Increase in Children Identified by Screening Who Have Received the Appropriate Services

Definition

Ensuring that children receive appropriate services includes screening and assessing children and then following up to make sure services are received for those with identified needs. This includes children who were assigned to specific programs to receive services (e.g., Early Intervention IDEA-Part C, home visiting programs, etc.).

This indicator, measured at the child level, can be calculated as the number of infants and toddlers (age zero to three years) in a state/community with identified needs who were referred to and received services, divided by the total number of children screened who had an identified need.

According to the CDC, 13% of children in the United States had developmental or behavioral disabilities in 2016.1 However, according to the U.S. Department of Education, fewer than half of children who have developmental delays are identified prior to starting school.2 It has been reported that physicians fail to identify and refer in a timely manner 60% to 90% of children with developmental delays.3

An implementation study of the American Academy of Pediatrics' (AAP) recommendations for developmental screening and referrals found that referral rates among children with failed screens were low, averaging 61% over the course of the study, with high variability in practice-specific referral rates, which ranged from 27% to 100%.4 Further, the mean time between identification of a developmental delay and referral for follow-up services has been reported to be more than five months.56

A 2008 study found that only 10% of children eligible for services through the Program for Infants and Toddlers with Disabilities (Part C of the IDEA) actually received services from that program.7 Black children eligible for the program were less likely to receive services than children of other tabulated races and ethnicities.8

A 2009 study found that only 45.7% of U.S. children with diagnosed or parent-reported delays and disabilities received early intervention services from any source.9 The percentage of children who received early intervention services varied significantly by state.10

  • 1. Boulet SL, Boyle CA, Schieve LA. Health care use and functional impact of developmental disabilities among US children, 1997-2005. Arch Pediatr Adolesc Med 2009; 163(1):19-26.
  • 2. U.S. Department of Education, Office of Special Education Programs [Internet], Data Analysis System (DANS), Part C Child Count, 1997-2006.
  • 3. National Collaborative for Innovation in Quality Measurement Center of Excellence (NCINQ). Developmental screening in children. Developed for NCINQ for use in the AHRQ PQMP Consortium; 2011.
  • 4. King TM, Tandon SD, Macias MM, et al. Implementing developmental screening and referrals: lessons learned from a national project. Pediatrics 2010; 125(2):350-60.
  • 5. Tang BG, Feldman HM, Huffman LC, et al. Missed opportunities in the referral of high-risk infants to early intervention. Pediatrics 2012; 129(6):1027-34
  • 6. https://www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra-16-p001-3-ef.pdf
  • 7. Rosenberg, S.A., Zhang, D., & Robinson, C.C. (2008). Prevalence of Developmental Delays and Participation in Early Intervention Services for Young Children. Pediatrics 121(6). Retrieved July 25, 2017 from: http://pediatrics.aappublications.org/content/121/6/e1503?download=true
  • 8. Rosenberg, S.A., Zhang, D., & Robinson, C.C. (2008). Prevalence of Developmental Delays and Participation in Early Intervention Services for Young Children. Pediatrics 121(6). Retrieved July 25, 2017 from: http://pediatrics.aappublications.org/content/121/6/e1503?download=true
  • 9. McManus, B., McCormick, M.C., Acevedo-Garcia, D., Ganz, M., & Hauser-Cram, P. (2009). The Effect of State Early Intervention Eligibility Policy on Participation Among a Cohort of Young CSHCN. Pediatrics 124(4). Retrieved July 25, 2017 from http://pediatrics.aappublications.org/content/pediatrics/124/Supplement_4/S368.full.pdf
  • 10. McManus, B., McCormick, M.C., Acevedo-Garcia, D., Ganz, M., & Hauser-Cram, P. (2009). The Effect of State Early Intervention Eligibility Policy on Participation Among a Cohort of Young CSHCN. Pediatrics 124(4). Retrieved July 25, 2017 from http://pediatrics.aappublications.org/content/pediatrics/124/Supplement_4/S368.full.pdf

Population and sub-population estimates are not available at the community level.

  • A community could request county-level, aggregate data through their state Early Intervention IDEA Part C office. This office should have the number of infants and toddlers, by county, who have had or are currently receiving services through an Individualized Family Services Plan (IFSP).
  • Communities could also work with their local health care or educational settings where infants and toddlers may receive a developmental screening such as the Ages and Stages Questionnaire, which is primarily completed at a pediatrician’s office. A community can evaluate where these screenings are being conducted and who is receiving them, and then establish a data-sharing partnership to access the number of children in their community who are receiving developmental screenings at specific ages. These data can then serve as a baseline denominator to better understand how many of this group had identified needs, and, of that number, how many received services.

Research Rationale

Studies have found that a significant portion of children with developmental delays do not receive early intervention services.12 As Begley (2016) writes, “It doesn’t help a child to be identified as developmentally delayed unless he or she then receives interventions that avert or diminish learning difficulties and other common consequences of developmental delays.”3

Ensuring that children receive the appropriate services involves the identification of families in need of additional supports, screening, further assessment to understand children’s developmental status, identification of potential delays, referral, follow-up, and efforts to support families if they are unable to receive additional services due to eligibility requirements or capacity issues.4

While most children develop in a predictable fashion, the development of some infants and toddlers may be atypical. Children with even mild developmental delays in language, cognition, and learning tend to have poorer health and academic outcomes in the absence of early and effective intervention.5 When developmental concerns are identified early, intervention services can provide support to promote the best possible developmental outcomes for the child. In general, the goals of early intervention are to enhance the development of infants and toddlers with disabilities, reduce educational costs by minimizing the need for special education through early intervention, minimize the likelihood of institutionalization and maximize independent living, and enhance the capacity of families to meet their child’s needs.6

  • 1. Rosenberg, S.A., Zhang, D., & Robinson, C.C. (2008). Prevalence of Developmental Delays and Participation in Early Intervention Services for Young Children. Pediatrics 121(6). Retrieved July 25, 2017 from: http://pediatrics.aappublications.org/content/121/6/e1503?download=true
  • 2. McManus, B., McCormick, M.C., Acevedo-Garcia, D., Ganz, M., & Hauser-Cram, P. (2009). The Effect of State Early Intervention Eligibility Policy on Participation Among a Cohort of Young CSHCN. Pediatrics 124(4). Retrieved July 25, 2017 from http://pediatrics.aappublications.org/content/pediatrics/124/Supplement_4/S368.full.pdf
  • 3. Begley, S. (2016). Does screening children for developmental delays prevent learning problems? STAT, Boston Globe Media. Retrieved July 25, 2017 from: https://www.statnews.com/2016/04/04/developmental-delays-children/
  • 4. https://www.zerotothree.org/resources/1634-identification-screening-assessment-and-referrals-in-early-childhood-systems
  • 5. Good Start, Grow Smart Interagency Workgroup. (2006). Good Start, Grow Smart: A guide to Good Start, Grow Smart and other federal early learning initiatives. Washington, DC: U.S. Department of Education. Scott-Little, C., Kagan, S. L., & Frelow, V. S. (2006). Conceptualization of readiness and the content of early learning standards: The intersection of policy and research? Early Childhood Research Quarterly, 21, 153-173.
  • 6. https://www.zerotothree.org/resources/83-making-hope-a-reality-early-intervention-for-infants-and-toddlers-with-disabilities