • Ripstein H.
        • Lyon N.
        • Wilczenski F.
        Measurements of functional outcomes in children with cerebral palsy.
        Ment Retard Dev Disabil Res Rev. 1997; 3: 194-203
        • Di Marino E.
        • Tremblay S.
        • Khetani M.
        • Anaby D.
        The effect of child, family and environmental factors on the participation of young children with disabilities.
        Disabil Health J. 2018; 11: 36-42
        • Albrecht E.C.
        • Khetani M.A.
        Environmental impact on young children’s participation in home-based activities.
        Dev Med Child Neurol. 2017; 59: 388-394
        • Khetani M.
        • Graham J.E.
        • Alvord C.
        Community participation patterns among preschool-aged children who have received Part C early intervention services.
        Child Care Health Dev. 2013; 39: 490-499
        • Hebbeler K.
        • Spiker D.
        • Bailey D.
        • et al.
        Early intervention for infants & toddlers with disabilities and their families: participants, services, and outcomes. Final report of the National Early Intervention Longitudinal Study (NEILS).
        (Available at:)
        • McManus B.M.
        • Richardson Z.
        • Scully E.A.
        • Dooling-Litfin J.K.
        • Graham J.E.
        • Khetani M.A.
        Early Intervention Colorado (EI-CO) participant characteristics, service use, and outcomes, Colorado, 2014-2016.
        Inter-University Consortium for Political and Social Research; 2018, Ann Arbor2018
      1. COLO, CODE REGS 2015, 2509-10 12. Available at: https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=6873&fileName=12%20CCR%202509-10. Accessed December 19, 2019.

        • Imms C.
        • Adair B.
        • Keen D.
        • Ullenhag A.
        • Rosenbaum P.
        • Granlund M.
        “Participation”: a systematic review of language, definitions, and constructs used in intervention research with children with disabilities.
        Dev Med Child Neurol. 2016; 58: 29-38
        • Adair B.
        • Ullenhag A.
        • Rosenbaum P.
        • Granlund M.
        • Keen D.
        • Imms C.
        Measures used to quantify participation in childhood disability and their alignment with the family of participation-related constructs: a systematic review.
        Dev Med Child Neurol. 2018; 60: 1101-1116
        • Dunst C.J.
        • Hamby D.
        • Trivette C.M.
        • Raab M.
        • Bruder M.B.
        Young children’s participation in everyday family and community activity.
        Psychol Rep. 2002; 91: 875-897
        • Bruder M.B.
        Service coordination and integration in a developmental systems approach to early intervention.
        in: Guralnick M.J. The developmental systems approach to early intervention. Brookes, Baltimore2005: 29-58
        • Early Childhood Technical Assistance Center
        Child outcome summary (COS) process.
        (Available at:)
        https://ectacenter.org/eco/pages/cos.asp
        Date accessed: January 31, 2019
        • Twardzik E.
        • Cotto-Negrón C.
        • MacDonald M.
        Factors related to early intervention Part C enrollment: a systematic review.
        Disabil Health J. 2017; 10: 467-474
        • Barfield W.D.
        • Clements K.M.
        • Lee K.G.
        • Kotelchuck M.
        • Wilber N.
        • Wise P.H.
        Using linked data to assess patterns of early intervention (EI) referral among very low birth weight infants.
        Matern Child Health J. 2008; 12: 24-33
        • Feinberg E.
        • Silverstein M.
        • Donahue S.
        • Bliss R.
        The impact of race on participation in Part C early intervention services.
        J Dev Behav Pediatr. 2011; 32: 284-291
        • McManus B.M.
        • Robert S.
        • Albanese A.
        • Sadek-Badawi M.
        • Palta M.
        Predictors of receiving therapy among very low birth weight 2-year olds eligible for Part C early intervention in Wisconsin.
        BioMed Cent Pediatr. 2013; 13: 1-9
        • Aday L.A.
        • Andersen R.
        A framework for the study of access to medical care.
        Health Serv Res. 1974; 9: 208-220
        • Kingsley K.
        • Mailloux Z.
        Evidence for the effectiveness of different service delivery models in early intervention services.
        Am J Occup Ther. 2013; 67: 431-436
        • Richardson Z.
        • Khetani M.A.
        • Scully E.A.
        • Dooling-Litfin J.K.
        • McManus B.M.
        Social and functional characteristics of receipt and service use intensity of core early intervention services.
        Acad Pediatr. 2019; 19: 722-732
        • Dumas H.M.
        • Fragala-Pinkham M.A.
        • Haley S.M.
        • et al.
        Computer adaptive test performance in children with and without disabilities: prospective field study of the PEDI-CAT.
        Disabil Rehabil. 2012; 34: 393-401
        • Khetani M.A.
        • McManus B.M.
        • Arestad K.
        • et al.
        Technology-based functional assessment in early intervention: a pilot study.
        BioMed Cent Pilot Feasibility Stud. 2018; 4: 1-9
        • Cunningham B.J.
        • Rosenbaum P.L.
        Measure of processes of care: a review of 20 years of research.
        Dev Med Child Neurol. 2014; 56: 445-452
      2. Gorter JW, Rosenbaum PL, Teplicky R, Williams U. Giving parents a voice: a systematic program evaluation of family-centred service delivery. Paper presented at: European Academy of Childhood Disability Conference. May 17-20, 2017; Amsterdam, The Netherlands.

      3. Noyes-Grosser DM, Elbaum B. Measuring the impact of early intervention services on children and families: a model approach to family-centered program evaluation and quality improvement. Paper presented at: Third Conference of the International Society on Early Intervention. May 2-5, 2011; New York, NY.

        • Fisher W.P.
        • Elbaum B.
        • Coulter W.A.
        Construction and validation of two parent-report scales for the evaluation of early intervention programs.
        J Appl Meas. 2012; 13: 57-76