Poster #57 - Social Determinants of Early Childhood Intervention Referral and Service Delivery

• In Event: Poster Session 17

Abstract

Background:
Early intervention (EI) is a federally mandated, state-administered system of care for children 0-3 with disabilities and developmental delays. Although many U.S. children should qualify for EI, both referral and service delivery rates are low (Rosenberg et al., 2008), and access gaps disproportionately affect children from racial minority and low income families (Feinberg et al., 2011). Understanding factors associated with referral and service delivery can identify whether inequities in early care systems exist and inform intervention targets. This study expands existing research by examining whether parenting factors previously linked to EI service receipt (e.g., motivation, preferences, and involvement; Jimenez et al., 2014), together with demographic characteristics (e.g., race) are related to rates of EI referral and service delivery for families with low incomes. Using data from an ongoing multi-site randomized controlled effectiveness trial, we describe EI referral and service delivery rates for 4-year-old children across two demographically diverse metropolitan areas. We also examine factors that predict EI referral and service delivery from parent cognitive stimulation and motivation factors, controlling for random assignment to a parenting intervention.

Design & Method:
Data for this study were drawn from the Smart Beginnings (SB) RCT, with sites in NYC and Pittsburgh, PA. SB is a tiered intervention integrating a universal parenting program delivered in primary care clinics with a selective parenting program for families with additional psychosocial risks. Participants were 403 children and their mothers from low-income (i.e., Medicaid-eligible) households. In NYC, families were primarily Hispanic/Latinx (84%) and in Pittsburgh, 90% of families were African American/Black. Randomization to intervention group occurred shortly after the child’s birth.

Data were collected at the age 4-4.5 year assessment (M age = 52 months; SD = 4.06). Primary outcomes were mother reports of EI referral and receipt of EI services. Predictor variables were mother reports of cognitive stimulation (STIM-Q; Dreyer et al., 2009) and desire to change their parenting (Parenting Your Toddler Scale; Guyon-Harris et al., 2022). Child race was mother-reported.

Data Analysis & Results
Across sites, 69% of mothers reported that their child had an EI evaluation, and 25% of those received services. Two logistic regressions examined associations between parenting factors and (a) EI referral and (b) service delivery, controlling for race and intervention status. Predictor variables were parental cognitive stimulation and desire to change parenting. For each analysis, treatment group and race/ethnicity were entered in blocks before parenting variables to ascertain the best fitting model (see Table 1). For EI referral, being a Hispanic/Latinx child (and living in NYC by proxy) decreased odds of receiving an EI referral compared to being Black (and living in Pittsburgh), while higher parental cognitive stimulation at home was positively related to referral. For receiving EI services, being in the intervention group and having higher desire to change parenting increased the odds of receiving services.

Implications concerning low rates of reported EI service delivery in this low-income sample and variation by race/metropolitan area, as well as parenting influences will be discussed in relation to EI practice and policy recommendations.

Authors

• Leah Hunter, University of Pittsburgh
  Presenting Author

• Daniel S. Shaw, University of Pittsburgh

• Katherine Leigh Guyon-Harris, University of Pittsburgh

• Elizabeth B. Miller, New York University School of Medicine

• Pamela Morris-Perez, New York University

• Alan L Mendelsohn, NYU Grossman School of Medicine