Skip to main content

Advertisement

SpringerLink
Log in

Maternal Socio-Economic and Race/Ethnic Characteristics Associated with Early Intervention Participation

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives To evaluate whether Massachusetts Early Intervention (EI) serves children at risk of developmental delay due to social factors, we identified socio-demographic characteristics associated with program enrollment and examined predictors of participation at each stage from referral to enrollment. Methods The Pregnancy to Early Life Longitudinal (PELL) data system linked birth certificate, hospital discharge, and EI data for all Massachusetts births, 1998–2000. We identified predictors of enrollment among births and predictors of referral, eligibility evaluation among those referred, and enrollment among eligible children using multivariate modified Poisson models to adjust for medical risks. Results Overall, 29,950 children (13.7% of births) enrolled in EI. Most social risk indicators predicted enrollment, including maternal government insurance (RR = 1.32, 95% CI 1.29–1.36) and maternal education ≤10 years (RR = 1.36, 95% CI 1.30–1.42). Having a foreign-born (RR = 0.77, 95% CI 0.74–0.80), non-English speaking (RR = 0.93, 95% CI 0.89–0.97) or Asian (RR = 0.88, 95% CI 0.82–0.94) mother was negatively associated with enrollment. Of births, 18.6% were referred to EI. Similar socio-demographic variables predicted referral as predicted enrollment. Among referrals, 87.7% received an evaluation. Evaluation was negatively associated with young maternal age, black maternal race, and high poverty level. Of eligible children, 93.0% enrolled. Enrollment among eligible children was negatively associated with young maternal age and high poverty level. Conclusion In Massachusetts, children born with social risk factors have high EI participation. Nevertheless, children in immigrant communities may face barriers to initial contact with EI, while children from low socioeconomic environments may be at risk for not enrolling after EI referral.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The authors linked birth, death, and hospital discharge data with Early Intervention (EI) program data in order to conduct this study on behalf of the Massachusetts Department of Public Health’s Early Intervention Program. Personally identifiable information received by the EI program is protected under the provisions of the Individuals with Disabilities Education Act (IDEA) which adopts the privacy protections of the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g and 34 CFR Part 99. Under these laws, parental consent is not required to disclose identifiable data to an organization that is conducting a study for or on behalf of the EI program. The use of EI program data for this study was permissible under these laws since the authors conducted the study on behalf of the EI program and destroyed direct identifiers from the analytic file once the linkage was completed.

References

  1. Miller, J. E. (1998). Developmental screening scores among preschool-aged children: the roles of poverty and child health. Journal of Urban Health, 75(1), 135–152.

    Article  PubMed  CAS  Google Scholar 

  2. Najman, J. M., Bor, W., Morrison, J., Andersen, M., & Williams, G. (1992). Child developmental delay and socio-economic disadvantage in Australia: A longitudinal study. Social Science & Medicine, 34(8), 829–835.

    Article  CAS  Google Scholar 

  3. To, T., Guttmann, A., Dick, P. T., Rosenfield, J. D., Parkin, P. C., Tassoudji, M., Vydykhan, T. N., Cao, H., & Harris, J. K. (2004). Risk markers for poor developmental attainment in young children: results from a longitudinal national survey. Archives of Pediatrics & Adolescent Medicine, 158(7), 643–649.

    Article  Google Scholar 

  4. Duncan, G. J., Brooks-Gunn, J., & Klebanov, P. K. (1994). Economic deprivation and early childhood development. Child Development, 65(2 Spec No), 296–318.

    Article  PubMed  CAS  Google Scholar 

  5. Berlin, L. J., Brooks-Gunn, J., McCarton, C., & McCormick, M. C. (1998). The effectiveness of early intervention: Examining risk factors and pathways to enhanced development. Preventive Medicine, 27, 238–245.

    Article  PubMed  CAS  Google Scholar 

  6. Campbell, A., & Ramey, C. T. (1994). Effects of early intervention on intellectual and academic achievement: A follow-up study of children from low-income families. Child Development, 65(2), 684–698.

    Article  PubMed  CAS  Google Scholar 

  7. Garber, H., & Heber, R. (1977). The Milwaukee project: Indications of the effectiveness of early intervention and preventing mental retardation. In P. Mittler (Ed.), Research to practice in mental retardation. Care and intervention (Vol. I, pp. 119–127). Baltimore: University Park Press.

  8. Johnson, D. L., & Walker, T. (1991). A follow-up evaluation of the Houston Parent-Child Development Center: School performance. Journal of Early Intervention, 15(3), 226–236.

    Google Scholar 

  9. Wasik, B. H., Ramey, C. T., Bryant, D. M., & Sparling, J. J. (1990). A longitudinal study of two early intervention strategies: Project Care. Child Development, 61(6), 1682–1696.

    Article  PubMed  CAS  Google Scholar 

  10. Adler, N. E., & Ostrove, J. M. (1999). Socioeconomic status and health: What we know and what we don’t. Annals of the New York Academy of Sciences, 896, 3–15.

    Article  PubMed  CAS  Google Scholar 

  11. Clements, K. M., Barfield, W. D., Kotelchuck, M., Lee, K. G., & Wilber, W. (2006). Birth characteristics associated with early intervention referral, evaluation for eligibility, and program eligibility in the first year of life. Maternal and Child Health Journal, 10(5), 433–441.

    Article  PubMed  Google Scholar 

  12. Scarborough, A. A., Spiker, D., Mallik, S., Hebbeler, K., Bailey, D., & Simeonsson, R. J. (2004). A national look at children and families entering early intervention. Exceptional Children, 70(47), 469–483.

    Google Scholar 

  13. Buysse, V., Bernier, K. Y., & McWilliam, R. A. (2002). A statewide profile of early intervention services using the Part C data system. Journal of Early Intervention, 25(1), 15–26.

    Article  Google Scholar 

  14. Hanley, J. A., Negassa, A., Edwardes, M. D., & Forrester, J. E. (2003). Statistical analysis of correlated data using generalized estimating equations: An orientation. American Journal of Epidemiology, 157, 364–375.

    Article  PubMed  Google Scholar 

  15. Scott, G., & Ni, H. (2004). Access to health care among Hispanic/Latino children: United States 1998–2001. Advance Data, 24(344), 1–20.

    Google Scholar 

  16. Yu, S. M., Nyman, R. M., Kogan, M. D., Huang, Z. J., & Schwalberg, R. H. (2004). Parent’s language of interview and access to care for children with special health care needs. Ambulatory Pediatrics, 4(2), 181–187.

    Article  PubMed  Google Scholar 

  17. Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. (2002). Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample. Medical Care, 40(1), 52–59.

    Article  PubMed  Google Scholar 

  18. Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18(12), 1028–1035.

    Article  PubMed  Google Scholar 

  19. Woloshin, S., Schwartz, L. M., Katz, S. J., & Welch, H. G. (1997). Is language a barrier to the use of preventive services? Journal of General Internal Medicine, 12(8), 472–477.

    Article  PubMed  CAS  Google Scholar 

  20. Ronsaville, D. S., & Hakim, R. B. (2000). Well child care in the United States: Racial differences in compliance with guidelines. American Journal of Public Health, 90(9), 1436–1443.

    Article  PubMed  CAS  Google Scholar 

  21. Wang, N. E., Gisondi, M. A., Golzari, M., van der Vlugt, T. M., & Tuuli, M. (2003). Socioeconomic disparities are negatively associated with pediatric emergency department aftercare compliance. Academic Emergency Medicine, 10(11), 1278–1284.

    Article  PubMed  Google Scholar 

  22. Scarfone, R. J., Joffe, M. D., Wiley, J. F., Loiselle, J. M., & Cook, R. T. (1996). oncompliance with scheduled revisits to a pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 150(9), 948–953.

    CAS  Google Scholar 

  23. Basic Facts About Low-Income Children in the United States: Birth to Age 3. National Center for Children in Poverty. http://www.nccp.org/pub_ecp06.html. Accessed August 8, 2006.

  24. El-Mohandes, A. A., Katz, K. S., El-Khorazaty, M. N., McNeely-Johnson, D., Sharps, P. W., Jarrett, M. H., Rose, A., White, D. M., Young, M., Grylack, L., Murray, K. D., Katta, P. S., Burroughs, M., Atiyeh, G., Wingrove, B. K., & Herman, A. A. (2003). The effect of a parenting education program on the use of preventive pediatric health care services among low-income, minority mothers: A randomized, controlled study. Pediatrics, 111(6), 1324–1332.

    Article  PubMed  Google Scholar 

  25. Williamson, D. L., & Drummond, J. (2000). Enhancing low-income parents’ capacities to promote their children’s health: Education is not enough. Public Health Nursing, 17(2), 121–131.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The PELL data system is supported by the Centers for Disease Control grants S1887—21/23 and S3485—23/23. Additional funding for Early Intervention program evaluation was provided by US Department of Education Early Intervention grant 45139021. We would like to thank Steven Evans, Mark McLaughlin, and Jean Shimer for their assistance in preparing the data files, and Howard Cabral for his careful review of the manuscript.

Author information

Authors and Affiliations

  1. Center for Community Health, Massachusetts Department of Public Health, 250 Washington St., 5th Floor, Boston, MA, 02108, USA

    Karen M. Clements & Nancy Wilber

  2. Division of Reproductive Health, Centers for Disease Control, 4770 Buford Highway NE, MS K-22, Atlanta, GA, 30341, USA

    Wanda D. Barfield

  3. Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany Street, Talbot Building W532, Boston, MA, 02118, USA

    Milton Kotelchuck

Authors
  1. Karen M. Clements
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wanda D. Barfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Milton Kotelchuck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nancy Wilber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen M. Clements.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clements, K.M., Barfield, W.D., Kotelchuck, M. et al. Maternal Socio-Economic and Race/Ethnic Characteristics Associated with Early Intervention Participation. Matern Child Health J 12, 708–717 (2008). https://doi.org/10.1007/s10995-007-0291-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-007-0291-3

Keywords

Search

Navigation