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Referral to and Contact with Early Intervention Services Among Children with Developmental Concerns

Friday, 3 May 2013: 14:00
Meeting Room 3 (Kursaal Centre)
M. E. Villalobos1, J. A. Pinto-Martin2 and D. S. Mandell3, (1)Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, (2)University of Pennsylvania School of Nursing, Philadelphia, PA, (3)Psychiatry, Center for Mental Health Policy and Services Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Background: It is well documented that children with developmental delays benefit from early intervention (EI) services—particularly when they are begun earlier in life.  Despite the positive outcomes associated with EI and the fact that EI programs provide free developmental evaluations without requiring a diagnosis, physicians often do not refer when delay is identified or suspected.  Little is known regarding physician referral behavior and parent follow-through with recommendations in children with developmental concerns. 

Objectives: The present study aimed to determine factors associated with pediatricians’ referral of children with developmental concerns to early intervention services (EI) and parental contact with EI following referral.

Methods: In one pediatric practice, records for all 15- and 30-month well-child visits occurring within calendar year 2005 were reviewed (n = 869). Records were abstracted for the 230 children for whom the physician or parent expressed a developmental concern. Two logistic regression analyses were conducted; the first examined predictors of referral and the second examined predictors of parents’ contacting EI after referral.

Results: Among children for whom developmental concerns were noted, 62% were referred to EI. In adjusted analyses, children of mothers with language barriers (odds ratio [OR] = 0.35, p = 0.018) and those for whom the parent, not the pediatrician, raised the concern (OR = 0.19, p = 0.002) were less likely to be referred. Of referred families, 45% contacted EI. In adjusted analyses, those cases in which the parent and pediatrician both had concerns were more likely to contact EI (OR = 3.41, p = 0.004). Neither referral nor follow up were predicted by child demographics, specific developmental concerns, or the results of developmental screening. 

Conclusions: Only 62% of children for whom delay was noted were referred to EI and less than half of those were referred contacted EI.  Our results suggest that language may play an important role in follow-through with treatment recommendations in young children.  It also appears that parent concern alone is not likely to necessitate a referral.  Further investigation of communication related factors between the parents and the pediatricians may elucidate the underlying challenges with EI referral and enrollment.

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