Early Intervention
Providing services when children are young allows for better outcomes and can potentially eliminate the need for therapy later on.
It’s been quite the week for big name newspapers publishing articles related to speech-language pathology! Last week, USA Today posted an article on how smartphone use impacts language development. This week, the New York Times published an article within their parenting section on Early Intervention.
If you’re new here, you may be asking: “What is Early Intervention?” Early Intervention (EI) is a nationwide program that provides services (e.g., speech therapy, occupational therapy, physical therapy, vision therapy, special education) to children under the age of 3 experiencing delays in one or more areas of development (e.g., speech and language, gross motor, fine motor, cognition, etc.). Created in 1986, EI was a result of the Infants and Toddlers with Disabilities Program (Part C) of the Individuals with Disabilities Education Act (IDEA).
While EI is a federally-mandated program, the services provided as well as eligibility requirements differ from state to state. For example, EI services in New York State are at no cost to families regardless of their income. However, families in New Jersey are charged a co-pay per session that is based on a sliding income scale. As you can imagine, some families choose to forego Early Intervention services in favor of outpatient (e.g., hospital, private practice) in states that charge a co-pay.
Eligibility requirements also differ between states. When I evaluate young children, families often report that their children did not demonstrate a “significant enough delay” to qualify for Early Intervention. In these instances, families either need to seek out services through other outlets (e.g., insurance) or utilize a “wait and see” approach to determine if their child catches up to typically developing children.
A research study investigating differences in Early Intervention participation across states found that eligibility requirements had the biggest impact on a child’s access to the system:
“Although differences in child characteristics did account for some state variation in EI participation, the overwhelming factor seemed to be state policy. States with a more lenient EI eligibility policy had higher rates of EI participation…” (McMacnus et al., 2009).
EI is crucial for young children and their families. First and foremost, it allows families to play an active role in their child’s therapeutic programming. Within the field of speech-language pathology, EI approaches therapy from a parent coaching model. For example, an SLP will teach parents how to modify the way they talk, interact, and play with their child to support their communication development. While it’s great if an EI SLP works with a child once a week for an hour, parents spend far more time each and every day with their child. When families are equipped with ways to best support their child’s development throughout the day, we see more progress!
An additional benefit of EI is the fact that it takes place within the home. This is such an amazing component of the program, as children under the age of 3 learn best in their natural environment. I wouldn’t expect an 18-month-old to act and communicate the same way he or she does at home when playing with an unfamiliar individual in a novel setting. We often see that kids retreat to their parents and appear hesitant to interact with adults in unfamiliar environments. With EI, children are able to communicate in the comfort of their own home and subsequently generalize the skills they learn to novel activities, people, and contexts.
Despite the many advantages of EI, difficulties with access remain an issue: families don’t always know EI exists, primary care physicians don’t make the appropriate referrals, children fail to meet the eligibility requirements (the same issue prevails within school districts), long waiting lists prevent children from receiving services in a timely manner, and families feeling hesitant to have their child evaluated for a potential delay. Racial and economic disparities also exist. According to data from the Early Child Longitudinal Study, black children were 5 times less likely to receive Early Intervention services than white children at 24 months of age (Feinberg et al., 2011). Additionally, families living below the poverty level are less likely to access EI services (McManus et al., 2009).
This all means we need more awareness surrounding EI services. How can make families and professionals become more aware of these services? What strategies can be utilized to increase referrals? Can we reduce the stigma surrounding therapy? Comment below with your thoughts and/or experiences with Early Intervention!
If you are interested in learning more about Early Intervention, I’ve linked some helpful resources below:
Research References:
Feinberg, Emily, et al. “The Impact of Race on Participation in Part C Early Intervention Services.” Journal of Developmental & Behavioral Pediatrics, vol. 32, no. 4, 2011, pp. 284–291., doi:10.1097/dbp.0b013e3182142fbd.
Mcmanus, Beth, et al. “The Effect of State Early Intervention Eligibility Policy on Participation Among a Cohort of Young CSHCN.” Pediatrics, vol. 124, no. Supplement 4, 2009, doi:10.1542/peds.2009-1255g.