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Early Intervention Program for Infants and Toddlers Fails to Reach Many

Published:  January 23, 2013
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Photo courtesy Angelica Lasala on Flickr under Creative Commons license.

One of the least-discussed federal special education programs is the Individuals with Disabilities Education Act (IDEA) Part C grants for infants and toddlers. IDEA Part C is a $443 million program housed in the Department of Education. It currently offers early intervention (EI) services to 350,000 infants and children between birth and age 2.

Little is known about those children, or about the children who need EI services but receive them outside the IDEA Part C program -- or do not receive them at all. A new study in the journal Pediatrics, “Part C Early Intervention for Infants and Toddlers: Percentage Eligible Versus Served,” sheds some light on these questions, finding many children with disabilities may not have access to Part C.

The problems are related to both eligibility and enrollment. Under Part C, states have a significant amount of discretion to define “developmental delay,” and therefore can control the share of children who qualify for services under the program. According to the study, four states – Massachusetts, New Hampshire, New Mexico and West Virginia – classify at-risk children as eligible for Part C dollars, even before there is evidence of any delay. Other states are far more restrictive, and permit only children with significant development delays to qualify. Additionally, in some states, the definition of “developmental delay” tightens as children get older, while in other states the definition relaxes.

The study found that in Michigan, the state with the broadest eligibility criteria, about 78 percent of 9-month-olds were eligible for Part C services, and about 58 percent of 2-year-olds qualified. The most restrictive state, Missouri, made only about two percent of children eligible at either 9 or 24 months. 

States with the broadest eligibility requirements, though, are not likely to serve all eligible children. According to study coauthor Steven A. Rosenberg, a professor at the University of Colorado School of Medicine, “Very broad [eligibility] definitions can make average children candidates for early intervention services,” which could mean that some less-severely delayed children are pushing children with moderate or severe delays out of the program.

The share of children actually enrolled in Part C programs confirms that not all eligible children have access. In Michigan, 26 times more children qualify for Part C services than receive them. The proportion of state populations served by Part C ranges from less than 1.5 percent in Georgia to nearly 7 percent in Massachusetts. Nationally, the estimated share of the population below age 3 with moderate to severe developmental delays is about 9 percent, but the national average of children served with IDEA Part C funds is only 2.8 percent, and no state exceeds 7 percent.

Clearly, there are many children who require early intervention – and whom the IDEA Part C program is intended to serve –yet who are excluded from the program, perhaps because of overly broad eligibility standards, or because of insufficient awareness among families. Another study published in Educational Researcher found that children ages 4 and below, especially those from low-income families or families in which English is not the primary language, are frequently underserved by IDEA programs. Children from non-English speaking households made up 16 percent of the total population, but only 8 percent of those receiving IDEA services.

According to a 2011 survey of IDEA Infant & Toddler Coordinators Association members, at least nine states have restricted Part C eligibility to cut costs, and another 10 planned to change their criteria in the following fiscal year. That could help target IDEA Part C dollars to the neediest infants and toddlers, but could also inadvertently restrict access to children who could be helped by those services.

Ultimately, states need better ways of identifying infants and toddlers with moderate or severe developmental delays, reaching out to their families and prioritizing early intervention services for the neediest children. And “states need to look at the criteria they use to determine which infants and toddlers are eligible for early intervention,” Rosenberg says. “They need to ask themselves why they have such broad criteria when they can’t serve all children under 3 years who have moderate or severe developmental delays.”

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