104 - Differential Access to Early Intervention Services in New York by Eligible Diagnosis

Poster Number: 104
Publication Number: 104.409

Amanda C. Esteves, Columbia University Irving Medical Center, Fort Lee, NJ, United States; Mandy Hsu, Columbia University Mailman School of Public Health, New York, NY, United States; Evelyn Berger-Jenkins, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Melissa S. Stockwell, Columbia University Irving Medical Center, New York, NY, United States; Beth J. Maletz, Columbia University School of Nursing, New York, NY, United States; Dodi Meyer, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Early Intervention (EI) is the gold standard treatment for developmental delays in children 0-3 years old. However, not all children eligible for services receive them, either because they are not referred, not evaluated, or fail to receive services once eligible. Disparities in access, particularly in vulnerable communities, are well documented, but limited literature explores differences in access by eligible diagnosis.

Objective: To assess differences in referral, evaluation, and service receipt status by diagnosis automatically eligible for EI in New York (NY). To identify patient and provider characteristics that impact connection to services.

Design/Methods: A retrospective chart review was conducted of patients 0-3 years old with an ICD10 diagnosis automatically eligible for EI in NY who had an encounter in 1 of 4 academic pediatric practices between 2/1/2020–11/1/2021. These practices serve an urban, underserved, publicly insured population. The relationship between qualifying diagnosis and referral/evaluation/service receipt rate was assessed using chi-square and time from first referral to services using one-way ANOVA. Bivariate and multivariable logistic regression was used to assess the relationship between patient and provider characteristics, social determinants of health, and service receipt status outcomes.

Results: 324 children aged 0-3 years met study criteria. The majority were male (61%) and identified as Hispanic or Latino (80%). Autism was the most common qualifying diagnosis (Nf161;49.7%)(Table 1). 90% (Nf290) of participants were referred, 82% (Nf265) evaluated, and 74% (Nf240) received services. There was significant variation in the referral rate and service initiation rate by diagnosis category (Table 2). Children with central nervous system anomalies, mostly microcephaly, were least likely to be referred and children with congenital anomalies, mostly cleft lip & palate, were least likely to receive services once evaluated. Housing insecurity (aOR 0.11; 0.44-0.33 95%CI), preferred language other than English or Spanish (aOR 0.13; 0.02-0.91 95%CI), and provider designated follow-up of >3 months (aOR 0.30; 0.01-0.89 95% CI) were all significantly associated with decreased service receipt (Table 3).Conclusion(s): Despite high referral rates and known eligibility status, differential access to EI services exists by diagnosis category in NY. Providers may consider increasing referral for microcephaly given risk of delay. Those with housing insecurity and preferred languages other than English or Spanish are vulnerable and close follow-up by the referring provider may be protective.
Table 1Study Population Demographic Characteristics
Table 2Rates of Referral, Evaluation, Service Receipt and Mean Time from First Referral to Service Receipt by Eligible Diagnosis