Listen: Apple | Spotify | YouTube
Full Course Details: Public course page
Learn more about our guest: Sarah Putt MA, OTR/L
Agenda
Intro (5 minutes)
Breakdown and analysis of journal article (5 minutes)
- 00:00:00 Intro to Early Intervention Timing & Intensity
- 00:01:10 OT Potential Podcast Intro
- 00:02:46 Intro to Early Intervention Services
- 00:04:01 What was the Intent of this Research?
- 00:04:35 What were Their Methods?
- 00:05:52 Results
- 00:08:04 Discussion and Conclusion
Discussion on practical implications for OTs (50 minutes)
- 00:09:34 Intro to Sarah Putt
- 00:11:39 Sarah’s Private Practice OT EI Business
- 00:15:59 Impressions of the Article
- 00:25:17 Barriers to Service Initiation and Intensity
- 00:31:00 Possible Solutions for Improving Access to EI
- 00:34:37 Systems to Improve Communication, with the Referrer and Family
- 00:39:35 Advice for Starting Your Own EI Business
- 00:48:59 EI Advocacy at the State and Federal Level
- 00:57:33 Final Thoughts
Supplemental Materials
- Ensuring Timely Connection to Early Intervention for Young Children With Developmental Delays
- Occupational therapy practice guidelines for early childhood: Birth–5 years
- Child characteristics and early intervention referral and receipt of services: a retrospective cohort study
- Early Intervention OT Guide
Article Review
Read Full Text: Timing and Intensity of Early Intervention Service Use and Outcomes Among a Safety-Net Population of Children
Journal: JAMA Network Open
Year Published: 2019
The main finding of this important research from JAMA is extremely promising for early intervention OT professionals.
In the study, greater intensity of early intervention service was associated with better functional gains.
But, there’s a problem.
Federal spending per child on early intervention services has declined over the past decade. And, in this climate of tightening budgets, most children in the study had:
- Delayed care, and
- Low service intensity.
After we review this article, we are so thankful to welcome pediatric private practice owner Sarah Putt, OTR/L. She and I will unpack what all of this means for the OT community.
Intro to Early Intervention Services
The Individuals with Disabilities Education Act (IDEA) provides state funding to establish early intervention services for infants and toddlers with developmental delays and disabilities.
To help ensure timely delivery of these services, federal policy clearly mandates that an EI care plan be written within 45 days of referral. Despite this mandate, previous research on service timeliness has suggested that children living in poor neighborhoods have less timely EI access—though this research is well over a decade old.
How much early intervention children should receive is less clear. While guidelines on pediatric service intensity do exist (see here and here), these studies are also outdated. Plus, they are not specific to early intervention.
Luckily, new reporting requirements are enabling a deeper understanding of EI service delivery. State EI programs must now report a child’s function at EI entry and exit.
Which leads us to this paper…
What was the intent of this research?
The author sought to examine data from primary care referral through EI exit outcomes in order to determine:
- The timeliness and intensity of EI services, and
- The association between service intensity and functional outcomes.
Because our nation’s lowest-income families have been shown to face greater barriers to EI access, the authors of this study chose to examine data from a large urban safety-net system.
What were their methods?
For this cohort study, researchers conducted a secondary data analysis, examining EI records from the Denver Health and Rocky Mountain Human Services Early Intervention Program. This large safety-net system serves around 50,000 children annually.
Participants
The study sample includes all children who:
- Received well-child care visits between October 2014 and September 2016.
- Were younger than 35 months at the time of service.
- Had a diagnosed condition or developmental delay.
The database used for this study categorizes patients based on the following 4 chronic condition tiers:
- No chronic health conditions.
- Mild severity (e.g., vision or hearing loss, cleft lip/palate, central nervous system anomaly).
- Moderate severity (e.g., autism, intellectual disability, very low birth weight).
- Greatest severity (e.g., cerebral palsy, Down syndrome, spina bifida).
The database also includes information on race and ethnicity, household income, sex, and primary language.
Outcomes
The timeliness of EI was calculated based on the number of days from referral to care plan creation.
Service intensity was calculated overall and for each individual care discipline:
- PT
- OT
- SLP
- Developmental intervention (typically education play and social interaction skill development)
Functional outcomes represented the difference between exit and entry on the Child Outcomes Summary Form.
Results
722 children in the sample received an EI care plan. Only 525 (73%) initiated services. And, only 448 (85%) completed functional outcome information.
Service use timeliness
Only 43% of children in the sample received an EI care plan within 45 days of referral. The median number of days to care plan creation was 56.
Service use intensity
The median intensity for all services was 2.7 hours per child, per month. Children from families who were above the federal poverty level received MORE intensive OT. Children with a race and ethnicity categorized as “other, non-hispanic” (e.g., Asian, Pacific Islander, or a combination of more than one race) received LESS intensive OT services.
Functional outcomes
ONE additional hour per month of EI services was associated with a 3-point gain in functional outcome scores. This is a clinically meaningful difference. For a example, an increase from a score of 3 to 6 represents a change from:
“child does not yet show functioning expected of their age in any situation”
to
“child’s functioning is generally considered appropriate for their age, but there are some significant concerns about not keeping pace with expectations”.
Discussion and Conclusion
The authors found that greater EI service intensity was associated with gains in social-emotional, cognitive, and adaptive and/or behavioral function. This is the first research of its kind—and at this point, the relationship is an association (and not necessarily causal), so further study is needed.
The study also suggested that more than half of children in the sample received delayed and low-intensity EI care. This is consistent with previous research indicating that EI intensity falls well below therapeutic levels.
The finding that children from families below the poverty line received LESS OT also is consistent with previous research. Although the study cannot determine the reason for this, previous literature suggests a lack of communication between medical systems and EI services may be to blame.
The strength of this study was that researchers were able to link primary care data and EI program data, which allowed them to follow children from referral to service provision. This type of data system integration could serve as a framework for other institutions to track EI-referred children and link EI needs, services, and outcomes.
Review %open%
After earning your certificate, please consider taking a moment to answer the following three questions:
1.) On a scale of 1-5 please indicate the degree to which the learning objectives were met.
- 1
- 2
- 3
- 4
- 5
2.) Please rate our instructors on a scale of 1-5.
- 1
- 2
- 3
- 4
- 5
3.) On a scale of 1-5, please rate the learning environment of the Club.
- 1
- 2
- 3
- 4
- 5