Addressing Inequities in Early Intervention Access

Supporting families in accessing early intervention (EI) services was an integral part of my job when I worked at The Primary School. Together with early childhood staff and families, we created handouts with individualized child data to share with pediatricians and regional centers to initiate referrals to services. The amount of time we invested in managing the referral and evaluation process paid off. In the 2021-22 school year, 83 percent of children under three who were eligible for services began receiving EI services. However, for every family that has a smooth experience resulting in actual access to services that are guaranteed to them as a civil right, it seems there are countless more who do not. Studies show that the percentage of children eligible for EI services is likely greater than the percentage actually served, which was 3.7 percent of the total birth to age three population in 2019. Research indicates that children and families of color have lower rates of and less positive experiences with EI service use.

This week, the National Institute for Early Education Research (NIEER) released a report titled State(s) of Early Intervention and Early Childhood Special Education: Looking at Equity, which provides a first-of-its-kind analysis of programs serving young children with developmental delays and disabilities. The report explores variations in access within and between states, by gender, by race and ethnicity, and during the COVID-19 pandemic. While this blog discusses the key findings related to EI access, the report also includes important trends in early childhood special education, the subsequent program following EI.

The researchers found that children living in states with a lower state median income are generally less likely to access EI services. They reported differences in access by gender, that boys are twice as likely as girls to receive EI services, and by race, that White non-Hispanic children are most likely to receive EI services. In addition, the researchers found that despite increased federal funding of the Individuals with Disabilities Education Act (IDEA) during the COVID-19 pandemic, fewer children - particularly Asian children - received EI services in inclusive, community-based settings, such as child care.

In the report, the researchers noted how some of the observed variations are clearly inequitable, such as the large disparities in Black children being identified for and receiving EI services. On the other hand, they commented on the need for more research and data to explore whether the gender differences in EI services they observed are due to biological differences in need. Additionally, they discussed the importance of looking within and between states, as they found large state-by-state differences in the percentage of children receiving EI services, the demographics of the percentage served, and the amount of funding available to provide these services.

The findings align with a recently released report by the National Academies of Sciences, Engineering, and Medicine, which summarized research on disparities in children’s access to EI services and various factors contributing to differences in access. Both reports discussed how state discretion in implementing EI translates to large differences in who is served and how. States decide the Part C lead agency, eligibility criteria, and funding structure - including whether or not families can be charged out-of-pocket for EI services. For example, a child who is born prematurely would be automatically eligible for EI services in South Dakota, but not in the neighboring state of North Dakota. Furthermore, because federal funding has not kept pace with the number of children receiving EI services, state-level decisions have a larger influence on the amount of funding per child available in each state.

These variations make it difficult to compare states to one another in a meaningful way and study the impact of specific policies. Increased investment in research and funding is needed to explore factors mediating access to EI services. In the report, the researchers specifically call for increased federal funding to address disparities related to state median income and a national commission of state leaders to address inequities in EI access. In addition, data disaggregated by disability category and various demographic factors, data on the workforce providing EI services, and data on the total cost of EI services could allow state leaders to begin identifying existing barriers. Taking these steps can help the nation fulfill the intended purpose of IDEA and ensure that all children and families in all states can access strong support as soon as a disability or developmental delay is identified.

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